Investigation of the effect of sildenafil on flap survival in a diabetic rat model.

OBJECTIVE: This study aimed to demonstrate the efficacy of sildenafil citrate in order to improve the distal necrosis of randomized flaps in diabetic rats, and to explore new methods to reduce distal necrosis encountered in flap surgery. MATERIALS AND METHODS: This is an experimental study in rats. The rats were first divided into three groups: Control(C), Diabetes(D), and Sildenafil(S). Streptozotocin 40mg/kg was administered intraperitoneally to the rats in groups D and S that would develop diabetes. Two days after the procedure, blood glucose was measured from the tail vein of the rats, and the rats with a blood glucose level of 250mg/dL and above were considered diabetic. 7×3cm McFarlane flap was randomly planned on the back of the rats. In the flaps, ischemia was measured at the 30th minute with Na fluorescein, flap necrosis was measured on days 4 and 7, and specimens were collected from the critical zone and distal zone regions for histological examination. RESULTS: The comparison of ischemia and necrosis regions, ischemia was found to be more significant in groups D and S compared to group C (P<0.05). In the comparison of necroses on days 4 and 7, it was determined that necrosis occurred significantly (P<0.05) less in group S compared to the other groups. It was determined that necrosis in group D was significantly (P<0.05) higher on days 4 and 7 compared to the other groups. CONCLUSION: The distal circulation is affected worse in randomized flaps in diabetes. Sildenafil citrate significantly increased the flap viability (P<0.05).

Chain purse-string suture used to shorten the vertical incision in vertical breast reduction.

BACKGROUND: Reduction mammaplasty is one of the most frequently performed operations in plastic surgery. Breast scarring can be troublesome for both the patient and the surgeon. This report offers an easy method for suturing a vertical incision that provides a better shape in final breast appearance. METHODS: In this study, 10 patients with an average age of 33 years (range, 27-44 years) underwent short-scar medial pedicle breast reduction. For the patients who underwent a medium reduction (401-800 g), after the excision of sufficient glandular and skin tissue, the vertical incision was closed as follows. Loose subcuticular sutures were placed, starting from the top of the incision and proceeding toward its bottom. In the distal corner of the incision, counterpart suturing was performed out through the opposite direction before the wound was approximated. In this way, the suture chain was completed. At the top of the incision, the sutures were pulled tight to gather the skin in a short vertical scar. RESULTS: The patients were followed up on the average for 12 months after the surgery. The majority of the patients were sufficiently satisfied with the results of the operations, including the scar length and the final appearance. Pseudoptosis did not occur. CONCLUSION: The findings show that the reported technique is an improvement over the existing vertical incision method by allowing for faster and simpler closure and resulting in a better breast shape and scar length. The bidirectional continuous suture is performed as a purse string in the longitudinal incision. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .