Double Z-plasty repair of large and small rhombic defects: the double-Z rhomboid

An alternative method for the repair of rhombic skin defects utilizing opposing Z-plasties has been developed and applied clinically. The design, orientation, and execution of this method share the simplicity of the Z-plasty. The technique has been employed successfully in over 100 cases during the past 5 years to resurface defects as large as 150 cm2, and it obviates many of the inherent limitations of the Limberg flap.     

Long-term survival of human skin allografts in patients with immunosuppression

Severe burn patients lack adequate skin donor sites to resurface their burn wounds. Patients with severe burn injuries to areas such as an entire face are presently reconstructed with skin grafts that are inferior to normal facial skin. This study was designed in part to determine whether human skin allografts would survive, repopulate, and persist on patients with immunosuppression and after discontinuation of immunosuppression. Small split-thickness skin grafts were synchronously transplanted at the time of renal transplantation from six renal transplant donors to recipients. All six patients were immunosuppressed with the usual doses of renal transplant immunosuppressants (methylprednisolone, cyclosporine, prednisone, and azathioprine). The skin allografts were biopsied when rejection was suspected and at various intervals. Special histologic studies were performed on skin biopsy specimens. Class II DNA tissue typing was performed on transplanted and autogenous skin biopsy specimens of four patients. Fluorescent in situ hybridization was performed successfully on skin biopsies of four patients' transplanted skin and on two of these four patients' autogenous skin. All six human skin allografts sustained a 100 percent take and long-term clinical survival. DNA tissue typing performed on skin allograft biopsy specimens from patients taking immunosuppressants all revealed donor and recipient cells. DNA tissue typing performed on autogenous skin biopsies from the same patients all revealed only recipient cells. Fluorescent in situ hybridization performed on allograft and autogenous specimens from patients taking immunosuppressants revealed transplanted donor cells with rare recipient cells in the allograft and only recipient cells in the autogenous skin. This study of six patients proves that it is possible for human skin allografts to survive indefinitely on patients taking the usual dosages of immunosuppressants used for renal transplantation. There was minimal repopulation of skin allografts by autogenous keratinocytes and fibroblast while patients were taking immunosuppressants. Immunosuppression was discontinued in two patients after renal transplant rejection after 6 weeks and 5 years. When immunosuppression was discontinued after 5 years in one patient, the skin allograft cells were destroyed and replaced with autogenous cells, but the skin graft did not reject acutely and persisted clinically. It is hypothesized that the acellular portion of the skin allograft was not rejected acutely because of relatively low antigenicity and because it acted as a lattice for autogenous cells to migrate into and replace rejected allograft skin cells. No chimerism was seen in autogenous skin in the skin-renal transplant patients in this study.     

The temporal island scalp flap for management of facial burn scars

Facial burn scars are difficult to conceal and often preclude an aesthetic rehabilitation of the patient. Multistaged scalp and neck flaps have been described to provide hair-bearing skin to resurface burn scars in men. We have been resurfacing the upper lip and cheek in a one-stage procedure using a temporal artery island scalp flap. The temporoparietal fascia has been well described in recent years, and the understanding of this anatomy has facilitated the use of the island scalp flap for more distal transfers.     

The recurrent neurotrophic buttock ulcer in the meningomyelocele paraplegic: a sensate flap solution

A large percentage of meningomyelocele paraplegic patients have a distal zone of sensation-bearing skin on their thighs. This sensate skin can be used as a fasciocutaneous flap to resurface a recidivistic ulcer after excision. In this study, because the transposition distance was significant, the flap length-width ratio was greater than normal and, therefore, required a 3-week elevation delay. This also permitted appraisal of the sensate flap after the first stage. The wound-healing was excellent after both stages. This reconstructive procedure was completed in four patients, with an average follow-up period of 13 years. These patients remain chronic sitters in administrative jobs and have been pressure sore-free after flap repair.     

