Pedicled ALT-flap for soft tissue reconstruction in the trochanteric area.

BACKGROUND: Coverage of soft tissue defects following surgery at the trochanteric area is challenging. Revision surgery in case of compromised wound healing may lead to soft tissue defects requiring reconstruction with pedicled or free flaps. Previous access to the hip joint may jeopardize neurovascular structures relevant to the flap. OBJECTIVE: In this study, we evaluated if the use of a pedicled anterior lateral thigh (ALT) flap is a valuable option for soft tissue reconstruction. METHODS: In this retrospective study, seven patients were included. Defect etiology was tumor resection in one case, screw osteosynthesis in another case and total hip arthroplasty in three cases. All patients underwent reconstruction by proximal pedicled anterior lateral thigh (ALT) flap. RESULTS: Pedicled ALT flap was a safe procedure in all cases. One patient showed delayed wound healing with need for additional surgery. No further complications were observed. CONCLUSIONS: Pedicled ALT flap transfer represents a reliable option for soft tissue coverage in the trochanteric area after primary surgery such as hip arthroplasty, osteosynthesis or tumor resection.

Study of the proviral load levels and mRNA expression of cytokines in peripheral blood mononuclear cells and somatic milk cells in cattle with different BLV infection profiles.

The retrovirus bovine leukemia virus (BLV) might produce abnormal immune function, associated with susceptibility to developing other infectious diseases, including mastitis. This study aimed to determine the proviral load and cytokines gene expression in peripheral blood mononuclear cells (PMBC) and milk somatic cells (SC) in BLV-infected and non-infected cattle. Of 27 BLV-infected cows in PBMC, 17 (62.96%) had a high proviral load (HPL), and 10 (37.04%) had a low proviral load (LPL). All SC samples had low proviral load (LPL-SC). Higher IFN-γ and IL-10 expression, and lower IL-12 and IL-6 expression, were found in PBMC from BLV-infected compared to BLV non-infected cattle. Moreover, higher IFN-γ, IL-12, and IL-6 expression, and lower IL-10 expression were observed in cattle with LPL-PBMC compared to HPL-PBMC. In milk samples, lower IFN-γ and higher IL-12 mRNA expression were observed in LPL-SC compared to BLV non-infected cattle in SC. IL-10 and IL-6 expression mRNA was significantly lower in LPL-SC than in SC from BLV non-infected cattle. This study shows that milk SC maintains lower proviral load levels than PBMC. This first report on Th1 and Th2 cytokines expression levels in SC may be relevant to future control strategies for BLV infection, mastitis, and udder health management.

[Vascular diagnostics before microvascular tissue transfer on the lower extremities : An algorithm]. / Gefäßdiagnostik vor mikrovaskulärem Gewebetransfer an der unteren Extremität : Ein Algorithmus.

Microsurgical free flap transfer plays a key role in soft tissue reconstruction of the lower extremities. Through close cooperation between plastic and orthopedic surgery, great progress and success in limb salvage could be achieved over the last decades. The risk for extremity malperfusion is especially high in older patients and after trauma. To maximize the success rate for free flap transfer there is need for interdisciplinary clinical examination and diagnostics. In addition to clinical methods radiological procedures are necessary to evaluate and optimize lower extremity perfusion before surgery.Vascular ultrasound provides important information about the arterial and venous status; however, DSA, CTA and MRA are well-established and exact methods to evaluate arterial inflow. The use of less invasive methods makes it much more feasible, economic and comfortable to perform preoperative selection of patients requiring interventional procedures.In the case of intraluminal stenosis without any option for PTA, a vascular surgeon can be involved at an early stage to evaluate further surgical options. In some cases, similar surgical revascularization and free flap transfer can be performed in a single surgery. The aim of this study is to implement a standardized algorithm for preoperative examination and radiological diagnostics before reconstructive surgery of the lower extremity.

Alterations in TNF-α and its receptors expression in cows undergoing heat stress.

