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1.
BMJ Open ; 11(9): e045239, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475143

RESUMO

INTRODUCTION: The emphasis on aesthetic outcomes and quality of life (QoL) has motivated surgeons to develop skin-sparing or nipple-sparing mastectomy (SSM/ NSM) for breast cancer treatment or prevention. During the same operation, a so-called immediate breast reconstruction is performed. The breast can be reconstructed by positioning of a breast implant above (prepectoral) or below (subpectoral) the pectoralis major muscle or by using the patients' own tissue (autologous reconstruction). The optimal positioning of the implant prepectoral or subpectoral is currently not clear. Subpectoral implant-based breast reconstruction (IBBR) is still standard care in many countries, but prepectoral IBBR is increasingly performed. This heterogeneity in breast reconstruction practice is calling for randomised clinical trials (RCTs) to guide treatment decisions. METHODS AND ANALYSIS: International, pragmatic, multicentre, randomised, superiority trial. The primary objective of this trial is to test whether prepectoral IBBR provides better QoL with respect to long-term (24 months) physical well-being (chest) compared with subpectoral IBBR for patients undergoing SSM or NSM for prevention or treatment of breast cancer. Secondary objectives will compare prepectoral versus subpectoral IBBR in terms of safety, QoL and patient satisfaction, aesthetic outcomes and burden on patients. Total number of patients to be included: 372 (186 per arm). ETHICS AND DISSEMINATION: This study will be conducted in compliance with the Declaration of Helsinki. Ethical approval has been obtained for the lead investigator's site by the Ethics Committee 'Ethikkommission Nordwest- und Zentralschweiz' (2020-00256, 26 March 2020). The results of this study will be published in a peer-reviewed medical journal, independent of the results, following the Consolidated Standards of Reporting Trials standards for RCTs and good publication practice. Metadata describing the type, size and content of the datasets will be shared along with the study protocol and case report forms on public repositories adhering to the FAIR (Findability, Accessibility, Interoperability, and Reuse) principles. TRIAL REGISTRATION NUMBER: NCT04293146.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Mamilos/cirurgia
2.
Handchir Mikrochir Plast Chir ; 53(4): 407-411, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-33862646

RESUMO

Aetiologically, prilocaine-induced methaemoglobinaemia is a rare form of acquired methaemoglobinaemia, which occurs rarely in the first place. The following report highlights a potentially dangerous complication arising after application of prilocaine during liposuction.A young female visited the Accident and Emergency Department following a pre-syncopal fall. As a consequence of her fall, she experienced debilitating wrist pain and exhibited a laceration on her chin. She had undergone liposuction of the lower extremity as an outpatient approximately 12 hours earlier and received regional anaesthesia in the process. A large volume of an anaesthetic solution containing prilocaine had been injected into the tissue.The patient was normotensive and slightly tachycardic and had oxygen saturations of 90 % on room air. She was cyanotic and her lips were pale. Initial arterial blood gas analysis showed a methaemoglobin fraction, which was increased significantly to 10.9 %. Conventional radiography confirmed the presence of a minimally dislocated distal radius fracture. Following subsequent oxygen therapy over a four-hour period, the patient's methaemoglobin level dropped to 6 %, her lip cyanosis abated and her vital parameters stabilised. The laceration of her chin was sutured and her wrist immobilised in a split plaster brace. After a 12-hour hospital stay, the patient was discharged. At her six-week follow-up appointment, the fracture had healed and both the functional and cosmetic aspects of her chin wound were adequate. We hope that this report draws the attention of emergency care personnel to the possible diagnosis of prilocaine-induced methaemoglobinaemia after liposuction and encourages more general discussions around the use of prilocaine.


