Outcome after urgent microvascular revision of free DIEP, SIEA and SGAP flaps for autologous breast reconstruction.

INTRODUCTION: Microvascular complications after free flap breast reconstruction are devastating, and revision of a compromised breast reconstruction is very challenging. The aim of this study was to review the different characteristics of urgent microvascular revision in DIEP, SIEA and SGAP flaps and to evaluate the final outcome after revision. MATERIALS AND METHODS: A retrospective chart review was performed for all patients who underwent an autologous breast reconstruction with a DIEP, SIEA or SGAP flap at the University Hospitals of Leuven between August 1997 and December 2013. The number of revisions, time to revision, reason for revision, and outcome after microvascular free flap revision were analysed. RESULTS: A total of 1562 free flaps were evaluated during the study period, of which 4.42% required urgent exploration. DIEP flaps (3.38%) had a statistically significant lower revision rate than SIEA flaps (11.76%) and SGAP flaps (8.42%). Venous insufficiency was the main reason for revision of DIEP flaps (86.7%) and SGAP flaps (62.5%). SIEA flaps mostly failed because of an arterial problem (62.5%). SIEA flaps (62.5%) had a higher revision failure rate than DIEP flaps (37.8%) and SGAP flaps (12.5%). We found a statistically significant difference (p < 0.001) in the outcome of revision in DIEP flaps in correlation to the time to revision. Our overall flap failure rate was 1.79% (DIEP 1.28%; SIEA 7.35%; SGAP 1.05%). CONCLUSIONS: The DIEP flap remains the most reliable flap for microvascular breast reconstructions. SIEA flaps are only performed when no suitable perforator for a DIEP flap is present. Multiple revisions are no longer performed, as the outcome after more than one revision is very disappointing. The difference in reason for revision between the different flaps led to the introduction of some technical refinements.

[Pathological fragmentation of the sesamoid bone of the index due to repetitive micro trauma: a case report and review of the literature]. / Pathologie par fragmentation du sésamoïde de l'index dans le cadre de microtraumatismes répétés: à propos d'un cas et revue de la littérature.

Pathology of the sesamoid bones have been rarely described in the literature especially those of the index. We present the case of a 45 years old amateur tennis player who presented with pain on the radial border of the index finger at the level of the metacarpophalangeal joint. The clinical examination and the operative findings allow us to conclude that the symptoms were due to tendinitis of the flexors of the index associated with fracture of the sesamoid and cartilaginous degenerative changes. We also present a review of the literature.

Introduction of cremaster muscle chamber technique for long-term intravital microscopy.

This study evaluated the microcirculatory hemodynamics of a new chamber implantation technique. The cremaster muscle island flap was employed. Seventeen male Sprague-Dawley rats were studied in two groups. In the control group, the standard cremaster muscle preparation with no chamber (N = 8) was used. After flap isolation, the muscle was preserved in the medial border of the hind limb and removed for observation after 24 hours. For the chamber group, the chamber was implanted after muscle isolation, and measurements were made 30 minutes postoperatively and at 24, 48, and 72 hours. The variables measured were microvessel diameter, red blood cell velocity, number of perfused capillaries, and the number of rolling, sticking, and transmigrating leukocytes in the postcapillary venules. The chamber group had a significantly greater number of perfused capillaries at 24 hours compared with controls (p < 0.05). The other variables did not differ significantly between groups at 24 hours. We can conclude that this cremaster muscle chamber model for chronic in vivo studies proved to be equal to the classic cremaster muscle preparation for chronic microcirculatory measurements for at least 24 hours.

Pharmacodynamics and pharmacokinetics of a single oral dose of nitrazepam in healthy volunteers: an interethnic comparative study between Japanese and European volunteers.

Potential interethnic differences in drug disposition and effects between Japanese and white subjects hamper the registration in Japan of medications already used in Western countries. This double-blind, placebo-controlled, crossover study was conducted to compare the pharmacodynamics and pharmacokinetics of a single oral dose of nitrazepam (5 mg) in age- and sex-matched Japanese (n = 8) and white (n = 8) healthy volunteers. The study was performed in centers in Japan and the Netherlands using the same methods and study design. Subjects were individually matched for gender, age, and body stature. Drug effects were measured by means of saccadic and smooth pursuit eye movements and visual analog lines obtained from the scales of Bond and Lader. There were no pharmacokinetic differences between the Japanese and white subjects. Clearance of nitrazepam was 0.91 +/- 0.165 mL/min/kg and 1.17 +/- 0.492 mL/min/kg, and half-life (t1/2) was 22.1 +/- 4.96 hours and 21.5 +/- 7.51 hours for the Japanese and European groups, respectively. Pharmacokinetic parameters showed no significant correlation with age, height, or weight. The average time-effect curves for the different parameters were comparable between groups. Compared with placebo, both groups showed similar significant reductions in average peak velocity and increases in saccadic inaccuracy and reaction time. Visual analog scores showed clear sedation in the white subjects, but insignificant effects in the Japanese subjects. Smooth pursuit did not change significantly in either group. Slope and intercept of the concentration-effect relationships for saccadic peak velocity showed considerable intersubject variability, but no clear differences between groups. The pharmacokinetics and pharmacodynamics of nitrazepam were similar in matched healthy Japanese and white subjects. Interethnic comparative studies are feasible, and provide meaningful information about potential racial differences in disposition and action of drugs. Such studies can form a rational basis for comparative clinical trials.