Free anterolateral thigh adipofascial perforator flap

The anterolateral thigh adipofascial flap is a vascularized flap prepared from the adipofascial layer of the anterolateral thigh region. It is a perforator flap based on septocutaneous or musculocutaneous perforators of the lateral circumflex femoral system. With methods similar to those used for the free anterolateral thigh flap, only the deep fascia of the anterolateral thigh and a 2-mm-thick to 3-mm-thick layer of subcutaneous fatty tissue above the fascia were harvested. In 11 cases, this flap (length, 5 to 11 cm; width, 4 to 8 cm) was used for successful reconstruction of extremity defects. Split-thickness skin grafts were used to immediately resurface the adipofascial flaps for eight patients, and delayed skin grafting was performed for the other three patients. The advantage of the anterolateral thigh adipofascial flap is its ability to provide vascularized, thin, pliable, gliding coverage. In addition, the donor-site defect can be closed directly. Other advantages of this flap, such as safe elevation, a long wide vascular pedicle, a large flap territory, and flow-through properties that allow simultaneous reconstruction of major-vessel and soft-tissue defects, are the same as for the conventional anterolateral thigh flap. The main disadvantage of this procedure is the need for a skin graft, with the possible complications of subsequent skin graft loss or hyperpigmentation.     

Closure of septal perforation in Osler-Weber-Rendu's disease by bilateral labial-buccal flaps. Case report

We present a case of septal perforation in Osler-Weber-Rendu's disease, treated by rotating bilateral labial-buccal flaps up into the nose to close the perforation and resurface the adjacent areas on the septum.     

Lateral cervical advancement flaps for the correction of webbed-neck deformity

In the webbed-neck deformity, a horizontal excess of cervical skin creates bilateral and often asymmetrical skin webs from the mastoid to the acromion. Hair extends laterally to the free edge on the posterior web surface, creating a wide nuchal hairline. A technique of correction is presented. Through an incision along or within the hairline, the glabrous anterior web surface is undermined with the platysma muscle into the anterior cervical triangle until posterosuperior traction will obliterate the web. The posterior hair-bearing web surface is also elevated, and an excess of scalp is excised anterior to the new hairline position determined by the surgeon. The anterior glabrous flap is advanced posteriorly to resurface the scalp defect and recreate a normal neck contour and symmetrical hairline. A Szymanowski triangle of scalp is excised to equalize wound margins creating two "lazy" Y incisions that join in the scalp midline on completion of the opposite neck web. All scars lie within or along the hairline or extend onto the posterolateral shoulder. The method allows precise control of bilateral neck contour and hairline position without intraoperative repositioning and avoids scars on the exposed anterolateral cervical surface. There has been no recurrence of the neck deformity after 2 years.     

The lateral intercostal neurovascular free flap

The lateral intercostal flap is a new neurovascular flap that may be used as a free or island flap. It is based on the lateral cutaneous branch of a single posterior intercostal neurovascular bundle. The donor area of the flap is the anterolateral skin of the abdomen. The flap is large, thin, and has a long pedicle that contains the lateral cutaneous nerve. The donor pedicles of the flap are multiple, and its venous drainage is adequate. The detection and design of this flap were based on information gained from the dissection of 95 intercostal spaces in 40 fresh cadavers. The flap was then applied 12 times in 11 patients. Ten flaps were successful, one flap was partially lost, and one was completely lost. The flap was used as a noninnervated flap to resurface six defects in the neck and one facial defect, and it was used as an innervated flap to cover two hand defects and two heel defects.     

Reverse anterior tibial artery flap for reconstruction of foot donor site

The foot offers numerous useful options for hand reconstruction. Hallux transfer, dorsalis pedis flap, second toe transfers, and toe joint transfers offer good functional results in reconstructed hands. However, when the donor site is repaired with skin grafts, delayed wound healing, scarring, and contractures often result. Poor cosmesis of the donor site and altered gait are the main drawbacks of the procedures. The authors propose a new concept of primary reconstruction of the donor foot using a reverse-flow anterior tibial flap from the same leg. Two flaps are raised from the same anterior tibial vessel system in continuity as a distal free flap for hand reconstruction and as a proximal reverse-flow pedicled flap to resurface the donor defect. This technique allows good flap reconstruction of the foot donor site, reducing morbidity and limiting the operation to the same limb. The authors report their experience of 33 cases. There were no failures. Primary wound healing was achieved in the foot donor site, with acceptable cosmesis and satisfactory function.     

Treatment of total loss of the Achilles tendon by skin flap cover without tendon repair.

We present two cases of conservative treatment of total loss of the Achilles tendon. In our opinion the functional result is acceptable, without tendon grafting. The action of the sural muscles is transmitted through scar underlying the pedicled flaps used to resurface the wounds.     

