Background: Only few studies have currently examined the hemodynamics of free tissue transfer to correlate quantitative results with clinical and technical observations. The aim of this study was to further evaluate the free flap skin island temperature as a potential tool of postoperative flap monitoring as temperature monitoring is more reliable if environmental influences on tissue temperature are eliminated.

Hypothesis: Differences between free flap Skin Island and healthy adjacent skin microcirculation correlate to the difference between free flap Skin Island and healthy adjacent skin temperatures.

Methods: ClinicalTrials.gov NCT01235299. Prospective cohort study. 56 free flaps (24 latissimus dorsi flaps,11 ALT,10 parascapular, 9 DIEP,1 serratus,1 VRAM) in 56 patients (35 males, age 49±14yrs) were prospectively monitored from November 2009 to January 2011 using a regular digital infrared surface thermometer simultaneously to microcirculatory assessment using combined Laser-Doppler and photo spectrometry (Oxygen-to-see).

Results: Free flap microcirculatory blood flow was 109±37arbitrary units [AU]. Adjacent skin capillary blood flow was 143±52AU. Free flap skin island temperature was 95.3±3.0°F. Temperature of adjacent skin was 96.6±1.9 °F. We found a positive correlation between the percentaged difference of free flap and adjacent skin temperatures and percentaged difference of free flap skin island and adjacent skin capillary blood flow (p=0.001).

Conclusion: Our hypothesis was confirmed. A 10% reduction of free flap skin island temperature compared to adjacent skin indicates a deterioration of flap microcirculation by 50%, if skin temperature of the adjacent skin remains the same. Trends in surface skin island temperature monitoring are found to correlate with microcirculatory blood flow. Eliminating environmental influences on temperature assessment by comparing the temperature of the skin island of the free flap to the temperature of the adjacent healthy skin makes free flap temperature monitoring more reliable in reconstructive microsurgery.

written by Anaplastology

Congenital facial paralysis is present right from the time of birth and its frequency is about two out of every 1000 newborns. About 8-14% of all pediatric cases of facial paralysis fall under the category of congenital type [4]. The most common unilateral syndromic condition associated with facial paralysis is Hemifacial microsomia. Möbius syndrome on the other hand is an example of a facial paralysis due to developmental cause with a frequency of 1 per 50,000 births [5]. Common problems faced by the newborns suffering from congenital facial paralysis are difficulty with nursing and incomplete eye closure. This condition needs to be addressed at an early stage of life, otherwise the child’s future speech might be affected, which in turn might affect their self esteem. The symptoms of congenital facial paralysis in children tend be to more conspicuous with increasing age.

written by Anaplastology

Tissue engineering as a field is rapidly developing in order to provide new scaffolds, tissues and organs or devices to replace or supplement function. One key limitation within tissue engineering is the need for rapid perfusion and microvascularization of implanted tissues. Many investigators are currently focused on the rational design of angiogenic tissue engineering scaffolds which can induce the formation of a microvascular host response. This contribution is critical to the field because recently developed tissue engineering products for use in humans lack microvascularization. These successfully engineered thin tissue components include cartilage, bladder and cornea. The lack of microvascularization limits the types of tissue replacements that can be engineered. In order to better understand the need for microvascularization, a basic discussion on the demand for tissue engineering, an overview of current strategies employed by tissue engineering and some successes and challenges within the field must first be presented.

written by Anaplastology