Heat stress is one of the environmental factors that most severely affects milk industry, as it has impact on production, immune responses and reproductive performance. The present study was conducted with high-performance Holando-Argentino cows. Our objective was to study TNF-α and its receptors pattern expression in cows from a region characterized by extreme climatic seasonality. Animals were evaluated in three periods: spring (n = 15), summer (n = 14) and autumn (n = 11). Meteorological records from a local station were used to estimate the temperature and humidity index (THI) by means of an equation previously defined. A THI higher than 68 is indicative of stressing conditions. During the summer period, the animals were exposed to 8.5 ±â€¯1.09 h of heat stress, or THI > 68. In spring, stress hours were reduced to 1.4 ±â€¯0.5 every day, while during the autumn, there were no recorded heat stress events. Expression of TNF-α, and its receptors was determined by qPCR. During the summer, TNF-α and its receptors expression diminished drastically compared to the rest of the year, when stressful conditions were infrequent. We conclude that animals that are not physiologically prepared to resist high temperatures might have a less efficient immune response, reinforcing the need to develop new strategies to improve animal welfare.

Complex Soft Tissue Defects in Operative Urology: Pedicled Perforator Flaps of the Anterior Lateral Thigh for Tissue Reconstruction of the Lower Trunk.

BACKGROUND: Complex soft tissue defects involving the lower abdomen, perineum, and groin (LAPG) represent reconstructive challenges following urologic surgery. Consequently, these often require an interdisciplinary approach involving plastic surgery. While pedicled flaps from the lower abdomen are a reliable option, previous placement of colostomies and urinary urostomies renders these flap types unavailable. Here, the pedicled anterolateral thigh perforator (ALT) flap represents a reliable pedicled alternative which can harvest from the thigh. MATERIALS AND METHODS: A retrospective data analysis of pedicled perforator flaps harvested from the thigh to reconstruct soft tissue defects was conducted. Seven patients treated in the urology department with soft tissue defects following tumor resection, infection, and dehiscence were included. RESULTS: In all patients, the ALT flap was utilized successfully to reconstruct soft tissue defects up to 450 cm2 in size. All flaps survived. In 1 case, prolonged wound healing was observed. All defects were adequately addressed with no recurrence of dehiscence or fistula formation. CONCLUSIONS: Pedicled perforator flaps represent a valid option for the soft tissue reconstruction of the lower abdomen and perineum when a pedicled rectus abdominis flap is no longer available. This flap is, therefore, a good option in an interdisciplinary approach to soft tissue reconstruction, especially following urologic surgery, which is predominantly performed in the LAPG region.

[The impact of SARS-CoV-2 restrictions on medical care in Plastic Surgery]. / Die Auswirkungen der SARS-CoV-2-Einschränkungen auf die Patientenversorgung im Fachbereich für Plastische, Rekonstruktive und Ästhetische Chirurgie.

BACKGROUND: To manage the expected COVID-19 patient load major restrictions in in- and outpatient treatment had to be made. Depending on local conditions and order supply differences SARS-CoV-2 restrictions had a massive impact on medical care. To show the impact of plastic surgery on emergency surgery during SARS-CoV-2 pandemic, the amount of surgical emergencies in a single center plastic surgery division were evaluated. METHOD: The number of plastic surgery cases in a university hospital was evaluated during 16.03.2020 to 27.04.2020 and compared with previous years. RESULTS: Due to cancelling of elective surgery the number of cases dropped to 57,3 % of the caseload of previous years. There was no change in ratio of emergency (2020: 56,4 %; 2017-2019: 54,9 %) and urgent (2020: 44,6 %; 2017-2019: 45 %) surgery. No changes in regard to the etiology of trauma cause nor insurance status (occupational insurance/health insurance) were noted. CONCLUSION: Based on the data of this evaluation there is a clear relevance of Plastic Surgery in the setting of general medical care. Even during the pandemic crises a sufficient plastic surgery service is mandatory in a tertiary referral center.

Development of novel biological resection criteria for safe and oncologically satisfying resection of hepatocellular carcinoma.

