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In Vitro Alternative Methods for the Assessment of Dermal Irritation and Inflammation
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
David W. Hobson, James A. Blank
Viable skin organ preparations have been developed from human or animal donors using either an epidermal slice technique or an isolated skin flap with an intact blood supply. Chapter 10 discusses the isolated skin flap technique in detail.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What are the broad types of tissue flaps that you can raise? Give a description.Random skin flap: A tissue flap consisting of the full thickness of the skin and subcutaneous tissue. The flap is connected by skin bridge to the surrounding skin.Pedicle flap: A tissue flap consisting of the full thickness of the skin, subcutaneous tissue with or without underlying muscles. The flap is attached to the body by a vascular pedicle.
Skin cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This is usually curative for early localized lesions, a wide excision down to subcutaneous fat being necessary including a margin of macroscopically normal skin, the size of which is dependent on the depth (if known). A centimetre of clearance for every millimetre of depth (clinical estimate or from result of previous excision biopsy) up to a maximum of 2 cm is adequate and re-excision is necessary if the margins are not clear microscopically. A skin graft or vascularized skin flap might be needed to close the defect if too large to heal by itself. In the case of subungual melanoma, amputation of the digit is performed.
The Effect of Adipose Derived Stromal Vascular Fraction on Flap Viability in Experimental Diabetes Mellitus and Chronic Renal Disease
Published in Journal of Investigative Surgery, 2022
Burak Özkan, Atilla Adnan Eyüboğlu, Aysen Terzi, Eda Özturan Özer, Burak Ergün Tatar, Cagri A. Uysal
Diabetes mellitus (DM) is still considered one of the leading causes of foot ulcers in the world. Almost one quarter of diabetic patients develop foot ulcers during their life time [1]. The concurrence of diabetes mellitus and chronic renal diseases (CRD) increases the risk of development of diabetic foot compared to diabetic patients with normal renal function. The risk of lower limb amputation in patients with renal failure is 10 times greater than that of diabetic patients without uremia [2]. Reconstruction of chronic wounds in patients with diabetic nephropathy has been a challenge for surgeons due to impaired wound healing capacity and the complexity of the wound itself. Treatment modalities include skin graft, local skin flaps, local or distant muscle or skin flaps. Skin flap surgery is indicated to cover exposed bones or tendons, or to cover deep tissue defects on weight bearing areas under the foot where skin grafts might be thin to withstand the applied pressure by the weight. Success rates in flap surgery are low compared to normal population [3]. Several studies have discussed different strategies to enhance skin flap circulation in diabetic individuals, such as atorvastatin, all-trans retinoic acid and adipose derived stem cells (ADSCs) [4–6].
Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report
Published in Journal of Investigative Surgery, 2022
Wenhu Jin, Shusen Chang, Ziyang Zhang, Xiangkui Wu, Bihua Wu, Jianping Qi, Zairong Wei
A 15-year-old male was admitted to the department of oncology because of a right tibial Ewing’s osteosarcoma. After 6 courses of chemotherapy, he underwent tibial resection and implantation of an artificial prosthesis. Unfortunately, skin necrosis of the lower leg was accompanied by external exposure of the prosthesis. The anterior tibial artery was ligated during the operation; however, the posterior tibial artery was intact. Thus, a parallel cross leg free left lateral femoral artery descending branch of the lateral circumflex femoral artery flap and chimeric muscle flap was designed. The muscle flap was used to fill the wound cavity and the skin flap was used to cover the wound. A left medial sural artery propeller flap was prepared to wrap the vascular pedicle. A Kirschner needle was used to fix the legs. The time from the procedure to pedicle division was 19 days. At the 10-month follow-up the flaps had an excellent appearance and texture, and the left leg functioned normally (Figure 1).
Therapeutic Effects against Tissue Necrosis of Remote Ischemic Preconditioning Combined with Human Adipose-Derived Stem Cells in Random-Pattern Skin Flap Rat Models
Published in Journal of Investigative Surgery, 2021
Chang Sik Pak, Soo Young Moon, Young Eun Lee, Hyo Jin Kang
We analyzed color changes in skin flaps on PODs 7 and 14. Previous studies reported significant effects, in terms of stem cells and biomaterial, using rIPC in skin flap models on POD 7 [28, 29]. However, in this study, there were no significant effects on POD 7 after either rIPC or hADSCs treatment; although a statistically significant effect was observed on POD 14 after rIPC combined with hADSCs. Analysis of the gross anatomy of skin flap tissue in the control group revealed that the skin flap sites had not healed, and scabbing of flap sites was seen. However, in the rIPC + hADSCs group, most of the skin flap sites had healed; any scabs present had separated from the flap sites. In addition, PKH26-labeled hADSCs were observed in the skin flap subcutaneous tissue, indicating migration to the skin flap site from the injection site. In our study, hADSCs were transplanted into the normal tissue at the skin flap boundary to supply it with sufficient nutrients and oxygen from unharmed tissues. The advantages of MSCs, including hADSCs, have been reported widely. For example, Ballestín et al. reported that hADSCs possess regenerative and immunosuppressant properties. Moreover, they involve minimally invasive procedures with simple isolation and culturing techniques [30]. hADSCs treatment significantly increased flap survival and improved neovascularization under an ischemia–reperfusion condition [5, 31]. The histopathologic results of the present study showed that the epithelial tissue had mostly regenerated, while epidermal appendages, such as sweat glands and hair follicles, were observed in the hADSCs groups.