Microsurgery Short Free Papers
Tracks
MR 12
Friday, September 27, 2024 |
9:00 - 10:00 |
MR 12 |
Speaker
Dingsheng Lin
Doctor
The Second Affiliated Hospital Of Wenzhou Medical University
Protective effects of geniposide on the survival of random flaps and the underlying mechanism.
Abstract
Background: Random skin flaps have many applications in plastic and reconstructive surgeries. However, distal flap necrosis restricts wider clinical utility. We evaluated whether geniposide can prolong the survival rate of random skin flaps.
Methods: Modified McFarlane flap models were established in 48 male Sprague-Dawley rats assigned randomly to three groups: a low-dose geniposide group (5 mg/kg/day), a middle-dose geniposide group (25 mg/kg/day), a high-dose geniposide group (50 mg/kg/day) and a control group. On day 7 after flap construction, the survival percentage of the flap model was calculated. H&E was used to evaluate the histopathological status of the flaps and MVD. LDF was used to detect blood perfusion. The levels of SOD and MDA in the middle areas of the flaps were measured to show the level of oxidative stress. The expressions of TLR4, NF-κB, IL-1β, IL-6, TNF-α and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry.
Results: geniposide significantly increased the average survival percentage of the flaps and reduced ischemia and necrosis of the distal end of the flaps. SOD activity significantly increased, while MDA significantly decreased, indicating that geniposide reduces oxidative damage. The expression of inflammatory immunoregulatory proteins (TLR4, NF-κB) was downregulated, and the levels of inflammatory factors (IL-1β, IL-6 and TNF-α) were lower. In addition, geniposide upregulated VEGF expression, promoted angiogenesis, and increased blood perfusion.
Conclusion: In random flap transplantation, a high dose of geniposide is beneficial to flap survival.
Keywords: Flap; geniposide; TLR4/NF-κB signaling pathway; angiogenesis; inflammation; ischemia/reperfusion injury.
Methods: Modified McFarlane flap models were established in 48 male Sprague-Dawley rats assigned randomly to three groups: a low-dose geniposide group (5 mg/kg/day), a middle-dose geniposide group (25 mg/kg/day), a high-dose geniposide group (50 mg/kg/day) and a control group. On day 7 after flap construction, the survival percentage of the flap model was calculated. H&E was used to evaluate the histopathological status of the flaps and MVD. LDF was used to detect blood perfusion. The levels of SOD and MDA in the middle areas of the flaps were measured to show the level of oxidative stress. The expressions of TLR4, NF-κB, IL-1β, IL-6, TNF-α and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry.
Results: geniposide significantly increased the average survival percentage of the flaps and reduced ischemia and necrosis of the distal end of the flaps. SOD activity significantly increased, while MDA significantly decreased, indicating that geniposide reduces oxidative damage. The expression of inflammatory immunoregulatory proteins (TLR4, NF-κB) was downregulated, and the levels of inflammatory factors (IL-1β, IL-6 and TNF-α) were lower. In addition, geniposide upregulated VEGF expression, promoted angiogenesis, and increased blood perfusion.
Conclusion: In random flap transplantation, a high dose of geniposide is beneficial to flap survival.
Keywords: Flap; geniposide; TLR4/NF-κB signaling pathway; angiogenesis; inflammation; ischemia/reperfusion injury.
Yanhao Li
Dorsal metacarpal artery perforated takecopter flap for stump salvage in consecutive multiple-finger necrosis/damage proximal to proximal interphalangeal joint
Abstract
Background:
Smash, avulsion or laceration injury to multiple fingers becomes more and more common. In the group of patients who suffered these injuries to the proximal phalanges, a few of these patients, luckily, received replantation surgery but some of them resulted in avascular or infectious necrosis, while others did not possess indications for replantation. Radical amputation to these fingers may leave inadequate stump bud for prosthesis wearing. Hence, we introduced our dorsal metacarpal artery perforated takecopter flap surgical technique for multiple proximal phalanges salvage and investigated its functional benefits.
