Effects of ischemic preconditioning protocols on skeletal muscle ischemia-reperfusion injury.

BACKGROUND: Ischemic preconditioning (IPC) is described as brief ischemia-reperfusion (I/R) cycles to induce tolerance to subsequent in response to longer I/R insults. Various IPC protocols can be performed in four combinations as follows: at early or late phases and on local or distant organs. Although many experimental studies have been performed on IPC, no consensus has been established on which IPC protocol is most effective. The aims of the present study were as follows: (1) to compare the variables of preconditioning in different combinations (in early versus late phases; local versus remote organ implementations) and (2) to determine the most therapeutic IPC protocol(s). MATERIALS AND METHODS: A subtotal hind limb amputation model with clamping an intact femoral pedicle was used for I/R injury. IPC was induced using hind limb tourniquet with 3 × 10 min I/R cycles before longer I/R insult. Forty-nine rats were divided into seven groups (n = 7), sham, IsO (ischemia only), I/R, early ischemic preconditioning (e-IPC), late ischemic preconditioning (l-IPC), early remote ischemic preconditioning (e-RIPC), and l-RIPC (late-remote) groups, respectively. In the sham group, pedicle occlusion was not performed. Six hours ischemia was challenged in the IsO group. Three hours ischemia followed by 3 h reperfusion was performed in the I/R group. The e-IPC group was immediately preconditioned, whereas the l-IPC group was preconditioned 24 h before I/R injury on the same hind limb. In the e-RIPC and l-RIPC groups, the same protocols were performed on the contralateral hind limb. At the end of the experiments, skeletal muscle tissue samples were obtained for biochemical analysis (Malondialdehyde [MDA], catalase, myeloperoxidase [MPO], and nitric oxide end products [NOx]), light microscopy, and caspase-3 immunohistochemistry for determination of apoptosis. RESULTS: Tissue biochemical markers were improved in nearly all the IPC groups compared with IsO and I/R groups (P < 0.05). Similarly, the histologic damage scores were decreased in all the IPC groups (P < 0.05). The lowest damage score was in the e-RIPC group followed by the l-RIPC, e-IPC, and l-IPC groups, respectively. The apoptosis scores were significantly high in the I/R group compared with the e-RIPC and l-RIPC groups (P < 0.05). Although apoptosis scores of the e-IPC and l-IPC groups were lower than the I/R group, this finding was not statistically significant (P > 0.05). CONCLUSIONS: All IPC protocols were effective in reducing I/R injury. Among these protocols, e-RIPC achieved most protection.

Labia Majora Augmentation with De-epithelialized Labial Rim (Minora) Flaps as an Auxiliary Procedure for Labia Minora Reduction.

BACKGROUND: Esthetic surgery of external female genitalia remains an uncommon procedure. This article describes a novel, de-epithelialized, labial rim flap technique for labia majora augmentation using de-epithelialized labia minora tissue otherwise to be excised as an adjunct to labia minora reduction. METHODS: Ten patients were included in the study. The protruding segments of the labia minora were de-epithelialized with a fine scissors or scalpel instead of being excised, and a bulky section of subcutaneous tissue was obtained. Between the outer and inner surfaces of the labia minora, a flap with a subcutaneous pedicle was created in continuity with the de-epithelialized marginal tissue. A pocket was dissected in the labium majus, and the flap was transposed into the pocket to augment the labia majora. RESULTS: Mean patient age was 39.9 (±13.9) years, mean operation time was 60 min, and mean follow-up period was 14.5 (±3.4) months. There were no major complications (hematoma, wound dehiscence, infection) following surgery. No patient complained of postoperative difficulty with coitus or dyspareunia. All patients were satisfied with the final appearance. CONCLUSION: Several methods for labia minora reduction have been described. Auxiliary procedures are required with labia minora reduction for better results. Nevertheless, few authors have taken into account the final esthetic appearance of the whole female external genitalia. The described technique in this study is indicated primarily for mild atrophy of the labia majora with labia minora hypertrophy; the technique resulted in perfect patient satisfaction with no major complications or postoperative coital problems. LEVEL OF EVIDENCE IV: 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 .

e-Flap nipple reconstruction in amputation mammaplasty.

