Frontalis sling operation with deep temporal fascial graft in blepharoptosis repair

WOS: 000173102600038PubMed: 11786820

Prefabrication of a free peripheral nerve graft following implantation on an arteriovenous pedicle

WOS: 000175839800005PubMed: 12022033Extensive nerve injuries frequently necessitate the use of long autografts, and sources of expendable donor nerves are limited. It is for these cases that nerve transplantation would have its greatest potential. However, regeneration in the rejected allograft fails because of a lack of the positive neurotropic and neurotrophic influences physiologically, provided by, viable Schwann cells. This report aims to show the feasibility, of vascularization of the peripheral nerve by, prefabrication. The study, was designed to vascularize an autogenous nerve graft segment by, using an arteriovenous bundle in the rabbit. A 3.5-cm segment of sciatic nerve was harvested and implanted in between the femoral vessels, and was isolated from secondary, revascularization by, a custom-made tube. A peripheral nerve graft was prefabricated by implantation on the vascular pedicle, and neovascularization was evaluated by, microangiography and histology,. The graft exhibited early neovascularization on day 2, and numerous new capillaries were noted to restore primarily perineurial blood flow on day 7, then all along the graft on day, 14. The viability, of the Schwann cells was preserved, and the structural integrity of the graft was maintained. This is a preliminary, report on secondary, vascularization of a segment of an autogenous nerve to maintain the viability of Schwann cells and the integrity of the conduit. In the future, with the concomitant use of host immunosuppression or with more advanced pre-treatment methods, nerve allografts could be revascularized by vascular bundles. The current tempo of medical research will hopefully enable the use of fresh nerve allografts that are rendered less immunogenic by, more refined techniques

Reconstruction of proximal nasal defects with island composite nasal flaps

WOS: 000226817300007PubMed: 15692344There are few local nasal flap options for repair of proximal nasal defects. Absence of suitable donor sites and the large dimensions of the defects limit the use of local nasal flaps in this region. Regional paranasal flaps may not be suitable in these cases because of color, texture, and donor-site scars. The composite procerus muscle and nasal skin flap, which is vascularized by the dorsal nasal branch of the angular artery, can be a useful treatment modality for proximal nasal reconstruction. Seven patients were successfully treated using the composite nasal flaps. The maximal size of the defects was 2.4 cm. In one case, the composite nasal flap was readvanced to close a new defect resulting from reexcision. The composite nasal flap has several advantages in reconstruction of proximal nasal defects. Reconstruction is performed with the same tissue and the donor defect is closed primarily. The composite nasal flap can be moved in multiple directions and has great mobility to reach every point of the proximal part of the nose with axial blood supply. Furthermore, it can be easily readvanced without additional morbidity in case of reexcision

Temporoparietal fascia: An anatomic and histologic reinvestigation with new potential clinical applications

Erdemli, Esra/0000-0002-9737-269X; Tuccar, Eray/0000-0002-1137-1961WOS: 000084513700007PubMed: 10626968Temporoparietal fascia constitutes a very important structural unit from both an aesthetic and a reconstructive surgical point of view. A histologically supported anatomic study was conducted for the reappraisal of the anatomic relationships and clinical application potentials of the data obtained. Anatomy of the temporoparietal fascia was investigated on 20 sides from 10 cadavers. After dissections, necropsies were obtained to demonstrate histologic features of the temporoparietal fascia. The outer part of the temporoparietal fascia is continuous with the superficial musculoaponeurotic system (SMAS) in the inferior border and with orbicularis oculi and frontalis muscles in the anterior border. Therefore, plication of the temporoparietal fascia call increase tightness of the SMAS, orbicularis oculi, and frontalis muscle in rhytidectomy. The frontal branches of facial nerve were noted to course parallel to the frontal branch of the superficial temporal artery, lying deeper to the temporoparietal fascia within the innominate fascia. In the view of these findings, conventional subfascial dissection, which is performed to protect frontal branches of the facial nerve, is not reasonable during the temporal part of rhytidectomy. Careful subcutaneous dissection just under the hair follicles is more appropriate to avoid nerve injury and also provides excellent exposure of the temporoparietal fascia for plication in rhytidectomy with protection of the auriculotemporal nerve and the superficial temporal vessels. Furthermore, two layered structures of the temporoparietal fascia ar-e very suitable to insert a framework into the temporoparietal fascia for ear reconstruction to eliminate some of the shortcomings of Brent's technique. A thin muscle layer was also noted within the outer part of the temporoparietal fascia below the temporal line; the term "temporoparietal myofascial flap" would, therefore, be more accurate than "temporoparietal fascial flap." Finally, the innominate fascia and the deep temporal fascia call be elevated with the two layers of the temporoparietal myofascial flap to obtain a well-vascularized, four-layered myofascial flap based on die superficial temporal vessels. This multilayered flap can be used to reconstruct all defects when fine, pliable, thin, multilayered flaps are required

Scalp reconstruction with island hair-bearing flaps

WOS: 000228172200023PubMed: 15809600

The effect of carnitine on random-pattern flap survival in rats

YILMAZ, TANER/0000-0001-8999-3237WOS: 000170901100021PubMed: 11547153Carnitine is an endogenous cofactor involved in the transport of long-chain fatty acids into the mitochondria where they undergo P-oxidation. Through another reaction, carnitine produces free coenzyme A and reduces the ratio of acetyl-coenzyme A to coenzyme A, thereby enhancing oxidative use of glucose, augmenting adenosine triphosphate synthesis, and reducing lactate production and acidosis. Because of its regulatory action on the energy flow from the different oxidative sources, especially under ischemic conditions, carnitine has been used in cardiovascular diseases such as coronary heart disease, congestive heart failure, peripheral vascular disease, dyslipidemia, diabetes, and chronic renal diseases with satisfactory results. A flap is also a relatively ischemic tissue and may obtain benefit from carnitine. To investigate this, 30 rats were divided into three groups of 10 animals: a control group and two carnitine-treated groups. Random dorsal skin flaps were elevated on the rats. In the control group, no pharmacologic agents were used. Of the two treated groups, group I was treated with 50 mg/kg/day carnitine for I week and group 2 was treated with 100 mg/kg/day carnitine for I week. The areas of flap necrosis were measured in each group. The median areas of flap necrosis of the groups were 12.55, 9.23, and 4.9 cm(2), respectively. There was a statistically significant improvement of flap necrosis in carnitine-treated groups compared with the control group (group 2, p = 0.001; group 3, p = 0.000). Furthermore, there was less necrosis in the high-dose carnitine-treated group than the low-dose carnitine-treated group. As a conclusion, carnitine may have a dose-dependent effect to increase flap survival in random skin flaps