Metformin promotes the survival of random skin flaps via the activation of Nrf2/HO-1 signaling.

The random flap is one of the commonly used techniques for tissue defect repair in surgery and orthopaedics, however the risk of ischaemic necrosis at the distal end of the flap limits its size and clinical application. Metformin (Met) is a first-line medication in the treatment of type 2 diabetes, with additional effects such as anti-tumor, anti-aging, and neuroprotective properties. In this study, we aimed to investigate the biological effects and potential mechanisms of Met in improving the survival of random skin flaps. Twenty-four male Sprague-Dawley rats and 12 male C57BL/6J mice underwent McFarlane flap surgery and divided into control (Ctrl) and Met groups (100 mg/kg). The survival rate of the flap were evaluated on day 7. Angiography, Laser doppler blood flow imaging, and H&E staining were used to assess blood flow supply and the levels of microvascular density. Then, reactive oxygen species (ROS) and malondialdehyde (MDA) levels, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured by test kits. Immunohistochemistry analysis was conducted to evaluate the expression of Vascular Endothelial Growth Factor A (VEGFA), Vascular endothelial cadherin (VE-cadherin) and CD31. Rats and mice in the Met group exhibited higher flap survival rate, microcirculatory flow, and higher expression levels of VEGFA and VE-cadherin compared with the Ctrl group. In addition, the level of oxidative stress was significantly lower in the met group. And then we demonstrated that the human umbilical vein endothelial cells (HUVECs) treated with Met can alleviate tert-butyl hydroperoxide (TBHP)-stimulated cellular dysfunction and oxidative stress injury. Mechanistically, Met markedly stimulated the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), and promoted Nrf2 nuclear translocation. Silencing of Nrf2 partially abolished the antioxidant and therapeutic effects of Met. In summary, our data have confirmed that Met has a positive effect on flap survival and reduces necrosis. The mechanism of action involves the regulation of the Nrf2/HO-1 signaling pathway to combat oxidative stress and reduce damage.

Combined simultaneous endoscopic endonasal and transcranial surgery using high-definition three-dimensional exoscope for malignant tumors of the anterior skull base.

BACKGROUND: Advanced surgical interventions are required to treat malignancies in the anterior skull base (ASB). This study investigates the utility of endoscopic endonasal and transcranial surgery (EETS) using a high-definition three-dimensional exoscope as an alternative to traditional microscopy. METHODS: Six patients with carcinomas of varying histopathologies underwent surgery employing the EETS maneuver, which synchronized three distinct surgical modalities: harvesting of the anterolateral thigh flap, initiation of the transnasal technique, and initiation of the transcranial procedure. RESULTS: The innovative strategy enabled successful tumor resection and skull base reconstruction without postoperative local neoplastic recurrence, cerebrospinal fluid leakage, or neurological deficits. CONCLUSION: The integration of the exoscope and EETS is a novel therapeutic approach for ASB malignancies. This strategy demonstrates the potential of the exoscope in augmenting surgical visualization, enhancing ergonomics, and achieving seamless alignment of multiple surgical interventions. This technique represents a progressive shift in the management of these complex oncological challenges.

Pedicled flaps reconstruction of hypopharynx and laryngeal defects: Successful preservation of laryngeal function in patients with advanced hypopharyngeal cancer.

BACKGROUND: Preserving laryngeal function and reconstructing the hypopharynx in advanced hypopharyngeal cancer pose significant challenges for head and neck surgeons. METHODS: A 48-year-old male patient was diagnosed with advanced hypopharyngeal cancer originating from the left pyriform sinus. The tumor extended into the hypopharynx, left vocal cord, ventricular fold, partial aryepiglottic fold, and a segment of the cervical esophagus. A curative tumor resection was performed, and a well-thought-out strategy was employed for hypopharyngeal repair and laryngeal reconstruction. RESULTS: Following the surgery, the patient demonstrated exceptional flap survival, and the tracheostomy tube was removed at the 6-month mark. No surgery-related complications were observed, and both swallowing and vocal functions exhibited a robust recovery. CONCLUSION: Our reconstruction strategy proves effective in preserving laryngeal function among patients with advanced hypopharyngeal cancer.