Materials and methods:
From 2019 to 2023, 18 fingers of 7 hands in 6 patients received first-stage dorsal metacarpal artery perforated reversed takecopter flap surgery for sectional coverage in consecutive multiple proximal phalanges stumps and second-stage spliting dactylylosis 6 to 8 weeks after the flap surgery. Control group was consist of 10 patients, who received consecutive multiple amputation that left no finger buds for prosthesis wearing. HISS scoring system was used to evaluate the severity of the initial injury and outcomes of these finger stumps were analyzed using DASH scoring system.
Results:
HISS score showed no significant difference in these 16 patients (P=0.638). However, DASH score was significantly improved in takecopter flap surgery group over the control (P<0.01). Temporary infection and abduction limitation was seen in two of the patients in flap surgery group.
Conclusion:
Dorsal metacarpal artery perforated reversed takecopter flap is an ideal method for phalangeal stump salvage, which would be beneficial for prosthesis wearing and hand function remodeling.
Smash, avulsion or laceration injury to multiple fingers becomes more and more common. In the group of patients who suffered these injuries to the proximal phalanges, a few of these patients, luckily, received replantation surgery but some of them resulted in avascular or infectious necrosis, while others did not possess indications for replantation. Radical amputation to these fingers may leave inadequate stump bud for prosthesis wearing. Hence, we introduced our dorsal metacarpal artery perforated takecopter flap surgical technique for multiple proximal phalanges salvage and investigated its functional benefits.
Materials and methods:
From 2019 to 2023, 18 fingers of 7 hands in 6 patients received first-stage dorsal metacarpal artery perforated reversed takecopter flap surgery for sectional coverage in consecutive multiple proximal phalanges stumps and second-stage spliting dactylylosis 6 to 8 weeks after the flap surgery. Control group was consist of 10 patients, who received consecutive multiple amputation that left no finger buds for prosthesis wearing. HISS scoring system was used to evaluate the severity of the initial injury and outcomes of these finger stumps were analyzed using DASH scoring system.
Results:
HISS score showed no significant difference in these 16 patients (P=0.638). However, DASH score was significantly improved in takecopter flap surgery group over the control (P<0.01). Temporary infection and abduction limitation was seen in two of the patients in flap surgery group.
Conclusion:
Dorsal metacarpal artery perforated reversed takecopter flap is an ideal method for phalangeal stump salvage, which would be beneficial for prosthesis wearing and hand function remodeling.
Dingsheng Lin
Doctor
The Second Affiliated Hospital Of Wenzhou Medical University
β-Caryophyllene promotes the survival of random skin flaps by upregulating the PI3K/AKT signaling pathway
Abstract
Background: Flap transplantation is a widely used plastic repair method in surgical operations to fill skin defects caused by various wounds and diseases. However, due to insufficient blood supply, ischemic necrosis often occurs in the distal flap, which affects wound healing and repair. β- Caryophyllene (BCP) has been proven to reduce oxidative stress and inflammatory reactions, have neuroprotective and analgesic effects and play a protective role in organs or tissues that undergo ischemia-reperfusion injury.
Methods: In this study, we built a modified McFarlane random flap model on rat dorsal to evaluate the effect of BCP on the survival of random flaps. After 7 consecutive days of gavage with different doses of BCP, we measured the survivable area ratio, angiogenesis and blood perfusion, tissue inflammation level, apoptosis-related protein, and PI3K/AKT signaling pathway expression of the random flap.
Results: This study found that BCP treatment increased the survival area of the flap in a dose-dependent manner after random flap transplantation in rats. BCP mainly promotes the formation of tissue blood vessels, improves flap blood perfusion, limits the local inflammatory response, and reduces apoptosis. In addition, we demonstrate that BCP works primarily by promoting the expression of PI3K/AKT signaling pathway-related proteins while enhancing the phosphorylation of AKT at Ser473. By using Wortmannin, a selective inhibitor of PI3K, the effects of BCP are eliminated.
Conclusion: BCP can promote the survival of random flaps by upregulating the PI3K/AKT signaling pathway, increasing tissue blood perfusion, and limiting inflammatory response and apoptosis.