BACKGROUND: Although widely used in women who have gigantomastia, free nipple graft breast reduction has several disadvantages with respect to the nipple-areola graft. In this report, we present the use of a nipple reconstruction method instead of free nipple grafting. METHOD: Free nipple reduction mammaplasty is performed according to the Wise pattern. The nipple is removed from the areola graft. Nipple reconstruction is done at the most proximal and projected part of the reduced breast, which corresponds to the future nipple site. Afterward, the reconstructed nipple is encircled with the areola graft. RESULTS: A total of 18 patients underwent breast reduction with nipple reconstruction and areola grafting between April 2007 and March 2010. The mean follow-up period was 8 months. With the proposed nipple reconstruction technique, the mean projections of the nipple at the end of the operation and at 6 months were 1.2 and 0.9 cm, respectively. CONCLUSION: The technique of using nipple reconstruction in amputation mammaplasty avoids the problems related to the nipple graft such as loss of projection, loss of sensation, or even total or partial loss of the nipple. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.

Rat tail revascularization model for advanced microsurgery training and research.

We describe a time-saving microsurgical exercise for continuing microsurgical training and research. The rat tail replantation model was simplified by excluding bone detachment. Rats were divided into two groups: devascularization only ( N = 3) and revascularization after devascularization ( N = 7). The tail was devascularized by ligation and division of artery and veins in the first group to reveal if a collateral circulation from bone existed. The divided vessels were reanastomosed in the second group. The circulation of the rat tails was followed for 1 week. The tails showed total necrosis in the devascularization group, whereas only two of seven tails showed partial necrosis in the revascularization group. Reexploration showed thrombosis narrowing the lumen at the anastomotic site of the partially necrosed tails, most likely due to an anastomotic insufficiency. The present study revealed that total amputation is not necessary for tail devascularization. The rat tail revascularization model provides a practical tool for advanced and continuing microsurgical training and research.

Do local anesthetics have antibacterial effect on Staphylococcus aureus under in vivo conditions? An experimental study.

OBJECTIVE: The antimicrobial properties against Staphylococcus aureus of some common local anesthetic preparations such as prilocaine, bupivacaine, articaine, and combinations were evaluated in a live rat surgical wound model. METHODS: This study was conducted at the animal research laboratory of Eskisehir Osmangazi University in 2003. Clean surgical wounds were created after local anesthetic application and inoculated with S. aureus (10(2) colony forming units/mL). Four days later, tissue cultures were harvested from control animals and animals given local anesthetic to determine the quantity of bacteria. RESULTS: The tissue cultures demonstrated that none of the local anesthetics used in the study showed any inhibitory or bactericidal activity on S. aureus. There was no statistical difference in bacterial count between the local anesthetic-treated and control group wounds. CONCLUSION: The results of the present study did not show any antimicrobial activity of above-mentioned local anesthetics in surgically created wounds of rats.

Intensity and localization of trauma in non-fatal electrical injuries.

BACKGROUND: Electrical injuries currently remain a worldwide problem. In Turkey, burns are relatively small in number among injuries overall, but they continue to be a major public health problem. Electrical injuries may occur due to high- or low-voltage contact. Injuries due to low voltage usually occur at home. High-voltage injuries are usually work-related and result from a shorter contact, but may cause serious tissue destruction and secondary injuries. METHODS: The objective of this study was to review a medical institution's experience with electrical injuries between 1997-2005. The institution admitted 55 electrical injury cases throughout this period. A computerized burns registry was used for data collection and analysis. RESULTS: The burn causes differed among age groups and between the sexes, with males constituting 89.1% of the electrical burn patients. Forty-one of the injuries were due to high voltage whereas 14 injuries were due to low voltage. Complications were most common in the high-voltage group. Mean length of stay was longest in this group, at 33.69+/-21.13 days, and the patients in this group also required the most operations. CONCLUSION: Work-related activity was responsible for the majority of these high-voltage injuries, with the most common occupations being linemen and electricians. These patients tended to be younger men in the prime of their working lives. Our study underlines the need for stronger efforts aimed at prevention, such as better public education and strict regulations regarding the distribution and use of electricity.