Chronic Cinacalcet improves skin flap survival in rats: the suggested role of the nitric oxide pathway.

Cinacalcet is a calcimimetic medicine that has been used to treat secondary hyperparathyroidism and parathyroid cancer. Various studies have proposed the positive role of calcium and its receptor in skin wound healing. Furthermore, Cinacalcet interacts with other skin repair-related mechanisms, including inflammation and nitric oxide pathways. The present study evaluated the effect of Cinacalcet on the random-pattern skin flap survival. Eighty-four Wistar male rats were used. Multiple doses of Cinacalcet (30, 3, 1, 0.3, and 0.05 mg/kg) were used in 3 different routes of administration before the surgery. Histopathological evaluations, quantitative assessment of IL-6, TNF-α, and nitric oxide (NO), and the expression of calcium-sensing receptor (CaSR) and E-cadherin were evaluated in the skin tissue. To assess the role of NO, a NO synthase inhibitor, N-nitro-L-arginine methyl ester hydrochloride (L-NAME), was used, and histopathological effects were investigated. Cinacalcet pretreatment at the IP chronic 1 mg/kg dose significantly increased the skin flap survival rate and enhanced the NO tissue level compared to the control. However, the administration of L-NAME abolished its protective effects. IP Chronic 1 mg/kg of Cinacalcet could also decline the levels of IL-6 and TNF-α and also increase the expression of CaSR and E-cadherin in the flap tissue compared with the control group. Chronic Cinacalcet at 1 mg/kg could improve skin flap survival, probably mediated by the CaSR, NO, and inflammation-related pathways.

Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK).

To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.

[Principle and clinical application of keloid core excision technique].

Objective: To review the research progress of the principle and clinical application of keloid core excision technique. Methods: The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed. Results: Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies. Conclusion: The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.

Innovative 3d-Printed Prosthesis In A Rare Case Of A Huge Mass Of Anterior Thoracic Wall - Low Grade Fibromyxoid Sarcoma (Lgfms).

The need for complete resection of chest wall tumors creates a huge challenge in terms of reconstructing the complex dynamics of the thorax. We are reporting a case of a low-grade fibromyxoid sarcoma (LGFMS) diagnosed in a young male, where the complete resection of the mass, sternum and parcially the pericardium was performed. Subsequently, a composite porous high-density polyethylene StarPore® prosthesis of the sternum and costal arches was used and the latissimus dorsi muscle free flap with skin graft was implanted over the sternum.

[A Case of Recurrent Tongue Cancer in a Patient of AYA Generation Who Underwent Salvage Surgery and Oral-Maxillofacial Reconstruction after Super-Selective Intra-Arterial Chemoradiotherapy].

Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage Ⅲ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage ⅣA tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.

[A Case of Giant Phyllodes Tumor Treated with Breast Reconstruction].

A 62-year-old woman was diagnosed with right breast tumor 2 years ago, which she refused to undergo surgery. The patient experienced a rapid enlargement of the mass over the past 1 month, and visited hospital. The patient was diagnosed with a borderline phyllodes tumor by needle biopsy. Her right breast was occupied by an 18 cm mass. We conducted tumor resection and immediate reconstruction with DIEAP flap. The pathological diagnosis was a malignant phyllodes tumor, and the postoperative radiation to the chest wall was performed. During a year and a half follow up, she has no recurrence and highly satisfied with the reconstructed breast. Phyllodes tumors may recur locally regardless of whether they are benign or malignant, and we need strict follow-up.

[A Case of Resection of Right Axillary Accessory Breast Cancer with Skin Invasion].

