Annals of plastic surgery
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Annals of plastic surgery · Jul 2006
ATP-sensitive potassium channels mediate the anti-ischemic properties of ischemic and pharmacologic preconditioning in rat random-pattern skin flap.
Ischemic preconditioning (IPC) and pharmacologic preconditioning by morphine and adenosine may significantly decrease the amount of necrosis in rat random pattern skin flaps. We examined the role of ATP-sensitive potassium channels (K(ATP) channels) in mediating these protective phenomenon by using glibenclamide a nonspecific blocker of these channels. We also investigated whether administration of diazoxide an opener of the K(ATP) channels could mimic the same protective effect. ⋯ IPC and pharmacologic preconditioning with morphine, adenosine, and diazoxide (in higher doses; 1, 5, and 15 mg/flap) improved survival area compared with the control group. Glibenclamide abolished their protective effect. K(ATP) channels may have a key role in anti-ischemic properties of IPC and pharmacologic preconditioning.
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Annals of plastic surgery · Jun 2006
Comparative Study Clinical TrialClinical experiences with a new tourniquet device.
Cessation of blood flow to the extremity improves the comfort of the surgeon. So pneumatic tourniquets are commonly used to obtain a bloodless field during upper- and lower-extremity surgery despite the several problems that tourniquet pressure may lead to. In this paper, we present our clinical experiences with a new tourniquet device called S-MART (OHK Medical Devices, Haifa, Israel) and compared the device with the traditional pneumatic tourniquet in terms of efficacy and complications. ⋯ No major complications were observed in either group. But it was observed that S-MART was unsuccessful to maintain a bloodless field during the whole operative procedure in some of the cases. In conclusion, application of S-MART is practical, provides bloodless field for a certain time, and does not increase the complication rate related with the pressure applied to underlying tissues, but it is not a suitable tourniquet device for long surgical procedures.
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Annals of plastic surgery · Jun 2006
Case ReportsDonor side selection in mandibular reconstruction using a free fibular osteocutaneous flap.
While the free fibular osteocutaneous flap is indispensable for mandibular reconstruction, reliable setting is often difficult because relative positions of the bone, skin island, and vascular pedicle are critical. We have an algorithm for donor-side selection of free fibular osteocutaneous flap. From July 2002 to March 2004, we performed 15 mandibular reconstructions using free fibular osteocutaneous flaps. ⋯ In type IV (flap ipsilateral to defect, n = 1), the skin island was fixed to the facial skin and the vascular pedicle arose from the posterior aspect. Flaps took completely except in 1 group II case with partial necrosis. Close attention to geometric characteristics of a free fibular osteocutaneous flap facilitates reconstruction of mandibular defects and selection of donor side.
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A 10-year experience with breast reconstruction in a university hospital was recently reviewed. The purpose of this study was to determine the subtypes of breast reconstructive procedures and to evaluate the frequency and change in technique over time of free TRAM (transverse rectus abdominis muscle) flap breast reconstruction performed at one institution. Trends in the development of the procedure over this period were also reviewed. ⋯ The experience with free tissue breast reconstruction reveals predominant use of the TRAM flap. This is justified by the reliability of this flap and the advances in achieving esthetic breast reconstruction. Additionally, we have begun performing DIEP free-flap reconstructions. Our clinical practice has evolved concurrent with standards of care, as noted by the increase in use of muscle-sparing techniques and the reduction in the use of dextran. We do not routinely use therapeutic anticoagulation in our cases. Our hospital length of stay and average intensive care length of stay have also decreased over time, consistent with a system-wide effort to increase the efficiency of healthcare delivery.