Assuntos
Lipectomia , Metemoglobinemia , Feminino , Humanos , Lipectomia/efeitos adversos , Prilocaína/efeitos adversos
4.
J Hand Surg Glob Online ; 3(3): 129-132, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-35415544

RESUMO

Purpose: Wide-awake local anesthesia with no tourniquet (WALANT) as a walk-in procedure has become a standard technique in open carpal tunnel release (OCTR) and continues to replace the long-established intravenous regional anesthesia with a tourniquet (IVRA/"bier-block") in our clinic. The aim of this study was to compare patient satisfaction with either WALANT or IVRA/"bier-block" and define subgroups that are particularly suited for either of the two procedures. We hypothesized that older patients would prefer IVRA because of a shorter period of postoperative surveillance. Methods: In this retrospective study we evaluated patient satisfaction with either WALANT or IVRA using an adjusted questionnaire on a standard Swiss grading system (from 1 = insufficient/very strong pain to 6 = excellent/no pain). Secondary outcomes included postoperative pain or satisfaction with the tourniquet and quality of postoperative care. Results: For the 176 patients (WALANT, n = 109; IVRA, n = 67) included in the study, there was high patient satisfaction with both procedures (WALANT, 5.5/6; IVRA, 5.5/6). Patients aged 80 years and older had significantly less postoperative pain after WALANT (WALANT, 5.8/6 vs IVRA, 4.9/6). Conclusions: Patients aged 80 years and older had significantly less postoperative pain after WALANT than that after IVRA. Here, sarcopenia may have contributed to the prolonged discomfort after tourniquet application. Immediate postoperative discharge after WALANT did not negatively affect older patients. Clinical relevance: For OCTR, WALANT as a walk-in procedure is a safe and comfortable alternative to IVRA, which is commonly planned with short postoperative surveillance. Both anesthesia techniques are suitable for all ages and sexes but based on this study we recommend WALANT as a tourniquet-free operation in older patients.

5.
J Tissue Eng Regen Med ; 13(3): 359-368, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30515986

RESUMO

Adipose-derived multipotent stem/progenitor cells (ASPCs) were shown to be ideal candidates for cell-based regenerative therapies. Yet, despite their huge potential, successful clinical applications are still rare. It was suggested that the efficacy of ASPCs at the recipient site depends on the vehicle of cell delivery. In this study, for preparation of a murine critical-size nerve defect model, we assessed the commercially available fibrin gel (ARTISS) as a potential cell carrier. In a thorough in vitro analysis, we investigated cell-fibrin interactions and analyzed the distribution and the long-term behavior of ASPCs cultivated in fibrin gel under normoxic and hypoxic conditions. ASPCs attached to the surface of a thin fibrin layer (two-dimensional condition) and spread with the abundant formation of actin stress fibers. Cells cultured within a fibrin matrix (three-dimensional condition) displayed a uniform distribution and formed interconnected networks while exhibiting strong cell-matrix interactions. Using time-lapse analysis, cells were found to migrate out of the gel and subsequently proliferated robustly both under hypoxic and normoxic conditions. During 14 days of culture in fibrin gel, ASPCs showed high viability, metabolic, and remodeling activities. At the end of the culture period, the fibrin matrix was degraded entirely accompanied by an upregulation of matrix metalloproteinases. In conclusion, fibrin gel stands out as a valuable biomaterial for delivering vital and active cells to damaged tissues. As a direct proof, ASPCs carried in a fibrin matrix will be evaluated in a murine critically sized peripheral nerve repair model.


Assuntos
Tecido Adiposo/citologia , Adesivo Tecidual de Fibrina/farmacologia , Regeneração/efeitos dos fármacos , Células-Tronco/citologia , Citoesqueleto de Actina/efeitos dos fármacos , Citoesqueleto de Actina/metabolismo , Animais , Fenômenos Biomecânicos , Contagem de Células , Sobrevivência Celular/efeitos dos fármacos , Fibrina/metabolismo , Masculino , Metaloproteinases da Matriz/metabolismo , Camundongos , Ratos Wistar , Células-Tronco/efeitos dos fármacos , Regulação para Cima/efeitos dos fármacos
6.
Neural Regen Res ; 13(5): 854-861, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29863016

