EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2006
J. Jawien
Abstract Background, Recent reports point to an important role of leukotrienes in atherogenesis. Leukotrienes are produced by 5-lipoxygenase co-operating with five lipoxygenase activating protein (FLAP). We hypothesized that MK-886, an inhibitor of FLAP, could attenuate the development of atherosclerosis in the atherogenic apolipoprotein E/low density lipoprotein receptor (apoE/LDLR) double knockout (DKO) mouse model. Materials and methods, Female apoE/LDLR-DKO mice at the age of 8 weeks were put on Western diet. The experimental group (n = 10) received the same diet as the control group (n = 10), but mixed with MK-886 (Merck, Rahway, NJ) at a dose of 4 µg per 100 mg of body-weight per day. At age 6 months the mice were sacrificed under anaesthesia. Results, Measured by the en face method, the percentage of area occupied by lesions in aortas in the control group was 25·15 ± 2·9%, whereas in the MK-886-treated group it was 11·16 ± 0·7% (P < 0·05). Lesion area measured by cross-section of aortic roots was 455 494 ± 29 564 µm2 in the control group versus 263 042 ± 20 736 µm2 in the MK-886-treated group (P < 0·05). The MK-886 did not change the plasma cholesterol lipoprotein profile as compared with the control mice. Finally, we show that MK-886 may increase plaque stability by decreasing the macrophage content as well as increasing the collagen and smooth-muscle cell content. Conclusions, Our results show for the first time that inhibition of FLAP by MK-886 reduces development of atherosclerosis in gene-targeted apoE/LDLR-DKO mice. [source]

The expression of cytosolic phospholipase A2 and biosynthesis of leukotriene B4 in acute myeloid leukemia cells

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007
Gudmundur Runarsson
Abstract Leukotrienes (LT) exert stimulatory effects on myelopoiesis, beside their inflammatory and immunomodulating effects. Here, we have studied the expression and activity of the enzymes involved in the synthesis of leukotriene B4 (LTB4) in acute myeloid leukemia (AML) cells (16 clones) and G-CSF mobilized peripheral blood CD34+ cells. CD34+ cells from patients with non-myeloid malignancies expressed cytosolic phospholipase A2 (cPLA2), 5-lipoxygenase activating protein (FLAP), and leukotriene A4 (LTA4) hydrolase but not 5-lipoxygenase (5-LO). The enzyme cPLA2 was abundantly expressed in AML cells and the activity of the enzyme was high in certain AML clones. The expression of 5-LO, FLAP, and LTA4 hydrolase in AML clones was in general lower than in healthy donor polymorphonuclear leukocytes (PMNL). The calcium ionophore A23187-induced release of [14C] arachidonic acid (AA) in AML cells was low, compared with PMNL, and did not correlate with the expression of cPLA2 protein. Biosynthesis of LTB4, upon calcium ionophore A23187 activation, was only observed in five of the investigated AML clones and only three of the most differentiated clones produced similar amounts of LTB4 as PMNL. The capacity of various cell clones to produce LTs could neither be explained by the difference in [1 , 14C] AA release nor 5-LO expression. Taken together, these results indicate that LT synthesis is under development during early myelopoiesis and the capacity to produce LTs is gained upon maturation. High expression of cPLA2 in AML suggests a putative role of this enzyme in the pathophysiology of this disease. [source]

Dorsal Nasal Flap for Reconstruction of Full-Thickness Defects of the Nose

DERMATOLOGIC SURGERY, Issue 7 2010
J. MICHAEL WENTZELL MD
J. Michael Wentzell, MD, has indicated no significant interest with commercial supporters. [source]

Medium-Sized Lower Eyelid Defect Reconstructed with a Bilobed Flap

DERMATOLOGIC SURGERY, Issue 5 2010
GALEN H. FISHER MD
Galen H. Fisher, MD, has indicated no significant interest with commercial supporters. [source]

Island Pedicle Flap for Alar Defects

DERMATOLOGIC SURGERY, Issue 3 2010
RICHARD A. KRATHEN MD
The authors have indicated no significant interest with commercial supporters. [source]

A Different Application of the Unilobed Flap: Bilateral Vascularized Scrotal Pedicle Flap for Reconstruction on the Scrotal and Peno-Scrotal Defects

