Time-related variations in viability of random pattern skin flaps: An experimental study in rats.

Chronobiological variations are in the fabric of life. The first ideas regarding the possible effects of circadian rhythm on surgical outcomes were published in the early 2000s. Some studies support and oppose this idea. The lack of experimental evidence in a controlled setting has led to this study. This study aimed to explore the chronobiological implications of surgical outcomes. The rats were divided into four groups. A random pattern dorsal skin flaps were elevated in all groups at six h intervals. Flap necrosis rates and melatonin, oxidant, and antioxidant factors were studied. Flap survival was better in the 06:00 h group. The flap necrosis was higher in the 18:00 h group. Some of the biochemical parameters displayed circadian variations. As an independent variable, the time of surgical intervention changed the flap survival rates. It should be noted that the study was held in a nocturnal animal model thus the pattern of flap survival can be in reversed fashion in a clinical scenario. This study is the first experimental evidence for "Chronosurgery" in a controlled setting. Further studies in all aspects of surgical disciplines are required.

The Effect of Botox on the Implant Stabilization and Capsular Formation: An Experimental Study.

BACKGROUND: Breast augmentation is one of the most common esthetic procedures with increasing frequency throughout the past years. The most demanding complications involving esthetic and reconstructive breast surgery are the malpositioning of the implant and capsular contracture. The etiology, prevention, and management remain to be fully explained. Botulinum toxin (BTX) administration has anti-inflammatory effects that can possibly decrease capsular contracture, and chemical denervation of the pectoral muscle theoretically may decrease incidence of malrotation. In our literature search, we found only 1 clinical study using BTX A for capsular contraction, and there were no experimental studies about the implant stabilization and capsular contracture. Therefore, we have studied the effect of BTX A on the prevention of breast implant malrotation and capsular contracture in a rabbit model. METHODS: Sixteen smooth-surfaced cohesive gel implants were implanted in 8 New Zealand white rabbits. The backs of the rabbits were divided into 2 groups. After skin incision, the exposed latissimus dorsi muscle was elevated, and a submuscular pocket was made. In the experimental group, Botox was injected in the muscle overlying the implant. In the control group, the implants were placed under the muscle, and saline was injected into the muscle. At the end of 3 months, the rabbits were imaged and evaluated by ultrasonography and x-ray to examine capsule formations and the movement of the implants. The animals were killed, and the implants with peri-implant capsule were excised. We evaluated collagen pattern and capsule thickness on ventral, lateral, and dorsal aspects. RESULTS: The Botox group showed less infiltration of inflammatory cells at the third month (P < 0.05). Statistically significant differences in capsular thickness were observed on histopathological examination and ultrasonographic imaging. The capsule was thinner on all aspects and the collagen pattern had a more parallel alignment at low density in the experimental group compared with the control group. With x-ray, we observed an increased lateral movement of the implants in the control group. CONCLUSIONS: The use of Botox effectively decreased implant movement and capsular formation at 12 weeks. More experimental and clinical studies will be required to determine whether this is a durable result that can be reproduced in humans.

2-octyl-cyanoacrylate glue for fixation of STSG in genitourinary tissue defects due to Fournier gangrene: a preliminary trial.

BACKGROUND: In these reported cases, we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue, which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene. METHODS: Fifteen patients with Fournier's gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2-octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined. RESULTS: Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications. CONCLUSION: Use of 2-octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after Fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.