Methods: In this study, we built a modified McFarlane random flap model on rat dorsal to evaluate the effect of BCP on the survival of random flaps. After 7 consecutive days of gavage with different doses of BCP, we measured the survivable area ratio, angiogenesis and blood perfusion, tissue inflammation level, apoptosis-related protein, and PI3K/AKT signaling pathway expression of the random flap.
Results: This study found that BCP treatment increased the survival area of the flap in a dose-dependent manner after random flap transplantation in rats. BCP mainly promotes the formation of tissue blood vessels, improves flap blood perfusion, limits the local inflammatory response, and reduces apoptosis. In addition, we demonstrate that BCP works primarily by promoting the expression of PI3K/AKT signaling pathway-related proteins while enhancing the phosphorylation of AKT at Ser473. By using Wortmannin, a selective inhibitor of PI3K, the effects of BCP are eliminated.
Conclusion: BCP can promote the survival of random flaps by upregulating the PI3K/AKT signaling pathway, increasing tissue blood perfusion, and limiting inflammatory response and apoptosis.
Kapil Sugand
Peripheral Nerve And Msk Surgery Fellow
Royal National Orthopaedic Hospital
C7 motor fascicle transfer to spinal accessory nerve for trapezius reanimation: a case series
Abstract
Introduction: Spinal accessory nerve (SAN) paresis is disabling and painful. We aimed to reanimate the spinal accessory nerve using the motor fascicle from the C7 nerve root. Methods: Surgical technique consisted of an anterior supraclavicular approach, divided omohyoid, exposure of upper and middle trunks prior to identify a C7 motor fascicle. Preference was given to a fascicle innervating latissimus dorsi on stimulation. SAN was then identified and cut proximally, with distal end brought through to meet with C7 motor fascicle. Neurorrhaphy was performed with 9/0 nylon suture and fibrin glue. Results: 5 patients with SAN dysfunction were selected for surgery over an 18-year period (2005 onwards). All right-handed, 3 males and 2 females had a median age of 40 years (±8; IQR: 33-48; 95% CI: 27-53), waited for a median time of 22 days (±17; IQR: 7-101; 95% CI: 0-197) until first clinic appointment and decision to surgery, median time of 38 days (±37; IQR: 1-66; 95% CI: 0-101) until surgery from presentation, first clinic follow-up at 12 weeks, and a median follow-up time of 38 months (±3; IQR: 36-40; 95% CI: 4-73). Patient outcomes at first follow up at 3 months included improved pain in 4 patients. By time of discharge shoulder forward flexion was possible between 110-150 degrees in 3 patients while 1 patient has yet to attend her 3-month follow-up. Conclusions: C7 motor fascicle transfer to SAN for its reanimation is a useful and effective procedure to improve range of movement and neuropathic pain.
Dingsheng Lin
Doctor
The Second Affiliated Hospital Of Wenzhou Medical University
Picroside II promotes skin flap survival in rats by inhibiting NLRP3 inflammasome activation and pyroptosis via promoting mitophagy
Abstract
Skin flap repair is a commonly used microsurgical method for wound repair and functional reconstruction in clinical settings. Nevertheless, distal necrosis of skin flaps remains a prevalent issue, with its mechanism not fully understood. Ischemia and hypoxia damage the mitochondrial structure and function in vascular endothelial cells, leading to pyroptosis and skin flap necrosis due to secondary reactive oxygen species, lipids, and peroxide metabolism disorder. Picroside II (PII), a glycoside derivative, a large number of studies have demonstrated the therapeutic potential of PII for the prevention and treatment of inflammatory diseases. In this study, we characterized the therapeutic potential of PII against inflammation and distal flap necrosis and elucidated the underlying mechanisms. We showed that pre-treatment with PII dose-dependently inhibited NLRP3 inflammasome activation in CoCl2-primed human skin fibroblasts (HSF) and human umbilical vein endothelial cells (HUVEC) and improved the flap survival rate in the modified McFarlane flap model, evidenced by attenuated cleaved caspase-1 and mature IL-1β release, reduced ASC speck formation, and subsequent gasdermin D (GSDMD)-mediated pyroptosis. Moreover, PII treatment reversed the diminished mitochondrial activity and ROS production after NLRP3 activation and elevated the expression of LC3-II. Hematoxylin-eosin staining and assay kit results showed that PII treatment reduced tissue pathological damage and oxidative stress levels. In conclusion, PII inhibits NLRP3 inflammasome activation and pyroptosis by promoting mitophagy. These results suggest PII is a promising drug candidate for the treatment of distal flap necrosis and inflammation-related disorders.
