Can ReGeneraTing Agents Improve Functional Recovery of Transected Peripheral Nerve through a Nerve Gap Bridged with an Artery Graft

Background The purpose of this study was to use artery grafts filled with CACIPLIQ20 and see if they promote nerve regeneration. Methods Sixty male Wistar rats were used. The rats were randomly divided into four experimental groups (n = 15): transected control group (negative control group [NCG]), sham-operated group (positive control group [SO]) artery graft group filled with saline (AG/NS), and CACIPLIQ20-treated group (AG/CACIPLIQ20). Fifteen rats were used as artery graft donors. In the SO group, the sciatic nerve was dissected from the surrounding tissues and left intact. In the NCG, AG/NS and AG/CACIPLIQ20) groups, a 10-mm gap was created in the left sciatic nerve. In the NCG group, the gap was not bridged with a graft. In the AG/NS group, the gap was bridged with a graft filled with saline. In the AG/CACIPLIQ20 group, the graft was filled with CACIPLIQ20. Walking track analysis was performed at 4, 8, 12, and 16 weeks after surgery. At 16 weeks postoperatively, the rats were sacrificed, nerve sections were harvested for histopathology analysis, and the weight ratio of the gastrocnemius muscle was measured. Results There was no significant difference in myelin sheath thickness between the AG/NS and AG/CACIPLIQ20 groups. Muscle weight in the AG/CACIPLIQ20 group was higher but not statistically significant (p = 0.168) compared with the AG/NS group. Also, AG/CACIPLIQ20 mean was better than AG/NS mean, although there was no statistically significant difference (p = 0.605). Conclusion There could be an indication that CACIPLIQ20 improves functional recovery of a transected peripheral nerve through a nerve gap bridged with an artery graft

Experimental study on the survival of autologous fat transplanted into the myocutaneous latissimus dorsi flap

Introduction: Since lipofilling is currently a common adjunct procedure in various reconstructive cases, namely breast reconstructions, improving fat graft retention remains a major concern for plastic surgeons. This experimental protocol simulates an autologous breast reconstruction technique using the pedicled fat-augmented latissimus dorsi myocutaneous flap in a rat model. The aim of the study is to evaluate the survival of fat graft after transplantation into three different host tissues, namely the pectoralis major and the Iatissimus dorsi muscles, and the subcutaneous tissue of the flap’s skin island. Material & Methods: Thirty rats were used, divided into five groups (A, B, C, D, and E) of six rats each. Different volumes of fat (1ml, 2ml, and 5ml) were in total injected in the three recipient areas in groups A, B, and C, respectively; postoperative radiation was administered to group D animals (2ml injected fat). Group E animals did not undergo fat grafting (controls). Adipocyte survival was assessed using histological and immunochemistry techniques. Results: Our results showed that the pectoralis major muscle was the substrate that provided the highest adipocyte survival rates, regardless of the amount of fat transplanted, followed by the latissimus dorsi muscle, and finally the flap’s skin island. In subcutaneous tissues, the increased volume of transplanted fat did not correspond to increased adipocyte incorporation. Irradiation of the host tissues resulted in a statistically significant decrease in surviving adipocytes in all three recipient areas (p<0.001). Conclusion: Our results suggest that muscle ensures optimal fat graft retention, whereas reduced vascular supply may negatively affect adipocyte survival following transplantation.Σκοπός: Η μεταφορά αυτόλογου λίπους αποτελεί ιδανική επανορθωτική μέθοδο τόσο σε επεμβάσεις αποκατάστασης όσο και σε αισθητικές επεμβάσεις. Η τελική επιβίωση του λίπους που μεταμοσχεύεται αποτελεί αντικείμενο εκτεταμένης μελέτης τα τελευταία έτη. Στόχος της πειραματικής μας μελέτης είναι να εκτιμηθεί το ποσοστό επιβίωσης του λίπους όταν εγχύεται στον υποδόριο ή τον μυϊκό ιστό σε ακτινοβολημένα και μη ακτινοβολημένα πειραματόζωα, χρησιμοποιώντας ένα πειραματικό μοντέλο προσομοίωσης μιας μεθόδου αποκατάστασης μαστού μετά μαστεκτομή, του μυοδερματικού κρημνού του πλατύ ραχιαίου ενισχυμένου με λίπος. Μέθοδοι – Υλικό: Στη μελέτη μας χρησιμοποιήθηκαν τριάντα πειραματόζωα (επίμυες), χωρισμένοι σε πέντε ομάδες (Α, Β, Γ, Δ και Ε). Διαφορετικοί όγκοι λίπους (1 ml, 2 ml και 5 ml) εγχύθηκαν συνολικά σε τρεις περιοχές λήπτες (υποδόριο, πλατύ ραχιαίο, μείζονα θωρακικό) στις ομάδες Α, Β και Γ, αντίστοιχα. Μετεγχειρητική ακτινοβολία χορηγήθηκε σε ζώα της ομάδας Δ (2 ml ενέσιμο λίπος). Τα ζώα της ομάδας Ε δεν υποβλήθηκαν σε μεταμόσχευση λίπους (μάρτυρες). Όλα τα ζώα θυσιάστηκαν την 8η εβδομάδα και δείγματα από τον υποδόριο ιστό, τον ΠΡ και τον ΜΘ εξετάστηκαν ιστολογικά και με ανοσοϊστοχημικές μεθόδους προκειμένου να εκτιμηθεί η συνολική επιβίωση του λίπους. Αποτελέσματα: Τα αποτελέσματά μας έδειξαν ότι ο μείζων θωρακικός μυς ήταν το υπόστρωμα που παρείχε τα υψηλότερα ποσοστά επιβίωσης λιποκυττάρων, ανεξάρτητα από την ποσότητα του μεταμοσχευμένου λίπους, ακολουθούμενο από τον πλατύ ραχιαίο μυ και, τέλος, την δερματική νησίδα του κρημνού. Στους υποδόριους ιστούς, ο αυξημένος όγκος του μεταμοσχευμένου λίπους δεν αντιστοιχούσε σε αυξημένη ενσωμάτωση λιποκυττάρων. Η ακτινοβόληση των ιστών του ξενιστή οδήγησε σε στατιστικά σημαντική μείωση των επιζώντων λιποκυττάρων και στις τρεις περιοχές λήπτες (p<0,001). Συμπεράσματα: Τα λιποκύτταρα ενσωματώνονται καλύτερα όταν ο ιστός του ξενιστή έχει αυξημένη αγγείωση, επομένως οι μύες αποτελούν ιδανικό υπόστρωμα για την επιβίωση των λιποκυττάρων. Όπως αναμενόταν, η ακτινοβολία μειώνει σημαντικά την επιβίωση του λίπους τόσο στον μυϊκό όσο και στον υποδόριο ιστό

