Histological effect on the adipocutaneous flap in rats after preconditioning with 2-chloro-N(6) -cyclopentyladenosine.

BACKGROUND: 2-chloro-N(6) -cyclopentyladenosine (CCPA) was proven to be a protective factor in ischemic reperfusion injury. The purpose of this study was to determine how CCPA would affect the single tissue layers of the adipocutaneous flap. METHODS: Seventy male Wistar rats were divided into 5 experimental groups. Samples were taken of the area of flap necrosis and the wound margin after classical or pharmacological preconditioning on the fifth postoperative day. All samples were fixed in formaldehyde, embedded in paraplast, and analyzed in 3- to 4-µm sections (hemalaun-eosin stain and light microscopy). RESULTS: In general, wound healing was alike and remained unaffected by the experimental design. The most sensitive part of the flap during preconditioning is the subcutis. The number of neutrophils and of plasma cells is reduced significantly (p < .05). CONCLUSION: CCPA has an effect on each tissue layer of the flap. Subcutis became apparent as the most sensitive layer. CCPA influences complement pathway and neutrophils directly and indirectly.

Highly selective A(1) -adenosine-agonist (2-chloro-N6-cyclopentyladenosine) and reduction of flap necrosis in adipocutaneous flaps in rats.

BACKGROUND: The 2-chloro-N6-cyclopentyladenosine (CCPA) was proven to be a protective factor in ischemic reperfusion injury in myocardium and to reduce the infarct size in the heart. The purpose of this study was to determine whether flap necrosis could be reduced by intravenous administration of CCPA. METHODS: Fifty-six male Wistar rats were divided into 4 experimental groups. An epigastric adipocutaneous flap was raised, and the area of flap necrosis was assessed for all groups on the fifth postoperative day with planimetry software. RESULTS: The control group had a significantly lower rate of flap necrosis than the ischemic control group (p < .05). The nonischemic CCPA group had a significantly lower rate of flap necrosis than the nonischemic control group (p < .05). The ischemic CCPA group had a highly significant (p < .0001) rate of lower flap necrosis than the ischemic control group. CONCLUSION: Our data show that reduction of flap necrosis can be achieved both with and without ischemic periods by intravenous administration of CCPA.

Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II.

BACKGROUND: Traumatic instability of the proximal carpal row is based either on a scaphoid fracture or a scapholunate dissociation. Long-standing scaphoid nonunion or scapholunate ligament insufficiency may lead to a carpal collapse and subsequent arthrosis. Controversy exists regarding the appropriate salvage procedure for patients with scapholunate advanced collapse (SLAC)- or scaphoid nonunion advanced collapse (SNAC)-wrist in stage II. Proximal row carpectomy (PRC) and midcarpal arthrodesis (MCA) are two commonly used options. The purpose of this retrospective study was to evaluate the functional outcome and pain relief in SNAC-SLAC-wrist stage II after MCA, compared to PRC in a long term follow up. METHODS: In the MCA group 17 patients, nine SLAC- and eight SNAC-wrists, with an average age of 47 years at surgery and a mean follow up of 42 months were examined. The PRC group consisted of 30 patients, seven SLAC- and 23 SNAC-wrists, with an average age of 39 years at surgery and a mean follow up of 27 months. Active range of motion (AROM) was verified with a goniometer, grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) under resting and stress conditions. Patients' upper extremity disability was measured with the DASH questionnaire. Radiographic evaluation was carried out by conventional X-ray to verify bony consolidation. RESULTS: Mean values of postoperative AROM in extension/flexion was 61 degrees in MCA, and 75 degrees in PRC patients; radial/ulnar deviation was 32 degrees and 33 degrees, respectively. Mean DASH-score was 21 in the MCA and 25 in the PRC group. Pain relief was 54% in MCA and 77% in PRC during resting conditions and 22% and 42% during stress conditions. Static grip strength was significantly higher following MCA than PRC (72% to 50%). Among both the MCA and PRC groups three patients required further treatment with total arthrodesis due to persisting pain or absence of bony consolidation. CONCLUSION: Our data demonstrate that PRC is more favourable for patients who require less grip strength at work. For patients carrying out heavy manual work we recommend MCA due to the significantly better grip strength postoperatively.