Increased Total Antioxidant Capacity Value Improves Survival of Fat Grafts in a Rat Model.

BACKGROUND: While studies aiming to increase fat graft survival continue, in this study, we aimed to investigate the effects of different antioxidants on total antioxidant capacity and their effect on graft survival. METHODS: Thirty-two male Wistar rats were divided into four equally sized groups, including a control group and three antioxidant groups receiving either Melatonin (10mg/kg), Zinc (2mg/kg), or Vitamin E and C (100mg/kg). Autologous fat grafts (1.7± 0.4gr) were transferred to the dorsal subcutaneous region, and total antioxidant capacity was measured on day 0 and 1, week 1 and monthly until the third month. Transferred graft volume and mass (1.3± 0.4gr) were measured using the liquid overflow method and precision scales at the end of the study. Routine hematoxylin-eosin staining and immunohistochemistry against perilipin were performed for semiqualitative analysis and h-score for viable adipose cells, respectively. RESULTS: Collected fat grafts measured significantly less in weight and volume and the survival rate was lower in the control group (p<0.01). Control group exhibited a reduction in TAC, while all groups receiving antioxidants had an increase in TAC during the first week (p=0.02, 0.008, and 0.004 for melatonin, zinc, and vitamins, respectively). Immunohistochemistry of the antioxidant group demonstrated a statistically significant excess and reactivity of cells staining with perilipin antibodies. CONCLUSIONS: In this animal study, the beneficial effect of antioxidants on fat graft survival can be related to the significant increase in TAC following the first week of their administration.

Superior Epididymal Artery-Based Paraepididymal Adipofascial Flap: An Experimental Adipofascial Flap Model in the Rat.

BACKGROUND: Flap surgery is widely performed in reconstructive surgery. Experimental research is vital to improve flap viability. However, the number of flap models for animals is still limited. In this study, we define a new adipofascial flap in rats that can be used to investigate pedicled flap and/or adipofascial flap physiology. METHODS: Eight Wistar male rats were used. Under deep anesthesia, paraepididymal adipofascial flaps were harvested. Flap perfusion was assessed using a near-infrared fluorescence imaging system. The length of the flap and the diameter of the flap pedicle were measured. RESULTS: All animals (n = 8) had sufficient sizes of paraepididymal fat pad, and no animals were lost. The only postoperative complication was testicular hematoma, which was observed in 2 animals. The maximum length of the harvested paraepididymal adipofascial flap was 9.7 cm with a mean of 6.6 cm. The maximum width of the flap was 3.3 cm with a mean of 2.6 cm. The mean pedicle diameter of the paraepididymal adipofascial flap was 1.1 mm. Near-infrared fluorescence imaging revealed adequate perfusion in all flaps. CONCLUSIONS: The number of reported adipofascial flap models in animals is low, and they are mostly limited to flaps based on epigastric vessels. Superior epididymal artery-based paraepididymal adipofascial flap can be used as a pedicled flap model for studies focusing on adipofascial and/or pedicled flap physiology. Uncomplicated surgical technique and short operative time make this flap a valuable alternative to other flap models.

Effects of negative pressure wound therapy on an axial congested rabbit skin flap model without any bare surface.

One of the most important problems encountered in reconstructive surgery is partial or total flap loss, and venous congestion is the most common reason. It should be solved as early as possible. The purpose of this study is to investigate the effects of Negative pressure wound therapy (NPWT) on an ideal congested rabbit skin flap model without any open wound. The current study included 28 female, adult, New Zealand albino rabbits. Animals were divided into four groups according to the duration of NPWT to be applied. An axial pattern ideal congested skin flap was designed on the posterior surface of the ear. After surgical intervention on the right ears, we applied NPWT treatment for 2, 4, 6 and 8 days. The left ears were followed without any treatment. Samples were taken for edema, congestion and neo-angiogenesis examination. There was no significant difference between the NPWT applied group and control group in the 2nd, 4th, 6th, and 8th days for edema and neo-angiogenesis and no differences in the 2nd, 6th, and 8th days for congestion. NPWT group had a higher flap survival rate than the control group but without a significant difference. This study used an ideal congested rabbit skin flap model imitating venous congestion. Our findings illustrate that NPWT treatment does not have a significant effect on the congested skin flap model we utilized where a closed system was created maintaining a skin barrier without a bare surface of the flap. Level of Evidence: Level I, experimental study.

Comparison of Real-Time Speech Magnetic Resonance Imagings With Perceptual Speech Analysis in Evaluation Velopharyngeal Sphincter Function.