DERMATOLOGIC SURGERY, Issue 4 2009
ILTERIS MURAT EMSEN MD
No abstract is available for this article. [source]

Dog Ear Island Pedicle Flap for Repair of Alar and Nasal Wall Defects

DERMATOLOGIC SURGERY, Issue 12 2008
PRIYA ZEIKUS MD
First page of article [source]

Modified Single-Sling Myocutaneous Island Pedicle Flap: Series of 61 Reconstructions

DERMATOLOGIC SURGERY, Issue 11 2008
ANDREA WILLEY MD
BACKGROUND Bilevel undermining above and below the transverse nasalis muscle in the construction of a myocutaneous island pedicle flap produces a bilateral or unilateral muscular sling with exceptional vascular supply for reconstruction of defects on the distal nose. We present further modification of the single-sling myocutaneous island pedicle flap that expands its application to a wide variety of nasal defects and further defines its usefulness in nasal reconstruction. METHODS A series of 61 consecutive myocutaneous island pedicle flap reconstructions performed after Mohs surgery between March 2005 and July 2006 are presented. Flap modifications are presented, and advantages and limitations are discussed. RESULTS Flap modifications introduce additional reach and rotational mobility to the flap that permit extension of the flap to defects on the nasal tip and distal ala. CONCLUSION Modifications of the bilevel approach to the single-sling nasalis myocutaneous island pedicle flap further define its practicality in nasal reconstruction and expand its application to a variety of nasal defects. [source]

Subcutaneous Island Pedicle Flap with Z-Plasty: A Cosmetic Enhancement

DERMATOLOGIC SURGERY, Issue 12 2007
JOHN W. SKOUGE MD
First page of article [source]

Tragus Reconstruction after Tumor Excision with Preauricular Folded Flap

DERMATOLOGIC SURGERY, Issue 6 2007
NETA ADLER MD
First page of article [source]

Nasolabial Hinge Flap with Simultaneous Cartilage Graft in Nasal Alar and Tip Reconstruction

DERMATOLOGIC SURGERY, Issue 4 2007
RON AZARIA MD
First page of article [source]

Nasal Tip Wound Repair Using a Rhombic Transposition Flap with a Double Z-Plasty at Its Base

DERMATOLOGIC SURGERY, Issue 7 2006
ADAM M. ROTUNDA MD
No abstract is available for this article. [source]

Letter: Unusual Complication of a Forehead Flap

DERMATOLOGIC SURGERY, Issue 7 2006
KANTAPPA GAJANAN MBBS
No abstract is available for this article. [source]

Alar Reconstruction with Subcutaneous Pedicled Nasolabial Flap: Difficulties, Considerations, and Conclusions for This Procedure

DERMATOLOGIC SURGERY, Issue 10 2005
Fumiya Iwao MD
Background. The subcutaneous pedicled nasolabial flap is a useful material for alar reconstruction. Objective. This article describes the difficulties and considerations in this procedure and discusses the procedural problems involved, drawing conclusions from them. Methods. Case 1: a folded flap was used with a conchal cartilage strut sandwich. Case 2: only a folded flap was used. Case 3: the flap was used to cover the outer surface of the ala, and a mucoperiosteal graft from the hard palate was used for the ala lining. Results. The cartilage strut was not sufficient to support the shape of the ala in case 1. Harvesting a sufficiently wide flap is thought to be important. However, a folded flap had some drawbacks, with the formation of a thick alar rim. Conclusions. The combination of a flap for the outer surface and a mucoperiosteal graft as a lining is thought to be an excellent option for alar reconstruction. [source]

Subcutaneous Pedicle Limberg Flap for Facial Reconstruction

DERMATOLOGIC SURGERY, Issue 8 2005
Li Jun-Hui MD
Background. A residual dog-ear arising from the traditional Limberg flap transposition sometimes influences the cosmetic outcomes, and the Limberg flap with a subcutaneous pedicle is an innovation applicable to a variety of facial defects and free from the dog-ear. Objective. To investigate the outcome of the subcutaneous pedicle Limberg flap for the reconstruction of medium-sized facial skin defects. Materials and Methods. From August 2002 to June 2004, the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients (19 flaps), and the size of the lesions ranged from 2.0 × 1.9 cm to 5.0 × 4.5 cm. Results. All flaps survived with primary healing postoperatively. The patients were followed up from 1 to 22 months, and functionally and cosmetically satisfactory outcomes were achieved. Conclusions. This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face. [source]

