Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

Abstract

A vulsion and degloving injuries are caused by a vast array of mechanisms, machines and situations, in which the hand is injured with low energy shearing forces in a rigid position.[1] These types of injuries have generally been viewed as among the most problematic of injuries to manage due to their extensive nature of associated damage. During degloving injuries, blood vessels having great elasticity, are disembodied and separated with irreversible injury along the entire length of involvement and so are the tendons and nerves. Furthermore in circumferential degloving injuries, the distal flap goes through a state of abrupt ischemia followed by reverse perfusion forming after the reattachment of the flaps back to its' origin. Arnez et al, recently reclassified degloving injuries according to the Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. The purpose of this study is to acknowledge if Sivelestat, known to ameliorate ischemia reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat's effects to Pentoxifylline. Methods: Total flap area (cm 2 ), area of necrosis in the flap (cm 2 ), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups were documented with CD31, anti-PECAM stainings. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis. Results: This study demonstrated that, Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia reperfusion injury more pertinently than Pentoxifylline which exerts only hemorheological effects. Conclusion:The anti-inflammatory effects of Sivelestat, will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline which exerts only hemorheological effects.

Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries

“…For the skin and soft tissue defects of hands and feet, the traditional skin grafts include autologous edge thick skin, medium thick skin, and full thick skin, which are suitable for the repair of different defect depths and defect sites, respectively. ere are more types of flaps, such as various arbitrary flaps, pedicled flaps, perforator vessel flaps, and free flaps [21,22]. e commonly used blade is thick skin, which is easy to survive after transplantation and convenient to obtain materials and will not cause damage to the skin donor area.…”

Hydrogen-rich saline reduces tissue injury and improves skin flap survival on a rat hindlimb degloving injury model

“…In circumferential degloving traumas distal flap area is nourished by reverse perfusion following the ischemic state 16 . The present study aims to investigate the protective effects of HRS on skin flap viability from i/r injury in a rat hindlimb degloving injury model by reducing inflammation and oxidative stress and inducing angiogenesis.…”