Deferoxamine attenuates ischemia-induced reperfusion injury in the skin and muscle of myocutaneous flaps in the pig.

The dose effect of deferoxamine treatment in attenuation of ischemia-induced reperfusion injury in the skin and muscle of latissimus dorsi myocutaneous flaps was studied in pigs weighing 19.7 +/- 0.5 kg. The latissimus dorsi myocutaneous flaps were subjected to 4, 6, or 8 hours of warm global ischemia. The length and area of viable and nonviable skin and muscle were assessed 48 hours after the ischemic insult by using the fluorescein and nitroblue tetrazolium dye tests, respectively. It was observed that perioperative deferoxamine treatment (250 mg/kg IV) was effective (p < 0.05) in attenuation of ischemia-induced reperfusion injury in the skin but not in the muscle of latissimus dorsi myocutaneous flaps subjected to 4, 6, or 8 hours (n = 10) of ischemia compared with the saline-treated control (n = 10). In a separate study, it was observed that preoperative deferoxamine treatment (250 mg/kg per day x 2 days, IM) plus perioperative deferoxamine treatment (250 mg/kg IV) was effective (p < 0.05) in attenuation of muscle ischemia-induced reperfusion injury in latissimus dorsi myocutaneous flaps subjected to 4 hours of ischemia and 48 hours of reperfusion (n = 10) compared with the saline treated control (n = 10). Morphologic studies with light and electron microscopy also provided evidence to indicate that preoperative plus perioperative deferoxamine treatment, but not perioperative deferoxamine treatment alone, remarkably reduced ischemia-induced reperfusion injury in the skeletal muscle of latissimus dorsi myocutaneous flaps compared with the saline-treated control. It is concluded that deferoxamine is effective in the attenuation of ischemia-induced reperfusion injury in the skin and muscle of pig latissimus dorsi myocutaneous flaps, but a longer period and/or higher dose of deferoxamine treatment is required for the muscle than for the skin. The pharmacologic actions and metabolism of deferoxamine relating to mitigation of ischemia-induced reperfusion injury in the pig skin and muscle are discussed.

Pathogenesis of ischemic necrosis in random-pattern skin flaps induced by long-term low-dose nicotine treatment in the rat.

The objectives of the present experiments were to study the effects of long-term low-dose nicotine treatment on skin hemodynamics, viability, and microvascular morphology in 4 x 10 cm dorsally based acute random-pattern skin flaps in the rat. In addition, the reversibility of the nicotine-induced detrimental effects on skin-flap viability following cessation of nicotine treatment also was investigated. Low-dose nicotine (0.6 mg/kg) administered twice daily and subcutaneously for 24 weeks significantly (p less than 0.05) decreased skin-flap capillary blood flow, distal perfusion, and length and area of skin viability compared with the saline-treated control (n = 15). However, these same parameters in rats (n = 15) whose nicotine treatment had been withheld for 2 weeks prior to skin-flap surgery were not significantly different from the control, thus indicating that the detrimental effects of this long-term, low-dose nicotine treatment were reversible. The mean plasma level of nicotine in the nicotine-treated rats was 8.1 +/- 0.4 micrograms/dl and was within the range of plasma nicotine levels reported for human heavy cigarette smokers. Light and electron microscopic studies did not show evidence of histologic damage to the cutaneous microvasculature in acute random-pattern skin flaps and samples of normal (nonoperated) skin in nicotine-treated rats. It is concluded that long-term plasma levels of nicotine similar to those of heavy cigarette smokers are detrimental to the capillary blood flow and viability of random-pattern skin flaps in the rat. These deleterious effects can be avoided if skin flaps are raised 2 weeks after cessation of nicotine treatment. This low-dose nicotine treatment does not cause histologic damage to the microvasculature. Other pathogenic mechanisms of nicotine-induced skin flap ischemia are discussed.

Abnormal carotid arteries in the velocardiofacial syndrome: a report of three cases.