Nasalis Island Pedicle Flap in Nasal Ala Reconstruction

DERMATOLOGIC SURGERY, Issue 4 2005
Maryam Asgari MD
Background. Defects of the nasal ala can be difficult to repair in a one-stage procedure. We describe a laterally based nasalis myocutaneous island pedicle flap to repair small but deep defects of the superior nasal ala. Objective. To describe a single-stage flap for repair of small defects on the nasal ala that confines the repair to one cosmetic unit. Methods. We discuss the anatomy of the flap and illustrate the method of placing the flap. Results. We present several case examples and discuss potential applications of the flap. We also discuss the flap's limitations by citing an example of necrosis. Conclusions. The nasalis myocutaneous island pedicle flap for repair of nasal alar defects is a new application of a one-stage procedure that yields excellent functional and cosmetic results. Knowledge of the limitations and the anatomy of the flap is crucial for a good outcome. MARYAM ASGARI, MD, MPH, AND PETER ODLAND, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Reconstruction of the Superior Helical Rim with a Postauricular Transposition Flap

DERMATOLOGIC SURGERY, Issue 1 2005
Genevi Fortier-Riberdy MD
No abstract is available for this article. [source]

A Simple Method of Designing a Bilobed Flap Using a Triangle Template

DERMATOLOGIC SURGERY, Issue 10 2004
Li-Xing Man MSc
Background. The bilobed flap is useful for the reconstruction of skin defects in which the primary closure is difficult. Proper design is paramount to achieve excellent cosmetic results, but flap design often appears unnecessarily complex and difficult. Objective. The objective was to discuss the geometry of the bilobed flap and describe a simple and practical method for constructing such flaps using a triangle template with emphasis on the pivot point. Methods. A detailed description with diagrams and an illustrative case are presented to demonstrate the technique. Results. A patient with a scalp defect was reconstructed with a triangle-template-designed bilobed flap with excellent postoperative results. Conclusion. This new method using a triangle template ensures proper placement of the pivot point and will enable practitioners to achieve superior outcomes. [source]

The Versatility of the Nasolabial Flap Enhanced by the Delay Procedure

DERMATOLOGIC SURGERY, Issue 2 2001
Isaac Zilinsky MD
Background. The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall following Mohs surgery. However, both extirpation of a tumor in the region of the base of the flap or previous use of the flap often destroy the proximal axial blood supply to the flap, excluding its immediate utilization. We describe a different use of the nasolabial flap and a technique for preserving its capacity in the case of reutilization Objective. To describe the versatility of the nasolabial flap and a delay procedure that enables its exploitation despite prior disruption of the proximal blood supply. Methods. Three different uses of the same nasolabial flap are demonstrated in one patient. The surgical techniques are discussed in detail. Results. The reconstructive results were excellent. There were no postoperative complications. Conclusion. The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall. When the nasolabial flap has been used before, or its blood supply compromised, the delay procedure can reestablish its applicability. [source]

Partial Closure of Transposition Flap

DERMATOLOGIC SURGERY, Issue 11 2000
Raymond T. Kuwahara MD
[source]

Utility of a Bilayered Banner Transposition Flap in Reconstruction of the Lower Third of the Pinna

DERMATOLOGIC SURGERY, Issue 7 2000
Dania Tannir MD
Background. Reconstruction of the entire ear lobule is challenging and complex. We present a case in which a banner transposition flap from the preauricular and mandibular area of the cheek resulted in an excellent cosmetic outcome. Objective. To demonstrate the utility of a bilayered banner transposition flap to reconstruct a full-thickness defect of the inferior one-third of the pinna. Methods., The technique employed in this reconstruction is described and previously reported techniques are reviewed. Results., A symmetrical earlobe with normal tissue consistency was created, as noted at 4 months postoperatively. Conclusion. Utilization of a banner transposition flap should be considered as an excellent method for reconstruction of full-thickness defects of the lower one-third of the ear. [source]

