Soner Tatlidede

Combination of stromal cell-derived factor-1 and collagen-glycosaminoglycan scaffold delays contraction and accelerates reepithelialization of dermal wounds in wild-type mice

While dermal substitutes can mitigate scarring and wound contraction, a significant drawback of current dermal replacement technologies is the apparent delay in vascular ingrowth compared with conventional skin grafts. Herein, we examined the effect of the chemokine stromal cell‐derived factor‐1 (SDF‐1) on the performance of a porous collagen–glycosaminoglycan dermal analog in excisional wounds in mice. C57BL/6 mice with 1 cm × 1 cm dorsal full‐thickness wounds were covered with a collagen–glycosaminoglycan scaffold, followed by four daily topical applications of 1 μg SDF‐1 or phosphate‐buffered saline vehicle. Some animals were also pretreated with five daily doses of 300 mg/kg granulocyte colony‐stimulating factor. Animals treated with SDF‐1 and no granulocyte colony‐stimulating factor reepithelialized 36% faster than vehicle controls (16 vs. 25 days), and exhibited less wound contraction on postwounding day 18 (∼35% greater wound area) plus three‐fold longer neoepidermis formed than controls. Conversely, granulocyte colony‐stimulating factor promoted contraction and no epidermal regeneration. Early (postwounding Day 3) inflammatory cell infiltration in the SDF‐1‐treated group was 86% less, while the fraction of proliferating cells (positive Ki67 staining) was 32% more, when compared with controls. These results suggest that SDF‐1 simultaneously delays contraction and promotes reepithelialization and may improve the wound‐healing performance of skin substitutes.

Lower lip reconstruction with local neuromusculocutaneous advancement flap

Various reconstruction techniques, using the remaining lip or the adjacent cheek tissue, have been described for the repair of lower lip defects. With these techniques, microstomia, commissural distortion, functional insufficiency, and sensorial loss might be observed. The authors describe a technique of lower lip reconstruction with preservation of neuromuscular tissue as a single-stage procedure. Lip sensation and orbicularis oris muscle function are preserved. Fifteen patients with lower lip defects, after tumour ablation or after traumatic loss, were treated by this technique. The only prerequisite for the application of this technique is the availability of at least 20% of the remaining lip tissue. Satisfactory functional, aesthetical, and sensational results were obtained.

A Novel Murine Island Skin Flap for Ischemic Preconditioning

BACKGROUND Ischemia reperfusion injury is a well-known phenomenon affecting skin flap viability. One method to improve flap viability is ischemic preconditioning. Previous murine flap models used random flaps. We developed a single pedicle island skin flap which allows us to create true ischemia by clamping the single pedicle. Our first aim was to describe a novel murine skin flap model with a definable, reproducible injury. Our second aim was to test the usefulness of this model by demonstrating mitigation of injury via ischemic preconditioning. MATERIALS AND METHODS Dorsal lateral thoracic artery pedicle island skin flaps (3.5 x 1.5 cm) were elevated in 39 male C57/BL6 mice: a Control group (n = 7), 10 h of ischemia (n = 21), and Preconditioning (2 cycles of 20 min ischemia: 20 minutes reperfusion) + 10-h ischemia (n = 11). After flap elevation, a silicon sheet barrier was placed. The axial pedicles were occluded, and the flaps were inset with 6-0 prolene. In all mice, ischemia was followed by 1 wk of reperfusion. At 1 wk, percent necrosis was measured and an analysis of variance was performed. RESULTS The percent of flap necrosis was 1.1% +/- 1.11% in controls. Animals that were subjected to 10 h of ischemia developed 33.14% +/- 7.23% necrosis. Preconditioned animals that underwent 10 h of ischemia demonstrated a 43% reduction in necrosis (18.82% +/- 5.68%). There was a statistically significant difference among all groups (P < or = 0.001). CONCLUSION Rat models have been the standard for skin flap experiments. We have developed a novel murine single pedicle island skin flap model with reproducible injury. This model has numerous advantages, including ease of handling, low cost, appropriateness for biomedical studies, and the availability of genetically altered animals. We also confirmed this models usefulness in a study of mitigation of ischemia reperfusion injury through ischemic preconditioning.

Improved Survival of Murine Island Skin Flaps by Prevention of Reperfusion Injury

Background: Studies have demonstrated that blocking a single specificity of self-reactive immunoglobulin M with a 12–amino acid peptide mimic of the antigen of immunoglobulin M can attenuate murine intestinal and skeletal muscle injury following ischemia and reperfusion. The aim of this study was to ascertain whether peptide (P8) had protective effects in an axial island skin flap model, where tissue loss is attributed to ischemia-reperfusion injury. Methods: Dorsal lateral thoracic artery island skin flaps (3.5 × 1.5 cm) were elevated in 82 male C57BL/6 mice and rendered ischemic for 10 hours by placing a 7-mm microclamp on the vascular pedicle followed by 7 days of reperfusion. Group I (n = 7), the sham group, had no clamp placed. Group II (n = 21) had clamp placement but no other treatment. Thirty minutes before clamp placement, group III (n = 18) received 0.25 cc of saline intravenously, group IV (n = 18) received 25 &mgr;g/0.25 cc P8 peptide, and group V (n = 7) received 25 &mgr;g/0.25 cc random 12-mer peptide. Animals in group VI (n = 11) underwent two cycles of 20 minutes of ischemic preconditioning before 10 hours of ischemia. After 1 week of reperfusion, percent necrosis was measured and results were compared using analysis of variance and an unpaired t test. Results: In animals treated with P8 peptide, flap necrosis was 14.61 ± 2.77 percent. This represents a statistically significant, 56 percent reduction in flap necrosis compared with controls (p < 0.001). Conclusion: These data demonstrate that prevention of ischemia-reperfusion injury with P8 peptide produces a significant reduction in necrosis of treated flaps.

