The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

BACKGROUND: Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes. METHODS: Twenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the 'Lymphatic Vessel Analysis Protocol' (LVAP) plug-in for Image J® software. RESULTS: We found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35 × 19 cm and 34 × 10 cm, respectively. CONCLUSION: Our findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a 'T' or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay

A specific, glycomimetic Langerin ligand for human Langerhans cell targeting

Langerhans cells are a subset of dendritic cells residing in the epidermis of the human skin. As such, they are key mediators of immune regulation and have emerged as prime targets for novel transcutaneous cancer vaccines. Importantly, the induction of protective T cell immunity by these vaccines requires the efficient and specific delivery of both tumor-associated antigens and adjuvants. Langerhans cells uniquely express Langerin (CD207), an endocytic C-type lectin receptor. Here, we report the discovery of a specific, glycomimetic Langerin ligand employing a heparin-inspired design strategy that integrated NMR spectroscopy and molecular docking. The conjugation of these glycomimetics to liposomes enabled the specific and efficient targeting of Langerhans cells in the human skin. This delivery platform provides superior versatility and scalability over antibody-based approaches and thus addresses current limitations of dendritic cell-based immunotherapies

Effect of phosphorus on arsenic uptake and metabolism in rice cultivars differing in phosphorus use efficiency and response

ABSTRACT A hydroponic experiment was carried out to investigate the effect of phosphorus (P) nutrition on arsenic (As) uptake and translocation within the seedlings of rice cultivars. The experiment occurred in three stages: I 5 days of acclimatization (nutritive solution); II 10 days under P (0.0 and 0.09 mM) and As (0.0 and 100 mM) treatments; III 5 days under recovery. The As exposure had significant effect reducing dry weights of shoots or roots, resulted in elevated concentrations of As in shoot tissues. BR-IRGA 409 showed the highest susceptibility to As in biomass production and root system parameters regardless the P level. This cultivar showed contrasting responses of As translocation to shoot tissue dependent on P levels, with the highest As concentration under low P and lowest under normal P levels. P nutrition was most striking on plants recovery for all cultivars under As exposure. Clearer separation of cultivars for phosphorus use efficiency (PUE) occurred at lower shoot P contents, that was, at higher levels of P deficiency stress. IRGA 424 showed higher PUE as compared to the others cultivars. Our results go some way to understanding the role of P nutrition in controlling the effects of As in rice shoots