Journal of reconstructive microsurgery最新文献

{"title":"The \"Flapbot\": A Global Perspective on the Validity and Usability of a Flap Monitoring Chatbot.","authors":"Hamza Ejaz, Stephen R Ali, Juan E Berner, Thomas D Dobbs, Iain S Whitaker, Flapbot Collaborative","doi":"10.1055/a-2355-3970","DOIUrl":"10.1055/a-2355-3970","url":null,"abstract":"<p><strong>Background: </strong> The Flapbot chatbot assists in free-flap monitoring, emphasizing accessibility, user-friendliness, and global reliability. This study assesses Flapbot's worldwide validity and usability and uses qualitative analysis to identify areas for future enhancement.</p><p><strong>Methods: </strong> Flapbot, built on Google's DialogFlow, was evaluated by international plastic surgeons. Invitations were sent to the International Lower Limb Reconstruction Collaborative (INTELLECT), International Confederation of Plastic Surgery Societies (ICOPLAST), and the International Microsurgery Club. Out of the 42 surgeons who agreed to participate, 21 tested the Flapbot and completed an online survey on its validity and usability. The survey had 13 validity items and 10 usability items. Data analysis involved computing the individual content validity index (I-CVI) and scale-wide content validity index (S-CVI) for validity, and the system usability score (SUS) for usability. Thematic analysis distilled free-text responses to identify key themes.</p><p><strong>Results: </strong> Nine of 13 items had an I-CVI over 0.78, denoting significant relevance. The S-CVI score stood at 0.82, indicating high relevance. The SUS score was 68, representing average usability. Themes highlighted issues with the current model, development suggestions, and surgeons' concerns regarding growing reliance on digital tools in health care.</p><p><strong>Conclusion: </strong> Flapbot is a promising digital aid for free-flap monitoring. While it showcases notable validity and usability, improvements in functionality, usability, and accessibility are needed for broader global use.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis.","authors":"Alexander Murray-Douglass, Pascalino Romeo, Carly Fox","doi":"10.1055/s-0044-1788543","DOIUrl":"https://doi.org/10.1055/s-0044-1788543","url":null,"abstract":"<p><strong>Background: </strong> Large defects of the lower lip often require free tissue coverage. Fasciocutaneous free flaps have been traditionally used, but innervated muscular free flaps may fundamentally address orbicularis oris deficiency and improve dynamic competence. This review aimed to determine if innervated muscular free flaps provided benefit over fasciocutaneous free flaps for reconstruction of defects of more than 50% of the lower lip. Outcomes of interest included functional oral outcomes including oral competence, aesthetic outcomes, and patient-reported outcome measures.</p><p><strong>Methods: </strong> Five databases (PubMed, Embase, Web of Science, CINAHL, and CENTRAL) were searched for variations of \"lip\" and \"free flap.\" Two authors screened articles and included primary research of free flap reconstruction of more than 50% of the lower lip from any etiology in living humans with an English full-text available. Composite bony flaps were excluded. Oral competence and aesthetic satisfaction, reconstruction details, and complications were extracted. Proportional meta-analyses were used to synthesize results for fasciocutaneous free flaps, which were compared with those for muscular free flaps.</p><p><strong>Results: </strong> Fifty-nine articles describing 242 patients were included. Muscular free flaps reported significantly higher proportional oral competence than fasciocutaneous free flaps (98 vs. 83%, <i>p</i> = 0.01). Aesthetic outcomes (98 vs. 97%, <i>p</i> = 0.22) and complications (17 vs. 18%, <i>p</i> = 0.79) were equivalent between fasciocutaneous and muscular free flaps.</p><p><strong>Conclusion: </strong> Muscular free flaps may address the fundamental orbicularis oris defect that causes oral incompetence and seem to provide better functional results. Aesthetic outcomes and complications seem to be equivalent.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Eye Closure Restoration in Facial Palsy with Neurotized Platysma Muscle Graft in Rats.","authors":"Tsz Yin Voravitvet, Yenlin Huang, Sawarin Voravitvet, Juan Larsson, Po-Hao Lien, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu, Tommy Nai-Jen Chang","doi":"10.1055/s-0044-1788565","DOIUrl":"https://doi.org/10.1055/s-0044-1788565","url":null,"abstract":"<p><strong>Background: </strong> One of the most devastating deficits of facial paralysis is eyelid dysfunction, which is controlled by the orbicularis oculi muscle (OOM), as it leads to loss of the protective mechanism of the eye. This study used a rat model to assess the functional outcomes of neurotized platysma muscle grafts (PMGs) for OOM replacement.