Internal carotid arteries of unusual size and tortuosity were found before or at the time of pharyngeal flap surgery in three children who had the velocardiofacial syndrome with velopharyngeal insufficiency. In two cases, medial displacement of the arteries prevented surgery, and in the other, hypernasality persisted because only a narrow, asymmetrical flap could be raised. Medial displacement of the internal carotid arteries inhibits surgical treatment of velopharyngeal insufficiency, necessitating treatment with a prosthetic speech device in such children. Since displacement and tortuosity may be associated findings in the velocardiofacial syndrome, the exact location of the internal carotids should be ascertained when pharyngeal flap surgery is planned.

Dose and time effects of nicotine treatment on the capillary blood flow and viability of random pattern skin flaps in the rat.

The deleterious effects of nicotine treatment on skin haemodynamics and survival of 4 X 10 cm acute random pattern skin flaps constructed on the dorsum of the rat were studied. Rats were injected subcutaneously with 0.2 ml of saline containing varying doses (0, 1, 2, 4 or 8 mg kg-1; bid) of nicotine for 5 weeks, starting 4 weeks before flap surgery. It was observed that nicotine treatment at the dose of 2 mg kg-1 (bid), or higher, significantly (p less than 0.05) decreased the length and area of skin flap survival compared with the control. This dose of nicotine treatment also significantly (p less than 0.05) decreased the capillary blood flow and distal perfusion in the skin flaps compared with the control. However, the detrimental effect of nicotine treatment on the survival of acute random pattern skin flaps was not seen if the treatment was started 2 instead of 4 weeks preoperatively. It is concluded that nicotine may cause hypoperfusion and necrosis in acute random pattern skin flap surgery, and the deleterious effects are time-dependent.

The decline of the Serengeti Thomson's gazelle population.

The population of Thomson's gazelles in the Serengeti National Park, Tanzania has declined by almost two thirds over a 13 year period. In the early 1970s, numbers stood at 0.66 million animals but had decreased to less than 0.25 million animals in 1985 as estimated by 5 different censuses using two different counting techniques. Predation, interspecific competition and disease are all factors that could have contributed to this decline, and at least one of these factors, predation, could now prevent the Thomson's gazelle population from increasing.

Augmentation of blood flow in delayed random skin flaps in the pig: effect of length of delay period and angiogenesis.

Skin capillary blood flow and angiogenesis were studied by radioactive microsphere and morphometry technique, respectively, in delayed random skin flaps in the pig. Skin flaps were delayed for 2, 3, 4, 6, or 14 days. Blood flow was measured 6 hours after complete raising of acute and delayed random skin flaps on the opposite flanks of the same pig. It was observed that the capillary blood flow increased significantly (p less than 0.05) within 2 days of delay compared to the acute skin flaps. This capillary blood flow further increased by about 100 percent between days 2 and 3, started to plateau after day 3, and remained unchanged between days 4 and 14 of delay. This increase in capillary blood flow was mainly in the distal portion of the delayed skin flaps. There was no indication of an increase in the density of arteries in all delay periods studied. Our observations did not support the hypotheses that the delay phenomenon involves angiogenesis or long-term adaptation to ischemia, as have been hypothesized previously. The possible mechanism of delay is discussed.

Functional, mechanical, and biochemical assessment of ultrasound therapy on tendon healing in the chicken toe.

We studied the therapeutic effect of ultrasound treatment on the functional recovery of surgically repaired profundus tendon in the right third toe of mature White Leghorn hens. Ultrasound treatment was given daily for 5 minutes for a total of 20 treatment days, starting immediately after 4 weeks immobilization. Ultrasound (frequency 3.0 mHz; intensity 0.75 W/cm2) was delivered to the right leg by a 5-cm2 probe through distilled water in a bath kept at 35 degrees C. The flexion of the toe was measured preoperatively for 4 consecutive days and daily for 6 weeks after the start of ultrasound treatment for the calculation of percent of functional recovery of the flexor tendon. The non-ultrasound-treated group of birds went through the same manipulations except that no ultrasound was given when the right leg was immersed in the water bath. Ultrasound treatment significantly (p less than 0.01) improved the functional recovery of the repaired tendons (less than 5-mm gap) starting on the third week of treatment (94 +/- 2 percent) compared with the non-ultrasound-treated group (79 +/- 4 percent). Ultrasound treatment had no effect on gap formation or breaking (tensile) strength of the repaired tendons. It is concluded that ultrasound enhanced functional return of repaired flexor tendons in the hen, and the clinical implication is discussed.