External ultrasonic lipoplasty: an effective method of fat removal and skin shrinkage

External ultrasonic lipoplasty is an effective method for the removal of localized fat and the fat due to moderate obesity. The ultrasound is externally applied and transmitted through the skin surface. The acoustic waves are selectively absorbed by previously injected tumescent fluid and fat. It is the combination of this acoustic wave and ultrasound-induced fluid streaming that facilitates fat removal. Multiple, 2.5- to 3.7-mm incisions are made, through which standard thin (2.3 to 3.5 mm) suction lipectomy cannulae are used to aspirate the emulsified fat and oil. A major advantage of this procedure is that superficial subdermal liposuction can be used safely, which enhances the thoroughness of fat removal and the contraction of the overlying skin. A total of 160 consecutive patients successfully underwent this procedure. Recovery was rapid, and patients returned to full activities within 24 to 48 hours. The skin remained soft, with minimal to no bruising throughout the entire postoperative period. The problems seen with internal ultrasonic liposuction, such as end hits and skin burns, were avoided. The large incisions required for internal ultrasound liposuction were not necessary. Previous models of externally applied ultrasound support current observations of the safety of external ultrasound lipoplasty. Only one small seroma was seen. External ultrasound lipoplasty is a safe, effective, and low-cost method of ultrasound-assisted removal of localized fat and the fat due to moderate obesity. Physician and patient satisfaction is high.     

Entire male pigs in farrow-to-finish pens—Effects on animal welfare

Aggressive and sexual behaviour can hamper animal welfare in entire male pig production. The aim of the present study was to investigate if rearing entire male pigs in sibling groups (in farrow-to-finish pens) could reduce aggressive and sexual behaviour and thereby improve animal welfare in entire male pig production. Frequencies of aggressive and sexual behaviour among finishing pigs were recorded in three different groups in one herd; FTF-group (entires + gilts, siblings), mix-group (entires + gilts, mixed) and castrate-group (castrates + gilts, siblings). Frequencies of skin wounds were recorded in this herd and in an additional herd (only FTF-group and mix-group) shortly before the animals were sent to slaughter. Higher skin lesion scores in the entire male pig groups were in accordance with the behaviour data. Rearing entire male pigs in sibling groups reduces aggressive behaviour, though the frequency of the aggressive behaviour bouts was still higher than it was in the castrate-group. The frequency of skin wounds in the FTF-group was reduced to similar levels as in the castrate-group. The findings suggest that rearing entire males in sibling groups may be an appropriate management strategy for improving animal welfare in entire male pig production.     

Subcutaneous mastectomy. The excess skin problem.

Subcantaneous mastectomy through a lateral approach, with preservation of the nipple and areola on a dermal pedicle, removing the excess skin at the time of aubautaneous mastectomy, is a safe procedure which results in esthetically acceptable breasts. The surgical approach greatly facilitates the removal of the entire glandular portion of the breast. The need for a second surgical procedure is eliminated. Lateral biopsy scars can be reinforced by the dermal sling support, thereby decreasing the chances of exposure of the implant. The implant is also successfully and easily held in position by the use of the dermal-fat sling support. The nipple and areola survive quite well on the dermal pedicle, with preservation of contractility and sensation, as well as of blood supply.     

Rhamm-/- fibroblasts are defective in CD44-mediated ERK1,2 motogenic signaling, leading to defective skin wound repair

Rhamm (receptor for hyaluronan-mediated motility) is an hyaluronan binding protein with limited expression in normal tissues and high expression in advanced cancers. To understand its physiological functions and identify the molecular mechanisms underlying these functions, we created mice with a genetic deletion of Rhamm. We show that Rhamm(-/-) fibroblasts fail to resurface scratch wounds >3 mm or invade hyaluronan-supplemented collagen gels in culture. We identify a requirement for Rhamm in the localization of CD44 to the cell surface, formation of CD44-ERK1,2 (extracellular-regulated kinase 1,2) complexes, and activation/subcellular targeting of ERK1,2 to the cell nucleus. We also show that cell surface Rhamm, restricted to the extracellular compartment by linking recombinant protein to beads, and expression of mutant active mitogen-activated kinase kinase 1 (Mek1) are sufficient to rescue aberrant signaling through CD44-ERK1,2 complexes in Rh(-/-) fibroblasts. ERK1,2 activation and fibroblast migration/differentiation is also defective during repair of Rh(-/-) excisional skin wounds and results in aberrant granulation tissue in vivo. These results identify Rhamm as an essential regulator of CD44-ERK1,2 fibroblast motogenic signaling required for wound repair.     