Alexandr Kriklivyy
Orthopaedic surgeon
National scientific center of traumatology and orthopedics named after academician N.D.Batpenov
A case report: Replacement of a femoral defect during post-traumatic osteomyelitis with a non-vascularized fibula autograft
Abstract
Background: This clinical case presents the combined technique of the induced membrane technique Masquelet with bone autoplasty of the fibula and fixation of fragments with the Ilizarov frame. Case Presentation: The patient, a 33-year-old female, was injured in a traffic accident. She was hospitalized with an open, multi-comminuted fracture of the right femur with displacement of bone fragments. Primary skeletal traction of the femur was applied. Osteomyelitis developed in the early period following the injury. The patient underwent several revision surgeries with the use of the Ilizarov apparatus, resulting in the formation of a 9.5 cm femoral bone defect. After the first stage, which was the Masquelet technique, the second stage was performed, involving the free autotransplantation of a fragment of the fibula to replace the bone defect of the right femur. The follow-up period for the patient was 60 months. The patient ambulates with full weight-bearing on the operated lower extremity, using a cane for support. The range of motion in the right knee joint is limited, with extension of 180 degrees and flexion of 30 degrees. After 60 months, control radiography of the femur revealed consolidation and integration of the autograft of the fibula. Conclusion: The Masquelet technique allows for the creation of a channel in the area of the defect. The combination of this method with the Ilizarov frame has the potential to prevent tissue perforation by the graft and to reduce the risk of infection around the pins.
Sharafuddeen Mammu
Associate Consultant
Mbbs Ms Ortho
Single stage Great hallux reconstruction with Free wraparound medial Plantar artery flap with Iliac bone graft - A case report
Abstract
Hallux is one of the most important structure in the medial longitudinal arch.Loss or major defects in the hallux can result in abnormalities in the gait cycle.Common cause leading to loss /defect of hallux is trauma.Usual treatment modality for such cases is partial or complete amputation of the toe, leaving it permanently lost. . In the case of tissue loss over hallux, it is very common to treat the soft defect conservatively or do skin grafting. But the loss of tissue leaves a shortened, hypersensitive, and deformed hallux .(1)The main aim of reconstruction is robust soft tissue cover with minimal contour abnormality to permit normal footwear and mobility.
We had a young female presented with gangrenous hallux, Single stage hallux reconstruction with Free wraparound medial Plantar artery flap with Iliac bone graft done.Postoperative period was uneventful resulting in a stable discharge.Patient was able to attend work and function in her premorbid capacities well with a good cosmetic and functional outcome.
We had a young female presented with gangrenous hallux, Single stage hallux reconstruction with Free wraparound medial Plantar artery flap with Iliac bone graft done.Postoperative period was uneventful resulting in a stable discharge.Patient was able to attend work and function in her premorbid capacities well with a good cosmetic and functional outcome.
Baris Sari
Resident Medical Doctor
ADANA CITY HOSPITAL
Bipedicled fibular flap results in distal tibia bone and soft tissue defects
Abstract
Purpose: To evaluate the effectiveness of reconstruction with bipedicled fibular flap in patients with distal tibia bone and soft tissue defects. Materials and Methods: 10 patients with distal tibia bone and soft tissue defects were included . The aim of the treatment was to control infection and restore defective bone integrity. Functional, radiographic results and complications were evaluated according to Paley criteria. Results: 6 of the patients were men. The average age was 33 years (range, 25-50). The patients were followed for an average of 24 months (min 6, max 36 months). In deep tissue cultures of patients; Staphylococcus aureus (n:5), pseudomonas aeruginosa (n:3) grew, and bacteria did not grow in 2 patients. Superficial skin necrosis developed in one patient postoperatively. In one patient, the infection continued even though union was achieved. Union was observed in all patients after 12 months (min 7-max 11 months). According to Paley criteria, 6 patients (60%) had excellent radiological scores, 2 patients (20%) had good radiological scores, and 2 patients (20%) had reasonable radiological scores. In terms of tibial function, excellent results were obtained in 6 (60%) patients. Conclusion: The distal tibia is a region where reconstruction options are quite limited. We think that the bipedicled fibular flap is a reliable technique in the repair of bone and soft tissue defects in the distal 1/3 of the tibia. Minimal bleeding, short operation time and short learning curve are among the advantages of this technique.
