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BACKGROUND: Despite the increasing popularity of various materials for ischemia-reperfusion (I/R) injury mitigation, research on botulinum toxin type A (BoNTA) remains limited. This study assesses BoNTA's efficacy in protecting flaps from I/R injury by inhibiting the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system and reducing reactive oxygen species (ROS) production. METHODS: Seventy-six Sprague-Dawley rats were studied. We examined the effects of BoNTA on superoxide production in four rats using a lucigenin-enhanced chemiluminescence assay (LECL). Another group of 60 rats had their superficial inferior epigastric artery (SIEA) flaps treated with either BoNTA or saline and clamped for 0, 1, and 4 hours before reperfusion. Flap survival and histological outcomes were assessed five days post-operation. ROS production in SIEA flaps and femoral vessels was analyzed in 12 additional rats, post-I/R injury. RESULTS: The LECL results showed that the BoNTA group had significantly lower superoxide production compared to controls, with notable reductions at 4 hours. While no significant differences were noted at the 0 and 1-hour marks, the 4-hour mark showed significant protective effects in BoNTA-treated groups. The survival rate was 90% for BoNTA-treated rats versus 60% for controls ( P = 0.028). Significant reductions in ROS were also observed in the 4-hour I/R group. CONCLUSIONS: BoNTA effectively protects against I/R injury by inhibiting the NADPH oxidase system and reducing ROS levels. These results support further investigation into the specific mechanisms of NADPH oxidase inhibition by BoNTA and its potential clinical applications, given its safety profile. CLINICAL RELEVANCE STATEMENT: The findings from the present study are expected to provide a basis for clinical studies regarding this use of BoNTA.
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Toxinas Botulínicas Tipo A , NADPH Oxidasas , Ratas Sprague-Dawley , Especies Reactivas de Oxígeno , Daño por Reperfusión , Animales , Daño por Reperfusión/prevención & control , Daño por Reperfusión/etiología , Toxinas Botulínicas Tipo A/farmacología , Toxinas Botulínicas Tipo A/administración & dosificación , NADPH Oxidasas/metabolismo , NADPH Oxidasas/antagonistas & inhibidores , Ratas , Masculino , Especies Reactivas de Oxígeno/metabolismo , Colgajos Quirúrgicos/irrigación sanguínea , Superóxidos/metabolismo , Modelos Animales de EnfermedadRESUMEN
BACKGROUND: While studies aimed at overcoming ischemia-reperfusion (IR) injury using various materials are becoming popular, studies using botulinum toxin type A (BoNTA) are still limited. This study tested the hypotheses that BoNTA can protect flaps from IR injury by inhibiting the NADPH oxidase system and suppressing ROS (reactive oxygen species) production. MATERIAL AND METHODS: The subjects were Sprague-Dawley rats (n = 76). In 4 rats, the effects of different dose of BoNTA on superoxide production was evaluated through lucigenin enhanced chemiluminescence assay (LECL) using SD rats' thoracic aorta ring. In 60 SD rats, The BoNTA and normal saline-pretreated superficial inferior epigastric artery (SIEA) flaps were clamped for 0, 1, and 4 hours, and reperfused. On the 5th day after the opeartion, well-maintained flaps were grossly inspected, survival rates were analyzed, and histological analysis was also performed. In 12 rats, after making IR injury through the same model, SIEA flap segments and femoral vessels were obtained, and ROS production was evaluated through LECL and dihydroethidium (DHE) staining. RESULTS: In LECL, the experimental group produced a smaller amount of superoxide than the control group through NADPH oxidase inhibition (p < .05). There was no significant difference between the experimental and control group in the 0, and 1 hour IR groups, but the experimental group (90%) showed a higher survival rate than the control group (60%) in the 4 hours IR group (p = .028). In the measurement of ROS production through LECL and DHE staining, there was no significant difference in the 0, and 1 hour IR groups, but a significant difference was shown in the 4 hours IR group in both the SIEA flaps and femoral vessels (p < .05). SUMMARY: This study verified hypothesis that BoNTA can protect flaps from IR injury by inhibiting the NADPH oxidase system and suppressing ROS production. Based on this research model, future research should be expanded into studies on subtypes or subunits of NADPH oxidase, and the findings from the present study are expected to contribute and lead to clinical studies on BoNTA, which has already been proven to be clinically safe.
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A gastrocnemius muscle flap is a versatile option for covering the proximal one-third of the lower leg and around the knee. On the other hand, it is of limited use in patients with short gastrocnemius muscle or insufficient volume. The authors present a case in which a knee soft tissue defect occurred in a very thin patient and was reconstructed using a gastrocnemius myocutaneous flap and a distally based gracilis flap as a supplementary flap.
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BACKGROUND: Cell-based therapies are popular in the field of reconstructive surgery. The stromal vascular fraction (SVF), comprised of mature adipocytes or blood, reportedly has a regenerative effect; however the mechanism remains unclear. This study aimed to prove the viability and effectiveness of using SVF in scar treatment. METHODS: This prospective double-blind study involved 20 patients who visited an outpatient clinic for 2 years, from July 2016 to July 2018, and underwent scar revision for traumatic or surgical scars. After scar revision surgery performed by a single surgeon, patient scars were divided into experimental and control sides. The subcutaneous layer of the experimental and control sides were injected with 0.1 mL/cm of SVF and normal saline, respectively. Each side was evaluated using the Patient and Observer Scar Assessment Scale (POSAS) before and six months after the surgery. RESULTS: Of the 20 patients who underwent scar revision surgery and SVF treatment, 4 dropped out for personal reasons. In 11 of 12 POSAS items, the experimental side showed significant improvements compared to the control side. CONCLUSIONS: Although more research is needed, autologous SVF is a valuable source of regenerative medicine that can be swiftly and inexpensively prepared from human fat tissue.
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Cicatriz , Fracción Vascular Estromal , Humanos , Cicatriz/etiología , Cicatriz/cirugía , Cicatriz/patología , Estudios Prospectivos , Reoperación , Tejido AdiposoRESUMEN
Background: Conventional tarsal fixation techniques for creating a static double-eyelid fold frequently result in a nonmobile overdepression of the fold, which is particularly pronounced in elderly patients. Objectives: We propose a novel surgical approach aimed at achieving better results with fewer complications. This approach involves imitating the natural double-fold physiology by employing a turn-over flap of the orbital outer septum and carefully managing the pretarsal soft tissue to create a double fold. Methods: A total of 503 patients underwent double-eyelid surgery, involving a turn-over flap of the outer orbital septum and pretarsal soft-tissue management. The orbital septum was exposed and transversely opened superior to the incision margin and the pretarsal soft issue was removed as necessary. Turn-over flaps were trimmed and attached to the dermis and orbicularis oculi muscle of the lower flap. Patient follow-up occurred for 2 to 7 years (mean, 3.8 years). Results: This surgical method achieves a double fold with shallow or moderate depth, creating a natural-appearing fold line. Of the 503 patients, 94% of respondents provided a satisfaction score of 4 and 5 points; 20 people provided a score of 3 points; 10 were dissatisfied. A review of the patient chart showed that there were no specific complications in >94% (473) of patients. Conclusions: We proposed a double-eyelid surgery technique using the outer septum to control the depth and pretarsal soft-tissue management to minimize resistance in the creation of the double eyelid. Our method showed a high patient satisfaction rate and fewer complications in elderly Asians.