Protective Topical Dual-Sided Nanofibrous Hemostatic Dressing Using Mussel and Silk Proteins with Multifunctionality of Hemostasis and Anti-Bacterial Infiltration.

Topical hemostatic agents are preferred for application to sensitive bleeding sites because of their immediate locoregional effects with less tissue damage. However, the majority of commercial hemostatic agents fail to provide stable tissue adhesion to bleeding wounds or act as physical barriers against contaminants. Hence, it has become necessary to investigate biologically favorable materials that can be applied and left within the body post-surgery. In this study, a dual-sided nanofibrous dressing for topical hemostasis is electrospun using a combination of two protein materials: bioengineered mussel adhesive protein (MAP) and silk fibroin (SF). The wound-adhesive inner layer is fabricated using dihydroxyphenylalanine (DOPA)-containing MAP, which promotes blood clotting by aggregation of hemocytes and activation of platelets. The anti-adhesive outer layer is composed of alcohol-treated hydrophobic SF, which has excellent spinnability and mechanical strength for fabrication. Because both proteins are fully biodegradable in vivo and biocompatible, the dressing would be suitable to be left in the body. Through in vivo evaluation using a rat liver damage model, significantly reduced clotting time and blood loss are confirmed, successfully demonstrating that the proposed dual-sided nanofibrous dressing has the right properties and characteristics as a topical hemostatic agent having dual functionality of hemostasis and physical protection.

S6K1 Phosphorylation of H2B Mediates EZH2 Trimethylation of H3: A Determinant of Early Adipogenesis.

S6K1 has been implicated in a number of key metabolic responses, which contribute to obesity. Critical among these is the control of a transcriptional program required for the commitment of mesenchymal stem cells to the adipocytic lineage. However, in contrast to its role in the cytosol, the functions and targets of nuclear S6K1 are unknown. Here, we show that adipogenic stimuli trigger nuclear translocation of S6K1, leading to H2BS36 phosphorylation and recruitment of EZH2 to H3, which mediates H3K27 trimethylation. This blocks Wnt gene expression, inducing the upregulation of PPARγ and Cebpa and driving increased adipogenesis. Consistent with this finding, white adipose tissue from S6K1-deficient mice exhibits no detectable H2BS36 phosphorylation or H3K27 trimethylation, whereas both responses are highly elevated in obese humans or in mice fed a high-fat diet. These findings define an S6K1-dependent mechanism in early adipogenesis, contributing to the promotion of obesity.

Verapamil-containing silicone gel reduces scar hypertrophy.

A hypertrophic scar is a common dermal fibroproliferative lesion usually treated with topical silicone. Verapamil, a type of calcium channel blocker, is considered a candidate drug for the treatment of hypertrophic scars. Here, we report that the addition of verapamil to topical silicone gel enhances treatment outcomes of hypertrophic scars. Upon creation of hypertrophic scars with the rabbit ear model, varying concentrations of verapamil-added silicone gel (0.1, 1, and 10 mg/g) were applied daily for 28 days. After the animals were euthanised, microscopic measurement was performed for (a) scar elevation index (SEI), (b) fibroblast count, and (c) capillary count. On gross analysis, features of hypertrophic scars were significantly alleviated in the verapamil-added groups. On histologic examination, verapamil-added groups showed (a) reduced SEI (1.93 (1.79-2.67) for control vs 1.34 (1.21-1.51) for silicone only and 1.13 (1.01-1.65) for verapamil-added silicone), (b) fibroblast count 700.5 (599.5-838.5) for control, 613.25 (461-762.5) for silicone only, and 347.33 (182.5-527) for verapamil-added silicone), and (c) capillary formation (52 (35.5-96.5) for control, 46 (28-64.5) for silicone only, and 39.83(24-70) for verapamil-added silicone) (Kruskal-Wallis test, P < .05). On western blot, expression levels of collagen I protein was lower in the 1 mg/g and 10 mg/g verapamil-added silicone compared with control. Therefore, we suggest a therapeutic concentration of verapamil-added silicone gel of at least over 1 mg/g. Further study regarding maximally effective concentration and deeper insight into the mechanism of action should follow.

Characterization of cell signaling, morphology, and differentiation potential of human mesenchymal stem cells based on cell adhesion mechanism.