A 56-year-old female was referred to our hospital for further examination and treatment because of her increasing right axillary mass for 1 year. Based on histological examination diagnosing the right axillary mass as carcinoma and radiological examination showing no evidence of distal metastasis, we decided to perform a radical resection. The patient underwent right axillary mass resection, axillary lymph node dissection, and latissimus dorsi musculocutaneous flap reconstruction. Right-sided breast cancer was diagnosed based on histopathological examination. The diagnosis was similar to that of breast cancer. The patient underwent adjunctive chemotherapy and is currently undergoing endocrine therapy. The incidence of accessory breast cancer is 0.2-0.6% among all breast cancers and is relatively rare. Postoperative adjuvant pharmacotherapy has no consensus. However, endocrine therapy, chemotherapy, and molecular target therapy are performed in cases of conventional breast cancer. Herein, we describe a case of right axillary accessory breast cancer with skin invasion successfully treated with radical resection.

Principle and clinical application of keloid core excision technique / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of the principle and clinical application of keloid core excision technique.@*METHODS@#The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed.@*RESULTS@#Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies.@*CONCLUSION@#The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.

Unexpectedly high corneal flap thickness and ectasia after mechanical LASIK / Espessura inesperadamente alta do flap corneano e ectasia após LASIK mecânico

ABSTRACT LASIK is a refractive surgical procedure in which a corneal flap is created to expose the corneal stromal bed. Preoperative estimation of corneal flap thickness is necessary to calculate the percentage tissue altered in LASIK, an important quantitative risk factor for ectasia. The objective of this study was to assess flap thickness and calculate percentage tissue altered to check if unexpectedly thicker flaps and higher percentage tissue altered could pose as risk factors of ectasia. Four subjects (eight eyes) were submitted to mechanical LASIK in 2009 and 2010. Pre and postoperative clinical and tomographic data were reviewed. Mean preoperative estimated percentage tissue altered was 39.18±1.31%, which was borderline for increased ectasia risk when considering the limit of 40%. However, when considering the postoperatively measured flap thickness, the actual mean percentage tissue altered turned out to be 45.17 ± 4.13%, which was significantly higher than predicted preoperatively (p=0.002). Unexpectedly higher postoperative percentage tissue altered may be responsible for corneal ectasia after mechanical LASIK.

RESUMO A LASIK é um procedimento cirúrgico refrativo, no qual um retalho corneano é criado para expor o leito estromal corneano. A estimativa pré-operatória da espessura do retalho corneano é necessária para calcular o percentual de tecido alterado no LASIK, um importante fator de risco quantitativo para ectasia. O objetivo deste estudo foi avaliar a espessura do retalho e calcular o percentual de tecido alterado para verificar se retalhos inesperadamente mais espessos e percentuais de tecido alterado mais altos poderiam representar fatores de risco de ectasia. Quatro indivíduos (oito olhos) foram submetidos à LASIK mecânica em 2009 e 2010. Dados clínicos e tomográficos pré e pós-operatórios foram revisados. A média de percentual de tecido alterado pré-operatória estimada foi de 39,18±1,31%, limítrofe para risco aumentado de ectasia quando considerado o limite de 40%. No entanto, ao considerar a espessura do retalho medida no pós-operatório, o percentual de tecido alterado médio real foi de 45,17±4,13%, ou seja, significativamente maior do que o previsto no pré-operatório (p=0,002). O percentual de tecido alterado pós-operatóriao inesperadamente mais alto pode ser responsável pela ectasia da córnea após LASIK mecânico.

