Effect of platelet-rich plasma on reconstruction with nerve autografts

WOS: 000394727100003PubMed ID: 28137414Despite advances in understanding of peripheral nerve injuries and regeneration and advances in surgical techniques, successful outcomes cannot be guaranteed after reconstructive surgery. Platelet-rich plasma (PRP) has been reported to have positive effects on nerve regeneration, as well as on tissue healing. The present study was designed to evaluate the effect of PRP on nerve-grafted defects. Sprague Dawley rats were divided into four surgery groups (n = 7 in each). A 1-cm long nerve defect was created in the upper thigh and then reconstructed using a nerve autograft in all groups. The wet muscle weights, electromyographic findings, and histomorphologic changes were evaluated 10 weeks later. As shown by both the electromyographic (p < 0.001) and histomorphologic findings (p < 0.001), PRP had more positive effects on nerve gap reconstruction in Group 3 then Group 4 as compared to the control groups. The present study is novel in that it evaluated the regeneration effect of PRP on a large nerve defect reconstructed with a nerve graft rather than primary repair. The results are encouraging for further experimental studies on the role of PRP in nerve healing. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/)

Traction Vasculogenesis: Experimental Vessel Elongation by Traction in Rat Model

WOS: 000462822700002Background: Microsurgeons may face inadequate vessel length in traumatic or post-resection vascular defects and flap surgery. As tissue regeneration by mechanical forces is possible like in tissue expansion and distraction osteogenesis, we questioned the effect of traction forces on isolated vessels, generated by an internal maxillary distraction device to overcome such problem. Methods: 30 Wistar-Albino rats were randomized in two groups as control and traction. By an internal maxillary distraction device placed subcutaneously to abdominal region, femoral artery and vein of traction group were applied daily traction for 10 days perpendicular to their course. Control group received the same procedure but no traction was applied. Vessel length, blood flow and histologic and microangiographic changes were evaluated on postoperative 11th day. Results: Final length of vessels was found to be higher in the traction group (21.93 mm) compared to control group (12.86 mm). (P = 0.000) Blood-flow patency rate of artery and vein was found 100 % in control group (n = 15) and 80 % in experiment group (n = 12). Microangiographic study showed patent blood flow in both control and traction groups. Histologic evaluation showed vascular wall thickening, perivascular adipocyte and neutrophil infiltration and vein lumen enlargement compared to control group. Conclusion: The preliminary "traction vasculogenesis" technique is found to be a promising technique to gain vessel length in vascular shortness problems. With further studies and refinements this technique may be carried to clinical applications in cases of vascular inadequacy

Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach

WOS: 000396042200096PubMed ID: 28045826Background: The fibula flap is a workhorse flap for bony reconstruction of oro-mandibular area and can be modified to include soft tissue for reconstruction of composite defects. However, the design of a reliable skin paddle that can be used for composite tissue reconstruction remains a challenge. The authors described the applicability of perforator concept for a more reliable free osteo-musculocutaneous fibula flap. Methods: Between 2013 and 2015, 29 patients underwent free fibula osteocutaneous flap reconstruction. Twenty-two patients have been operated due to squamous cell carcinoma and 7 patients due to gunshot injuries. Results: The mean harvesting time was 60 +/- 15 minutes. The range of width of the skin paddle was 3 to 12 cm and length was 6 to 23 cm. The range of length of bone was 5 to 18 cm. One patient had revision due to venous occlusion. All flaps have survived. Conclusion: The authors advocate approaching all components of flap individually using the perforator concept and dissection. Good exposure is mandatory for a reliable dissection. In our opinion, the posterior approach is more useful as it reveals all vascular relationships between the bone, muscle, skin paddle, and peronel vessels

Nasal Functional Evaluation Using Nasal Endoscopy, Acoustic Rhinometry, and Rhinomanometry on Nasal Airway-Obstructed Patients after Endoscopic Septoplasty, Corrective Rhinoplasty, and Internal Nasal Valve Surgery

WOS: 000413900600006Objective: Rhinoplasty is a very common surgical procedure that is performed throughout the world as well as in our country for aesthetic concerns, nasal obstruction, or both. However, functional results still remain subjective, and compared to the vast number of operations, studies about functional results in the literature are very limited. The aim of this study is to evaluate respiratory functions after corrective rhinoplasty and to find the benefits both numerically and statistically. Material and Methods: Thirty patients who were admitted to our department with nasal obstruction based on the statements of the patients were included in the study. Patients who were admitted only for aesthetic considerations were excluded from the study. These patients were preoperatively evaluated with radiographic and endoscopic imaging; preoperative nasal resistance and nasal airway cross-sectional area values were measured and recorded with acoustic rhinometry and rhinomanometry devices. Then, patients were operated by open rhinoplasty technique, and measurements were repeated at three months and one year postoperative follow-ups. Results: As a result of measurements made with rhinomanometry one year after the surgery, a decrease in resistance value was observed in 20 patients, and an increase in minimal cross-sectional area measured with acoustic rhinometry was observed in 24 patients. The values measured by both methods were found to be statistically significant. Conclusion: As a result of our study, we advocate performing both functional and aesthetic rhinoplasty operations instead of functional or aesthetic purposes alone.Ege University Scientific Research ProjectEge University [2011-TIP-018]Supported by Ege University Scientific Research Project (No: 2011-TIP-018)

A systematic review of penile replantations: May it guide us in penile allotransplantation?

Introduction: Penis replantation cases may serve as a model for identifying important elements in developing clinical penile allotransplantation. Material and Methods: We reviewed 82 published cases of penis replantation. Results: Besides the basic repair of urethra and corpora, we found that dorsal artery and dorsal nerve repair was associated with significantly better sensory return. Deep dorsal vein repair was associated with decreased sensation and increased complication rates. Conclusion: Penile allotransplantation may need to incorporate these findings