It is essential to characterize the cellular properties of mesenchymal stem cell populations to maintain quality specifications and control in regenerative medicine. Biofunctional materials have been designed as artificial matrices for the stimulation of cell adhesion and specific cellular functions. We have developed recombinant maltose-binding protein (MBP)-fused proteins as artificial adhesion matrices to control human mesenchymal stem cell (hMSC) fate by using an integrin-independent heparin sulfate proteoglycans-mediated cell adhesion. In this study, we characterize cell adhesion-dependent cellular behaviors of human adipose-derived stem cells (hASCs) and human bone marrow stem cells (hBMSCs). We used an MBP-fused basic fibroblast growth factor (MF)-coated surface and fibronectin (FN)-coated surface to restrict and support, respectively, integrin-mediated adhesion. The cells adhered to MF exhibited restricted actin cytoskeleton organization and focal adhesion kinase phosphorylation. The hASCs and hBMSCs exhibited different cytoplasmic projection morphologies on MF. Both hASCs and hBMSCs differentiated more dominantly into osteogenic cells on FN than on MF. In contrast, hASCs differentiated more dominantly into adipogenic cells on MF than on FN, whereas hBMSCs differentiated predominantly into adipogenic cells on FN. The results indicate that hASCs exhibit a competitive differentiation potential (osteogenesis vs. adipogenesis) that depends on the cell adhesion matrix, whereas hBMSCs exhibit both adipogenesis and osteogenesis in integrin-mediated adhesion and thus hBMSCs have noncompetitive differentiation potential. We suggest that comparing differentiation behaviors of hMSCs with the diversity of cell adhesion is an important way to characterize hMSCs for regenerative medicine.

Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant.

The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.

Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years.

BACKGROUND: Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction. PATIENTS AND METHODS: A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3-year period were retrospectively reviewed. Primary microvascular anastomoses were performed to the thoracodorsal vessels in both unipedicled and bipedicled DIEP groups. In bipedicled DIEP flap cases, additional secondary microvascular anastomoses were performed either by extraflap or intraflap options. Clinical characteristics and outcomes were recorded. RESULTS: Unipedicled (n = 89; 53%) and bipedicled flaps were used. Both groups were comparable for mean age, diabetes mellitus, hypertension, smoking, and chemotherapy. BMI was 24.9 ± 3.6 in the unipedicled group and 22.8 ± 2.9 in the bipedicled group (p < .001). The surgical duration was longer in bipedicled group (367 ± 86.5 minu vs 403.7 ± 65.6 min, p < .05) but incidence of fat necrosis decreased in the bipedicle group (24 patients [27%] vs. 7 patients [8.9%] p < .05). There was no flap loss or instance of abdominal hernia in any group. CONCLUSIONS: The bipedicled DIEP flaps may be a feasible option for large breast reconstruction in thin patients. However, the additional microsurgical technical complexity and longer operative time must be considered.

Reconstruction of wide soft tissue defects with extended anterolateral thigh perforator flap turbocharged technique with anteromedial thigh perforator.

BACKGROUND: The necrotic change may sometimes occur in peripheral parts of the flap when harvesting a wide flap in a patient with a relatively thin thigh in anterolateral thigh (ALT) flap. Here, we explore the prophylactic measure of turbocharging the ALT flap with anteromedial thigh (AMT) perforator based on the circumference of the patient's thigh to reduce the risk of partial flap necrosis for the reconstruction of wide defects. PATIENTS AND METHODS: From January 2015 to December 2017, extended ALT perforator turbocharged flaps were done in nine patients. The majority of patients had post oncological or traumatic defects of upper & lower extremities and groin. The age group ranged from 22 to 86 years. The flap size ranged from 12 × 20 cm to 15 × 28 cm. To augment the viability of the ALT flap, we performed an additional microvascular augmentation of the distal or descending branch of the lateral circumflex artery (LCFA) with the sizable AMT perforator. RESULTS: The extended ALT turbocharged flaps survived completely without peripheral necrosis. The average flap width to circumference ratio of the deep tissues including muscles of thigh was 0.379, and the patients' average harvested flaps width and thigh circumference were 14.3 cm and 40.2 cm, respectively. The mean follow-up was 9.3 months. No complications were recorded during the follow-up. CONCLUSION: We believe that augmentation of the ALT and AMT perforator flaps by turbocharging can repair wide soft tissue defects. This method may be another promising option when reconstructing wide defects in the supine position.