Key words: Distal tibia, bone defect, bipedicled fibular flap
Key words: Distal tibia, bone defect, bipedicled fibular flap
Shibin Tao
PhD student
The Second Xiangya Hospital of Central South University
Modified medial gastrocnemius myocutaneous flap with extended boundaries: anatomical research and a clinical series
Abstract
Introduction:This study aimed to investigate the vascular anatomical basis and clinical reliability of the modified MGM flap with extended anterior, inferior and/or posterior boundaries. Methods: Five fresh lower limb specimens from patients with recurrent tumors in the thigh were immediately irrigated and perfused.The stripped integuments were radiographed.The pretibial skin was equally divided into nine zones.The modified MGM flap viability was documented in 33 patients. Results: True anastomotic connections existed among the branches of the saphenous artery, the perforator from the inferior medial genicular artery and 3–5 (mean, 4.5) perforators from the posterior tibial artery in the upper two-thirds of leg. The anterior margins of 26 modified flaps with extended anterior boundaries exceeded the medial edge of the tibia by 1.0–4.5 cm (mean, 2.1 cm). Fourteen modified MGM flaps were used to repair the defects involving the lower third leg, whose distal edges were located in the seventh (n = 8) or eighth (n = 6) zone. A 1–169 month follow-up was conducted for 33 patients. Of the 33 flaps, 29 (87.9 %) survived completely, partial necrosis occurred in four flaps with extended anterior (n = 2) or inferior (n = 2) boundaries. Conclusions: Multiple source vessels are the vascular anatomical basis of the modified MGM flap with extended anterior, posterior and/or inferior boundaries.The modification of the MGM flap is feasible and reliable, broadening the applicable scope of the flap. The modified MGM flap can be applied to repair more distal, wider and larger-area defects with a simpler design and procedure.
Qingtang Zhu
The reliability of a WeChat mini program-based method for the movement monitoring of patients with total brachial plexus injuries
Abstract
Background: Patients with total brachial plexus injuries (TBPI) usually need long-term follow-up. The frequent hospital visiting could be exhausting for these patients. With the help of social media platforms and human pose estimation algorithms, it is possible to monitor the motor function recovery of TBPI patients at a distance. However, the reliability of this method is still unclear. Materials and methods: We established a WeChat mini program to deliver the tele-assessment service for TBPI patients. To verify the reliability of this method, we retrospectively collected movement images of patients with TBPI. These images were analyzed through the program, and the results of measurements were accomplished by an HPE algorithm (BlazePose). The results were compared to the outcomes of photography-based goniometry to assess the reliability. The mean difference between the two methods was calculated. The Altman-Bland analysis evaluated the limit of agreement and the reliability was investigated by the intra-class correlation coefficients.Results: A total of 1241 images of 177 patients were collected for this analysis. The mean difference between the two methods ranged from 0.05 to 2.84. The results of the Altman-Bland analysis indicated that the limit agreement ranged from -10.29 to 7.99. The intra-class correlation coefficients also showed high agreement between the two methods, with the value from 0.930 to 0.994.Conclusion: Our results developed a WeChat mini program for the tele-assessment of TBPI patients and found that it is comparable to photography-based goniometry. The proposed method could be a valuable tool in the motor recovery monitoring of TBPI patients.
Moderator
Mohammed Mostafa Kotb
Professor
ASSIUT university
Slađana Matić
Head Of Department For Hand Surgery And Microsurgery
University Clinical Center Of Serbia