Modified Burow's Wedge Flap for Upper Lateral Lip Defects

DERMATOLOGIC SURGERY, Issue 5 2000
Minh Dang MD
Background. There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. Objective. We describe a modified Burow's wedge flap for upper lateral lip defects. Method. Report of an illustrated case. Result. A patient with an upper lip defect was successfully reconstructed using the modified Burow's wedge flap, where the Burrow's wedge is placed on the mucocutaneous lip. Conclusion. Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. For the Burow's wedge flap, the dermatologic surgeon has several options in placing the Burow's triangle. This is an example of how alternatives in a closure can be used depending on the laxity of the skin and the size of the defect. Advantages and disadvantages of this alternative placement of the Burow's triangle are discussed. [source]

A Rare Case of Anterior Chest Closure Only with Omental Flap after Devastating Mediastinitis: Case Report

JOURNAL OF CARDIAC SURGERY, Issue 5 2008
Vinicio Fiorani M.D.
The anterior mediastinum was closed with an omental flap that was allowed to epitelize spontaneously. The patient was discharged after 110 days. Despite the large number of cases with mediastinitis described in the literature, the chest closure with only an omental flap without closure of subcutaneous tissue and skin is rare. [source]

Vascularized Cadaveric Fibula Flap for Treatment of Erectile Dysfunction Following Failure of Penile Implants

THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010
Christopher J. Salgado MD
ABSTRACT Introduction., Postpriapism erectile dysfunction in patients with sickle cell disease is a particularly devastating condition. Where penile implants have failed, there is no good surgical alternative at present. Free tissue transfer is fraught with risks in patients with sickle cell disease and are not the best option for treatment. Aim., To describe a new surgical technique involving prefabrication of a bone flap for treatment of erectile dysfunction in a patient with sickle cell disease. Methods., The descending branch of the lateral circumflex femoral artery was isolated and implanted within a cadaveric bone segment. The prefabricated flap was then transferred 2 months later as a neophallus for penile autoaugmentation. Results., Bone scan showed viability of the bone flap after transfer. The patient was able to have vaginal intercourse and successfully achieve orgasm 2 months after the second stage surgery. Conclusions., Prefabrication of a cadaveric bone flap and subsequent transfer is a novel and effective technique for treatment of erectile dysfunction refractory to medical management. This technique may be particularly useful for "implant cripples," who have no other surgical option. Salgado CJ, Chim H, Rowe D, and Bodner DR. Vascularized cadaveric fibula flap for treatment of erectile dysfunction following failure of penile implants. J Sex Med 2010;7:3504,3509. [source]

Reconstruction of the Through-and-Through Anterior Mandibulectomy Defect: Indications and Limitations of the Double-Skin Paddle Fibular Free Flap,

THE LARYNGOSCOPE, Issue 8 2008
Frederic W.-B.
Abstract Objectives/Hypothesis: The purpose of this report is to describe our recent experience using a double-skin paddle fibular free flap (DSPFFF) for reconstruction of the through-and-through anterior mandibulectomy defect and to present a reconstructive algorithm based on the extent of lip and mental skin resection. Study Design: Retrospective review of 10 consecutive patients with through-and-through anterior mandibulectomy defects. Methods: Outcomes that were examined included methods of reconstruction based on the cutaneous defect, flap complications, fistula rate, and donor site complications. Results: Seven patients were reconstructed with a DSPFFF. For lip reconstruction, two patients were also concomitantly reconstructed with Karapandzic or lip advancement flaps. Three patients were reconstructed with both a fibular free flap and a second free flap (1 radial forearm fasciocutaneous flap and 2 anterolateral thigh flaps). The transverse dimensions of the DSPFFFs were as great as 15 cm. None of the patients developed a fistula. All free tissue transfers were successful. One patient developed partial loss of the fibular skin paddle used for submental skin replacement. Conclusions: DSPFFF is a safe and reliable way to reconstruct an anterior through-and-through mandibular defect. Indications for using a DSPFFF are 1) a cutaneous defect that lies at or below the plane of the reconstructed mandible, 2) a transverse width of the oral mucosa and cutaneous defect that does not exceed 15 cm (the approximate distance from the mid-calf to the anterior midline), and 3) a lip defect that, if present, can be reconstructed with local flaps. [source]