ABSTRACT: Identifying substantial data and their normative values related to velopharyngeal structures in cleft palate patients may have clinical significance, in order to selection of surgical intervention and prediction of postsurgical outcomes. Previous studies are lack of referring certain anatomic locations or distances that may have affect on speech intelligibility, especially in dynamic state. The aim of this study is to investigate effectiveness of magnetic resonance imagings on the velopharyngeal sphincter function and the correlation with speech intelligibility after functional cleft palate repair. Seventeen patients with repaired cleft palate by single surgeon were enrolled in this study.Quantitative velopharyngeal measures from the oblique coronal plane and midsagittal plane in static and dynamic positions were collected. Patients' speech intelligibility was evaluated by using Pittsburgh Weighted Speech Scale and nasalance score was also measured. Correlation analysis methods were used for evaluating relation between MRI gathered measurements and speech intelligibility scores for determiningconsequential data.Our study shows that the velar knee-posterior pharyngeal wall distance measurement while explosive sound production is the most related data with speech intelligibility. Although future works with more sample number is needed, according to current study the authors think magnetic resonance imagings is a very helpful method in providing reliable information.

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap.

ABSTRACT: Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.

Comparison of Ischemic Preconditioning and Systemic Piracetam for Prevention of Ischemia-Reperfusion Injury in Musculocutaneous Flaps.

BACKGROUND: Ischemia-reperfusion injury plays an important role in flap failure. Ischemic preconditioning technique is the only proven method for preventing ischemia-reperfusion injury, but it is not used widely in daily practice because of difficulties such as prolonging the operation time, need for surgical experience, and increasing the risk of complications. This study has been performed with the assumption that piracetam may be a simple and inexpensive alternative to the preconditioning technique due to its antioxidant, antiaggregant, rheological, anti-inflammatory, antiapoptotic, cytoprotective, and immune modulating effects. METHODS: Thirty-two rats were divided into four groups and latissimus dorsi musculocutaneous flaps were raised. No extra procedure was applied, and no treatment was given to the control group. Four hours of ischemia was created by clamping the thoracodorsal pedicle in the second group. The animals in the third group were treated with 10 minutes of ischemia and reperfusion periods as a preconditioning procedure before the 4 hours of ischemia. Animals in the fourth group received systemic piracetam 30 minutes before and 6 days after reperfusion. Nitric oxide and myeloperoxidase levels in serum and tissue, acute inflammatory cell response, and vascular proliferation in tissue were examined at the postoperative 24th hour and 10th day. RESULTS: Myeloperoxidase activity in both preconditioning and piracetam groups, was significantly lower than the ischemia-reperfusion group. Acute inflammatory cell response was similarly decreased in both preconditioning and piracetam groups compared with ischemia-reperfusion group. Tissue measurements of nitric oxide were also significantly higher in both preconditioning and piracetam groups than in the ischemia-reperfusion group. However, vascular proliferation increased in the preconditioning group, while it did not show any significant change in the piracetam group. CONCLUSION: This study shows that systemic piracetam treatment provides protection against ischemia-reperfusion injury in musculocutaneous flaps and can offer a simple and inexpensive alternative to the preconditioning technique.

Anthropometric breast measurements of young women with no history of pregnancy or surgery in Turkey.

Anthropometric measurements of the breast play a guiding role in surgical planning. In our study, it was aimed to determine the normal shape and size of the breast by taking measurements in young women who did not experience pregnancy or surgery and comparing them with the results of other studies. The breast parameters of 88 women aged between 18 to 30 years old, with a normal body mass index, with no history of previous pregnancy, surgery or rapid weight gain were measured. The measured parameters were age, body mass index, cup size, distance between nipple and suprasternal notch, distance between both nipples, distance between midclavicular point and nipple, distance between midclavicular point and upper border of the breast, the distance between the midaxillary line and nipple, the distance between the nipple and inframammarian fold, the projection of the breast, the projection of the nipple and the chest circumference under the breast. The mean values ​​were determined and the correlation between the parameters was evaluated statistically. A significant correlation was found between cup size and all parameters except for the chest circumference and nipple projection. The distance between the midclavicular point and upper border of the breast was found correlated with the cup size. In addition, a significant correlation was found between body mass index and all other parameters. This study revealed the average breast size and measurements of women in Turkey. It can be useful to guide for both reconstructive and aesthetic procedures of the breast.

