Oxigenoterapia hiperbárica. Sus aplicaciones en Cirugía Plástica / Hyperbaric oxygen therapy. Its applications in Plastic Surgery

La oxigenoterapia hiperbárica (OHB) puede mejorar la cicatrización de las heridas. La hipoxia, la alteración de la angiogénesis y la inflamación prolongada son condiciones constantes que la OHB favorece su reversibilidad; hace ya muchos años que, en el listado de indicaciones reconocidas por Sociedades Científicas que rigen esta práctica, se encuentra como indicación aceptada para el tratamiento coadyuvante en injertos o colgajos en riesgo isquémico, como también en heridas refractarias; en la última década, paulatinamente, con la difusión y el aumento de las facilidades para acceder a equipos hiperbáricos, las indicaciones se extendieron al área de la cirugía plástica, para tratamiento de complicaciones posoperatorias en tejidos isquémicos o necrosados y también para preacodicionamiento preoperatorio y sostén posoperatorio de cierto grupo de pacientes con mayor riesgo de sufrir una complicación, en las lipotransferencias como coadyuvante para aumento de la preservación de una mayor cantidad de tejido graso. Las publicaciones al respecto son cada día más frecuentes, algunas presentan un pequeño número de casos, otras son estudios de cohorte retrospectivos, con un nivel de evidencia elevado. El objetivo de este artículo es presentar el concepto básico de los efectos de la OHB, referencia al estado actual de las distintas indicaciones en uso en cirugía plástica y medicina cosmética y la experiencia personal al respecto.

Hyperbaric oxygen therapy (HOT) can improve wound healing, hypoxia, alteration of angiogenesis and prolonged infl ammation are constant conditions that HOT favors its reversibility for many years now, in the list of indications recognized by Scientifi c Societies. that govern this practice, is a recognized indication for adjuvant treatment in grafts or fl aps at ischemic risk, as well as in refractory wounds; In the last decade, gradually, with the dissemination and increase in the facilities to access hyperbaric equipment, the indications were extended to the area of plastic surgery, for the treatment of post-operative complications in ischemic or necrotic tissues as well as for preconditioning. operative and post-operative support of a certain group of patients with a higher risk of suff ering a complication, in lipotransferences as an adjuvant to increase the preservation of a greater amount of fatty tissue. Publications in this regard are becoming more frequent every day, some present a small number of cases, others are retrospective cohort studies, with a high level of evidence. The objective of this article is to present the basic concept of the eff ects of HOT, reference to the current state of the diff erent indications in use in plastic surgery, and cosmetic medicine and personal experience in this regard

Evaluation of the radiofrequency ablation of lumbar sympathetic ganglia in lower limb ischemic ulcers in indian population: radio frequency ablation and lower limb ischemic ulcers / Evaluación de la ablación por radiofrecuencia de los ganglios simpáticos lumbares en las úlceras isquémicas de las extremidades inferiores en la población de la India: ablación por radiofrecuencia y úlceras isquémicas de las extremidades inferiores

Background:Lumbar sympathectomy through radio ablation is a useful treatment of peripheral ischemia. However, clinical efficacy with respect to lower limb ulcers is not adequately established in the Indian population. The study was conducted to evaluate the role of radiofrequency ablation (RFA) of the lumbar sympathetic ganglia in healing of ischemic ulcers of the lower limb.Method:The prospective study with 63 patients registered in the General surgery department with lower limb ischemic ulcers between December 2017­ July2019 were treated with RFA. Patients with cardiopulmonary disease, pregnant, congenital malformation, or skin infection at the site of intervention, or suffering from bleeding disorders, were excluded from the study. Clinical investigation of the wound was performed, and demographic data was collected. Comparative reduction in wound size was assessed through Friedman`s ANOVA (P<0.001). Difference in pain score, hospital stay, and walking distance were evaluated using Wilcoxon matched pair test (P<0.001), Unpaired t-test, and Paired t-test (P<0.05).Result:Majority of the patients were male (n=40) with a mean age of 60.93 SD14.34 years. Significant reduction in wound size, pain scores and hospital stay were observed post procedure(P<0.001). Number of RFA sessions was significantly associated with the size of the ulcer and Fontaine's classification 2 and 3 (P<0.0001).Conclusion:RFA of lumbar sympathetic ganglia is a potential treatment modality for lower limb ischemic ulcers.