Influence of social mixing and group size on skin lesions and mounting in organic entire male pigs

Alternatives to surgical castration are needed, due to stress and pain caused by castration of male pigs. One alternative is production of entire male pigs. However, changed behaviour of entire males compared with castrated males might adversely affect the welfare of entire males and changes in management procedures and production system might be needed. Elements from the organic pig production system might be beneficial in this aspect. The aim of this article is to investigate the effect of grouping strategy including social mixing and group size on levels of mounting behaviour and skin lesions, hypothesising that procedures that disrupt the social stability (e.g. regrouping) will have a larger negative effect in small groups compared with large groups. Approximately 1600 organic entire male pigs of the breed (Landrace×Yorkshire)×Duroc were reared in parallel in five organic herds, distributed across four batches in a 2×2 factorial design in order to test the influence of social mixing (presence or absence of social mixing at relocation) and group size (15 and 30 animals). Animals were able to socialise with piglets from other litters during the lactation period, and were all mixed across litters at weaning. A second mixing occurred at insertion to fattening pens for pigs being regrouped. Counting of skin lesions (1348 or 1124 pigs) and registration of mounting behaviour (1434 or 1258 pigs) were done on two occasions during the experimental period. No interactive effects were found between social mixing and group size on either skin lesions or mounting frequency. Herd differences were found for both mounting frequency and number of skin lesions. No association between skin lesions and mounting were revealed. Social mixing and group size were shown as interacting effects with herds on mounting frequency (P<0.0001), but with no consistent pattern across all herds. In addition, no effect of social mixing was found on mean number of skin lesions, but more lesions were observed in large groups (P<0.036). This could indicate that keeping entire male pigs in groups of 30 animals as compared with smaller groups of 15 may marginally decrease the welfare of these animals.     

CCN2 is not required for skin development

Mice lacking the pro-adhesive matricellular protein connective tissue growth factor (CTGF/CCN2) display an embryonic lethal phenotype due to defects in bone and cartilage. However, the specific role of CCN2 in skin development is unknown. Here, we generated mice deleted for CCN2 in the entire body (using a cre/lox system in which CCN2 is deleted in the entire body due to the presence of a constitutively expressed cre recombinase). We found that CCN2 was not required for the development of skin as defined by skin thickness measurements, trichrome staining and immunostaining with anti-CD31 (to detect endothelial cells) and anti-α−SMA (to detect smooth muscle cells and pericytes) antibodies. Thus, although recently we have shown that CCN2 is required for fibrogenesis in postnatal mice, CCN2 is not required for skin development during embryogenesis.     

Cutaneous oxygen uptake and its relation to skin blood perfusion and ambient salinity in the plaice, Pleuronectes platessa

Oxygen uptake across plaice skin was unaffected by temporary arrest of skin blood flow. This indicates that oxygen taken up across the skin is consumed by the skin itself. Weight specific rate of O2-consumption of skin is estimated to be 1.7-1.9 times that of the entire fish. Total resting O2-consumption increased from 0.43 to 0.58 mg X kg-1 X min-1 when salinity was raised from 8.5 to 25%. The relative increase in O2-uptake across the skin following an increase in salinity was smaller than the increase in total O2-uptake. This is taken to indicate that the high O2-consumption of skin is not specifically related to an osmoregulatory function of the skin.     

Australian grapevine viroid--evidence for extensive recombination between viroids.

Australian grapevine viroid (AGV, 369 residues) is a novel viroid with less than 50% sequence similarity with any known viroid. Nevertheless its entire sequence can be divided into regions, each with a high sequence similarity with segments from one of citrus exocortis, potato spindle tuber, apple scar skin, and grapevine yellow speckle viroids. AGV contains the entire central conserved region of the apple scar skin viroid group and is proposed as a member of this group. AGV appears to have originated from extensive RNA recombination involving other viroids. The vegetatively propagated grapevines which have been exposed to multiple viroid infections during their long history of cultivation may have allowed such recombination.     

吉林产哈士蟆中氨基酸含量的研究

应用日立835—50型氨基酸自动分析仪,对哈士蟆十种干样品进行了氨基酸成分的比较分析,结果表明:①必需氨基酸含量由高至低依次为雄蛙腿肉,雌蛙腿肉、卵、整只雄蛙、整只雌蛙、雄蛙皮、哈士蟆油、雌蛙皮、雌蛙腿骨、雄蛙腿骨。②氨基酸总量由高至低依次为雄蛙腿肉、雌蛙腿肉、雄蛙皮、雌蛙皮、卵、整只雄蛙、整只雌蛙、哈士蟆油、雌蛙腿骨、雄蛙腿骨。③雄蛙腿肉和雌蛙腿肉中各种氨基酸含量由大到小的排列顺序基本一致。