Although ischemia-reperfusion (I/R) strongly influences muscle flap survival in reconstructive surgery, there is limited knowledge about its relation to hemorheological parameters and oxidative stress markers in flaps. In the present study we investigated these changes during I/R of latissimus dorsi muscle (LDM) flaps in beagle dogs. In four animals LDM flaps were prepared bilaterally. The right side served as control, while the left side's vascular pedicle was clamped for 60 minutes, and a 60-minute reperfusion was allowed afterward. Blood samples (0.5 ml each) were taken from the pedicle's vein bilaterally before and after the ischemia, and at the 5th, 15th, 30th, 45th, and 60th minutes of the reperfusion, for hematological and erythrocyte aggregation tests. In muscle biopsies, taken before and after I/R, histological investigations and tests for measuring gluthation-peroxidase (GSH-PX) activity, glutathione (GSH) and carbonyl concentrations, and thiobarbituric acid reactive substances (TBARS) content were carried out. In I/R side leukocyte count increased during the reperfusion with a peak at the 30th minute. Hematocrit continuously increased from the 15th minute. In the first 5 minutes of the reperfusion, erythrocyte aggregation increased, than tented to be normalized. In muscle homogenates GSH-PX activity did not change markedly, GSH content slightly decreased, carbonyl and TBARS content increased during reperfusion. A 1-hour ischemia and reperfusion of LDM flaps caused local changes of leukocyte distribution and erythrocyte aggregation, supposedly due to the metabolic and inflammatory reactions. Oxidative damage during reperfusion was also demonstrated.

PURPOSE:To examine how the ischemia-reperfusion injury of latissimus dorsi-cutaneous maximus (LDCM) musculocutaneous flap affects the microcirculatory (flap's skin surface) and hemorheological parameters, and whether an intraoperative deterioration would predictively suggest flap failure in the postoperative period. METHODS:Ten healthy male rats were subjected to the study. In Group I the left flap was sutured back after 2-hour, while the contralateral side was right after its elevation. In Group II the same technique was applied, but the pedicle of the left flap was atraumatically clamped for 2-hour. The contralateral side was left intact. On the flap skin surface laser Doppler tissue flowmetry measurements were done before and after and during the protocols applied in the groups. Microcirculatory and hemorheological examinations were done postoperatively. RESULTS:The microcirculatory parameters significantly decreased during immobilization and ischemia. Afterwards, all the regions showed normalization. In the retrospective analysis there was a prominent difference between the microcirculatory parameters of necrotic and survived flap during the early postoperative days (1-3) in Group II. Erythrocyte aggregation and deformability showed only slight differences.CONCLUSIONS: Two-hour ischemia and reperfusion caused deterioration in latissimus dorsi-cutaneous maximus flap microcirculation.Predicting the possible postoperative complication, the intraoperative laser Doppler measurement can be informative.

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull.

Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue into the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 3rd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.

Authors report the application of Integra dermal regeneration matrix in 10 patients in 12 indications (ages 25-74 years, 6 female and 4 male patients). The smallest reconstructed area was 6 cm2, the largest was 500 cm2. Skin coverage was needed on the lower arm in two patients, on the lower arm and the hand in two patients and on the hand in six patients. Skin grafting onto the neodermis was made on days 19-25. The take rate of Integra was equal or higher than 97%, and the take rate of the skin graft was equal or higher than 90%. Integra dermal regeneration template proved to be suitable for the management of complex wounds on the hands and upper extremities.

a flap harvested and transferred on the first superficial perforating branch(es) of the inferior gluteal artery offers a definitive and recurrence-free surgical solution for SDC.

We hypothesized that isolated small veins (similarly arterioles) develop an appreciable myogenic tone in response to elevation of intraluminal pressure and aimed to elucidate the constrictor mechanism(s) involved. Thus small veins were isolated from gracilis muscle of male Wistar rats, then cannulated and incubated in the presence of 10 mmHg of intraluminal pressure at T = 37°C in a special pressure myograph chamber. Isolated small veins developed a substantial myogenic tone in response to increases in intraluminal pressure (from 1 to 12 mmHg). Calculated maximum myogenic tone was 70 ( 5 % of PD at 10 mmHg. Presence of indomethacin or catalase or SQ 29,548 reduced significantly the pressure‐induced myogenic tone. Also, H2O2 (10‐9‐10‐5 M) elicited concentration dependent constrictions, which were inhibited by the indomethacin or SQ 29,548. Arachidonic acid (10‐7–10‐4M) elicited concentration dependent constrictions, which were inhibited by indomethacin or SQ 29,548. In conclusion, in isolated small veins, 1) increases in pressure and H2O2 elicit substantial constrictons, both of which are inhibited by catalase, indomethacin or SQ 29,548 suggesting that the myogenic mechanism is mediated by H2O2 ‐induced arachidonic acid derived constrictor metabolite(s) such as prostaglandin H2/thromboxane A2 acting on TP receptors.Support: AHA Founders Aff. 0855910D and Hungarian Sci. Res. Funds, OTKA‐T48376.

Advanced heart failure (HF) is one of the leading causes of mortality and morbidity. With an aging population, its prevalence is expected to rise further. Although orthotopic heart transplantation (HTX) remains the gold standard in therapy, there is a significant deficiency in the ratio of donor organs to recipient patients. Left ventricular assist devices (LVAD) could relieve this problem either as a bridge-to-transplant (BTT) or as a destination therapy (DT). Despite the widespread implantation of ventricular assist devices, their efficacy may be limited by some serious adverse events, while infection is a major issue. A longer period of LVAD support significantly increases the risk of driveline infections (DLI). The Jarvik 2000® ventricular assist device (Jarvik Heart, New York, NY, USA) offers prolonged infection-free survival. In our report, we present the case of a 61-year-old female patient with a driveline pedestal that has become fully detached from the skull following a fall trauma. We describe how the traumatized pedestal was surgically replaced by removing the previous, damaged unit and inserting a repositioned new one. The surgical procedure presented in our case has not been performed before and we have not found any similar one in the literature. It requires individual surgical planning and a multidisciplinary surgeon’s team to ensure the procedure is safe and feasible.