Antecedentes: La simpatectomía lumbar a través de la ablación por radiofrecuencia es un tratamiento útil de la isquemia periférica. Sin embargo, la eficacia clínica con respecto a las úlceras en las extremidades inferiores no está adecuadamente establecida en la población india. El estudio se llevó a cabo para evaluar el papel de la ablación por radiofrecuencia (RFA) de los ganglios simpáticos lumbares en la curación de las úlceras isquémicas de la extremidad inferior. Método: El estudio prospectivo con 63 pacientes registrados en el departamento de cirugía general con úlceras isquémicas de las extremidades inferiores entre diciembre de 2017 y julio de 2019 fueron tratados con RFA. Los pacientes con enfermedad cardiopulmonar, malformación embarazada, congénita o infección de la piel en el lugar de la intervención, o que sufren de trastornos hemorrágicos, fueron excluidos del estudio. Se realizó una investigación clínica de la herida y se recopilaron datos demográficos. La reducción comparativa en el tamaño de la herida se evaluó a través del ANOVA de Friedman (P<0.001).Resultado: La diferencia en la puntuación del dolor, la estancia en el hospital y la distancia a pie se evaluaron mediante la prueba de par coincidente de Wilcoxon (P<0.001), la prueba t no emparejada y la prueba t emparejada (P<0.05). La mayoría de los pacientes eran varones (n-40) con una edad media de 60,93 SD14,34 años. Se observó una reducción significativa en el tamaño de la herida, las puntuaciones de dolor y la estancia hospitalaria (P<0.001). El número de sesiones de RFA se asoció significativamente con el tamaño de la úlcera y las clasificaciones 2 y 3 de Fontaine (P<0.0001).Conclusión: LA RFA de los ganglios simpáticos lumbares puede constituir una opción terapéutica para las úlceras isquémicas de las extremidades inferiores.

Transcutaneous Electric Nerve Stimulation on ischemic rest pain in inpatients: randomised trial

SUMMARY OBJECTIVE: To investigate the efficacy of a short-term application of Transcutaneous Electric Nerve Stimulation to relieve rest pain in patients with chronic limb-threatening ischemia. METHODS: In patients ³18 years old, with chronic limb-threatening ischemia and rest pain ³3 in the Visual Analogue Scale, without diabetic neuropathy were randomly assigned to 1) Transcutaneous Electric Nerve Stimulation (100 Hz, 200 μs) or 2) sham intervention, both during one or two 20 min treatment sessions. The primary outcome was pain intensity, assessed by the visual analogue scale (0-10 cm) and described by the McGill Pain Questionnaire. We used a t-test for difference of means. RESULTS: A total of 169 patients were assessed, 23 met the study criteria and were randomized. Thirty-four applications were performed in two days: in the 17 Transcutaneous Nerve Stimulation and 17 sham. The within-group analysis indicated a pain decrease in both groups (Transcutaneous Electric Nerve Stimulation, from 7-3.9 cm, p<0.0001, and sham from 5.8-3.2 cm, p<0.0001). No statistically significant difference was verified between-groups (p=0.5). CONCLUSIONS: Both groups showed a decrease in rest pain of 54 and 55%, respectively. However, there was no difference between short-term high-frequency Transcutaneous Electric Nerve Stimulation and sham intervention to relieve ischemic rest pain in chronic limb-threatening ischemia patients.

