Transdermal Nitroglycerine Patch: An Optional Device to Reduce Flap Venous Congestion? A Case Report

ABSTRACT Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the authors suggest the application of nitroglycerine patch in the congested area of the flap few hours before the surgical exploration of the anastomosis. If there is a fast improvement of the clinical feature of the flap, the surgical exploration could be avoided. The authors underline that applying the nitroglycerin patch should not be regarded in any way as a therapy of a free flap venous thrombosis but only as an useful device, an option to be taken only when the surgeon is undecided whether to revisit the anastomosis or not

Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps.

BACKGROUND: Bisphosphonate Osteonecrosis of the Jaw (BRONJ) is a newly recognized condition reported in patients treated with aminobisphosphonates (BF). BRONJ is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates who has not had radiotherapy to the jaw. Treatment protocols have been outlined, but trials and outcomes of treatment and long-term follow-up data are not yet available. In 2004 an expert panel outlined recommendations for the management of bisphosphonate-associated osteonecrosis of the jaws. Through the histological study of the oral mucosa over the bone necrosis and around the osteonecrosis area in 8 patients affected by BRONJ at III stage, the authors highlight the inappropriateness of the local mucosal flaps to cover the losses of substance of the jaw, BF-related. METHODS: Mucosa tissue was taken from 8 patients, affected by BRONJ, III stage. The samples taken from the mucosa around and over the osteonecrosis area were fixed with formalin and an ematossilina-eosin dichromatic coloring was carried out. RESULTS: The samples of mucosa showed pathognomonic signs of cell suffering that prove that in these patients using local mucosa flaps is inappropriate. CONCLUSIONS: The authors suggest that only a well vascularized flap as free flap must be used to cover the osteonecrosis area in patients with BRONJ stage III. Because of the structural instability of the mucosa in patients suffering of osteonecrosis Bf related the local flaps are prone to ulceration and to relapse

ANTITHROMBOTIC PROPHYLAXIS IN MICROSURGERY

Background. The most common complication of microsurgical reconstruction is graft failure secondary to thrombosis. It is clear that thromboprophylaxis is helpful for a successful microsurgery. However, it's also obvious that thrombosis can't be avoided in cases of poor microsurgical technique. There is no consensus regarding the use of anticoagulation therapy during and after microsurgery. The authors compared two different antithrombotic prophylaxis protocols used in the past ten years, and analyzed the effectiveness and risks of different pharmacological protocols. Materials and methods. The authors performed a retrospective review of microsurgical patients operated between 2005-2014 by the same surgical team. 37 patients (Group A) operated between 2005-2010 and 45 patients (Group B) operated between 2011-2014 were selected. The majority of patients had generic and specific risk factors. Different thromboprophylaxis therapies were used in the two groups. While reviewing medical records, the authors compared Hb values before and after surgery, the free flap success rate, the need for blood transfusions intra and post-op in order to assess the efficacy (failure rate), and safety of the administered antithrombotic therapies (bleeding complications). Results. The pharmacological protocol used for the patients from Group B was more effective and less risky compared to results obtained from Group A. The therapy used in Group B did not increase the risk of bleeding and postoperative blood loss, and the flap success rate in Group B was significantly higher than that of Group A (p<0.000). Discussion and Conclusion. This study suggests that even in a perfect microanastomosis, prothrombotic mechanisms are activated, which lead to flap failure. A reasoned and balanced drug therapy can counteract the natural tendency of pedicle thrombosis, without exposing the patient to bleeding complications. Vasoactive drugs, although still experimental in microsurgery, may be used in the near future in order to further improve the success rates of free flap