The effect of intradermal administration of inactive platelet-rich plasma on flap viability in rats

Abstract Purpose: To evaluate the effect of inactive form of platelet rich plasma (PRP) on the flap viability. Methods: Thirty six rats were used. Rats were divided into six groups then 9x3 cm random pattern skin flaps were elevated from dorsum of all rats. For precluding vascularization from the base, a silicone layer was placed under the flap in groups 2(only flap+silicone), 4(saline+silicone) and 6(PRP+silicone). In groups 1(only flap), 2(only flap+silicone) nothing was done except flap surgery. In groups 3(saline) and 4(saline+silicone), saline was applied intradermally , in groups 5(PRP) and 6(PRP+silicone), inactive form of PRP which obtained from different 16 rats was applied intradermally, into certain points of flaps immediately after surgery. After 7 days flap necrosis ratio was measured in all groups. Results: Mean necrosis rate in group 5(PRP) (16.05%) was statistically significantly lower than group 1(only flap) (31,93%) and group 3(saline) (30,43%) (p<0.001). Mean necrosis rate in group 6(PRP+silicone) (36.37%) was statistically significantly lower than group 2(only flap+silicone) (47.93%) and group 4(saline+silicone) (45.65%) (p<0.001). Conclusion: Intradermal inactive platelet rich plasma administration decreases flap necrosis so for skin application.

Avaliação de 40 ritidoplastias realizadas no Hospital Federal do Andaraí segundo duas técnicas distintas: smasplastia cervicofacial mediante sutura de vetores e retalho subSMAS / Evaluation of 40 rhytidoplasties performed at the Federal Hospital of Andaraí to compare two different techniques: cervicofacial SMAS-plasty according to vector suturing and the sub-SMAS flap approach

Introdução: A ritidoplastia se tornou uma das cirurgias estéticas mais realizadas no mundo. Alguns preferem uma abordagem mais conservadora e outros defendem que, para obter resultados mais duradouros e efetivos, necessitam de intervenções agressivas. O objetivo é comparar resultados de 40 ritidoplastias realizadas no Hospital Federal do Andaraí ao longo de 22 meses, utilizando duas técnicas distintas, smasplastia mediante sutura de vetores e retalho subSMAS. Métodos: Trata-se de um estudo descritivo em que 20 pacientes foram submetidas à smasplastia e outras 20 à retalho subSMAS. Um avaliador observou sob o ponto de vista estético algumas variáveis em regiões específicas da face e classificou a melhora baseado em fotografias pré-operatórias e 6 meses após o procedimento. A observação da ficha de coleta de dados possibilitou quantificar as complicações nas duas técnicas separadamente. Resultados: As duas técnicas demonstraram resultados semelhantes sob o ponto de vista estético com o objetivo de rejuvenescimento facial, melhora da flacidez cervical e definição da transição face/pescoço. Em especial, o retalho proporcionou melhores resultados na atenuação no sulco nasogeniano. Houve um caso de hematoma em cada técnica. Houve uma lesão nervosa na smasplastia. Não houve lesão do nervo facial, nem infecção. Edema superior a 3 meses foi mais prevalente naquelas submetidas ao retalho. Conclusões: Os dois métodos possuem vantagens e desvantagens e o melhor resultado depende do grau de envelhecimento do esqueleto facial, da perda de apoio de tecidos frouxos em áreas críticas como a região malar e próxima ao sulco labiomandibular, da característica de pele no pré-operatório e da experiência do cirurgião na técnica empregada.

Introduction: Rhytidectomy has become one of the most performed aesthetic surgeries in the world. Some surgeons prefer a more conservative approach, and others maintain that aggressive interventions are required to obtain results that are more durable and effective. This study aimed to compare the results of 40 rhytidectomies performed using either of two techniques, namely superficial musculoaponeurotic system (SMAS)-plasty according to vector suturing and the sub-SMAS flap approach, at the Federal Hospital of Andaraí over 22 months. Methods: This is a descriptive study that included 20 patients who underwent SMAS-plasty and 20 patients who received a sub-SMAS flap. An assessor identified some variables in specific regions of the face from an aesthetic point of view, and he rated improvements based on photographs obtained before and 6 months after operation. The data collected allowed to quantify complications of both techniques separately. Results: From an aesthetic point of view, the two techniques showed similar results in terms of facial rejuvenation, improvement of cervical flaccidity, and definition of face/neck transition. The flap provided better results regarding the attenuation in the nasogenian sulcus. A case of hematoma occurred in each technique. Nerve injury occurred in the SMAS-plasty group. However, neither facial nerve injury nor infection occurred in both groups . Edema for >3 months was more prevalent in the sub-SMAS flap group. Conclusions: The two methods have advantages and disadvantages, and the best result depended on the degree of aging of the facial skeleton, the loss of supporting tissues in critical areas such as the malar region and next to the labiomandibular fold, the preoperative characteristic of the skin, and the surgeon's experience in the technique.