RESUMO

Despite the regenerative capabilities of peripheral nerves, severe injuries or neuronal trauma of critical size impose immense hurdles for proper restoration of neuro-muscular circuitry. Autologous nerve grafts improve re-establishment of connectivity, but also comprise substantial donor site morbidity. We developed a rat model which allows the testing of different cell applications, i.e., mesenchymal stem cells, to improve nerve regeneration in vivo. To mimic inaccurate alignment of autologous nerve grafts with the injured nerve, a 20 mm portion of the sciatic nerve was excised, and sutured back in place in reversed direction. To validate the feasibility of our novel model, a fibrin gel conduit containing autologous undifferentiated adipose-derived stem cells was applied around the coaptation sites and compared to autologous nerve grafts. After evaluating sciatic nerve function for 16 weeks postoperatively, animals were sacrificed, and gastrocnemius muscle weight was determined along with morphological parameters (g-ratio, axon density & diameter) of regenerating axons. Interestingly, the addition of undifferentiated adipose-derived stem cells resulted in a significantly improved re-myelination, axon ingrowth and functional outcome, when compared to animals without a cell seeded conduit. The presented model thus displays several intriguing features: it imitates a certain mismatch in size, distribution and orientation of axons within the nerve coaptation site. The fibrin conduit itself allows for an easy application of cells and, as a true critical-size defect model, any observed improvement relates directly to the performed intervention. Since fibrin and adipose-derived stem cells have been approved for human applications, the technique can theoretically be performed on humans. Thus, we suggest that the model is a powerful tool to investigate cell mediated assistance of peripheral nerve regeneration.

7.
Neurol Res ; 37(3): 197-203, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25213596

RESUMO

The treatment of obstetric brachial plexus palsy has been limited to conservative therapies and surgical reconstruction of peripheral nerves. In addition to the damage of the brachial plexus itself, it also leads to a loss of the corresponding motoneurons in the spinal cord, which raises the need for supportive strategies that take the participation of the central nervous system into account. Based on the protective and regenerative effects of VEGF on neural tissue, our aim was to analyse the effect on nerve regeneration by adenoviral gene transfer of vascular endothelial growth factor (VEGF) in postpartum nerve injury of the brachial plexus in rats. In the present study, we induced a selective crush injury to the left spinal roots C5 and C6 in 18 rats within 24 hours after birth and examined the effect of VEGF-gene therapy on nerve regeneration. For gene transduction an adenoviral vector encoding for VEGF165 (AdCMV.VEGF165) was used. In a period of 11 weeks, starting 3 weeks post-operatively, functional regeneration was assessed weekly by behavioural analysis and force measurement of the upper limb. Morphometric evaluation was carried out 8 months post-operatively and consisted of a histological examination of the deltoid muscle and the brachial plexus according to defined criteria of degeneration. In addition, atrophy of the deltoid muscle was evaluated by weight determination comparing the left with the right side. VEGF expression in the brachial plexus was quantified by an enzyme-linked immunosorbent assay (ELISA). Furthermore the motoneurons of the spinal cord segment C5 were counted comparing the left with the right side. On the functional level, VEGF-treated animals showed faster nerve regeneration. It was found less degeneration and smaller mass reduction of the deltoid muscle in VEGF-treated animals. We observed significantly less degeneration of the brachial plexus and a greater number of surviving motoneurons (P < 0·05) in the VEGF group. The results of this study confirmed the positive effect of VEGF-gene therapy on regeneration and survival of nerve cells. We could demonstrate a significant improvement on the motor-functional as well as on the histomorphological level. However, increased vascularization of the nerve tissue caused by VEGF does not seem to be the major reason for these effects. The clinical use of adenoviral VEGF-gene therapy in the newborn cannot be justified so far.


Assuntos
Neuropatias do Plexo Braquial/tratamento farmacológico , Terapia Genética/métodos , Regeneração Nervosa/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Adenoviridae/genética , Animais , Animais Recém-Nascidos , Atrofia , Neuropatias do Plexo Braquial/patologia , Neuropatias do Plexo Braquial/fisiopatologia , Vértebras Cervicais , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Vetores Genéticos , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Neurônios Motores/efeitos dos fármacos , Neurônios Motores/patologia , Neurônios Motores/fisiologia , Degeneração Neural/tratamento farmacológico , Degeneração Neural/patologia , Degeneração Neural/fisiopatologia , Regeneração Nervosa/fisiologia , Distribuição Aleatória , Ratos Sprague-Dawley , Raízes Nervosas Espinhais/efeitos dos fármacos , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/fisiopatologia , Extremidade Superior/patologia , Extremidade Superior/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo
8.
Aesthetic Plast Surg ; 38(1): 146-150, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24310582