</p><p><strong>Methods: </strong> Forty male Sprague-Dawley rats with iatrogenic right eyelid dysfunction were divided into five groups: one control group and four groups utilizing PMG with different sources of nerve innervation. Eyelid function recovery was assessed at 2, 4, 6, and 8 weeks. The PMGs were harvested for pathological examination at the end of the study.</p><p><strong>Results: </strong> All rats except those in the control group and one from the group using ipsilateral frontal and upper zygomatic frontal nerve branches directly neurotized to the PMG (nerve-to-muscle) recovered eyelid closure function within 8 weeks of the study period. The mean recovery time was 3.87 ± 1.28 weeks. A total of 87.5% of rats that had the contralateral zygomatic branch as the donor nerve regained the consensual corneal reflex (<i>p</i>-value < 0.001).</p><p><strong>Conclusion: </strong> Replacement of neurotized PMG for OOM function is successful in a rat model. Using the upper zygomatic branch as the donor nerve, it was possible to restore the consensual corneal reflex. This method shows promise for further human studies.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Microsurgical Skills Curriculum to Develop Unconscious Competence.","authors":"Jeremy V Lynn, Christine S W Best, Nicholas L Berlin, Theodore A Kung","doi":"10.1055/s-0044-1788547","DOIUrl":"https://doi.org/10.1055/s-0044-1788547","url":null,"abstract":"<p><p>The attainment of microsurgical competency is an important milestone for plastic surgery trainees. Technical skill and a practiced disposition are required to successfully perform microsurgical procedures. Microsurgical skills curricula may foster both proficiency with technical movements and facilitate performance with minimal cognitive burden while using the operating microscope. The microsurgical skills curriculum presented in this article focuses on three fundamental principles: intrinsic muscle strength, accuracy and precision of movement, and supervised practice. Progressive operative entrustment of trainees is earned through successful completion of deliberate microsurgical exercises rather than timed anastomosis trials. The overarching goal of this curriculum is to develop unconscious competence in microsurgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function.","authors":"Jason S Kofoed, Fatma B Tuncer, Alvin C Kwok, Jayant P Agarwal, Bradley A Ruple, Marta Borrelli, J David Symons, Russell S Richardson, Ryan M Broxterman","doi":"10.1055/s-0044-1788326","DOIUrl":"https://doi.org/10.1055/s-0044-1788326","url":null,"abstract":"<p><strong>Background: </strong> Surgeons routinely apply papaverine, lidocaine, or verapamil to produce acute vasodilation and prevent vasospasms during microvascular surgeries. There is evidence that topical vasodilators may induce postoperative endothelial and smooth muscle dysfunction, which would present after the acute vasodilatory effects of the topical drugs wear off. Therefore, the purpose of the current study was to evaluate the lasting effects of papaverine, lidocaine, and verapamil on human deep inferior epigastric perforator artery vasodilatory function after the acute effects of the topical drugs had worn off.</p><p><strong>Methods: </strong> Deep inferior epigastric arterial samples were obtained from 12 patients during surgery. Each artery was dissected into four rings which where incubated for 1 minute in either physiological saline solution (control), papaverine (30 mg/mL), lidocaine (20 mg/mL), or verapamil (2.5 mg/mL), followed by a 2-hour washout. Endothelial-dependent and -independent vasorelaxation were then assessed by the isometric tension responses to acetylcholine or sodium nitroprusside, respectively.</p><p><strong>Results: </strong> Peak acetylcholine-evoked vasorelaxation (mean ± standard deviation) was not different between control (62 ± 23%) and lidocaine (57 ± 18%, <i>p</i> = 0.881), but was reduced (all <i>p</i> < 0.002) in papaverine (22 ± 27%) and verapamil (22 ± 20%). Peak sodium nitroprusside-evoked vasorelaxation was not different (all <i>p</i> > 0.692) among control (132 ± 35%), lidocaine (121 ± 22%), and verapamil (127 ± 22%), but was less in papaverine (104 ± 41%; <i>p</i> = 0.045) than control.