Neutrophil localization following reperfusion of ischemic skin flaps.

A swine model of island latissimus dorsi myocutaneous and buttock cutaneous flaps was used to examine neutrophil localization and flap survival after 6 hours of global ischemia followed by 24 hours of reperfusion. Radioactivity from autotransfused neutrophils labeled with indium-111 enabled their localization. Radioactivity in ischemic latissimus dorsi flaps was increased by 101 +/- 30 percent over contralateral control latissimus dorsi flaps (n = 6, p = 0.01). Radioactivity in ischemic buttock flaps was increased by 142 +/- 40 percent over contralateral control buttock flaps (n = 6, p = 0.008). Despite increased neutrophil localization to ischemic flaps, the magnitude of tissue radioactivity failed to provide sufficient information to predict ischemic injury as measured by flap survival and tissue water content.     

The versatile gastrocnemius myocutaneous flap.

The medial and lateral gastrocnemius myocutaneous flaps are described. Their usefulness, as direct flaps without a delay, in reconstruction of the lower extremity is described. In our practice, this flap has supplanted the cross-leg flap for most reconstructions in the lower extremity.     

The medial gastrocnemius myocutaneous flap.

Our experience with the medial gastrocnemius myocutaneous flap is presented. We have found it to be a reliable flap which can be transferred in one stage to solve difficult coverage problems about the knee and upper leg.     

The free latissimus dorsi myocutaneous flap.

The general anatomy and the detailed vascular anatomy of the latissimus dorsi myocutaneous flap is described, and its use as a free flap is illustrated. The speed and ease with which it can be raised, its long vascular pedicle, the large diameter of the donor vessels, and the potentially large size of the flap are emphasized.     

Uses of the rectus femoris myocutaneous flap.

The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.     

Repair of a lower leg defect with an ipsilateral gracilis myocutaneous flap.

We report the use of a gracilis myocutaneous flap from the same thigh to repair a defect of the lower leg. This could be a useful alternative in well selected cases.     

Immediate reconstruction of full-thickness burn of an ear with an undelayed myocutaneous flap. Case report.

We report a case in which an undelayed cervical myocutaneous flap was used early to cover the denuded cartilage of a burned ear. The ear was saved, and a good result was obtained.     

The tensor fascia lata myocutaneous free flap.

The tensor fascia lata muscle and its overlying skin provide a reliable myocutaneous unit containing a large amount of soft tissue for a free flap transfer. Its anatomy is outlined, and the operative technique for transfer is detailed in a case of chronic stasis ulcer of the lower leg.     

缺血后处理对缺血／再灌注大鼠心肌间质保护效应机制的探讨

目的：观察缺血后处理（IPIC）对缺血／再灌注（I／R）大鼠心肌基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶抑制剂-2（TIMP-2）变化的影响,探讨IPTC保护I／R心脏间质的机制。方法：24只健康雄性SD大鼠随机分为3组（n：8）：假手术组（SC组）、I／R组和IPTC组。记录各组左室血流动力学变化,观察心肌胶原含量,测定血浆中肌酸激酶（CK）和乳酸脱氢酶（LDH）浓度。以Westernblot法测定心肌组织中MMP-2和TIMP-2蛋白表达水平,以实时定量PCR（RT-PCR）法检测MMP-2和TIMP-2的表达水平。结果：与sC组相比,I／R组心肌胶原含量和左室舒缩功能明显降低,血浆cK、LDH活力和心肌MMP-2蛋白表达及mRNA水平明显升高,TIMP-2蛋白及mRNA水平明显降低;而IPTC组,大鼠心肌胶原含量和左室舒缩功能明显升高,血浆cK、LDH活力和心肌MMP-2蛋白表达及mRNA水平降低,TIMP-2蛋白及mRNA水平升高。结论：IPTC对再灌注损伤心肌间质有保护作用,其机制可能与抑制心肌中MMP-2表达,促进TIMP-2表达有关。     

Immediate reconstruction of the penis using an inferiorly based rectus abdominis myocutaneous flap

A new method for reconstruction of the penis using an inferiorly based rectus abdominis myocutaneous flap is described that seems to be particularly suitable for immediate one-stage reconstruction. Function of the residual portion of rectus muscle is preserved, and the abdominal wall is not significantly weakened.     

The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.

A compound flap is described that utilizes skin from the anterior chest on a narrow segment of pectoralis major muscle, with its underlying axial neurovascular bundle. This flap has been used successfully to reconstruct large defects in 4 consecutive patients. Our experience with this flap suggests that it may be more versatile than the deltopectoral flap.     

Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results.

A review was performed on 170 patients who underwent 173 consecutive latissimus dorsi myocutaneous flap breast reconstructions between 1978 and 1989. The majority of the patients had modified radical mastectomies, and reconstruction was usually delayed for 3 to 18 months after mastectomy. Acceptable symmetry was obtained in the majority of patients without the need for surgery on the opposite breast. Perioperative and long-term complications are reviewed. Patients were followed for an average of 4.7 years after reconstruction. Ninety-four percent of patients demonstrated little or no change in the reconstructed breast after the first year. This method of reconstruction has met patient expectations with a minimum number of procedures and low morbidity.     

Complicated neck contracture treated with a pectoralis major myocutaneous flap.

A case is presented which demonstrates the use of a pectoralis major myocutaneous flap for repair in a heavily radiated neck and chest, with neck contracture and a tracheocutaneous fistula.     

Aesthetic considerations of the medial gastrocnemius myocutaneous flap

A technique for the repair of a high anterior tibial defect is described in three clinical cases using a modified medial gastrocnemius myocutaneous island flap. The repair was done in such a way as to preserve as much of the normal contour as possible, after the fashion of the muscle flap alone, while retaining the advantages of full-thickness myocutaneous coverage of the defect. The result was an aesthetically improved reconstruction that we feel justifies further use of the gastrocnemius myocutaneous flap in selected patients.     

One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap.

The sternomastoid muscle has 3 blood supplies: the occipital artery superiorly, the superior thyroid artery in the middle, and the thyrocervical trunk below. We report the use of a myocutaneous flap consisting of a "paddle" of skin on the end of a pedicle of sternomastoid muscle--with the latter based either on its superior or inferior blood supply. Fourteen such flaps have been used successfully in 13 consecutive patients for one-stage reconstructions of defects of the oral cavity and oropharynx. Although there was partial epithelial loss of the skin "paddle" in 7 cases, in each case the surviving dermis became resurfaced with epithelium.