RESUMO

BACKGROUND: An extended asymmetric funnel chest deformity with the breast gland located in the thoracic mold can lead to a fictitious aplasia of the breast. The authors termed this condition "pseudo-Amazon syndrome" because the breast tissue and the pectoralis muscle are fully developed. METHODS: This report presents a detailed technical approach to the fabrication of a precise-fitting custom-made silicone implant. The design of the implant was achieved using a computed tomography (CT) data set and rapid prototyping. The volumes of the "hidden" and the normal breasts measured preoperatively by processing the CT data were similar. These volumes were compared with the breast volumes measured by three-dimensional photography 4 years postoperatively to assess the predictability of the volume congruency. The silicone implant was surgically placed in the epicostal plane and extended almost over the right hemithorax. RESULTS: The implantation was performed without the necessity of further trimming. Both the surgeon and the patient rated the aesthetic and functional long-term result as good in terms of symmetry and the possibility of exercise without restrictions. The final breast volume of the surgically treated side was 95 % of the volume of the normal contralateral breast. CONCLUSION: The described method reduces the operation time and the operative trauma by primary implant fit. However, the method is rather elaborate and the production process is expensive. This in turn reduces the generation of proceeds to a minimum. LEVEL OF EVIDENCE V: 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 .


Assuntos
Implantes de Mama , Tórax em Funil/cirurgia , Desenho de Prótese/métodos , Silicones , Feminino , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Clin Hemorheol Microcirc ; 50(3): 157-66, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22240349

RESUMO

PURPOSE: Indocyanine green (ICG) fluorescence angiography is used to evaluate tissue perfusion in many different medical fields. This study aims to evaluate the value of ICG angiography in the determination of tissue perfusion in the PAD lower extremities. MATERIAL AND METHODS: In a prospective clinical study, ICG angiography was used to evaluate tissue perfusion and collateralization in 30 PAD patients. The perfusion index and maximum fluorescence intensity (MPI) were calculated as arterial perfusion parameters. RESULTS: Significant differences in the perfusion index were found for the different PAD stages (p < 0.001). Poor collateralization was associated with a significantly lower perfusion index than good collateralization (p = 0.003). A ROC analysis for the perfusion index showed a positive likelihood ratio of 6.00 and a negative likelihood ratio of 0.00 with an area under the curve of 0.949 to discriminate critical and non-critical PAD. CONCLUSION: ICG angiography is a promising diagnostic tool to quantify tissue perfusion and demonstrate critical limb ischemia and collateralization in lower extremities affected by PAD.


Assuntos
Corantes , Angiofluoresceinografia/métodos , Verde de Indocianina , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Doença Arterial Periférica/patologia , Estudos Prospectivos , Fluxo Sanguíneo Regional
11.
J Surg Res ; 171(1): 329-38, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20605609

RESUMO

BACKGROUND: Vascular endothelial growth factor (VEGF)(165) induces formation of immature blood vessels with increased permeability. In this study, we used a cell-based gene-transfer model of fibroblasts to investigate the effects of a combined in vivo treatment consisting of the VEGF165 and basic fibroblast growth factor (bFGF) proteins on ischemic and non-ischemic tissues. MATERIALS AND METHODS: After controlled in vitro adenoviral transfection we transplanted fibroblasts into either healthy tissue, or into an ischemic skin flap model at different tissue locations and at different time points. Subsequent protein expression and angiogenic effects were measured using ELISA, PCR, immunohistology, planimetry, and microangiography. RESULTS: Transfected fibroblasts temporarily produced VEGF(165) and bFGF. After transdermal implantation we found an up-regulation of genes encoding for both factors in tissue samples. The combined transplantation of VEGF(165) and bFGF modified cells increased the number of sm-actin+/CD31+ blood vessels and reduced necrosis by 25%. The number of functional blood vessels increased over a period of 168 d even in healthy tissue. CONCLUSIONS: We achieved stable vessel growth in healthy tissue by inducing a temporary overexpression of VEGF(165) and bFGF and improved the survival of ischemic tissue. One possible mechanism for the latter observation is the stabilization of VEGF(165)-induced hyperpermeable vessels by a bFGF-mediated pericytial recruitment of smooth muscle cells.


