Prompt, Objective, and Accurate Measurement of Rat Abdominal Flap Blood Flow Using Laser Speckle Flowgraphy.

Background: The indications for free flap procedures have expanded, with recent technical advances enhancing procedural safety. However, few objective indicators exist to monitor flap status during and after the operation. This experimental study assessed laser speckle flowgraphy (LSFG) as a prompt and accurate indicator of free flap blood flow. Methods: After elevating bilateral lower abdomen flaps with superficial inferior epigastric artery (SIEA) and superficial inferior epigastric vein vasculature in Wistar rats, the right flap with the SIEA was cut (ischemic group) or the superficial inferior epigastric vein was cut (congestive group), and the unaltered left flaps were monitored using LSFG every 5 minutes for a 30-minute period. Flap survival or necrosis was assessed after 7 days. Results: In the ischemic group, LSFG measurements were significantly lower after cutting the SIEA than beforehand (74% at 5 minutes and 72% at 30 minutes). Similar findings were seen in the congestive group (63% at 5 minutes and 55% at 30 minutes). LSFG measurements were significantly lower in the congestive group than in the ischemic group. Seven days afterward, whereas all right-side flaps with cut vessels were necrotic, all unaltered left-side flaps had survived. Conclusions: Our preliminary results demonstrated that LSFG could objectively identify abnormal blood flow in skin flaps as early as 5 minutes into surgery and predict graft survival. LSFG may potentially enable quick and objective assessment of flap blood flow and reduce the risk of complications and flap loss.

Madelung's disease: long-term follow-up.

Madelung's disease (MD) is a rare lipid metabolic disorder of adipose tissue overgrowth, which has been reported to be related to alcohol abuse. Although it does not affect survival itself, alcoholism and metabolic disorders associated with MD can be life-threatening. Although surgical procedures and classifications have been reported, long-term follow-up has rarely been reported. Here, we report a 61-year-old Japanese man with MD who has been followed-up for 12 years. Lipectomy was performed three times over the first 3 years and a total of 4 kg of adipose tissue was excised. Relapse has not been observed. He was diagnosed with multiple hepatocellular carcinomas (MHC) and placed on dialysis due to hepatorenal syndrome caused by alcoholism. Moreover, one of the MHC ruptured resulting in hemorrhagic shock. The cause of death in MD is not fat proliferation but comorbidities. Long-term observation and multidisciplinary systemic management are necessary for MD patients.

Therapeutic strategies for elbow ankylosis due to heterotopic ossification in patients with severe burns.

BACKGROUND: Heterotopic ossification (HO) occurs frequently in the elbow in burn patients, and extends beyond the anatomical structure. HO of the elbow can cause joint contracture and adversely affect activities of daily living.Currently, there is no effective prophylaxis for HO as the precise underlying mechanism remains unknown. Therefore, there is no choice but to treat HO after it has developed. To date, however, no effective standard treatment has been reported, and therefore treatment methods vary between different facilities. Surgical resection is widely accepted as the only therapeutic option once HO limits functional mobility of the elbow. PURPOSES: Based on past reports, we examined our cases and recommend effective therapeutic strategies. We posed the following three questions: (1) Is the surgical intervention effective or detrimental for elbow ankylosis due to HO? (2) What is the best timing for the intervention? (3) What is the most effective postoperative rehabilitation plan? METHODS: We treated three patients with complete ankylosis of the elbow due to HO after severe burn injury using different protocols. RESULTS: Surgery was performed in two cases and rehabilitation therapy was commenced immediately from the first postoperative day. Both patients showed improvement in the active range of motion in their elbow joints. The other patient did not undergo surgery, and his elbows became fixed in the completely extension position. CONCLUSION: Surgical resection is beneficial for elbow ankylosis due to HO after burn injury. Although the exact surgical timing is still controversial, we recommend that surgery should be performed as soon as possible after improving the skin condition around the elbow and confirming the maturation of HO on radiographs. Early rehabilitation and pain control are also important after surgery.