OBJECTIVE: To develop criteria for safe and oncologically satisfying liver resection in case of early hepatocellular carcinoma with a 5-year overall survival (OS) similar to liver transplantation. SUMMARY BACKGROUND DATA: Liver resection (LR) and liver transplantation (LT) are potentially curative treatment options for hepatocellular carcinoma. Generally, LT achieves better OS. Due to organ shortage, however not all patients can receive a LT. METHODS: To decide which patients to resect and which to transplant we have developed biological resection criteria (BRC) as a compound out of mGPS (modified Glascow Prognostic Scale) and the Kings-Score (for HCV cirrhosis). These are based on routine clinical values that reflect both liver function and tumor biology/immunology. RESULTS: 276 patients were analyzed. Patients undergoing LR within BRC (inBRC) had a significantly better overall (73.6% vs. 35.4%, (p < 0.001)) and disease-free survival (54.7% vs. 17.2%, (p < 0.001)) as compared to patients outside the BRC (outBRC). The predictive value of BRC was independent of tumor burden. In a subgroup analysis outBRC patients had significantly worse outcome after major resection. In LT patients BRC had no predictive value. CONCLUSIONS: BRC may be a valuable tool to predict survival after LR for HCC. Patients resected inBRC may achieve comparable survival as LT. LR in outBRC patients are unlikely to be curative. All outBRC patients should be monitored closely for salvage LT.

Resection or Transplant in Early Hepatocellular Carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) has an incidence of 5-10 per 100 000 persons per year in the Western world. In 20% of cases, surgical liver resection (LR) or liver transplantation (LT) can be performed. LT results in longer survival, as it involves resection not only of the tumor, but of pre - cancerous tissue as well. The optimal allocation of donor organs depends on the identification of patients for whom LR is adequate treatment. In this meta-analysis, we compare LT and LR for patients with early HCC and wellcompensated cirrhosis. METHODS: A systematic review of the pertinent literature was followed by a subgroup analysis of the studies in which patients with early HCC and wellcompensated cirrhosis were followed up after either LR or LT. Overall survival at 1, 3, and 5 years, as well as morbidity and mortality, were compared in a random effects meta-analysis. RESULTS: 54 studies with a total of 13 794 patients were included. Among patients with early HCC, the overall survival after LT became higher than the overall survival after LR 5 years after surgery (66.67% versus 60.35%, odds ratio 0.60 [0.45; 0.78], p <0.001); there was no significant difference 1 year or 3 years after surgery. Nor was there any significant difference in morbidity or mortality between the two types of treatment in this subgroup. These findings contrast with the results obtained in all of the studies, which documented significantly better survival 3 years after LT. CONCLUSION: Three years after surgery, the survival rates and complication rates of patients with early HCC treated with either LR or LT are comparable. Resection should therefore be the preferred form of treatment if the prerequisites for it are met. In case of recurrent tumor, these patients can still be evaluated for liver transplantation. This strategy could improve the allocation of donor organs.

Left ventricular pressure-volume measurements and myocardial gene expression profile in type 2 diabetic Goto-Kakizaki rats.

The Goto-Kakizaki (GK) rat, a non-obese model of type 2 diabetes mellitus (T2DM), was generated by the selective inbreeding of glucose-intolerant Wistar rats. This is a convenient model for studying diabetes-induced cardiomyopathy independently from the effects of the metabolic syndrome. We investigated the myocardial functional and structural changes and underlying molecular pathomechanisms of short-term and mild T2DM. The presence of DM was confirmed by an impaired oral glucose tolerance in the GK rats compared with the age-matched nondiabetic Wistar rats. Data from cardiac catheterization showed that in GK rats, although the systolic indexes were not altered, the diastolic stiffness was increased compared with nondiabetics (end-diastolic-pressure-volume-relationship: 0.12 ± 0.04 vs. 0.05 ± 0.01 mmHg/µl, P < 0.05). Additionally, DM was associated with left-ventricular hypertrophy and histological evidence of increased myocardial fibrosis. The plasma pro-B-type natriuretic peptide, the cardiac troponin-T, glucose, and the urinary glucose concentrations were significantly higher in GK rats. Among the 125 genes surveyed using PCR arrays, DM significantly altered the expression of five genes [upregulation of natriuretic peptide precursor-A and connective tissue growth factor, downregulation of c-reactive protein, interleukin-1ß, and tumor necrosis factor (TNF)-α mRNA-level]. Of the altered genes, which were evaluated by Western blot, only TNF-α protein expression was significantly decreased. The ECG recordings revealed no significant differences. In conclusion, while systolic dysfunction, myocardial inflammation, and abnormal electrical conduction remain absent, short-term and mild T2DM induce the alteration of cardiac TNF-α at both the mRNA and protein levels. Further assessments are required to reveal if TNF-α plays a role in the early stage of diabetic cardiomyopathy development.