Surgical Treatment of Extravasation Injuries

The authors present their experience of treating anti-cancer drug extravasation by means of a composite surgical technique that consists of infiltration with physiological solution and hyaluronidase and subsequent manual aspiration of solutes alternated with profuse irrigation of the infiltrated area. In the immediate post-op we carry out a medical therapy that consists of calciparine and topic antibiotic and/or steroid creams. Since the year 2000 this technique has been used on 25 patients. We have had neither complications nor scars. Copyright 2005 Wiley-Liss, IncSurgical treatment of extravasation injuries. Napoli P, Corradino B, Badalamenti G, Tripoli M, Vieni S, Furfaro MF, Cordova A, Moschella F. Source Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Italy. [email protected] Abstract The authors present their experience of treating anti-cancer drug extravasation by means of a composite surgical technique that consists of infiltration with physiological solution and hyaluronidase and subsequent manual aspiration of solutes alternated with profuse irrigation of the infiltrated area. In the immediate post-op we carry out a medical therapy that consists of calciparine and topic antibiotic and/or steroid creams. Since the year 2000 this technique has been used on 25 patients. We have had neither complications nor scars

Detection of flap venous and arterial occlusion using interstitial glucose monitoring in a rodent model.

LETTER TO EDITO

Tecnica Co.Di per la produzione di cartilagine solida umana

Abstract English Tissue or organ transplantation is severely limited by the problems of donor shortage and immune rejection from the patients. The cartilage defects are difficult to reconstruct. In head and neck surgery, as in septal reconstruction, auricular reconstruction for injury or malformation, in laryngotracheal reconstruction, surgeons harvest autologous cartilage from a donor site (of the patient) in order to reconstruct the defect. Today's current therapies to reconstruct cartilage defects involve the use of autologous cartilage grafts or biocompatible implants, but these seem inadequate to restore form and function, have many limits and are related with many complications. Due to the its limited ability to self repair, cartilage is an ideal candidate for tissue engineering. The essential requirement for a bio-engineered cartilage are: cell source and 3D biocompatible scaffold that allow cell replication and chondrogenesis. The main problem in tissue engineered cartilage is the scaffold. Several scaffold material shave been investigated for tissue engineering cartilage. It is necessary a 3 D scaffold that could define the shape of the engineering tissue, had to support the cell proliferation, maintaining their differentiation. The three-dimensional scaffold used by the authors is a dermal substitute usually employed to cover the loss of cutaneous substance and for the treatment of difficult wounds. This scaffold is a 3-dimensional porous matrix of cross-linked collagen and glycosaminoglycans. The authors used human chondrocytes Kit: hyaline human chondrocytes, in specific chondrocytes grow medium for cells ready to be used, are easy to be bought. The authors have produced three-dimensional hyaline cartilage using human chondrocytes on a three-dimensional scaffold, a cube , and implanting the chondrocyte-scaffold complex, without adding growth factors or other, in a subcutaneous pocket created on the back of a rabbit. After 8 weeks the neocartilage was explanted and hystological analysis by light microscopy and HLA typization were made. Histological section shows the following: proliferation of immature cartilage associated with abundant neoangiogenesis, with a central portion of mature cartilage, in the form of plate. Is evident also an eosinophilic infiltrate (immuno-allergic phase) to the periphery of the specimen. The inflammatory infiltrate, evident in the sample, was identified and consists mainly of eosinophils and T lymphocytes (CD3 positive). No evidence of inflammatory reaction to foreign body. Proliferating chondrocytes present cytoplasms and nuclei without necrobiotic alterations, cytolytic (as coagulation and / or colliquative necrosis) and apoptotic. These are signs of cell viability. HLA tissue typing showed the human origin of proliferating chondrocytes The exams confirm that the tissue engineering product is a well organized cartilage, that maintains the cube shape of the scaffold. In all the samples neocartilage was produced and was similar histologically to native cartilage. The advantages of this engineered tissue are multiple: the new cartilage retains the original 3-D shape of the scaffold so that it could be created into the desired shape preoperatively, using an easy-to-find scaffold. In addition, the engineered cartilage is an autologous tissue that would avoid the risk of graft rejection or extrusion while encouraging long-term durability and even proportional growth

One Versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.

Letter to Edito