ABSTRACT
OBJECTIVE: To elucidate the factors that play a role in the decision-making process to use the scapular donor site, we have reviewed our 15-year experience with 57 clinical cases, to our knowledge the largest case series to date. DESIGN: Retrospective, single-surgeon medical record review. PATIENTS AND METHODS: Retrospective review of 57 consecutive cases (53 patients) involving mandibular and maxillary reconstruction using bone-containing scapular free flaps over a 15-year period. Composite flap composition as well as donor and recipient site complications were recorded. RESULTS: Forty-one reconstructions were performed for mandibular defects, 11 were performed for maxillary defects, and 5 for combined defects involving the mandible and maxilla. Seven flaps were composed of 2 separate bone flaps using the angular branch and the circumflex scapular artery. A total of 6 flaps were failures in 5 patients, giving an overall success rate of 89%. CONCLUSIONS: The subscapular system of flaps is a versatile donor site that offers distinct advantages in the older patient population as well as in patients with a preexisting gait disturbance. It is particularly advantageous in patients requiring a large surface area of soft tissue to restore their defect.
Subject(s)
Bone Transplantation , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Mandibular Neoplasms/surgery , Maxillary Neoplasms/surgery , Surgical Flaps , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
Although the pattern of expression of various sodium channel alpha- and beta-subunits changes as development proceeds, the mechanisms that control the expression of these subunits are not yet understood. To study the role of nerve growth factor (NGF) in modulating the expression of sodium channel subunits, we used in situ hybridization cytochemistry to examine the distribution of sodium channel alpha- and beta 1-subunit mRNAs in embryonic day 16 (E16) dorsal root ganglia (DRG) neurons cultured in the absence or presence of NGE. At 4 days in vitro in the absence of NGF, sodium channel alpha-subunit II mRNA was expressed at low-to-moderate levels in DRG neurons, but the transcripts for sodium channel alpha-subunits I, III and NaG and beta 1-subunit were not detectable. In the presence of NGF, DRG neurons expressed low-to-moderate levels of sodium channel alpha-I, high levels of alpha-II and low levels of alpha-III; NaG mRNA was not detectable. Sodium channel beta 1 mRNA was up-regulated and was expressed at high levels in DRG neurons in NGF-containing media. These observations demonstrate that the NGF exerts a differential up-regulation of sodium channel alpha- and beta-subunit mRNAs in DRG neurons derived from E16 embryos.
Subject(s)
Ganglia, Spinal/embryology , Nerve Growth Factors/pharmacology , RNA, Messenger/metabolism , Sodium Channels/biosynthesis , Animals , Cells, Cultured , Embryo, Mammalian , Female , Ganglia, Spinal/drug effects , Ganglia, Spinal/metabolism , Immunohistochemistry , In Situ Hybridization , Neurofilament Proteins/genetics , Neurofilament Proteins/metabolism , Rats , Rats, Sprague-Dawley , Sodium Channels/genetics , Up-RegulationABSTRACT
The expression of rat brain sodium channel alpha-subunit mRNAs I, II and III and a putative glial cell-specific sodium channel (NaG) mRNA was examined in cultured astrocytes from P-0 rat spinal cord by RNA blot hybridization and by non-isotope in situ hybridization cytochemistry utilizing two independent sets of isoform-specific RNA probes. Sodium channel mRNA I was not detectable in the cultured astrocytes by RNA blot or in situ hybridization. Sodium channel mRNA II showed negligible-to-low levels of expression in flat, fibroblast-like and 'pancake' astrocytes at 4 days in vitro (div), while stellate, process-bearing astrocytes exhibited low-to-moderate levels of mRNA II expression. At 7 div, mRNA II expression ranged from low-to-moderate in flat astrocytes and was moderately high in most process-bearing astrocytes. In RNA blots, a weak band was observed at 9.5 kb. Sodium channel mRNA III expression was negligible in flat astrocytes and was detectable in low-to moderate levels in stellate astrocytes beginning at 4 div; by 7 div, mRNA III was detectable in low levels in flat astrocytes and low-to-moderate levels in stellate astrocytes. RNA blots showed two bands of nearly equal intensity, one at 9.0 kb and one at 7.2 kb. NaG mRNA showed increased expression with time in culture, being detectable in flat and stellate astrocytes at 4 div and becoming very prominent in flat astrocytes at extended times in culture. In RNA blots of cultured astrocytes at 7 div, a strong hybridizing signal with the NaG probe was observed. These observations demonstrate that flat and stellate astrocytes cultured from rat spinal cord express rat brain sodium channel mRNA II and III, and NaG, and suggest that astrocytes in vitro may co-express multiple forms of sodium channel mRNA.
