Normothermic preservation of the rat hind limb with artificial oxygen-carrying hemoglobin vesicles.

BACKGROUND: For managing major limb amputation, it is important to consider ischemic time and reperfusion injury by free radicals after the blood supply is reestablished. State of preservation during transplant surgery is crucial for the survival and function of the tissue, graft, or organ. In this study, we confirmed the effect of intermittent blood flow in rat ischemic hind limb and developed a new oxygenic preservation method using artificial oxygen carrying hemoglobin vesicles (HbVs). METHODS: We first compared a continuous ischemic model and an intermittent reflow model on rat hind limb. At postoperative day 7, hind limbs were evaluated. Next, we performed total amputation, normothermic preservation by perfusion with extracellular-trehalose-Kyoto (ETK) solution or HbV, and microsurgical replantation of the left hind limb. Venous efflux was analyzed, the amputated limb evaluated after 6 hr perfusion, and the replantation outcome of each model was compared. RESULTS: In our early study, 24 hr continuous ischemic model necrotized, but intermittent reflow model almost survived except for partial necrosis at postoperative day 7. Scar tissue on the right limb showed myonecrosis and infiltration of inflammatory cells. Skeletal muscle on the right limb was structurally well maintained. Hemoglobin vesicle-treated limbs appeared to have much better oxygenation than ETK-treated limbs. Aerobic respiration remained in the amputated limb, gastrocnemius muscle was well maintained, and the overall replantation was successful in the limb preserved using HbV. CONCLUSION: These studies demonstrated that oxygenic preservation is effective for rat ischemic limb, suggesting that this method may be useful for other replantation and transplantation surgeries.

A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction.

We describe a novel free vascularised iliac bone flap based on superficial circumflex iliac perforators (SCIPs). Compared with a conventional iliac bone flap, which is based on deep circumflex iliac vessels, this flap is less invasive, less bulky and can include a reliable skin island. In addition, an SCIP-deep inferior epigastric perforator (DIEP) bipedicle soft--tissue flap has been developed, which can contribute to safer transfer of larger DIEP flaps. We successfully applied these new flaps to a case of maxillary reconstruction.

Combination of costal cartilage graft and rib-latissimus dorsi flap: a new strategy for secondary reconstruction of the maxilla.

In secondary reconstruction of the maxilla, skeletal reconstruction as well as soft tissue augmentation is required to obtain a good contour. We present a new strategy for combining a costal cartilage graft with a rib-latissimus dorsi flap. We used this method to treat a 39-year-old man who had previously undergone total maxillectomy. First, a vascularized rib, elevated together with a latissimus dorsi flap, was fixed between the middle of the maxilla and the edge of the zygomatic arch. The small defects that could not be reconstructed with the rib only were reconstructed with a costal cartilage graft. The patient did not develop any postoperative infection or flap necrosis. Thirteen months after the secondary reconstruction, he presented with a good contour of the cheek. Our method was effective for the reconstruction of a complex skeletal defect of the maxilla.