Effect of platelet glycoprotein IIb/IIIa receptor antagonist on survival of epigastric island flaps in rats with total venous occlusions.

We evaluated the effect of tirofiban hydrochloride on the survival of epigastric island flaps in rats that had had all the veins occluded. Male Wistar Albino rats were randomly assigned to control (treated with sterile saline) and experimental (treated with tirofiban hydrochloride 1 mg/kg intravenously) groups. An epigastric island skin flap 3x6 cm was raised in each rat. All veins that drained the flap were ligated to give total venous occlusion. Blood flow was recorded by laser Doppler preoperatively (baseline), immediately after the flap had been sutured back to its original position (acute) and on postoperative days 1 and 3. The degree of necrosis was evaluated on day 3. Mean percentage necrosis and minimum laser Doppler values were compared in the two groups. Total necrosis was evident on day 1 in the control group and on day 3 in the experimental group. Macroscopic evidence was confirmed by histopathological examination. There were appreciable differences in blood flow and in the necrotic area of the flap in the experimental group compared with the control group on both days 1 and 3. Tirofiban hydrochloride might be effective in this flap model.

Necrotizing fasciitis in children: diagnostic and therapeutic aspects.

BACKGROUND: Necrotizing fasciitis (NF) is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Its incidence owing to invasive Streptococcus pyogenes has significantly increased in children recently. Our experience with NF in children to describe diagnostic and therapeutic aspects is hence presented herein. METHODS: Records of children who were treated for NF in our unit from 1999 to 2006, inclusive, were reviewed retrospectively. Information recorded for each patient included medical history, clinical characteristics, diagnostic procedures, treatment methods, and the outcome. RESULTS: Thirteen patients with a mean age of 35 months were treated for NF during the study period. All of the 13 children had no previous immunosuppression. The predisposing factors were composed of varicella lesions, intramuscular injections, application of a cream containing menthol to the cervical region, penetrant gluteal trauma, omphalitis, dental abscess, and streptococcal toxic shock syndrome. The most common site of the initial involvement was the abdominal wall, followed by the gluteal region and thigh, head and neck, and upper and lower extremities. The initial skin presentations were induration or cellulitis and erythema and edema with progression to skin discoloration and bullae formation. Fever and tachycardia were the most common clinical features. S. pyogenes was the most common causative microorganism, followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. All patients underwent extensive surgical debridement and received appropriate antibiotics and supportive therapy. Twelve patients survived, and 1 patient with delayed diagnosis of NF died of septic shock. CONCLUSION: Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized. All children with NF should undergo early surgical debridement to prevent delay in treatment. The mortality and morbidity associated with NF in children can be decreased with clinical awareness, early diagnosis, and adequate and urgent surgical debridement followed by intensive supportive care and early wound resurfacing.

The V-Y island dorsal nasal flap for reconstruction of the nasal tip.

The dorsal nasal flap and its modifications have proved reliable in the coverage of defects on or adjacent to the tip of the nose. However, the problems inherent in the nature of the flap are limited rotational movement afforded by the pedicle, visible scars crossing the dorsum and the natural concavity of the alar crease, skin thickness discrepancy between the flap and the skin, and dog-ear deformity created by the rotation. The purpose of this study was to design a new modification of the dorsal nasal flap, in the highlight of a cadaveric study, that can overcome the traditional drawbacks. Ten adult human cadavers were used to study the vascular basis of the flap and to simulate application of the flap. Cadaveric dissections demonstrated that a skin island over the nasal dorsum and glabellar area can be elevated safely based on a dual axial supply (i.e., the terminal branches of the angular artery and vein bilaterally), and can be advanced easily in a V-Y manner to cover the nasal tip defect. The result obtained in the clinical case showed that the V-Y island dorsal nasal flap provided a sizable amount of skin with more appropriate texture and color for coverage of the nasal tip defect without tension or secondary deformity.