Nasometric evaluation of resonance disorders: A norm study In Turkish.

OBJECTIVE: The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage. METHODS: 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy. RESULTS: This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels. CONCLUSION: This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.

The detection of hipO gene by real-time PCR in thermophilic Campylobacter spp. with very weak and negative reaction of hippurate hydrolysis.

A total of 190 Campylobacter spp. isolates, of which 34 gave the result of very weak activity, and 156 gave the negative activity in the test for hippurate hydrolysis were characterized. The genomic DNA was isolated from a fresh culture of each isolate and the real-time PCR, targeting the hipO gene, was used to confirm the species distribution of Campylobacter isolates. The hipO gene was detected in 17 isolates (11%) within the total of 156 negative isolates for hippurate hydrolysis. Out of 34 isolates with very weak activity, 19 isolates (56%) were also found to be positive for hipO gene and characterized as C. jejuni. The real-time PCR assay used in this study could be employed for more accurate diagnosis of Campylobacter infections at species level after the biochemical characterization based on hippuricase activity of the isolates. This could also provide important data for the epidemiology of infections associated with these zoonotic pathogens.

A new apparatus for standardization of experimental burn models.

BACKGROUND: Burns have severe economic burden for families and countries therefore its treatment modalities have utmost importance. Several study both experimental or clinic has been reported accordingly. Although contact burns were frequently used models, most of them were manually designed. The elapsed time was recorded only. However, the real time contact surface temperature (T) and weight force (WF) were fundamental characteristics of a burn model. The aim of this study is to create a standard burn model with recording real time variables on behalf of custom designed apparatus. METHODS: A custom designed apparatus was manufactured in which the variables of real time T, WF and elapsed time could be set and record. A vertical angle was provided to ensure the applied WF. And hence, Sprague-Dawley rats were randomly divided into four groups: (1) Burned at 60±1°C with low WF(G60WFL), (2) Burned at 60±1°C with high WF(G60WFH), (3) Burned at 80±1°C with low WF(G80WFL), (4) Burned at 80±1°C with high WF(G80WFH). The healthy skin thickness and burn depth were measured. The percentage of burn depth to healthy skin was used for statistical analysis. RESULTS: Constant variables T and WF were achieved. The pressure applied on skin was not significant between low [G60WFL vs G80WFL, (p=0.1704)] and high [G60WFH vs G80WFH (p=0.2369)] WF groups. However the percentage of burn depth was increasing owing to applied WF in 60°C group [G60WFL vs G60WFH, (p=0.0125)] and in 80°C group [G80WFL vs G80WFH (p<0.0001)]. And also the percentage was significantly increasing owing to set T, in low WF group [G60WFL vs G80WFL (p<0.0001)] and high WF group [G60WFH vs G80WFH (p<0.0001)]. Besides neither T nor WF has priority. CONCLUSION: Without recording the real time T and WF, it is infeasible to achieve a standard burn model. For a standard depth of burn, variables should be under control, as if our custom designed apparatus.

Nerve Tissue Prefabrication Inside the Rat Femoral Bone: Does It Work?

AIM: To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. MATERIAL AND METHODS: Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. RESULTS: All results showed that axonal growth existed through the osseous canal. CONCLUSION: To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

BACKGROUND: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described. AIMS: To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects. STUDY DESIGN: Animal experimentation. METHODS: Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week. RESULTS: Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group. CONCLUSION: Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.

Freestyle Perforator-Based Fasciocutaneous Flap Reconstruction in Nicolau Syndrome-Related Tissue Necrosis.

The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve direct vascular damage and vasospasm. Many NS cases were reported in the literature but a treatment protocol is still not established. However, after demarcation of the necrotic tissue, surgical intervention is mandatory. Five NS cases with extensive tissue necrosis on the upper lateral gluteal region were analyzed retrospectively. Operative technique was described in details for freestyle perforator-based fasciocutaneous flaps from the gluteal region to reconstruct defects of NS-related tissue necrosis. Freestyle perforator-based fasciocutaneous flaps were used for defect closure in all patients. All flaps survived totally. No complications occurred during the follow-up period. Although rare, NS is a serious complication of inadvertent intramuscular injections. Prevention is the best treatment. However, in case of large-tissue necrosis, freestyle perforator-based fasciocutaneous flaps harvested from the gluteal region is a satisfactory option for reconstruction.

