Granulocyte-colony stimulating factor improves the survival of ischaemic skin flaps by the induction of angiogenesis.

In this study the effects of granulocyte-colony stimulating factor (G-CSF) on angiogenesis and the survival of ischaemic skin flaps are evaluated. Thirty adult Wistar rats were equally randomised into three groups. Caudal-based, ischaemic skin flaps of 10 x 3 cm were designed on the back and injected with saline in group 1 and with 100 microg/kg G-CSF in groups 2 and 3. The injections were performed just prior to flap elevation in groups 1 and 2 and 2 days earlier in group 3. Peripheral leukocyte counts, tissue myeloperoxidase enzyme assays, necrotic to total flap area ratio (NA/TA) calculations, flap tissue inflammation gradings, immunohistochemical vessel counts, and electron microscopic evaluation of endothelial cells were performed on the 8th day. No significant difference was encountered between the groups in terms of the leukocyte counts, myeloperoxidase enzyme assays and inflammation gradings (P > 0.05), demonstrating the absence of an increased inflammatory response within the flap tissue. The surviving flap portions were observed to be increased with the application of G-CSF. The mean NA/TA results (when measured in situ) were 0.44+/-0.13 for group 1, 0.30+/-0.17 for group 2, and 0.22+/-0.16 for group 3. The difference between groups 1 and 3 was statistically significant (P = 0.009). The mean vessel count was 3.53+/-1.20 in group 1, 7.36+/-1.41 in group 2 and 7.43+/-0.92 in group 3. The differences between groups 1 and 2 and groups 1 and 3 were statistically significant (P < or = 0.001). Early apoptotic changes were encountered in the endothelial cells of group 1, while activated and proliferating endothelial cells were seen in groups 2 and 3 with electron microscopy. G-CSF promotes angiogenesis by increasing the number of activated and proliferating endothelial cells within the ischaemic flaps by the resettlement of G-CSF-stimulated endothelial progenitor cells into the ischaemic tissue. The overall result is an improved survival of ischaemic skin flaps. These effects are more pronounced when G-CSF is introduced 2 days prior to flap elevation.

Augmentation rhinoplasty with a combination of triple cartilage grafts for secondary rhinoplasty in a middle-aged population.

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault can cause a functional airway disorder, and the nose also may need a complete correction for cosmetic purposes. To achieve aesthetic and functional outcomes, augmentation rhinoplasty using a combination of triple cartilage grafts, namely, spreader, columellar, and dorsal onlays, was performed for 12 patients. Sufficient nasal airways with satisfactory appearance were achieved for 11 of 12 patients. Only one patient had improved but still insufficient nasal function with a good aesthetic result. Augmentation rhinoplasty using a combination of triple cartilage grafts for middle-aged patients could be considered an effective procedure for improving the patient's nasal airway and appearance.

Versatile anterolateral thigh perforator flap: case of tailored reconstruction for a large temporal and parotidectomy defect.

Perforator flaps have introduced an advance in microsurgical reconstruction, by allowing the design of flaps that are tailored for a specific defect. In this report, the reconstructive technique in a case of temporal squamous-cell carcinoma is presented as an example of this trend. Following wide resection of the skin tumor, superficial parotidectomy was performed as a part of the lymph-node dissection. An anterolateral thigh perforator flap was harvested, including a segment of the vastus lateralis muscle in connection with the skin perforators, to reconstruct both the skin defect and the parotidectomy-related soft-tissue deficit. The muscle segment was reinnervated by the greater auricular nerve to diminish atrophy. The aesthetic result was satisfactory. Minor's starch-iodine test demonstrated prevention of Frey's syndrome. The anterolateral thigh flap is a versatile donor that allows individual variations in design for custom-made flaps.