Resultados do tratamento das oclusões arteriais agudas de membros em hospital universitário - estudo retrospectivo / Results of treatment of acute occlusions of limb arteries at a university hospital - retrospective study

Resumo Contexto As oclusões arteriais agudas (OAA) de membros vêm crescendo paralelemente com a longevidade da população. Objetivos O objetivo deste estudo foi avaliar fatores de risco, salvamento de membros e sobrevida dos pacientes com OAA tratados em instituição universitária. Métodos Este é um estudo coorte retrospectivo de pacientes consecutivos. Os desfechos incluíram: sucesso técnico, sintomas, comorbidades, categoria Rutherford, artérias acometidas, complicações pós-operatórias, taxa de salvamento de membros em 30 dias e óbitos. Resultados Avaliou-se 105 prontuários, havendo predomínio do sexo masculino (65,7%) e idade entre 46 a 91 anos. As etiologias identificadas foram trombóticas (54,3%), embólicas (35,2%) e indefinidas (10,5%). Cerca de dois terços apresentavam-se nas Categorias II e III de Rutherford. Os sintomas associados encontrados foram dor (97,1%), esfriamento (89,5%), palidez (64,7%), parestesias (44,7%), paralisias (30,5%), anestesias (21,9%), edema (21,9%) e cianose (15,2%); e as comorbidades associadas observadas foram hipertensão (65,0%), tabagismo (59,0%), arritmias (26,6%), dislipidemias (24,0%) e diabetes (23,8%). O segmento femoral superficial-poplíteo-distal foi o mais acometido (80%). A tromboembolectomia com cateter Fogarty foi realizada em 73,3% dos casos (81,0% nas embolias, 71,9% nas tromboses e 54,5% nos indefinidos), sendo isoladamente em 41 pacientes (39,05%), nos quais ocorreram 11 reoclusões, 20 amputações e 14 óbitos. A reoclusão arterial foi mais frequente nas tromboses (12,9%; p = 0,054). Até 30 dias após tratamento, o óbito total foi de 14,6% e a amputação maior foi de 19,8%, sendo menos frequente na Classe I Rutherford (p = 0,0179). Conclusão O tratamento da OAA feito prioritariamente por meio de tromboembolectomia com cateter Fogarty, isolado e/ou associado, proporcionou taxas de amputação e complicações compatíveis com as apresentadas na literatura e progressivamente menores nas categorias Rutherford menos avançadas.

Abstract Background Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. Objective To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Methods Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. Results Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). Conclusion Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.

Colgajo glúteo mayor en reconstrucción de úlcera isquiática bilateral / Gluteal maximus flap for reconstruction of bilateral ischial ulcer

Propósito y objetivo. Demostrar una de las opciones más empleadas para la cobertura de úlceras isquiáticas en paciente parapléjico. El colgajo glúteo mayor sería de primera elección en el caso presentado de una paciente con diagnóstico de escaras isquiáticas bilateral Grado IV. Introducción. El colgajo glúteo mayor, colgajo musculocutáneo, es un procedimiento muy utilizado y de primera línea para el tratamiento de úlceras isquiáticas. Debemos tener en cuenta que para el éxito y buena evolución de la cirugía es necesario la conformación de un equipo multidisciplinario, para su seguimiento y control. Las opciones de cobertura dependen de la topografía de la lesión. Algunas de las opciones de cobertura son: colgajo glúteo inferior de rotación, colgajo glúteo inferior de avance en V-Y, colgajo de isquiotibiales en V-Y, colgajo de cara posterior de muslo y colgajo extendido de fascia lata, entre otros. Material y método. Se presenta el caso clínico de una paciente femenina con diagnóstico patológico de cavernoma intramedular D9, que padece paraplejía de un año de evolución, presentando escara isquiática bilateral grado IV acompañadas de osteomielitis. Se trató quirúrgicamente con colgajo glúteo mayor bilateral Resultados. En esta paciente se alcanzó una adecuada cobertura del defecto, que permitió su pronta rehabilitación, y un minucioso control posoperatorio que no mostró complicaciones ni recidiva, hasta la fecha. Discusión. Las úlceras isquiáticas profundas ubicadas cerca del tracto genitourinario presentan mayor dificultad para su reconstrucción. El colgajo musculocutáneo de glúteo mayor a pedículo inferior permite el cierre de cualquier úlcera isquiática y el cierre primario del sitio donador asegurando un cierre sin tensión; otras opciones quirúrgicas, como los colgajos basados en la pelvis o el tronco, son menos susceptibles a la tensión que aquellos ubicados en la porción móvil de la extremidad inferior, por lo que los colgajos de glúteo mayor, inferior y de cara posterior al muslo tienen mayor porcentaje de éxito que los colgajos de tensor de fascia lata e isquiotibiales. Conclusión. El colgajo glúteo mayor es un tratamiento de primera elección para la cobertura de úlceras isquiáticas de alta morbilidad en pacientes parapléjicos, tratado por un equipo multidisciplinario, cuya técnica quirúrgica presentó buena cobertura con un control estricto del posoperatorio con excelente evolución y sin ninguna complicación esperada

