Abstract:
:Although endothelial cell injury and microcirculatory intravascular thrombosis have been implicated in the pathophysiology of skin-flap failure, the basic underlying pathophysiology has not been documented previously. This study focuses on the morphologic changes and the alteration in platelet, fibrinogen, antithrombin III, and von Willebrand factor levels in flaps injured by arterial ischemia and reperfusion. A thrombogenic arterial anastomosis model is compared with simple arterial clamping as methods to achieve flap ischemia. Bilateral buttock skin flaps and latissimus dorsi island flaps were elevated in 12 pigs. All flaps had a primary ischemic insult of 2 hours' duration by simple clamp application. During this interval, a thrombus-generating, microvascular anastomosis was prepared, and during a 2-hour period of reperfusion, laser Doppler and transiluminator monitoring of the vascular pedicle allowed documentation of embolic events from the thrombus-generating anastomosis. In group 1 (n = 6), the flaps were then subjected to 7 (buttock skin) and 5 (latissimus dorsi) hours of complete arterial ischemia by clamping. During the secondary ischemic period, the poor microanastomosis was resected and repaired. Radioactively labeled autologous platelets (111In) and human fibrinogen (125I) were injected intravenously half an hour before secondary reperfusion. After 4 hours of reperfusion, flap biopsies and venous effluent were collected and prepared for electron microscopic analysis. The flaps and control tissue were harvested and the radioactivity was counted. In group 2 (n = 6), flaps were subjected to 6 hours of secondary ischemia by using the same technique as in group 1. Central venous and flap venous blood was sampled at baseline as well as upon immediate secondary reperfusion and after 4 and 8 hours of reperfusion. The hematocrit, platelet count, fibrinogen, antithrombin III, and von Willebrand factor levels were determined for these intervals. Platelets and fibrinogen accumulated significantly in buttock skin flaps and in the latissimus dorsi skin and muscle components as compared with similar control tissue (p < 0.05). There was no significant difference in platelet or fibrinogen accumulation after comparing the two ischemic models. Electron microscopic studies showed occluded capillaries with activated platelets in the flaps. Control tissue showed very little capillary occlusion. Platelet count was significantly decreased both in central venous (p < 0.05) and in adventitial infolding flap venous blood (p < 0.025) during immediate reperfusion as compared with baseline. These findings confirm that microcirculatory intravascular thrombosis is implicated in skin-flap ischemia-reperfusion injury. This study provides physiologic support for treatment modalities aimed at counteracting the various components in the coagulation pathways responsible for thrombus formation.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Hjortdal VE,Sinclair T,Kerrigan CL,Solymoss Sdoi
10.1097/00006534-199402000-00024subject
Has Abstractpub_date
1994-02-01 00:00:00pages
375-85issue
2eissn
0032-1052issn
1529-4242journal_volume
93pub_type
杂志文章abstract:BACKGROUND:The septal extension graft is currently the most commonly used primary and secondary rhinoplasty technique in Asia because it provides maximal tip projection and rotational controllability. The authors compared the tip projection amount and rotational controllability of the tip support between the septal ext...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003920
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Recent publications have implicated computed tomographic scans in the genesis of cancer and developmental delay. To determine whether the imaging protocols used in the authors' craniofacial practice could be harmful, they reviewed patient radiation exposure data for 77 patients. They then reviewed the litera...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181b59d2d
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Sharing and storing digital patient photographs occur daily in plastic surgery. Two major risks associated with the practice, data theft and Health Insurance Portability and Accountability Act (HIPAA) violations, have been dramatically amplified by high-speed data connections and digital camera ubiquity. The...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000001712
更新日期:2015-11-01 00:00:00
abstract::The use of nonpenetrating clips to accomplish wound closure as an alternative to suture in the repair of simulated cleft lips in partially exteriorized fetuses has been described previously. In this study, the fetus is approached endoscopically, and clipped (n = 8) and sutured (n = 4) intrauterine endoscopic repairs i...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199807000-00001
更新日期:1998-07-01 00:00:00