Comparison of ischemic preconditioning and BotulinumA Toxin injection for the prevention of ischemia-reperfusion injury in musculocutaneous flaps

Background/aim: The aim of the study was to evaluate the protective effect of Botulinum A toxin injection against ischemia-reperfusion injury. Materials and methods: Thirty-two Sprague-Dawley rats were divided into: control, ischemia-reperfusion, ischemic preconditioning, and botulinum groups. In all groups the musculocutaneous pedicle flap was occluded for 4 h, and then reperfused to induce ischemia-reperfusion injury. Serum and tissue myeloperoxidase (MPO) and nitric oxide (NO) levels were measured at 24 h and at 10 days. Results: Tissue MPO levels did not differ significantly between the ischemic preconditioning and botulinum groups at 24 h but was significantly lower in the botulinum group at 10 days. Tissue NO levels were significantly higher in the ischemic preconditioning group compared to the botulinum group at 24 h and at 10 days. Serum MPO showed no significant difference between these two groups at 24 h but was significantly lower in the ischemic preconditioning group compared to the botulinum group at 10 days. Serum NO levels were not significantly different at 24 h but significantly higher in the botulinum group at 10 days. Conclusion: Findings show that botulinum has a protective effect against the ischemia-reperfusion injury via increased NO and decreased MPO levels in tissue. Based on tissue NO levels, ischemic preconditioning was significantly higher than botulinum.

Nasolabial Perforator Flap: A Multi-Tool for Reconstruction of Facial Units.

BACKGROUND: Nasolabial flap is a work-horse flap for coverage of many facial units. However, these flaps have limited mobility and these limit their use in many instances. Facial artery with its numerous small cutaneous perforators can be a source for free-style skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory flap. METHODS: The authors present a case series of 35 patients with central facial unit defects reconstructed by a single flap harvested from the nasolabial sulcus. RESULTS: In our series, we did not encounter any significant flap loss and patient satisfaction was high both functionally and aesthetically. Main drawbacks were temporary venous congestion and hair bearing flaps in male patients. CONCLUSION: The authors think with its reliability and versatility nasolabial perforator flaps, based on the same donor area as the traditional nasolabial flap can be a valuable addition to our arsenal in reconstruction of central facial unit defects.

Risk Assessment of Surgical Interventions Performed on Non-Infected Patients During COVID-19 Pandemic.

Background A number and a variety of surgical interventions were highly affected by the novel coronavirus disease (COVID-19) outbreak. Most of the elective operations were discontinued with the fear of exacerbating the disease in patients and spreading it among healthcare professionals. Objective The objective of this study was to report postoperative rates of COVID-19 in patients who underwent emergency and urgent surgery during the pandemic and to determine a safe algorithm in order to propose an ideal approach for surgeries. Patients and methods A total of 162 patients being operated upon emergency or urgent causes between March 11 and May 31 2020 were included in the study. Safety measures advised by the World Health Organization were applied. The patients' operative data and postoperative COVID-19 status were recorded and statistically evaluated. Results Surgical interventions were required for skin cancer, upper extremity trauma, soft tissue infections, maxillofacial trauma, lower extremity trauma and other causes. Local anesthesia was used for 127 patients (78.4%). General anesthesia was used for 28 patients (17,3%). Two of 162 patients contracted COVID-19 postoperatively on days 15 and 21, respectively. No statistical significance was found between surgery and anesthesia types regarding COVID-19 risk. Conclusion It appears that emergency and urgent surgeries can be performed safely. However, this relies upon adequate safety measures being taken with regards to screening for COVID-19 antigen positivity in patients preoperatively. Further evidence is required to determine the safety of elective surgeries.

A Practical Noncontact Model to Create Standardized Experimental Burn Wounds of Any Thickness: Blue Beam Laser Pointer for Burn Induction.

The objective of this study was to describe a predictable and easy-to-use model that can create standardized burn wounds. A 450-nm 1000-mW blue beam laser pointer was used to create burn wounds on the dorsal skin of 24 Sprague Dawley rats. Twelve distinct areas of dorsal skin were pulsed for 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, and 23 seconds with the help of a punched plastic card template. Three groups of 8 animals were killed immediately after on the third day and on the seventh day of the procedure and tissue samples were taken for histological evaluation and measurements. A second-degree burn was obtained in all animals with 3 and 5 seconds of laser application on the same day, third day, and seventh day measurements. Seven seconds of application resulted in a burn depth of 84.87% of dermis on the application day which deepened to involve the whole dermal layer on the third and seventh day. Nine seconds and longer application times resulted in third-degree burn wounds. Burn induction with blue beam laser pointer is an easy-to-use, predictable and safe model to create a standardized burn wound of desired thickness.

Effects of Insulin, Metoprolol and Deferoxamine on Fat Graft Survival.