Assuntos
Fator 2 de Crescimento de Fibroblastos/genética , Fibroblastos/transplante , Terapia Genética/métodos , Isquemia/terapia , Neovascularização Fisiológica/fisiologia , Fator A de Crescimento do Endotélio Vascular/genética , Adenoviridae/genética , Animais , Células Cultivadas , Feminino , Fibroblastos/citologia , Fibroblastos/fisiologia , Técnicas de Transferência de Genes , Sobrevivência de Enxerto/fisiologia , Ratos , Ratos Sprague-Dawley , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea
12.
Vasc Endovascular Surg ; 44(4): 269-73, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20356863

RESUMO

OBJECTIVE: Amputations of the lower extremity due to irreversible ischemic tissue loss are performed as distally as possible. Therefore, oftentimes wound-healing disorders develop, requiring additional surgical treatment. METHODS: The amputations stumps of 10 patients with irreversible ischemic tissue loss due to arteriosclerosis were investigated within 72 hours postoperatively with indocyanine green (ICG) fluorescence. RESULTS: For 6 of the investigated stumps, no perfusion deficit could be seen through fluorescence angiography. All stumps displayed primary healing. In the fluorescence angiography of 3 amputations, stump perfusions deficits predicted later tissue necrosis and had to be amputated again in a second operation. One amputation wound showed a small ICG perfusion deficit that represented a blood clot. CONCLUSION: Indocyanine green fluorescence angiography allows a perfusion analysis of amputation stumps and therefore a prediction of the expected tissue necrosis. This tool may allow reliable prediction of amputation level.


Assuntos
Amputação/efeitos adversos , Arteriopatias Oclusivas/cirurgia , Angiofluoresceinografia , Corantes Fluorescentes , Verde de Indocianina , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Complicações Pós-Operatórias/diagnóstico , Idoso , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/fisiopatologia , Diagnóstico Precoce , Feminino , Gangrena , Humanos , Isquemia/etiologia , Isquemia/patologia , Isquemia/fisiopatologia , Extremidade Inferior/patologia , Masculino , Necrose , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reoperação , Fatores de Tempo , Resultado do Tratamento , Cicatrização
13.
J Sex Med ; 7(8): 2899-902, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20102482

RESUMO

INTRODUCTION: Sex reassignment surgery (SRS) can be considered a reasonable and secure treatment for transsexualism, today. Because the population of patients who have received SRS is growing steadily, it can be expected that the number of patients who present with diseases specific to their original gender will increase as well. AIM: In female-to-male transsexuals, vaginal cancer has not been reported so far. This article reports, to our knowledge, the first case of a female-to-male transsexual who developed vaginal cancer. METHODS: Eighteen years after receiving female-to-male SRS, the patient presented with vaginal cancer, which infiltrated rectum and bladder and also showed involvement of inguinal lymph nodes. Surgery consisted of an anterior and posterior pelvic demolition and extended lymphadenectomy with preservation of the penoid and reconstruction of the pelvic defect with multiple flaps. RESULTS: The tumor was removed completely (R0), and 2 years after surgery, the patient has no signs or symptoms of tumor recurrence and enjoys good quality of life. CONCLUSIONS: In SRS patients, diseases of their original gender should always be considered and patients should be encouraged to participate in screening programs. When choosing the surgical approach for SRS, the risks for developing cancer from remaining structures of the genetic gender should be considered. Of course, removal of e.g., ovaries, cervix and vagina, will prevent cancer of these structures. When it comes to surgery in SRS patients with malignancies, an interdisciplinary approach should be chosen.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Papillomavirus Humano 16 , Infecções por Papillomavirus/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Cirurgia de Readequação Sexual , Transexualidade/cirurgia , Neoplasias Vaginais/diagnóstico , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Comportamento Cooperativo , Feminino , Seguimentos , Humanos , Comunicação Interdisciplinar , Excisão de Linfonodo , Metástase Linfática , Imageamento por Ressonância Magnética , Microcirurgia/métodos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/cirurgia , Exenteração Pélvica , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Próteses e Implantes , Reto/patologia , Retalhos Cirúrgicos/irrigação sanguínea , Telas Cirúrgicas , Bexiga Urinária/patologia , Neoplasias Vaginais/patologia , Neoplasias Vaginais/cirurgia
14.
J Cell Mol Med ; 14(3): 587-99, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19040418