Trochanteric area reconstruction with free flap using perforators as recipients: An alternative and effective option.

BACKGROUND: Reconstructing soft tissue defect on the trochanteric area is challenging. Due to the significant complications associated with regional flap, free tissue transfer is an appropriate option. However, this area has poor recipient vessels. Therefore, we present perforators as suitable recipient vessels to facilitate the use of free flap coverage for the successful reconstruction of defects in the trochanteric area. PATIENTS AND METHODS: From 2013 to 2017, 10 patients underwent free flap reconstruction for soft tissue defects of the trochanteric area. After preoperative computed tomography or magnetic resonance imaging images confirmed the enhanced perforating artery, the skin site was identified by Doppler. If the vessel was confirmed as reliable, the operation was performed in the same manner as for other free flaps. RESULTS: All of the flaps survived, and the perforators selected for surgery included four superficial circumflex iliac artery perforators, four tensor fasciae latae artery perforators, and two inferior gluteal artery perforators. The average diameter of the recipient artery was 0.97 mm and that of the vein was 0.94 mm. One case exhibited arterial insufficiency caused by compression of hematoma; however, complete flap survival was achieved in this case with revised surgery. CONCLUSION: Reconstructing soft tissue defects in the trochanteric area is limited in recipient vessels. However, using a perforator vessel as a recipient facilitates the reconstruction by free flap coverage. This method leads to acceptable flap survival and sufficient padding, with reduced morbidity and collateral injury.

Cryopreservation of lipoaspirates: in vitro measurement of the viability of adipose-derived stem cell and lipid peroxidation.

As the storage time of the fat tissue passes by, lipid peroxidation and creation of by-products may take place. The objective of this study was to evaluate the cell viability and functional changes of adipose-derived stem cells (ADSCs) in the cryopreserved lipoaspirates at different temperatures in accordance with lipid peroxidation. Lipoaspirates acquired from liposuction were divided into four different temperature groups and stored at 4°C, -20°C, -80°C, and -196°C. After isolating ADSC from each sample, gross cell morphology and cell viability were compared with doubling time and colony-forming unit (CFU) formation ability. Acid value, that is, thiobarbituric acid value was measured to assess lipid peroxidation. No viable ADSC was observed in -20°C and -196°C samples for past 1 week and a superior number of the live cells were detected in the 4°C group compared with the -80°C group. However, the persistence of cell division and CFU formation after 1 week was only observed in adipocytes stored at -80°C. Lipid peroxidation mainly occurred at 4°C and -20°C storage samples. If the lipoaspirates were planned to be cryopreserved, it is advised to store at -80°C. However, the number of actually functional ADSCs is very low. Furthermore, even in the cryopreserved status, continuous lipid peroxidation and by-product creation took place, suggesting shorter preservation period as possible in the clinics.

Reconstruction of radiation-induced ulcers with free flaps using the perforating vessel as a recipient vessel.

BACKGROUND: Free flaps can be options for coverage of radiation ulcers. However, due to radiation damage, it may be hard to find and dissect a reliable recipient vessel for microsurgical anastomosis. When the radiation fields are targeted for deep tissues, superficial tissues may be less affected by radiation. Therefore, damage to perforator vessels near the skin may be lesser than that to the major vessels in deeper structures. We would like to introduce our experiences of using these less injured perforating vessels within or near the wound as recipient vessels for free flap coverage. PATIENTS AND METHODS: From 2013 to 2015, 11 patients underwent free flap coverage for the treatment of radiation-induced ulceration. The location of ulcers were three cases of thigh, two cases of inguinal area, axilla, trochanteric area, chest wall, lower leg, perineal area, and back. Eleven cases were reconstructed using the anterolateral thigh (ALT) perforator flap, and in one case, the thoracodorsal artery perforator (TDAP) flap was used for inguinal area defect. With preoperative computed tomography, we found perforating vessels around the radiation ulcer. The perforating vessels that were identified before the operation were detected by hand-held Doppler during the operation and meticulous dissection was performed. In all-cases, the perforating vessels were accompanied by vena commitantes. A reliable perforator is one with visible pulsation, strong sound detected on Doppler, and sufficient diameter, preferably larger than 0.6 mm. Anastomosis was performed after confirming that the blood vessel was reliable. RESULTS: The flap sizes ranged from 7 × 6 cm to 24 × 10 cm. No flap total necrosis developed. Patients were followed in the outpatient clinic for 21 to 31 months postoperatively. No patients experienced recurrence of ulceration during the follow-up. CONCLUSIONS: In free flap reconstruction of radiation ulcers, using perforating vessels within or outside the ulcer as recipient vessels provided less damaged vessels and healthier flaps for the defects with minimal wound complications. These perforating vessels can be a good option as recipient vessel for free flap coverage of radiation ulcers.