Effects of rolling inhibition on smoke inhalation injury.

Inhalation of chemical and particulate products of smoke is one of the principal determinant of mortality following burn injury. Inflammatory responses have been implicated in the pathogenesis of lung injury after smoke inhalation. In the current study, we tested the inhibitory effect of Fucoidin on the neutrophil rolling stage of inflammatory response and determined the degree of pulmonary injury. Fifteen rats were divided into three groups: sham group (N: 5) of rats inhaled room air; control group (N: 5) inhaled smoke, and experimental group inhaled smoke and received Fucoidin. All the rats were sacrificed 24h after smoke inhalation. The trachea and lungs were removed totally; samples for histopathological and biochemical (myeloperoxidase (MPO)) analysis were taken from each lung and trachea. Morphologic studies using light and electron microscopes showed a decrease in lung parenchymal and tracheoepithelial injury in the experiment group of rats. Also, biochemical analysis of tissue MPO was significantly lower in test group than in control group. These results suggest that the inhibition of neutrophil rolling leads to a reduction of neutrophil invasion to pulmonary parenchyma and trachea, which may be beneficial for attenuating neutrophil mediated inhalation injury.

Lyophilised polyurethane membrane dressing for surgically-separated pseudosyndactyly in epidermolysis bullosa.

The results of paraffin gauze dressing and lyophilised polyurethane membrane dressing were studied in a patient with surgically-separated pseudosyndactyly of dystrophic epidermolysis bullosa. Polyurethane membrane dressing decreased the time to epithelialisation and the need for anaesthesia.

Imaging findings of an extradigital fibro-osseous pseudotumor.

Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superficial variant of myositis ossificans (MO), this rare entity mostly occurs in the subcutaneous tissues of the digits. The FOPT clinicopathological features may mimic a variety of benign and malignant soft tissue lesions, and the diagnosis can be difficult when it arises in an unusual anatomic location. In this report we describe the clinical and radiological features of a case of an FOPT that involved the hypothenar region of the hand.

The effects of combined application of autogenous fibroblast cell culture and full-tissue skin graft (FTSG) on wound healing and contraction in full-thickness tissue defects.

INTRODUCTION: This study investigates the effects of culture grown fibroblasts on contraction and dermal regeneration when used concurrently with full-thickness skin graft (FTSG) in full-thickness wounds. MATERIALS AND METHODS: Fourteen Sprague-Dawley male rats were divided into two groups. In the first group, wound contraction was evaluated visually. Two full thickness tissue defects were produced on the back of the seven rats. The skin harvested from these areas was prepared as a full-thickness graft and sutured back to their original beds. Just before the last suture, autogenous fibroblast suspension was applied between the graft and the bed in area 1, and area 2 served as control. The surface area of grafts were calculated and compared with "Image J" program. In the second group, contraction and dermal regeneration were evaluated histologically. Three full-thickness tissue defects were produced on the back of seven rats. Area 1 and 2 were prepared as described above and area 3 was left to secondary healing. On the 14th and 30th days, punch biopsies were harvested from the center of the areas 1-3. Preparations were examined under light microscopy. RESULTS: Wound contraction was significantly less in area 1 on day 14 (p<0.01). Histologically neovascularization, fibroblast density and collagen synthesis were more evident in cultured fibroblast applied areas on day 14. However epithelialization did not show any difference between areas both on days 14 and 30. On day 30, area 1 still a higher degree of fibroblast intensity than the other areas but neovascularization and collagen synthesis were not different than the other areas. CONCLUSION: According to the data obtained from the study, cultured fibroblasts, particularly with a dermal support, do not regress when transplanted to a living tissue. They contribute to the wound healing process; reduce the contraction of the wound; and support collagen synthesis and neovascularization.