Satisfacción de la reconstrucción mamaria tras mastectomía: diferencias entre la colocación de expansor-prótesis y uso del colgajo de dorsal ancho / Satisfaction with post-mastectomy breast reconstruction: differences according to the use of expander/prosthesis or latissimus dorsi flap

Objetivo. El tratamiento actual del cáncer de mama se basa en conseguir un resultado oncológico y estético óptimo, aunque van a afectar a su imagen corporal, sexualidad, bienestar físico, psíquico y vida social. Hemos valorado el grado de satisfacción de las pacientes tras la reconstrucción inmediata mamaria y si existen diferencias en función del tipo de reconstrucción realizada (reconstrucción con dorsal ancho y prótesis vs. expansor-prótesis). Pacientes y métodos. Estudio retrospectivo donde se incluye a todas las mujeres con cáncer de mama no metastásico en las que se ha realizado mastectomía y reconstrucción posterior con expansor-prótesis o dorsal ancho desde enero del 2008 hasta enero del 2015, evaluando el grado de satisfacción mediante el cuestionario MBROS Body Image Questionnaire. Resultados. Se incluyó a 31 pacientes, 17 con mastectomía y reconstrucción con expansor-prótesis y 14 pacientes con mastectomía y reconstrucción con colgajo muscular de dorsal ancho y prótesis. La puntuación obtenida entre las pacientes del primer grupo (expansor-prótesis) osciló entre 24 y 33, y la obtenida entre las pacientes del segundo grupo (dorsal ancho y prótesis) osciló entre 31 y 37. Conclusiones. Las pacientes mastectomizadas a las que se les realiza una reconstrucción con expansor y prótesis parecen tener mayores secuelas físicas y psíquicas, así como una mayor alteración de la imagen corporal y la sexualidad, cuando las comparamos con pacientes mastectomizadas a las que se les realiza una reconstrucción con dorsal ancho y prótesis (AU)

Aims. Current treatment of breast cancer is based on optimal oncological and aesthetic results, since the results will affect body image, sexuality and physical, mental and social life. We evaluated patient satisfaction after immediate breast reconstruction, and assessed differences depending on the type of reconstruction (reconstruction with latissimus dorsi flap and prosthesis vs. expander-prosthesis). Patients and methods. A retrospective study was conducted that included all women with nonmetastatic breast cancer and mastectomy and subsequent reconstruction with expander/prosthesis or latissimus dorsi flap from January 2008 to January 2015. Patient satisfaction was evaluated with the MBROS body image questionnaire. Results. We included 31 patients, 17 with mastectomy and reconstruction with expander/prosthesis and 14 patients with mastectomy and reconstruction with latissimus dorsi muscle flap and prosthesis. The score obtained from the patients in the first group (expander-prosthesis) ranged between 24 and 33; the score obtained from patients in the second group (latissimus dorsi and prosthesis) ranged between 31 and 37. Conclusions. Mastectomy patients reconstructed with an expander and prosthesis seem to have more physical and psychological effects, as well as a more altered body image and sexuality compared with mastectomy patients reconstructed with latissimus dorsi flap and prosthesis (AU)

Remote limb ischemic post-conditioning attenuates ischemia-reperfusion injury in rat skin flapby limiting oxidative stress