Comparison of the efficacy and safety of povidone-iodine foam dressing (Betafoam), hydrocellular foam dressing (Allevyn), and petrolatum gauze for split-thickness skin graft donor site dressing.

We evaluated the efficacy and safety of a povidone-iodine (PVP-I) foam dressing (Betafoam) for donor site dressing versus a hydrocellular foam dressing (Allevyn) and petrolatum gauze. This prospective Phase 4 study was conducted between March 2016 and April 2017 at eight sites in Korea. A total of 106 consenting patients (aged ≥ 19 years, scheduled for split-thickness skin graft) were randomised 1:1:1 to PVP-I foam, hydrocellular, or petrolatum gauze dressings for up to 28 days after donor site collection. We assessed time to complete epithelialisation, proportion with complete epithelialisation at Day 14, and wound infection. Epithelialisation time was the shortest with PVP-I foam dressing (12.74 ± 3.51 days) versus hydrocellular foam dressing (16.61 ± 4.45 days; P = 0.0003) and petrolatum gauze (15.06 ± 4.26 days, P = 0.0205). At Day 14, 83.87% of PVP-I foam dressing donor sites had complete epithelialisation, versus 36.36% of hydrocellular foam dressing donor sites (P = 0.0001) and 55.88% of petrolatum gauze donor sites (P = 0.0146). There were no wound infections. Incidence rates of adverse events were comparable across groups (P = 0.1940). PVP-I foam dressing required less time to complete epithelialisation and had a good safety profile.

Perforating vessel as an alternative option of a recipient selection for posterior trunk-free flap reconstruction.

BACKGROUND: The reconstruction of complex defects in the posterior trunk is a challenging problem. Various surgical methods using local flap, propeller flap, and muscle flap have been reported. However, in case where a free flap is inevitable, due to the absence of usable recipient vessels, eventually it may fail to perform or the use of long vessel graft is mandatory. To overcome this problem, we investigated use of perforator as recipient vessel in posterior trunk region and here we report satisfactory outcomes of the cases. PATIENTS AND METHODS: Eighteen cases with posterior trunk defects underwent reconstruction surgeries using various free flaps. Perforating vessels, from either the base or margin of the defect, were evaluated by preoperative computed tomography and hand-held Doppler. During the dissection, preoperatively marked perforators, with visual healthy pulsation and appropriate diameter for anastomosis, were selected and used for a recipient vessel for free flap. RESULTS: Perforating vessels from the posterior trunk (0.8-1.3 mm in diameter) were used as recipient vessels and the average size of the defect was 85.2 cm2 . In all cases, one artery and vein was used for anastomosis. No flap necrosis occurred. Hematoma developed in one case and partial wound disruption developed in 2 cases. CONCLUSION: Surgical method using perforators as recipients for free flap reconstruction can be one of a good treatment option for posterior trunk reconstruction. We think that microsurgeons need not to hesitate when they use perforating vessel as a recipient vessel.

Factors for postoperative complications following pressure ulcer operation: stepwise multiple logistic regression analysis.

Patients with pressure ulcers are generally older, have a long hospital stay and often have a variety of comorbidities. The decision to perform surgery for pressure ulcer management can be difficult because of concerns about the risk of postoperative complications. The aim of this study was to analyse the relationship between comorbid conditions and surgical outcomes in order to guide patient selection for pressure ulcer surgery. In 57 patients, data on age, defect size, operating time, hospital stay, body mass index, surgical site, mobility state, cardiac ischaemic history, diabetes, renal failure, ventilator dependency, tracheostomy state, use of haemodilution therapy and cancer were evaluated using stepwise multiple logistic regression analysis to determine the relationships between variables. There were no postoperative cardiac ischaemic events. Wound complications occurred in 8 patients (14%), pneumonia in 12 patients (21·1%) and mortality in 1 patient (1·7%). The risk of postoperative pneumonia increased 1·069-fold in elderly patients (odds ratio = 1·069, P < 0·05) and increased 44·17-fold in preoperative ventilator users (odds ratio = 44·17, P < 0·05). The risk of wound complication increased 1·012-fold with the presence of a larger defect site (odds ratio = 1·012, P < 0·05) and increased 7·474-fold in patients who received haemodilution therapy (odds ratio = 7·474, P < 0·05). Our results indicate that most comorbid conditions did not significantly affect postoperative cardiopulmonary or wound complications. However, the risk of postoperative pneumonia increased in patients with ventilator use or old age, and the risk of wound complication increased in patients with a large defect size and in those who used haemodilution therapy.