Effect of glucocorticoid treatment on skin capillary blood flow and viability in cutaneous and myocutaneous flaps in the pig.

The effect of methylprednisolone treatment on skin-flap viability and capillary blood flow was studied in a series of four experiments. Intramuscular methylprednisolone injections (30 mg/kg per day), given in single or divided doses preoperatively or postoperatively, had no effect in augmenting skin viability in arterialized cutaneous, myocutaneous, or random skin flaps compared with the control. Capillary blood flow was studied in arterial buttock flaps and latissimus dorsi myocutaneous flaps raised on animals treated preoperatively with methylprednisolone or saline (control), and no significant difference in capillary blood flow was noted between the treatment and control flaps. It was concluded that methylprednisolone has no significant therapeutic effect either in increasing flap viability or in increasing capillary blood flow in skin flaps in pigs.

Pharmacologic action of isoxsuprine in cutaneous and myocutaneous flaps.

The therapeutic effects of isoxsuprine on skin capillary blood flow and viability were studied in arterial buttock flaps, latissimus dorsi myocutaneous flaps, and random skin flaps in pigs. It was observed that parenteral isoxsuprine increased capillary blood flow to the skin of arterial buttock flaps and the skin and muscle of latissimus dorsi myocutaneous flaps in a dose-response manner, with a maximum vascular effect observed at 1.0 mg/kg. However, this maximum effective dose of isoxsuprine did not have any significant effect on skin viability in the cutaneous and myocutaneous flaps compared with the control. Examination of the distribution of capillary blood flow within the flaps at varying distances from the pedicle revealed that isoxsuprine did not increase capillary blood flow or perfusion distance in the distal portion of the skin of arterial buttock flaps, latissimus dorsi myocutaneous flaps, and random skin flaps. The increased capillary blood flow as a result of isoxsuprine treatment was limited only to the arterial portion of the arterial buttock flaps and latissimus dorsi flaps. Therefore, it is concluded that isoxsuprine alone is not effective in augmentation of skin viability in cutaneous and myocutaneous flaps. The pharmacologic action of isoxsuprine on the vasculature in the skin and muscle of flaps was also discussed.

Silastic rod pseudosheaths and tendon graft healing.

By examining the breaking strength and gap formation of tendon graft junction sites covered with pseudosheath at various times of immobilization, no significant increase was found compared to junction sites not covered by the pseudosheath. The optimum time for immobilization following tendon grafting is between 4 and 5 weeks in the chicken. Total coverage of the junction sites by pseudosheath did not affect gap formation.

Upper extremity gangrene: a complication of subclavian artery division.

Gangrene of the upper extremity is a rare complication following subclavian artery ligation. Two case reports from the 23-year experience at the Hospital for Sick Children are presented. If gangrene is to be eliminated in such cases, early recognition of inadequate limb perfusion is mandatory. A suspicion of inadequate perfusion justifies heparin therapy, and prompt revascularization and fasciotomy must be considered.

Functional return of tendon graft protected entirely by pseudosheath--experimental study.

Sixty-three white Leghorn chickens were used in a two-stage tendon grafting into the deep flexor of the third toe. In the first stage, a 4- or 8-week-old pseudosheath was created around the Silastic rod. In the second stage, the grafting was carried out: in 33 birds the new sheath covered the entire tendon graft and its junctions; in 30 controls, only the main portion of the graft was covered by pseudosheath. Following 6 weeks of immobilization, the toe was left free for 8 weeks and active flexion was registered once a week at perching. The covered junctions were found to be of high anatomical quality; they were, on an average, stronger, and flexion return was significantly greater (in 8-week-old pseudosheath) when compared with noncovered control grafts.

Congenital abnormalities of the mouth.

The spectrum of congenital malformations in the mouth is broad. The incidence of any one condition is not great, with the exception of the anomalies of cleft lip and cleft palate. Most of these oral malformations can produce urgent problems in neonatal management for the physician, including the care of the distraught parents. Considerable plastic and reconstructive surgery is involved in the subsequent management. The modern key to the complete successful management of these patients is the participation of a multidiscipline team.