PURPOSE: To investigate the effect of remote ischemic post-conditioning (RIPoC) against ischemia-reperfusion (I/R) injury on flaps of rats. METHODS: Sprague-Dawley rats were randomized into the Sham, Control, RIPoC1 and RIPoC2 groups. All the animals were submitted to a 5×4 cm superficial inferior epigastric artery flap. Eight hours of flap ischemia was induced and two protocols of limb RIPoC were applied. Tissue MDA level and SOD activity in 24-h reperfusion were assessed. Flap survival was assessed 7 days postoperatively. RESULTS: Compared to the Control group, the RIPoC1 group showed statistically decreased MDA level at 6-, 12-, and 24-h reperfusion (P = 0.01, P < 0.01 and P < 0.01, respectively), and statistically increased SOD activity at 12- and 24-h reperfusion (P < 0.05 and P < 0.01, respectively). Flap survival rate on the 7th day was significantly higher in the RIPoC1 group than the control group (47.9 ± 6.4 vs . 29.4 ± 7.1 %, P < 0.01). CONCLUSION: Three cycles of 5-min Limb remote ischemic post-conditioning rather than a single cycle of 15-min limb RIPoC has protective effect on flaps against ischemia-reperfusion injury by attenuating oxidative stress.

Manejo quirúrgico de la aplasia cutis congénita / Surgical management of aplasia cutis congenita

Introducción: La aplasia cutis congénita (ACC) es una malformación congénita rara que afecta sobre todo al cuero cabelludo, aunque puede afectar al pericráneo, el cráneo y la meninges. Las complicaciones pueden llegar a ser fatales, por lo que es necesario un tratamiento oportuno. El tratamiento sigue siendo controvertido, sin encontrar un consenso entre el abordaje conservador y el quirúrgico. El objetivo de este estudio es describir nuestra experiencia en el manejo de la ACC. Material y métodos: Estudio descriptivo retrospectivo de las historias clínicas de los pacientes menores de 14 años con diagnóstico de ACC, atendidos entre el año 2000 y el 2013. Resultados: Veintidós casos de ACC con lesiones que variaban de 1cm (0,79 cm2) a 14cm (153,94 cm2). Dieciocho casos presentaron lesiones en el cuero cabelludo, 3 en extremidades y uno en tronco. Se realizó tratamiento conservador en 9 y quirúrgico en 13 (8 cierres primarios, 2 plastias, 2 injertos cutáneos y un colgajo). Dos pacientes fallecieron por complicaciones de otras patologías no asociadas a la ACC. Conclusiones: La ACC es infrecuente y puede tener un desenlace fatal. Para prevenirla es necesaria una evaluación inicial completa para establecer un tratamiento oportuno. La cirugía es una buena opción terapéutica, sobre todo en defectos con diámetro>4cm (12,6 cm2), ya que disminuye el riesgo de complicaciones mortales (AU)

Introduction: Aplasia cutis congenita (ACC) is a rare congenital malformation that commonly involves the scalp, but can affect pericranium, bone and dura mater. Complications are rare, but can be fatal, so early treatment must be achieved. The treatment remains controversial with no consensus between the conservative and surgical approach. The aim of this study is to describe our experience in the management of ACC. Material and methods: Retrospective review of the medical records of all children up to 14 years diagnosed with ACC and treated between 2000 and 2013. Results: There were a total of 22 cases of ACC with lesions ranging from 1cm (0.79 cm2) to 14cm (153.94 cm2). ACC of the scalp was found in 18 cases, with 3 in extremities and 1 in trunk. Conservative treatment was performed on 9 patients and 13 underwent surgical treatment (8 primary closures, 2 plasties, 2 skin grafts, and 1 skin flap). Two patients died due to complications of other diseases not related with the ACC. Conclusions: ACC is a rare disease that can be fatal. A complete initial assessment to establish early treatment is necessary to prevent this. Surgery should be considered as an initial therapeutic option in defects >4cm (>12.6 cm2) as it prevents the risk of fatal complications (AU)