Intramuscular Lipoma-Induced Occipital Neuralgia on the Lesser Occipital Nerve.

Occipital neuralgia (ON) is commonly characterized by a neuralgiform headache accompanied by a paroxysmal burning sensation in the dermatome area of the greater, lesser, or third occipital nerve. The authors report a rare case of ON caused by an intramuscular lipoma originating from the lesser occipital nerve.A 52-year-old man presented with sharp pain in the left postauricular area with a 3 × 2-cm palpable mass. Computed tomography revealed a mass suspiciously resembling an intramuscular lipoma within splenius muscle. In the operation field, a protruding mass causing stretching of the lesser occipital nerve was found. After complete resection, the neuralgiform headache symptom had resolved and the intramuscular lipoma was confirmed through histopathology.Previous studies on the causes of ON have reported that variation in normal anatomic structures results in nerve compression. Occipital neuralgia, however, caused by intramuscular lipomas in splenius muscles have not been previously reported, and the dramatic resolution following surgery makes it an interesting case worth reporting.

Efficacy of one-stage surgical treatment and clinical features in patients with multiple pressure ulcers.

Treating patients with multiple pressure ulcers is a very challenging task for physicians. However, there are very few reports on treatment protocols for multiple pressure ulcers and treatment outcomes. The authors have consistently treated multiple pressure ulcers in a one-stage operation rather than a staged operation. We evaluated multiple pressure ulcers patients who underwent a one-stage operation from 2007 to 2014. A comparison was made between 20 patients who underwent a one-stage operation on 44 foci and 68 patients with a single focus. Though the results, we could conclude that one-stage operation of multiple pressure ulcers was found to have a shorter recovery period and shorter hospitalization without a significant increase in complications.

The effect of diabetes on the wound healing potential of adipose-tissue derived stem cells.

To investigate whether diabetes mellitus affects the wound-healing-promoting potential of adipose tissue-derived stem cells, we designed a wound-healing model using diabetic mice. We compared the degree of wound healing between wounds treated with normal adipose tissue-derived stem cells and wounds treated with diabetic adipose tissue-derived stem cells. We evaluated the wound-healing rate, the epithelial tongue distance, the area of granulation tissue, the number of capillary and the number of Ki-67-stained cells. The wound-healing rate was significantly higher in the normal adipose tissue-derived stem cells group than in the diabetic adipose tissue-derived stem cells group; it was also significantly higher in the normal adipose tissue-derived stem cells group than in the control group. Although the diabetic adipose tissue-derived stem cells group showed a better wound-healing rate than the control group, the difference was not statistically significant. Similar trends were observed for the other parameters examined: re-epithelisation and keratinocyte proliferation; granulation tissue formation; and dermal regeneration. However, with regard to the number of capillary, diabetic adipose tissue-derived stem cells retained their ability to promote neovasculisation and angiogenesis. These results reflect the general impairment of the therapeutic potential of diabetic adipose tissue-derived stem cells in vivo.

Internal pudendal perforator artery-based gull wing flap for vulvovaginal 3D reconstruction after tumour excision: a new flap.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task. A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150°-180° internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume. Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.

Secretory factors of human chorion-derived stem cells enhance activation of human fibroblasts.

