Adjustment of radial forearm free flap design around self-inflicted wrist wounds.

The radial forearm free flap (RFFF) is one option of many free-tissue flaps that is frequently selected to reconstruct defects of the head and neck. It is popular due to its relatively thin and pliable associated soft tissue, reliable supplying vasculature, and appropriate diameter and length of the supplying vessels to perform microvascular anastomosis. This case report describes the use of the RFFF to reconstruct an oral cavity defect following tumor resection in a patient who required adjustment of the typical RFFF design. This patient has a significant psychiatric history leading to self-induced forearm lacerations that resulted in substantial scarring of her bilateral forearms in the anatomical area typically included in the RFFF. Since the RFFF was the optimal reconstructive option for this patient, the design of the RFFF was able to be moved proximally up her forearm to avoid inclusion of the scars in the flap. Adequate blood flow of the ulnar artery was confirmed with an Allen's test preoperatively to ensure the radial artery could be taken as part of the RFFF without causing ischemia of the hand. Following surgical resection of the patient's tumor, the RFFF was harvested and inset to reconstruct the resulting oral cavity defect. The patient has had no complications following her resection and reconstruction to date. This report highlights the adaptability of the RFFF, allowing adjustments to typical flap design to optimize outcomes for each individualized patient.

Heparin-Eluting Electrospun Nanofiber Yarns for Antithrombotic Vascular Sutures.

The surgical connection of blood vessels, anastomosis, is a critical procedure in many reparative, transplantation, and reconstructive surgical procedures. However, effective restoration of circulation is complicated by pathological clotting (thrombosis) or progressive occlusion due to excess cell proliferation that often leads to additional surgeries and increases morbidity and mortality risk for patients. Pharmaceutical agents have been tested to prevent these complications, but many have unacceptable systemic side effects. Therefore, an alternative approach to deliver these drugs at the site of injury in a controlled manner is necessary. The objective of this study was to develop electrospun nanofibers composed of polyester poly(lactide- co-glycolide) (PLGA), poly(ethylene oxide) (PEO), and positively charged copolymer, poly(lactide- co-glycolide)- graft-polyethylenimine (PgP) for electrostatic binding and release of heparin for application as an antithrombotic microvascular suture. PgP was synthesized with different coupling ratios between PLGA and branched polyethylenimine (bPEI) to obtain PgP1 (∼1 PLGA grafted to 1 bPEI) and PgP3.7 (∼3.7 PLGA grafted to 1 bPEI). Nanofiber yarns (PLGA/PEO/PgP1 and PLGA/PEO/PgP3.7) were fabricated by electrospinning. Heparin immobilization on the positively charged nanofiber yarns was visualized using fluorescein-conjugated heparin (F-Hep), and the amount of immobilized F-Hep was higher on both PLGA/PEO/PgP3.7 and PLGA/PEO/PgP1 than yarns without PgP (PLGA/PEO). We also found that F-Hep was released from both PgP-containing yarns in a sustained manner over 20 days, while over 60% of F-Hep was released within 4 h from PLGA/PEO. Finally, we observed that heparin-eluting nanofiber yarns with both PgP1 and PgP3.7 showed significantly longer clotting times than nanofiber yarns without PgP. The clotting time of PLGA/PEO/PgP3.7 was not significantly different than that of free heparin (0.5 µg/mL). These results show that heparin-eluting electrospun nanofiber yarns may offer a basis for the development of microvascular sutures with anticoagulant activity.