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

PURPOSE:To investigate the effect of Botulinum toxin A (BoNTA) on skin flap viability in healthy, tobacco-exposed and diabetic rats.METHODS: Ninety male Wistar rats (250-300g) were randomly divided into six groups: control+saline (C1), control+BoNTA (C2), tobacco-exposed+saline (T1), tobacco-exposed+BoNTA (T2) diabetes+saline (D1) and diabetes+BoNTA (D2). A dorsal cutaneous flap (3×10cm) was performed. Survival area and total area of the flaps were measured. Lumen diameter, external arterial diameter and lumen/wall thickness ratio were recorded.RESULTS: Survival area increased in control group with BoNTA injection compared with control animals injected with saline (C2 x C1; 0.9±0.1 vs0.67±0.15, p= 0.001). A similar result was found in diabetes group injected with BontA (D2 x D1; 0.97±0.2 vs0.61±0.24, p=0.018). No difference was observed in skin flap viability in tobacco-exposed groups (T2 x T1; 0.74±0.24 vs 0.64±0.21, p=0.871). Lumen diameter (p= 0.004), external arterial diameter (p = 0.0046,) and lumen/wall thickness ratio (p= 0.003) were increased in diabetes+BoNTA-treated animals. This effect was not observed in control or in tobacco-exposed groups.CONCLUSIONS:Botulinum toxin A increased skin flap viability in control and diabetic rats on the seventh post-operative day. Increased lumen diameter, external arterial diameter, and lumen/wall thickness ratio were observed in the diabetes+BoNTA group. BoNTA had no effect in the tobacco-exposed group on the seventh postoperative day.

Action of hyperbaric oxygenation in the rat skin flap

PURPOSE: To evaluate the morphology, necrotic area and collagen content in skin flaps of rats subjected to hyperbaric oxygenation (HBO). METHODS: Forty adult rats were divided into four groups: GEC - epilated; GE/HBO - epilated subjected to HBO; GER - epilated submitted to skin flap (2 cm in width /8 cm length in the dorsal area) and GER/HBO - epilated, subjected to skin flap and HBO. HBO (2.4 ATA) was performed for two hours during seven consecutive days. In the eighth day, the rats were anesthetized and the skin flaps were removed and separated into three portions, relative to pedicle fixation. The material fixed in 10% formalin was processed for paraffin embedding; sections were stained by H.E and subjected to picrosirius-red method. The slides examined under light microscopy for evaluation of the collagen content in polarized light microscope and ImageLab(r) software (Bio-Rad). RESULTS: The data showed larger area of necrosis and lower levels of collagen in the three regions of the GER group, whereas in the GER/HBO group the collagen content was similar to the GEC and GE/HBO groups. CONCLUSION: Hyperbaric oxygenation reduced the area of necrosis and preserved the morphology and collagen content in skin flaps of rats. .

Adipose-derived stem cells (ADSC) in the viability of a random pattern dorsal skin flap in rats

PURPOSE: To evaluate the viability of random pattern dorsal skin flaps in rats after injection of adipose-derived stem cells (ADSC). METHODS: Thirty five adult male Wistar EPM rats (weight 250-300 g) were distributed, at random, in two groups. I- Control (flap elevation with injection of saline solution) with fifteen animals and II- Experimental (flap elevation with injection of ADSC ) with fifteen animal. The ADSC were isolated from others five adult male rats. A dorsal skin flap measuring 10x4 cm was raised and a plastic barrier was placed between the flap and its bed in both groups and the injection (cells or saline solution) were perfomed immediately after the surgery. The percentage of flap necrosis was measured on the seventh postoperative day. RESULTS: The ADSC were able to replicate in our culture conditions. We also induced their adipogenic, osteogenic and chondrogenic differentiation to verify their mesenchymal stem cells potentiality in vitro. The results were statistically significant showing that the ADSC decreased the area of necrosis (p<0.05). CONCLUSIONS: The cells demonstrated adipogenic, osteogenic and chondrogenic differentiation potential in vitro. The administration of adipose-derived stem cells was effective to increase the viability of the random random pattern dorsal skin flaps in rats. .