BACKGROUND AIMS: Wound healing remains a principal challenge in modern medical science. Chorion-dervied stem cells (CDSCs), isolated from human placenta, have largely been overlooked, and few studies on their potential in wound healing have been conducted. In this study, we investigated the functional characteristics of CDSCs compared with adipose-derived stem cells (ASCs) on human fibroblasts (HFs). METHODS: We analyzed CDSCs by means of flow cytometry to confirm their mesenchymal stromal cell characteristics. We then evaluated the paracrine effects of CDSCs on HFs in a co-culture system and focused on fibroblast proliferation, migration and collagen synthesis. To explore the potential of CDSCs in wound healing, CDSC- and ASC-secreted factors were compared by use of a cytokine antibody array. RESULTS: CDSCs had morphology similar to MSCs and expressed a mesenchymal stromal cell phenotype. HF proliferation and migration increased more than 5-fold when co-cultured with CDSCs. Furthermore, Western blot and reverse transcription-polymerase chain reaction analysis showed that expression of collagen (types I and III) in fibroblasts was upregulated 2-fold when co-cultured with CDSCs. Cytokine array results of CDSC-conditioned medium and ASC-conditioned medium revealed the presence of growth factors known to influence wound healing, including interleukin -6, interleukin -8, monocyte chemotactic protein 1 and regulated on activation, normal T cells expressed and secreted. CONCLUSIONS: Our data demonstrated that CDSCs are functionally similar to ASCs, promote HF activation, and secrete growth factors that influence wound healing. Therefore, we suggest that CDSCs are potentially applicable in wound healing.

Feasibility of a deepithelialized superior gluteal artery perforator propeller flap for various lumbosacral defects.

Skin and soft tissue defects in the lumbosacral area are commonly encountered in the field of reconstructive surgery, and it is well documented that the superior gluteal artery perforator (SGAP) flap provides excellent coverage of these defects. In this article, we describe our experience using a modified version of the SGAP propeller flap, in which the distal redundant portion of an elevated SGAP flap is deepithelialized, thereby maximizing the effect of the soft tissue augmentation. Thirteen patients with lumbosacral soft tissue defects treated between May 2010 and June 2012 were included in this study. The wound causes were pressure ulcer (n = 9), pseudomeningocele (n = 2), and hardware exposure (n = 2). In all patients, an elevated SGAP flap was rotated 180 degrees over the defect area and the extra distal portion of the flap was deepithelialized and used as a soft tissue filler or tamponade. During the follow-up period (mean, 26 months), 12 of 13 flaps survived completely. One flap was totally necrosed due to progressive venous congestion and was reconstructed with local advancement flaps. No further complications were noted. Because of the redundancy and pliability of the tissue in the gluteal area, a flap relatively wider or longer than the defect can be elevated safely. Hence, the redundant tissue volume can be tucked inside to facilitate soft tissue augmentation of the area. We propose that the deepithelialized version of the SGAP propeller flap is an effective option for the reconstruction of various lumbosacral soft tissue defects because it offers thick and healthy soft tissue from a distant site to the defect areas.

Improved skin flap survival in venous ischemia-reperfusion injury with the use of adipose-derived stem cells.

INTRODUCTION: The purpose of this study was to investigate the efficacy of stem cell therapy as an adjuvant treatment for congested skin flap. METHOD: Sprague-Dawley rats (n = 21) were randomized into three groups. In group I, the flap was sutured without venous ischemia. In group II, the vein was selectively clamped for 4 hours, and complete medium was administered upon clamp removal. In group III, ADSCs were administered upon removing the clamp. On postoperative day 7, the survival areas and the histopathologic findings were assessed. In addition, the expression of heme oxygenase (HO)-1 and nuclear factor (NF)-κB was assessed using immunofluorescent staining and western blot analyses. RESULTS: Compared with group II, group III showed significantly increased flap survival (31.2% ± 11.9% vs. 51.6% ± 13.6%, P < 0.05). The degree of histological abnormalities was significantly lower in group III than in group II (9.38% ± 1.39 vs. 6.46% ± 2.57, P < 0.05). In addition, in group III, the expression of NF-κB was significantly lower (0.51 ± 0.21 vs. 0.34 ± 0.21, P < 0.05), whereas that of HO-1 was significantly higher (0.25 ± 0.11 vs. 0.43 ± 0.18, P < 0.01). Immunofluorescent staining also showed more HO-1-positive cells in group III than in group II (10.9% ± 1.6% vs. 16.0% ± 1.7%, P < 0.01). CONCLUSION: Our study demonstrated that treatment with ADSCs significantly increased flap survival in venous ischemia-reperfusion conditions. Further investigation of these protective effects and optimization of the treatment protocol could make cell therapy a viable treatment.