A new technique in nipple reconstruction: dome technique with double pedicle.

Background:One of the main steps for satisfactory breast reconstruction is symmetrical nipple reconstruction in an ideal position and projection. Various techniques, using cartilage, bone, fat, and even hydroxyapatite crystals, have been proposed to overcome projection loss in late term. Method:We present a new nipple reconstruction technique performed in 6 cases. In this technique, the nipple dome is nourished by a double pedicle and supported by lateral flaps. Nipple projection is secured with 4/0 nylon sutures, which are applied between pedicles. Skin excess is advanced to the donor areas of nipple flaps. Results:All patients were discharged the day after the operation, and nipple flaps healed well. No projection loss was noted in the 8- to 12-month follow-up period. Areola shape and consistency were acceptable. Conclusion:Due to the presence of a double pedicle, this technique is especially helpful for patients with possible circulatory problems. Tension-free closure and rich blood supply to the nipple dome prevent loss of projection in the late term.

A useful tool for intraoperative photography: underwater camera case.

The use of cameras in the operating room is increasing. However, there is not always a free person or an assistant who is familiar with your camera. In order to take faster and high quality photographs in the operating room, we use under water camera cases. These cases are produced for each type of camera and can be gas sterilized prior to operation.

Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study.

Abstract Objectives: Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. Methods: The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre + post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded. Results: The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p = 0.01 and p = 0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre + post-con group on Day 7 (p = 0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre + post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap. Conclusion: The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.

An Alternative Low-Cost Illumination Apparatus for Surgical Procedures

Dear Editor, Illumination is an important element for conducting surgical procedures and is commonly provided by ceiling lamps in a standard operating room. While operating at deep tissues or narrow regions, using forehead lamps and/or lighted retractors are advantageous to avoid having miosis (ie, reduced ability of seeing of deep and poorly illuminated regions) in a strongly illuminated environment. Insufficient ceiling illumination could be listed as another reason for the need for additional illumination equipment. However, it is reported that such equipment can put the sterility of the operating area at risk. In addition, surgeons sometimes have difficulties while wearing forehead lamps since the position of the lamp could easily alter during an operation, leading to discomfort. Fiberoptic light sources mounted on retractors are usually the best option for working in deep regions; however, the direction of the light is limited by the fixed retractor. Even though they are defined as cold light sources, the temperature may rise on metal connections and harm the patient. Last but not the least, this kind of equipment is usually expensive. As an alternative approach, we build a mini-LED system to produce local cold illumination. This system is composed of 4.5 V LED(s) and single strand copper wire (coated) of varying thickness. As a power source, a variable (3-12 V) AC-DC power adapter (ATABA, Istanbul, Turkey) is used. LED(s) and wire are soldered together, and the junction is covered with heat-resistant silicon material to prevent short-circuit. Plastic heatshrinkable material is used to cover the cables from LED(s) to the power adapter connection port. A proper device can be chosen to connect the power adapter and the cable. The length of the system, which is sterilized with ethylene oxide, is 2 meters, and this distance protects it from any connection with nonsterile power source. The total cost of this specific configuration is detailed in Table 1. The approximate cost of this apparatus is

Does vitamin B alter the efficacy of botulinum toxin

2.50 excluding the power adapter, because only 1 power adapter is enough to supply many systems. Our design is composed of 1 or 4 LEDs, 4 meters of cable (2 meters + 2 meters—polarization), a 2-meter plastic heat-shrinkable tube, and 5-cc heat-resistant silicon. To achieve stronger illumination and better duration, we can use this combination of multiple LEDs and thicker cables. Additionally, this system is suitable as a lighting retractor if cable thickness is increased. We have been routinely using these systems in our clinic for intraoral procedures, rhinoplasty, augmentation mammaplasty, and similar operations. Undoubtedly, our illumination system is an effective cold light source. This system could be attached to retractors (with sterile strips, etc) or used alone. The type of cable may vary to give the ideal flexibility and malleability for specific procedures. Batteries or a power adapter can be used as an energy source depending on operating conditions. The current apparatus is the first-generation design tested continuously in our clinic in case of need for extra 535861 SRIXXX10.1177/1553350614535861Surgical InnovationGörgülü et al research-article2014

Effects of vinblastine on microvascular anastomosis healing in diabetic rats.

Botulinum toxin prevents acetylcholine release at motor nerve terminals. Group B vitamins (B-vit) are essential for proper nerve function. The present study addresses the question of whether B-vit accelerate recovery in rat skeletal muscle after botulinum toxin A (Btx-A) injection. Forty-four adult male Wistar albino rats were used in this experimental study. Rats were divided into three groups: group 1 rats were given Btx-A injection only, group 2 rats were given B-vit supplementation before Btx-A injection, and group 3 rats were given Btx-A and B-vit injections together. During the experiment, compound muscle action potential (CMAP) of the gastrocnemius muscle was recorded before Btx-A injection and sequentially ten times after toxin injection. The statistical significance of the CMAP amplitude change among the groups was analyzed. All groups showed similar amplitude change between consecutive measurement points. In conclusion, combining Btx-A injection with B-vit supplement does not decrease the efficacy of the toxin.