Vascularized Mucoperiosteal Pull Through Flap for Closure of Large Septal Perforation: A New Technique,

THE LARYNGOSCOPE, Issue 4 2007
Mark J. Shikowitz MD
First page of article [source]

Radial Forearm Osteocutaneous Free Flap in Maxillofacial and Oromandibular Reconstructions

THE LARYNGOSCOPE, Issue 9 2005
J H. Kim MD
Abstract Objectives/Hypothesis: The radial forearm osteocutaneous free flap is an excellent reconstructive modality for oromandibular and maxillofacial reconstruction in certain well-defined circumstances. The initial concern over donor site morbidity and the ability of the bone to reconstruct mandibular defects have led to only a few published series. Study Design: Retrospective study of the experience of two tertiary medical centers with radial forearm osteocutaneous free flap. Methods: Retrospectively, 52 patients were studied who underwent radial forearm osteocutaneous free flap reconstruction for cancer (49 cases) and trauma (3 cases). Bone length and skin paddle harvested, general morbidity (hematoma, wound infection, and dehiscence), recipient site morbidity (nonunion of neomandible, flap failure, and bone or plate exposure), and donor site morbidity (radius bone fracture, plate exposure, and skin graft failure) were reviewed. Results: The average skin paddle size was 55.1 cm2 (range, 15,112 cm2). The average radius bone harvest length was 6.3 cm (range, 2.5,11 cm). Donor site complications included tendon exposure (3 cases), radius bone fracture (1 case), and exposure of the plate (0). Recipient site complications included nonunion of the mandible (4), exposed mandible (1), exposed mandibular plates (2), exposed maxillary plates or bone (0), venous compromise (1), and flap failure (1). Two patients had perioperative deaths. Conclusion: Radial forearm osteocutaneous free flap is a valuable and viable option for oromandibular and maxillofacial reconstruction. [source]

Increasing Use of the Scapula Osteocutaneous Free Flap ,

THE LARYNGOSCOPE, Issue 9 2000
Sean C. Coleman MD
Abstract Objectives To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity. Study Design Retrospective review and prospective physical therapy evaluation. Methods A computer database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive 2-year intervals (1992,1999). A single physical therapist performed a structured evaluation of the donor site. Results Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increased from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SOFF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm2 (range, 48,200 cm2) compared with 55.4 cm2 (range, 25,102 cm2) and 77.6 cm2 (range, 50,120 cm2) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as "mild," for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as "not limited" or "limited a little" in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1° to 12° in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength. Conclusions The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly. [source]

Reiteration of core principles of the Keystone Island Flap

ANZ JOURNAL OF SURGERY, Issue 12 2006
Felix C. Behan FRACS
No abstract is available for this article. [source]

Trabeculectomy with an active postoperative regimen: results and resource utilization

ACTA OPHTHALMOLOGICA, Issue 5 2009
Amelie B. Taube
Abstract. Purpose:, To evaluate intraocular pressure (IOP) and resource utilization after trabeculectomy, using an active postoperative regimen, in a Swedish population. Methods:, A retrospective analysis was performed on the patient charts of all patients who underwent trabeculectomy in a Swedish university hospital during 1 year (November 2000,December 2001). Trabeculectomy was performed in 34 eyes and trabeculectomy in combination with phacoemulsification in 10 eyes. Intraocular pressure, visual acuity, complications and numbers of injections of 5-fluorouracil, suture removal, needling procedures and visits to ophthalmologists were recorded for 2 years. Results:, Mean IOP before surgery was 30.4 mmHg (standard deviation [SD] 9.5) in eyes with capsular glaucoma and 28.7 mmHg (SD 9.3) in eyes with primary open-angle glaucoma. Mean IOP after 2 years was 15.3 mmHg (SD 3.9) in all eyes. Intraocular pressure of < 18 mmHg was achieved in 65% of the eyes after 2 years, as was IOP , 13 mmHg in 37%. Flap or suture manipulation was performed in 41 of 44 eyes. Needling procedures were carried out a mean of 2.3 times in 31 eyes. The mean number of visits to an ophthalmologist was 14.1 during the first postoperative year and 4.4 during the second. Conclusions:, The results were encouraging, with few complications and modest resource utilization. [source]