Protective Effects of Geraniol on Long Term Renal Ischemia/Reperfusion Injury in Rats

Abstract Possible protective effects of geraniol, known as antioxidant properties, were analyzed biochemically and histologically on experimental long-term renal ischemia/reperfusion I/R injury in rats. This study used 3-4 months old male Wistar albino rats and were divided into 4 groups (n = 7) by random selection: Group I (Sham Group), Group II (I/R+SF), Group III (I/R+50 mg/kg geraniol), and Group IV (I/R+100 mg/kg geraniol). A right nephrectomy was performed in all groups under anesthesia. Groups I and II were inoculated with SF (1 ml/kg) and Groups III and IV were inoculated with 50 mg/kg and 100 mg/kg of geraniol, injected intraperitoneally. For Groups II, III, and IV, I/R durations were determined to be 60 mins ischemia and 24 hours reperfusion. At the end of the experiment, Urea (BUN), Creatinine (CRE) activities in the blood serum and the catalase (CAT), glutathione peroxidase (GPx) and Superoxide dismutases (SOD), enzyme activities in kidney tissue were measured. Histologic sections were examined by light microscopy using Hematoxylin & Eosine. As a result, it was determined that 100 mg / kg geraniol against renal I/R injury shows more antioxidant effect and protection than 50 mg / kg geraniol.

Cardioprotection of Rosuvastatin Pre-conditioning on Myocardial Ischemia / Reperfusion Injury in a Rat Model

Abstract This study aimed to investigate the cardioprotection of rosuvastatin pre-conditioning (R-Pre) in a rat model of myocardial ischemia / reperfusion (I/R). Male SD rats were assigned into three groups: sham group, I/R group and R-Pre group. Rats in I/R group and R-Pre group received ischemia for 30 min and reperfusion for 2 h. In R-Pre group, rats received intragastrical administration with rosuvastatin at 5 mg/kg once daily for 1 week. After 2-h reperfusion, the cardiac function was detected by ultrasonography; the blood was collected for biochemical analysis; the heart was collected for the TUNEL staining and immunohistochemistry for Bcl-2 and Bax. Our results showed rosuvastatin pre-conditioning for 1 week could significantly reduce the infarct ratio and improve the cardiac function after myocardial I/R injury, in which attenuation of oxidative stress and cell apoptosis played an important role. Our study provides evidence on the cardioprotection of rosuvastatin pre-conditioning and highlight the use of rosuvastatin before cardiopulmonary bypass.

Curativo com filme e gel de biopolímero de celulose bacteriana no tratamento de feridas isquêmicas após revascularização de membros inferiores / Bacterial cellulose biopolymer film and gel dressing for the treatment of ischemic wounds after lower limb revascularization

RESUMO Objetivo: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. Métodos: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. Resultados: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). Conclusão: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores

ABSTRACT Objective: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. Methods: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. Results: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). Conclusion: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.