RESUMO

Adenoviral transduction of the VEGF gene in an oversized skin flap increases flap survival and perfusion. In this study, we investigated the potential of magnetofection of magnetic lipospheres containing VEGF(165)-cDNA on survival and perfusion of ischemic skin flaps and evaluated the method with respect to the significance of applied magnetic field and ultrasound. We prepared perfluoropropane-filled magnetic lipospheres ('magnetobubbles') from Tween60-coated magnetic nanoparticles, Metafectene, soybean-oil and cDNA and studied the effect in an oversized random-pattern-flap model in the rats (n= 46). VEGF-cDNA-magnetobubbles were administered under a magnetic field with simultaneously applied ultrasound, under magnetic field alone and with applied ultrasound alone. Therapy was conducted 7 days pre-operative. Flap survival and necrosis were measured 7 days post-operatively. Flap perfusion, VEGF-protein concentration in target and surrounding tissue, formation and appearance of new vessels were analysed additionally. Magnetofection with VEGF-cDNA-magnetobubbles presented an increased flap survival of 50% and increased flap perfusion (P < 0.05). Without ultrasound and without magnetic field, the effect is weakened. VEGF concentration in target tissue was elevated (P < 0.05), while underlying muscle was not affected. Our results demonstrate the successful VEGF gene therapy by means of magnetobubble magnetofection. Here, the method of magnetofection of magnetic lipospheres is equally efficient as adenoviral transduction, but has a presumable superior safety profile.


Assuntos
Terapia Genética/métodos , Sobrevivência de Enxerto/fisiologia , Transfecção/métodos , Fatores de Crescimento do Endotélio Vascular/fisiologia , Animais , Procedimentos Cirúrgicos Dermatológicos , Ensaio de Imunoadsorção Enzimática , Lipídeos/química , Magnetismo , Masculino , Microesferas , Microvasos/fisiologia , Modelos Animais , Músculos/metabolismo , Ratos , Ratos Sprague-Dawley , Pele/metabolismo , Transplante de Pele , Retalhos Cirúrgicos/irrigação sanguínea , Ultrassom , Fatores de Crescimento do Endotélio Vascular/genética , Fatores de Crescimento do Endotélio Vascular/metabolismo
15.
J Plast Reconstr Aesthet Surg ; 62(11): 1534-42, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18815084

RESUMO

BACKGROUND: The angiogenic potential of vascular endothelial growth factor (VEGF) and its oxygen pressure-dependent regulation suggest a strong connection between this growth factor and the 'delay phenomenon'. In this study we focused on the chronological changes in VEGF concentration and flap perfusion in order to optimise the duration of surgical delay. METHODS: The VEGF concentration in skin and underlying muscle was measured in oversized, random-pattern flaps on 38 male Sprague-Dawley rats after 3, 5 or 7 days of surgical delay. Additionally, flaps were raised 5 or 7 days past preconditioning. The effect on flap perfusion was measured using indocyanine green fluoroscopy and the size of surviving and necrotic areas of the flaps were analysed. Microvessel density was assessed using a monoclonal CD31 antibody, and vessel diameter and morphometry were appraised by means of corrosion casting. RESULTS: VEGF expression in the distal half of the flaps was significantly increased 3 days after preconditioning and perfusion was significantly enhanced after day 5. An interval of 5 days between preconditioning and flap transposition resulted in a significantly reduced average necrosis rate. Microvessel density was significantly increased and vessel diameters were enlarged (P<0.05). CONCLUSIONS: We illustrated the chronology of events from the ischaemic procedure to the rise in VEGF concentration and changes in flap perfusion, and demonstrated vasodilatation and the formation of new vessels. Most significantly, we were able to further specify the optimal length of surgical delay based on alterations on a molecular level as well as changes in vascularisation and perfusion.


Assuntos
Microcirculação/fisiologia , Neovascularização Fisiológica/fisiologia , Transplante de Pele/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Fatores de Crescimento do Endotélio Vascular/metabolismo , Animais , Biomarcadores/análise , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Rejeição de Enxerto , Sobrevivência de Enxerto , Fluxometria por Laser-Doppler , Masculino , Análise Multivariada , Probabilidade , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Pele/irrigação sanguínea , Estatísticas não Paramétricas , Retalhos Cirúrgicos/fisiologia , Fatores de Tempo , Fatores de Crescimento do Endotélio Vascular/análise
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