Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model.

BACKGROUND: Ischemia-reperfusion (I/R) injury is a serious condition that can affect the success rate of microsurgical reconstructions of ischemic amputated limbs and complex tissue defects requiring free tissue transfers. The purpose of this study was to evaluate the effects of ischemic preconditioning (IPC) and C1 esterase inhibitor (C1-Inh) intravenous administration following I/R injury in a rat skin flap model. METHODS: Superficial caudal epigastric skin flaps (3 cm × 7 cm) were performed on 50 Wistar rats that were randomly divided into five groups. Ischemia was not induced in the control group. All other flaps underwent 8 hours of ischemia prior to revascularization: I/R control group (8-hour ischemia), IPC group (preconditioning protocol + 8-hour ischemia), C1-Inh group (8-hour ischemia + C1-Inh), and IPC + C1-Inh group (preconditioning protocol + 8-hour ischemia + C1-Inh). Survival areas were macroscopically assessed after 1 week of surgery, and histopathological and biochemical evaluations were also measured. RESULTS: There were no significant differences in flap survival between the treatment groups that were suffering 8 hours of ischemia and the control group. A significant increase in neovascularization and lower edema formation were observed in the IPC group compared with that in the I/R group. Biochemical parameters did not show any significant differences. CONCLUSION: Intravenous administration of C1-Inh did not significantly modulate I/R-related damage in this experimental model, but further research is needed. On the other hand, IPC reduces tissue damage and improves neovascularization, confirming its potential protective effects in skin flaps following I/R injury.

Nasal root island flap for reconstruction of glabellar defects.

BACKGROUND: The glabella is an aesthetic subunit placed on the forehead between the eyebrows. The reconstruction of this area can be challenging for cosmetic outcomes. In our experience, moderate glabellar defects reconstruction should introduce extra skin to preserve the interciliary space. METHODS: Under local anesthesia, tumoral excision with safety margins on the glabellar area was performed in 5 patients. The oncologic resection resulted in moderate sized glabellar defects. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site. RESULTS: Five nasal root island flaps were successfully performed for glabellar defects reconstruction after tumoral excisions. The aesthetic results were satisfactory with respect to color and texture match and scars qualities. The eyebrow junction was successfully avoided. CONCLUSIONS: We present an alternative method for the reconstruction of central and moderate sized glabellar defects. The nasal root island flap is a reliable and easy to perform 1-stage technique with satisfactory aesthetic outcomes.