Liver ischemia and reperfusion injury. Pathophysiology and new horizons in preconditioning and therapy

Abstract It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.

Oclusão arterial aguda / Acute limb ischemia

Objetivos: expor de forma sucinta e objetiva as principais características da síndrome de oclusão arterial aguda, além de sua importância do ponto de vista epidemiológico, tendo em vista a elevada morbidade e mortalidade em nosso meio. Propõe-se a discussão do quadro clínico, o reconhecimento das características de cada tipo de oclusão e a possibilidade de reversão do quadro. Métodos: revisão de literatura realizada entre abril e junho de 2017 no banco de dados PubMed, através do uso dos termos chaves "membros", "isquemia", "revascularização" e "oclusão arterial aguda". Resultados: a oclusão arterial aguda consiste numa das mais dramáticas complicações da doença arterial periférica; porém, apresenta potencialidade de reversão, apresentando taxas de salvamento de membros de 85%, se reconhecida e prontamente tratada. Conclusão: A elevada morbimortalidade dessa patologia faz com que sejam envidados todos os esforços na tentativa de se obter o diagnóstico precoce, permitindo uma terapêutica ágil e resolutiva, diminuindo o número de amputações e mortes.

Aims: to present a brief and objective analysis of the main characteristics of the acute arterial occlusion syndrome, in addition to its epidemiological importance, considering the high morbidity and mortality in our country. It is proposed to discuss the clinical picture, the recognition of the characteristics of each type of occlusion and the possibility of reversion of the condition. Methods: literature review performed between April and June 2017 in the PubMed database, using the key terms "limbs", "ischemia", "revascularization" and "acute limb ischemia". Results: acute limb ischemia is one of the most dramatic complications of peripheral arterial disease; however, it has a potential for reversion, presenting limb salvage rates of 85%, if recognized and promptly treated. Conclusion: the high morbidity and mortality of this pathology means that all efforts must be made in the attempt to obtain the early diagnosis, allowing agile and resolutive therapy, decreasing the number of amputations and deaths.

Effect of remote ischemic postconditioning in inflammatory changes of the lung parenchyma of rats submitted to ischemia and reperfusion / Efeito do pós-condicionamento isquêmico remoto nas alterações inflamatórias do parênquima pulmonar de ratos submetidos à isquemia e reperfusão

AbstractObjective:To assess the effects of postconditioning remote in ischemia-reperfusion injury in rat lungs.Methods:Wistar rats (n=24) divided into 3 groups: GA (I/R) n=8, GB (R-Po) n=8, CG (control) n=8, underwent ischemia for 30 minutes artery occlusion abdominal aorta, followed by reperfusion for 60 minutes. Resected lungs and performed histological analysis and classification of morphological findings in accordance with the degree of tissue injury. Statistical analysis of the mean rating of the degree of tissue injury.Results:GA (3.6), GB (1.3) and CG (1.0). (GA GB X P<0.05).Conclusion:The remote postconditioning was able to minimize the inflammatory lesion of the lung parenchyma of rats undergoing ischemia and reperfusion process.

ResumoObjetivo:Avaliar os efeitos do pós-condicionamento remoto no fenômeno de isquemia e reperfusão nos pulmões de ratos.Métodos:Ratos Wistar (n=24) divididos em 3 grupos: GA (I/R) n=8, GB pós-condicionamento remoto n=8, GC (controle) n=8, submetidos à isquemia de 30 minutos por oclusão da artéria aorta abdominal, seguida de reperfusão de 60 minutos. Ressecados os pulmões e realizada a análise histológica e classificação dos achados morfológicos de acordo com o grau de lesão tecidual. Análise estatística das médias da classificação do grau de lesão tecidual.Resultados:GA (3,6); GB (1,3) e GC (1,0). (GA X GB P<0,05).Conclusão:O pós-condicionamento remoto foi capaz de minimizar a lesão inflamatória do parênquima pulmonar de ratos submetidos ao processo de isquemia e reperfusão.