The effect of host tissue and radiation on fat-graft survival: A comparative experimental study

Summary: Because lipofilling is often associated with various reconstructive procedures, especially breast reconstructions, improving fat-graft retention remains a major concern for plastic surgeons. We conducted an experimental protocol in a rat model simulating an autologous breast reconstruction method using the fat-augmented latissimus dorsi myocutaneous (LDM) flap. This study aimed to compare the survival rates of autologous adipocytes when injected subcutaneously and intramuscularly and to evaluate the role of recipient host tissue, volume of the injected fat, and postoperative radiation on fat-graft retention.Thirty rats were divided into five groups (A, B, C, D, and E), of six rats each. All animals underwent a pedicled LDM flap transfer to the anterior thoracic wall, and different volumes of autologous fat were injected into three recipient areas, namely, the pectoralis major and latissimus dorsi muscles and the subcutaneous tissue of the flap's skin island, as follows: 1 mL of fat was injected in total in group A, 2 mL in groups B and D, and 5 mL in group C. Group D animals received postoperative radiation (24 Gy), whereas group E animals (controls) did not undergo any fat grafting procedure. Eight weeks after surgery, adipocyte survival was assessed in all groups using histological and immunochemistry techniques.The results showed that the pectoralis major muscle was the substrate with the highest adipocyte survival rates, which were proportional to the amount of fat injected, followed by the latissimus dorsi muscle and the subcutaneous tissue. Increased volumes of transplanted fat into the subcutaneous tissue did not correspond to increased adipocyte survival. Irradiation of host tissues resulted in a statistically significant decrease in surviving adipocytes in all three recipient sites (p<0.001). Our study strongly suggests that muscle ensures optimal fat-graft retention, whereas postoperative radiation negatively affects adipocyte survival following fat transplantation

Predesigned chimeric deep inferior epigastric perforator and inguinal lymph node flap for combined breast and lymphedema reconstruction: A comprehensive algorithmic approach

Summary: The combined use of a deep inferior epigastric perforator (DIEP) flap coupled with vascularized inguinal lymph nodes (VILNs) for simultaneous breast and lymphedema reconstruction has already been well established, and promising results have been reported. However, a standardized approach for the planning and shaping of this combined flap is still lacking. We aimed to propose a comprehensive algorithmic approach for delayed unilateral breast and lymphedema reconstruction using a predesigned abdominal flap associated with inguinal lymph node transfer.We present in detail the preoperative measurements and surgical technique of the chimeric flap, which combines a predesigned DIEP template and a preselected inguinal lymph node flap, based on the preoperative computed tomography angiography and SPEC-CT findings, respectively; four different flap types are described according to the location of the pedicles of the two flap components. Our results of a series of 34 consecutive female patients with unilateral mastectomy and arm lymphedema, who underwent this combined predesigned reconstructive procedure, are retrospectively analyzed and reported.We recorded a high survival rate of the chimeric flaps in our series, with only one case of partial ischemic loss of a DIEP skin island. In the majority of our patients, the pedicles of the combined flaps were located in opposite positions. After a mean 35-month follow-up, we recorded a 47% mean volume difference reduction of the lymphedematous compared to the unaffected arm; no donor-site lymphedema was documented. Self-evaluation questionnaires showed high patient satisfaction rates regarding breast reconstruction. This algorithmic approach provides standardized guidance for accurate design and transfer of the DIEP-VILN chimeric flap while achieving highly satisfactory outcomes for both breast and lymphedema reconstruction

Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR