To treat longer defects, further implant development is needed, a goal that could be achieved, for example, by more closely imitating the intact nerve architecture and regulatory cell-cell interactions.

The dominance of the radial or ulnar artery at the forearm level and their contributions to the circulation of the hand remain a matter of contention. Therefore, the authors proposed to investigate the predominance of one of these arteries first by anatomic studies on 40 fresh cadaver upper extremities, and then by dynamic studies. The dynamic studies included color Doppler sonography in 22 individuals (44 hands) and five-channel plethysmography in 40 individuals (40 right hands). It was found that the ulnar artery is dominant at the elbow, but after originating its collateral branches, the radial artery becomes the dominant artery in the distal forearm and, consequently, constitutes the major source of vascularization to the hand. The ulnar artery is rarely dominant at the forearm level and is physiologically less important. Therefore, there is no hemodynamic reason to prefer the radial artery to the ulnar artery for any invasive maneuvers.

Muscle-in-vein conduits may be a good alternative solution to autografts for the reconstruction of digital nerves, since no significant differences could be demonstrated between the two methods.

Background: Despite advances in the monitoring of free flaps, there is still a demand for new technology to detect ischemic complications at an early stage. The aim of the present study was to evaluate the reliability of the O2C-device in terms of detecting flap failure in commonly used perforator flaps for breast reconstruction. Methods: A total of 34 patients undergoing breast reconstruction were involved in this study. The perfusion dynamics of 23 deep inferior epigastric perforator flaps and 11 superior gluteal arterial perforator flaps were assessed using the O2C-device, which combines a laser light, to determine blood flow (flow), velocity, and white light to determine hemoglobin oxygenation (SO 2 ) and relative amount of hemoglobin (rHB). Measurements were carried out intra-operatively after clamping and declamping the perforator vessels. In the post-operative period measurements were carried out every hour for the first 48 hours and from 3rd to 7th for every 2 hours. These dates were compared to findings of clinical assessment. Results: Several intra-operative measurements, during the clamping and declamping the different perforator vessels, revealed a high correlation for all parameters: Flow (r 5 0.89, P < 0. 05), Velo (r 5 0.92, P < 0. 05), SO 2 (r 50.84, P <0. 05), and rHB (r 50.83 P < 0.05). Vessel occlusion was detected in five cases, of which three were due to arterial thrombosis and two further cases were due to venous occlusion. Of the five cases, one flap loss caused by venous occlusion was noted. Conclusion: The O2C-device seems to be a reliable, objective, and non-invasive device for the monitoring of free flaps. Thus, it may improve flap survival rates by detecting vascular compromise at an early stage. V V C 2013 Wiley Periodicals, Inc. Microsurgery 33: 350-357, 2013.

No abstract

Cutaneous scarring observed in wounds is, to a significant degree, dependent upon the time it takes for the wounds to heal. Various topical dressings are proposed to influence healing time in donor sites. In this prospective randomized study, we examined the effect of Vaseline gauze (VD; Branolind, Paul Hartmann AG, Germany), Biobrane (BD; Bertek Pharmaceuticals, Inc., Morgantown, WV), an occlusive film dressing Barrier Flex (OD; Moelnlycke Health Care GmbH, Germany), and an equine collagen foil, Tissu Foil E (CD; Baxter, Heidelberg, Germany), on re-epithelialization and scarring in standardized donor site wounds. At 6 months after surgery, donor site scars and normal uninjured mirror sided skin were evaluated in 33 patients using both the Vancouver Scar Scale (VSS) and the cutometer SEM 575 (Courage and Khazaka). The median healing time for OD was 14 days, BD 16 days, CD 19 days, and VD 19 days. The single parameter pliability of the VSS was not significantly different from uninjured skin when all donor site scars were pooled. No difference was found between the four groups. Viscoelastic analysis of all pooled patient data showed a significant difference for Uf (total deformation), Ua (total recovery), Ur (immediate retraction), Ue (immediate distension), Ur/Ue, and Ur/Uf, indicating that donor sites significantly differed from normal uninjured skin. No significant correlation between objective viscoelastic measurements and the subjective pliability assessment of the VSS was found. Viscoelastic differences were greatest in the VD and BD groups. Viscolelastic differences did not significantly correlate with healing time. Various wound dressings had minimal yet significant influence on healing time and scarring. In contrast to the VSS, viscoelastic measurements of skin pliability can objectify scarring when few differences are anticipated.

No abstract

The authors' combined study showed varying perfusion characteristics between anatomical and clinical settings, which could be caused by a number of complex systemic and local processes. Thus, the selection of the DIEP zones should be assessed individually depending on the anatomy in question and the characteristics of the perforators until the mentioned issues are clarified in detail.