Isquemia intestinal, reconocimiento y manejo / Intestinal ischemia, diagnosis and treatment

Intestinal ischemia remains a high risk mortality disease. Early detection has a huge impact in survival. The development of new biochemical markers will be useful in ischemia screening. Computed tomography (CT) scan and AngioTC, has a great value to assess viability of small bowel areas. Basic treatment and even surgery have the best results in early diagnosis setting.

La isquemia intestinal continúa siendo una patología de alto riesgo de mortalidad. El reconocimiento clínico precoz tiene impacto en la sobrevida. Se están desarrollando nuevos marcadores bioquímicos para optimizar la pesquisa de isquemia. En estos casos, la tomografía computada (TC) multicorte y angioTC, son de gran utilidad para establecer la viabilidad de un segmento y la probabilidad de resección. En tratamiento general y quirúrgico si corresponde, tiene mejores resultados en escenarios de diagnóstico precoz.

Bone marrow mesenchymal stem cells overexpressing human basic fibroblast growth factor increase vasculogenesis in ischemic rats

Administration or expression of growth factors, as well as implantation of autologous bone marrow cells, promote in vivo angiogenesis. This study investigated the angiogenic potential of combining both approaches through the allogenic transplantation of bone marrow-derived mesenchymal stem cells (MSCs) expressing human basic fibroblast growth factor (hbFGF). After establishing a hind limb ischemia model in Sprague Dawley rats, the animals were randomly divided into four treatment groups: MSCs expressing green fluorescent protein (GFP-MSC), MSCs expressing hbFGF (hbFGF-MSC), MSC controls, and phosphate-buffered saline (PBS) controls. After 2 weeks, MSC survival and differentiation, hbFGF and vascular endothelial growth factor (VEGF) expression, and microvessel density of ischemic muscles were determined. Stable hbFGF expression was observed in the hbFGF-MSC group after 2 weeks. More hbFGF-MSCs than GFP-MSCs survived and differentiated into vascular endothelial cells (P<0.001); however, their differentiation rates were similar. Moreover, allogenic transplantation of hbFGF-MSCs increased VEGF expression (P=0.008) and microvessel density (P<0.001). Transplantation of hbFGF-expressing MSCs promoted angiogenesis in an in vivo hind limb ischemia model by increasing the survival of transplanted cells that subsequently differentiated into vascular endothelial cells. This study showed the therapeutic potential of combining cell-based therapy with gene therapy to treat ischemic disease.

Treatment of critical lower limb ischemia using a hybrid technique / Tratamento de isquemia crítica de membro inferior com técnica híbrida

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed...

A isquemia crítica de membro inferior é uma condição que constitui uma ameaça à viabilidade do membro e deve ser prontamente tratada para evitar uma amputação maior. A revascularização é o tratamento mais eficaz, podendo ser por técnica cirúrgica ou endovascular. Nos pacientes com aneurisma toracoabdominal da aorta, a combinação das duas técnicas, denominada técnica híbrida, permite ampliar a possibilidade de tratamento de pacientes que não seriam adequadamente tratados por nenhuma das duas técnicas isoladamente. Descrevemos o tratamento de uma isquemia crítica de membro inferior utilizando a combinação de cirurgia convencional e tratamento endovascular, também se constituindo, assim, em uma técnica híbrida, mas em outro território arterial...