BACKGROUND: The main problem faced with fat grafting is unpredictable resorption rates. Many substances have been reported to increase the survival of fat grafts. The aim of this study was to compare the effects of insulin, metoprolol and deferoxamine on fat graft survival. METHODS: Inguinal fat pads of male Sprague-Dawley rats were harvested and split into four parts as grafts. The grafts were placed in subcutaneous pockets in four quadrants on the back area of the rats. The insulin and metoprolol group fat grafts were incubated in regular insulin and metoprolol solutions, until they were placed. Deferoxamine and control group fat grafts were placed without incubation. After surgery, the control group fat grafts were injected with 10 doses of NaCl solution once every 3 days, and the deferoxamine group fat grafts were injected with 10 doses of deferoxamine solution once every 3 days. After a graft maturation period of 3 months, the grafts were harvested for weight measurements and histological and immunohistochemical evaluation. RESULTS: According to the rate of perilipin staining, the metoprolol group had 30% more mature viable adipocytes than the control and insulin group fat grafts (p < 0.05 and p < 0.01, respectively). CD31 activation rates were significantly higher in the deferoxamine and insulin group than in the metoprolol group (p < 0.05). CD34 staining rates did not differ between any groups (p > 0.05). CONCLUSIONS: In this experimental study, we have shown that there was no significantly increased fat graft survival rate seen in any drug treatment group. Low survival rates of stem cells demonstrated that the adipogenesis period ended at 3 months. Treatment of fat grafts with the selective ß1-blocker metoprolol resulted in good quality better graft take with more viable mature adipocytes. However, better viability of adipocytes did not result in increased weight of the fat graft. Studies aiming to compare the effects on fat graft survival of beta-blockers with long or short durations of action, different potencies and different receptor selectivity may be designed in the future. In addition, further studies may be performed, in which immunohistochemical markers used to assess inflammation and fibrosis are added to the study after the completion of the fat graft maturation period at the end of the first year to test the permanence of the results. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors - www.springer.com/00266 .

Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures.

BACKGROUND: Although early free flap coverage for lower extremity traumatic defects has been recommended by several authors, it is often not practical due to associated patient injuries or logistics. The aim of this study was to evaluate the impact of subacute and delayed surgical timing on flap success. METHODS: A retrospective analysis of adult patients who underwent a microsurgical free flap operation between 2007 and 2012 following lower extremity trauma was performed. The patients were divided into 2 groups according to the time period between the injury and the free flap operation: a subacute group (flap performed 10 to 29 days after injury) and a delayed repair group (>30 days after injury). The details of patient demographics, the mechanism of injury, timing from operation to discharge, minor and major complications, and flap failure rates were evaluated and compared. RESULTS: The study included 35 patients who underwent 37 free flap operations. A total of 20 patients were operated on 10 to 29 days after the injury (subacute repair group), and 15 patients were operated on more than 30 days after the injury (32-92 days) (delayed repair group). No significant correlation was found between the timing of the reconstruction, flap failure, and complication rates. CONCLUSION: Both subacute and delayed reconstruction for lower extremity traumatic defects can be performed with favorable results with appropriate wound preparation and precise preoperative planning.

Prelaminated extended temporoparietal fascia flap without tissue expansion for hemifacial reconstruction.

BACKGROUND: Disfigurement of the face caused by postburn scars, resected congenital nevi and vascular malformations has both functional and psychological consequences. Ideal reconstruction of the facial components requires producing not only function but also the better appearance of the face. The skin of the neck, supraclavicular or cervicothoracic regions are the most commonly used and the most likely source of skin for facial reconstruction in those techniques which prefabrications with tissue expansion are used. This retrospective cohort study describes the two staged prelaminated temporoparietal fascia flap which eliminates the usage of tissue expansion by using skin graft harvested from the neck and occipital region and the application of this flap for the lower three-fourths of the face. METHOD: 5 patients received prelaminated temporoparietal fascia flap without tissue expansion for facial resurfacing. The mean age at surgery was 39, 2 years (range, 17-60 years). The average follow up was 21.6 months (range, 10-48 months). RESULT: The size of the raised prelaminated temporoparietal fascia flaps ranged from 9 × 8 cm to 14 × 10 cm. All flaps survived after second stage. Varied degrees of venous congestion were observed after flap insets in all cases but none required any further treatment for the congestion. The entire lesion could not be resected due to the large size of the lesion in all patients. CONCLUSION: Two stage prelaminated temporoparietal fascia flap with skin graft is an effective technique for the reconstruction of partial facial defects in selected patients. It is simple, quick, safe and reliable, and requires no expansion of skin or no microsurgery.