Long-term outcome of pressure sores treated with flap coverage.

This article provides our experience with 45 ischial sores and 24 sacral sores in 53 paraplegic patients between 1990 and 1995. Data were evaluated as to the sites of sores and types of the transferred flaps. Types of the transferred flaps were categorized into the fasciocutaneous flap and the myocutaneous or muscle flap. In the treatment of 45 ischial sores, 18 were reconstructed with the fasciocutaneous flaps and 27 with the myocutaneous or muscle flaps. In the treatment of 24 sacral sores, 23 were reconstructed with the fasciocutaneous flaps and 1 with the myocutaneous flap. The recurrence rate was analyzed by percent pressure sore free survival (%PSFS) by the Kaplan-Meier method. Overall, the ischial sores provided a higher recurrence rate than sacral sores; however, there was no significant difference in the %PSFS between the sites of sores. The group of the sores reconstructed with the fasciocutaneous flap demonstrated significant or marginally significant better results in the %PSFS (total of ischial and sacral, p = 0.0155; ischial, p = 0.0555) compared with the group of the sores reconstructed with the myocutaneous or muscle flap. These findings indicated that the use of the fasciocutaneous flap is expected to provide a better long-term result in surgical reconstruction of pressure sores than the myocutaneous or muscle flap.

[Clinical efficacy of silver sulfadiazine (AgSD: Geben cream) for ulcerative skin lesions infected with MRSA].

The clinical efficacy was evaluated on 1% silver sulfadiazine (AgSD) cream (Geben cream) for the treatment of ulcerative skin lesions infected with MRSA (methicillin-resistant Staphylococcus aureus). 1% AgSD cream was applied once a day to cutaneous ulcers such as burns or decubitus or various other ulcers, infected with MRSA, in 13 patients. MRSA was eradicated in 45.5% of 11 evaluable patients. The clinical efficacy rate of 1% AgSD cream was 72.7% in this series of treatment. No side effects were noted in any of the patients, either locally or systemically. The results of the present study have indicated that 1% AgSD cream is useful for cutaneous ulcers such as burns or decubitus, infected with MRSA.

[Clinical study of panipenem/betamipron for burn infections in the domain of plastic and reconstructive surgery].

The effectiveness and the safety of panipenem/betamipron, new antibiotics of the carbapenems for burn infections, were studied and the following results were obtained: 1. The preparation, 0.5 g/0.5 g, was administered by intravenous drip infusion twice a day to 11 cases of patients with burn infections. In 10 cases for which clinical effects were evaluable, results were rated as "excellent" in 2 cases, "good" in 2 cases and "fair" in 6 cases, with an efficacy rate of 40%. 2. Penetration to the affected tissue was studied in 2 cases. The tissue level of panipenem was 0.20 micrograms/g immediately after the end of drip infusion and 6.86 micrograms/g 60 minutes thereafter. 3. As for the safety, a slight increase in GOT, GPT and Al-P was noted in 1 case; a slight increase in GPT, NAG and beta 2MG was found in 1 case; and a slight increase in GOT, GPT, Al-P and LAP was noted in 1 case, as abnormal variations in laboratory test results.

Correction of microtia with construction of the tragus using a chondrocutaneous flap.

For microtia correction we have been inserting a cartilage framework and reconstructing the tragus at the first operation in one stage, using part of the microtic ear. This procedure is started with transposition of the lower two-thirds of the microtic ear to make a lobule. The upper third of the microtic ear is elevated as a chondrocutaneous flap which is then transposed downwards to the conchal cavity to make a tragus. The cartilage of the chondrocutaneous flap is anchored, using a bolster to pull it back and outwards. Using this technique, we have reconstructed 34 microtic ears. Adequate positioning of the auricle and tragus has been achieved and a natural auricle obtained even when observed from a frontal oblique direction.

Effects of enriched lactate solution (ELS) for resuscitation after burn injury.

Full skin thickness burns covering 35 per cent of the total body surface of rabbits were followed by measurements of Na-K ATPase and arterial blood gas analyses, before and after the burn injury. Studies of the effects of intravenous fluids with different compositions showed that the active transport of the cell membrane was depressed in vivo immediately after a burn injury, mainly due to acidosis. This phenomenon was not completely corrected by the Baxter formula which uses conventional lactated Ringer's solution. However, an improvement was observed in those groups given the 'Enriched Lactate Solution' (ELS) containing large quantities of lactate as the base source. These results suggest that ELS, which positively corrected acidosis in accordance with its concentration, is very effective and more appropriate than the conventional lactated Ringer's solution for early burn resuscitation.

A study on the effectiveness of a thromboxane synthetase inhibitor (OKY-046) in increasing the survival length of skin flaps.

In an experimental study to test the thromboxane (TX) synthetase inhibitor OKY-046, two random-pattern skin flaps, each measuring 15.5 x 2 cm, and caudally based, were elevated on the backs of rabbits, and the effect of the test drug on their survival length was evaluated. The results indicated that the survival length of the skin flaps was 4.5 +/- 0.2 cm in the control group and 6.8 +/- 0.3 cm in the OKY-046-treated group, hence exceeding the control value by more than 50 percent, which was statistically significant. A laser speckle flow-meter showed that the OKY-046-treated flaps had significantly greater blood flow as compared with the control group both at 1 and 48 hours after operation. Whereas the blood flow values were significantly lower at 48 hours than at 1 hour after operation in the control group, no such reduction was noted in the OKY-046-treated group. On the other hand, while plasma TXB2 was found elevated at 1 hour postoperatively in the control group, such a response to the surgical intervention was blocked and the plasma TXB2/6-keto prostaglandin (PG) F1a ratio was decreased in the OKY-046-treated group. These results clearly indicated that OKY-046 suppressed a plasma thromboxane elevation induced by surgery, it augmented the flap blood flow, and it thereby increased flap survival length, suggesting that the drug might be helpful clinically and that further investigation must be carried out concerning its application.

The effects of drugs on the arachidonate cascade in experimentally burned rabbits.

Platelet reduction and renal dysfunction may occur after major thermal injury and be causally related to changes in the arachidonate cascade. In this article two new drugs, prostaglandin I2 analog OP-41483 (Venopirin) and thromboxane synthetase inhibitor OKY-046 (Cataclot), were tested in addition to aspirin in animal experiments with rabbits. The rabbits were divided into five groups and measurements made before and 8 and 24 hours after burn injury. The results indicate that platelet reduction and renal dysfunction occur within 8 hours after thermal injury in the no-therapy group and renal dysfunction could not be prevented completely even by adequate infusion therapy, but treatment with OP-41483 proved to suppress platelet reduction and improve renal function. Improvement in renal function was also noted in animals treated with aspirin or OKY-046, but platelet reduction could not be prevented by these drugs. Analysis of the time course of changes in thromboxane B2 level and 6-keto prostaglandin F1 alpha level disclosed that animals treated by infusion showed an elevation in thromboxane B2 and a significant elevation in the thromboxane B2/6-keto prostaglandin F1 alpha ratio, whereas animals treated with these three drugs showed a reduction in the thromboxane B2/6-keto prostglandin F1 alpha ratio. These results indicate that an effective measure for prevention of dysfunction of the organs after thermal injury is treatment with drugs that can modify the arachidonate cascade and cause an absolute or relative reduction in TXA2.