abstract::Three-dimensional surface reconstruction from computed tomographic (CT) data has been used to plan craniofacial operations. Cephalometric and anthropometric databases were integrated with three-dimensional CT reconstructions to quantitate the skeletal deformity and to assist in the design of the surgical procedure. In...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract::In recent studies we demonstrated that platelet emboli induced by arterial injury impair the microcirculation. The present study was performed to determine if heparin or dietary cod liver oil reduces the incidence of emboli following the same arterial injury and, in turn, whether these agents prevent the associated de...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199302000-00020
更新日期:1993-02-01 00:00:00
abstract::One-hundred and fifty consecutive free-tissue transfers were reviewed to evaluate the role of emergent exploration in flap survival. Eleven flaps exhibited signs of circulatory failure between 1 hour and 6 days postoperatively and required return to the operating room. In eight patients the preoperative diagnosis was ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract::A study of our hospital records has confirmed a striking increase in the number of melanoma cases. An examination of the New York State statistics demonstrates a 202 percent increase in the case rate from 1950 to 1971. The Connecticut statistics extending from 1935 to 1972 show an age-adjusted incidence rate increase ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197601000-00010
更新日期:1976-01-01 00:00:00
abstract:BACKGROUND:In 2002, the author implemented a new two-stage approach, "delayed-immediate breast reconstruction," for patients who desire breast reconstruction and who are at an increased risk for conditions necessitating postmastectomy radiotherapy. There is increasing acceptance of this approach in clinical practice. T...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181c82d58
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Since the inception and popularization of microsurgery in the 1960s and 1970s, it has been commonly accepted that the outcome of free tissue transfer directly correlates with surgeon experience. METHODS:The clinical outcomes of three young microsurgeons at a single institution were retrospectively reviewed....
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e318262efdf
更新日期:2012-10-01 00:00:00
abstract::Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. The factors involved in nasal tip support are numerous; however, the role of the anterior septum versus the lower lateral cartilages has been debated in the literature. The purpose of this study was to quantitate, using fres...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199901000-00040
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:It is not easy to find a management-based classification of palatal fistula in the literature. A few attempts have been made to classify the wide variety of fistulae that do not describe the fistula details comprehensively and guide toward its management. The authors have come across a wide variety of fistul...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000005169
更新日期:2019-01-01 00:00:00
abstract::To develop new types of surgical flaps that utilize portions of the skin and subcutaneous tissue (e.g., a thin flap or an adipofascial flap), three-dimensional investigation of the vasculature in the skin and subcutaneous tissue has been anticipated. In the present study, total-body arterial injection and three-dimens...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199809030-00020
更新日期:1998-09-01 00:00:00
abstract::An inflatable breast implant having a detachable filling reservoir is described. Once in position, the implant can be filled under controlled conditions postoperatively. The implant functions either as a tissue expander or as a delayed-filling implant in the initial stages of the procedure. Once the desired breast siz...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198404000-00031
更新日期:1984-04-01 00:00:00
abstract::There are several anecdotal clinical articles claiming wound healing and scar superiority using obsidian (volcanic glass) scalpels. In order to determine if skin incisions made with obsidian were superior to those made with standard surgical steel, wound tensile strength, scar width, and histology were assessed in 40 ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Bariatric surgery, particularly the Roux-en-Y gastric bypass, is currently the most effective method of sustainable weight loss for the morbidly obese patient population. Unfortunately, the nutritional adequacy of the postoperative diet has frequently been overlooked, and in the months to years that follow, ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e31817d6023
更新日期:2008-08-01 00:00:00
abstract::Twelve male cadaver specimens were injected with a latex solution to define the cutaneous blood supply of the penis. The cutaneous blood supply of the penile shaft is derived solely from a pair of axial arteries running in the dartos layer. Additional deep perforating arteries from the dorsal penile artery and corpora...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198902000-00001