Clinical Application of Adipose Stem Cells in Plastic Surgery

Adipose stem cells (ASCs) are a type of adult stem cells that share common characteristics with typical mesenchymal stem cells. In the last decade, ASCs have been shown to be a useful cell resource for tissue regeneration. The major role of regenerative medicine in this century is based on cell therapy in which ASCs hold a key position. Active research on this new type of adult stem cell has been ongoing and these cells now have several clinical applications, including fat grafting, overcoming wound healing difficulties, recovery from local tissue ischemia, and scar remodeling. The application of cultured cells will increase the efficiency of cell therapy. However, the use of cultured stem cells is strictly controlled by government regulation to ensure patient safety. Government regulation is a factor that can limit more versatile clinical application of ASCs. In this review, current clinical applications of ASCs in plastic surgery are introduced. Future stem cell applications in clinical field including culturing and banking of ASCs are also discussed in this review.

Prognostic Usefulness of Metabolic Syndrome Compared with Diabetes in Korean Patients with Critical Lower Limb Ischemia Treated with Percutaneous Transluminal Angioplasty

PURPOSE: Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients. MATERIALS AND METHODS: We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66+/-14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes. RESULTS: The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038). CONCLUSION: As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.

Effects of ischemic preconditioning and cilostazol on muscle ischemia-reperfusion injury in rats

PURPOSE: To evaluate effects of ischemic preconditioning and Cilostazol on muscle ischemia-reperfusion injury. METHODS: Male Wistar rats were submitted to muscle ischemic and reperfusion injury (4h of the left common iliac artery occlusion followed by 1h of reperfusion). Five experimental groups were constituted: Control group (n=4); Ischemia-Reperfusion (IR, n=5); Ischemic preconditioning group (IP, n=6); Ischemia-Reperfusion group treated with cilostazol (IRCi, n=6) and Ischemic preconditioning group treated with cilostazol (IPCi, n=6). At the end, left gracile muscle was removed and embedded in paraffin. Histopathology, neutrophil infiltration, myocyte necrosis and edema were analyzed. RESULTS: When compared with the control group, IR group showed increased neutrophil infiltration, severe necrosis and edema. There was significant difference between myocytes necrosis of IR group and IP group. There was no difference between the histopathological changes between IP, IRCi and IPCi groups. CONCLUSIONS: The model of IR caused severe muscle injury in the rat hind limb and ischemic preconditioning has a protective effect, reducing myocyte necrosis, however, treatment with cilostazol and also the association between cilostazol and preconditioning has no protective effect on the skeletal muscle subjected to ischemia and reperfusion injury. .

Is combined therapy more effective than growth hormone or hyperbaric oxygen alone in the healing of left ischemic and non-ischemic colonic anastomoses?

OBJECTIVE: Our aim was to investigate the effects of growth hormone (GH), hyperbaric oxygen and combined therapy on normal and ischemic colonic anastomoses in rats. METHODS: Eighty male Wistar rats were divided into eight groups (n = 10). In the first four groups, non-ischemic colonic anastomosis was performed, whereas in the remaining four groups, ischemic colonic anastomosis was performed. In groups 5, 6, 7, and 8, colonic ischemia was established by ligating 2 cm of the mesocolon on either side of the anastomosis. The control groups (1 and 5) received no treatment. Hyperbaric oxygen therapy was initiated immediately after surgery and continued for 4 days in groups 3 and 4. Groups 2 and 6 received recombinant human growth hormone, whereas groups 4 and 8 received GH and hyperbaric oxygen treatment. Relaparotomy was performed on postoperative day 4, and a perianastomotic colon segment 2 cm in length was excised for the detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. RESULTS: Combined treatment with hyperbaric oxygen and GH increased the mean bursting pressure values in all of the groups, and a statistically significant increase was noted in the ischemic groups compared to the controls (p<0.05). This improvement was more evident in the ischemic and normal groups treated with combined therapy. In addition, a histopathological evaluation of anastomotic neovascularization and collagen deposition showed significant differences among the groups. CONCLUSIONS: Combined treatment with recombinant human growth hormone and hyperbaric oxygen resulted in a favorable therapeutic effect on the healing of ischemic colonic anastomoses. .