Flap necrosis is the most frequent postoperative complication encountered in reconstructive surgery. We elucidated whether adipose-derived stem cells (ADSCs) and their derivatives might induce neovascularization and protect skin flaps during ischemia/reperfusion (I/R) injury. Flaps were subjected to 3 hours of ischemia by ligating long thoracic vessels and then to blood reperfusion. Qtracker-labeled ADSCs, ADSCs in conditioned medium (ADSC-CM), or ADSC exosomes (ADSC-Exo) were injected into the flaps. These treatments led to significantly increased flap survival and capillary density compared with I/R on postoperative day 5. IL-6 levels in the cell lysates or in conditioned medium were significantly higher in ADSCs than in Hs68 fibroblasts. ADSC-CM and ADSC-Exo increased tube formation. This result was corroborated by a strong decrease in skin repair after adding IL-6-neutralizing antibodies or small interfering RNA for IL-6 ADSCs. ADSC transplantation also increased flap recovery in I/R injury of IL-6-knockout mice. IL-6 was secreted from ADSCs through signal transducer and activator of transcription phosphorylation, and then IL-6 stimulated angiogenesis and enhanced recovery after I/R injury by the classic signaling pathway. The mechanism of skin recovery includes the direct differentiation of ADSCs into endothelial cells and the indirect effect of IL-6 released from ADSCs. ADSC-CM and ADSC-Exo could be used as off-the-shelf products for this therapy.

The most common postoperative complication after reconstructive surgery is flap necrosis. Adipose-derived stem cells (ADSCs) and their secretomes are reported to mediate skin repair. This study was designed to investigate whether conditioned media from ADSCs (ADSC-CM) protects ischemia/reperfusion- (I/R-) induced injury in skin flaps by promoting cell proliferation and increasing the number of hair follicles. The mouse flap model of ischemia was ligating the long thoracic vessels for 3 h, followed by blood reperfusion. ADSC-CM was administered to the flaps, and their survival was observed on postoperative day 5. ADSC-CM treatment led to a significant increase in cell proliferation and the number of hair follicles. IL-6 levels in the lysate and CM from ADSCs were significantly higher than those from Hs68 fibroblasts. Furthermore, a strong decrease in cell proliferation and the number of hair follicles was observed after treatment with IL-6-neutralizing antibodies or si-IL-6-ADSC. In addition, ADSC transplantation increased flap repair, cell proliferation, and hair follicle number in I/R injury of IL-6-knockout mice. In conclusion, IL-6 secreted from ADSCs promotes the survival of I/R-induced flaps by increasing cell proliferation and the number of hair follicles. ADSCs represent a promising therapy for preventing skin flap necrosis following reconstructive and plastic surgery.

Objective:This study examines the 2009 patient operating room (OR) length of stay data for a medical center in Taipei City. Using a statistical method based on regression analysis, the crucial factors that influence OR efficiency and performance were identified. The analytical results indicated that surgical procedures with general anesthesia and high surgical complexity incurred high surgical fees. Additionally, the anesthesia fees, operating time, and operating time variance rises as the squared number of surgical procedures increases. Therefore, for the hospitals 2010 OR scheduling management strategy, we adjusted the priority regulations for daily OR use to enhance the safety and quality of surgical patient health care and improve OR efficiency.Method:We collected 11 case ORs, that is, 9 inpatient and 2 outpatient ORs, for this study. The pre-implementation data were collected between January 1, 2009, and December 31, 2009. The post-implementation data were collected between January 1, 2010, and December 31, 2010; both forms of data included patients OR length of stay information. Furthermore, the indicators that were compared and analyzed for this study included variances in the number of cases in which general anesthesia was administered, the number of scheduled surgical procedures, the number of emergency surgical procedures, and OR use rates.Results:A total of 20,731 surgical operations were performed in 2009, among which general anesthesia was administered 6,925 times, 10,122 scheduled surgical procedures were performed, 1,305 emergency surgical procedures were performed, and the OR use rate was 70.30%. A total of 21,105 surgical operations were performed in 2010, among which general anesthesia was administered 7,106 times, 10,549 scheduled surgical procedures were performed, 1,319 emergency surgical procedures were performed, and the OR use rate was 71.05%.