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:Craniofacial dysostosis syndromes produce multisutural synostoses combined with severe midfacial retrusion. This may cause serious functional problems, including airway obstruction, exposure of the eyes, visual pathway dysfunction, and raised intracranial pressure. Early midface advancement may be necessary ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000305538.75347.52
更新日期:2008-04-01 00:00:00
abstract::Muscle transplantation has become an indispensable tool to restore the smile in patients with long-standing or congenital facial paralysis. However, little is known of the effect of this surgical intervention on craniofacial growth and development or of the adaptation of the transplant to its recipient site under circ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200001000-00020
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:There is proven therapeutic benefit in bariatric surgery for obese patients. Successful bariatric surgery will result in massive weight loss and ptotic skin, which can cause significant functional and psychological problems. As the incidence of bariatric surgery increases, so will the demand for plastic surg...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/PRS.0000000000000695
更新日期:2014-11-01 00:00:00
abstract::The pathologic cause of both rare craniofacial clefts and congenital limb ring constrictions is the subject of some debate. Uncommon though these two conditions are, they have often been anecdotally reported in association. This study sought to determine the frequency of congenital limb anomalies in general and limb r...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199803000-00010
更新日期:1998-03-01 00:00:00
abstract::Amputated rat hindlimbs were subjected to either normothermic (26 degrees C) or hypothermic (4 degrees C) ischemia. Experimental limbs had their microcirculation washed out (either before or after the ischemic insult) with a physiologic acellular plasma substitute previously reported to enhance flap survival following...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198710000-00020
更新日期:1987-10-01 00:00:00
abstract::Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin excision must: (1) include the nipple-areola complex, (2) include the biopsy site, and (3) allow for access to the axilla for possible dissection. In...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Displaced subcondylar fractures of the mandible are difficult to treat. Open reduction with internal fixation carries significant risks including devascularization of the condylar segment, facial nerve injury, and scarring. Closed treatment with mandibular-maxillary fixation alone accepts a misaligned fractu...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000178047.97112.fa
更新日期:2005-09-15 00:00:00
abstract::The results of the correction of the medial scar depression and diastasis of the pubic hair of the mons veneris in three postpuberal female patients operated on for bladder exstrophy are reported. The reconstructive surgery is carried out using skin expanders. The expanded skin is utilized to create two dermoadipose f...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199303000-00026
更新日期:1993-03-01 00:00:00
abstract::Since the 1970s, anecdotal reports have described a relatively small number of women who received silicone gel breast implants and later developed either a recognized rheumatologic disease or unexplained symptoms suggestive of an autoimmune disorder. The study reported here examined whether there is any association be...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract::Breast cancer is the tumor with the highest prevalence and incidence in women. Reduction mammaplasty is one of the most common procedures performed in Brazil by the plastic surgeon, and it is not uncommon for the surgeon to find a breast tumor during the operation or afterward, when the histopathological report is rec...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000152683.62899.50
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:The current standard of care for the prevention and treatment of scarring after burn injury is pressure garment therapy. Although this therapy has been used clinically for many years, controversy remains regarding its efficacy. The authors evaluated the efficacy of pressure garment therapy in a female red Du...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000001507
更新日期:2015-09-01 00:00:00
abstract::Expeditious yet efficacious removal of skin tumors is a common responsibility for the plastic surgeon. The need to minimize potential risks for mortality or morbidity from undue or excessive surgical resections and to control costs by avoiding unnecessary procedures behooves us to make a precise clinical diagnosis pre...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199804050-00014
更新日期:1998-04-01 00:00:00
abstract::A new method of vaginal reconstruction is reported. In the procedure, the left inferior abdominal wall flap with the subcutaneous pedicle containing epigastric superficial blood vessels and/or the circumflex iliac superficial vessel and the external pudendal vessel and their branches is raised and passed through an im...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198906000-00013
更新日期:1989-06-01 00:00:00