</p><p><strong>Conclusion: </strong> Surgically used doses of papaverine and verapamil, but not lidocaine, have lasting negative effects on arterial vasodilatory function despite the acute effects of the drugs having worn off. These findings, in conjunction with the spasmolytic properties of each drug, may help guide the selection of an optimal topical vasodilator for use during microvascular surgeries.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular Free-Flap Head and Neck Reconstruction: The Utility of the Modified Frailty Five-Item Index.","authors":"Sammy Othman, Emma Robinson, Dev Kamdar, Lucio Pereira, Brett Miles, Armen Kasabian, Joseph A Ricci, Denis Knobel","doi":"10.1055/s-0044-1788540","DOIUrl":"https://doi.org/10.1055/s-0044-1788540","url":null,"abstract":"<p><strong>Background: </strong> Microvascular free tissue transfer is a common tool for the reconstruction of oncologic head and neck defects. Adequate preoperative assessment can aid in appropriate risk stratification and peri-operative optimization. The modified five-item frailty index (mFI-5) is a validated risk-assessment scale; however, its utility in head and neck free-flap reconstruction is unknown when compared with other common risk factors.</p><p><strong>Methods: </strong> A retrospective, single-institution chart review (2017-2020) was performed. Patient demographics, defect and repair characteristics, pre- and peri-operative factors, and flap outcomes were recorded. A high mFI-5 score was defined as greater than 2. The total score, as well as other patient factors, was correlated to postoperative flap complications.</p><p><strong>Results: </strong> A total of 214 patients were deemed appropriate for conclusion. The mean age was 63.9 ± 12.8 years. There were an even number of males (52.8%) and females (47.2%). A fifth of subjects (20.8%) underwent preoperative radiotherapy. There were 21 cases (9.8%) of complete flap loss. A total of 34 patients (29.4%) experienced any postoperative complication related to flap outcomes. An elevated mFI-5 was significantly associated with a higher overall rate of postoperative complications (39.7 vs. 29.4%, <i>p</i> < 0.019) and total flap loss (16.7% vs. 6.6%, <i>p</i> < 0.033). Preoperative radiation was found to be associated with an increased complication rate (<i>p</i> < 0.003).</p><p><strong>Conclusion: </strong> The mFI-5 score may be a potentially significant tool in the risk stratification of patients undergoing head and neck free-flap reconstruction as opposed to commonly utilized risk factors. Preoperative radiotherapy is significantly associated with postoperative complications. Appropriate preoperative assessment may help tailor patient care preoperatively.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HoloDIEP-Faster and More Accurate Intraoperative DIEA Perforator Mapping Using a Novel Mixed Reality Tool.","authors":"Fabian N Necker, David J Cholok, Marc J Fischer, Mohammed S Shaheen, Kyle Gifford, Michael Januszyk, Christoph W Leuze, Michael Scholz, Bruce L Daniel, Arash Momeni","doi":"10.1055/s-0044-1788548","DOIUrl":"https://doi.org/10.1055/s-0044-1788548","url":null,"abstract":"<p><strong>Background: </strong> Microsurgical breast reconstruction using abdominal tissue is a complex procedure, in part, due to variable vascular/perforator anatomy. Preoperative computed tomography angiography (CTA) has mitigated this challenge to some degree; yet it continues to pose certain challenges. The ability to map perforators with Mixed Reality has been demonstrated in case studies, but its accuracy has not been studied intraoperatively. Here, we compare the accuracy of \"HoloDIEP\" in identifying perforator location (vs. Doppler ultrasound) by using holographic 3D models derived from preoperative CTA.</p><p><strong>Methods: </strong> Using a custom application on HoloLens, the deep inferior epigastric artery vascular tree was traced in 15 patients who underwent microsurgical breast reconstruction. Perforator markings were compared against the 3D model in a coordinate system centered on the umbilicus. Holographic- and Doppler-identified markings were compared using a perspective-corrected photo technique against the 3D model along with measurement of duration of perforator mapping for each technique.</p><p><strong>Results: </strong> Vascular points in HoloDIEP skin markings were -0.97 ± 6.2 mm (perforators: -0.62 ± 6.13 mm) away from 3D-model ground-truth in radial length from the umbilicus at a true distance of 10.81 ± 6.14 mm (perforators: 11.40 ± 6.15 mm). Absolute difference in radial distance was twice as high for Doppler markings compared with Holo-markings (9.71 ± 6.16 and 4.02 ± 3.20 mm, respectively). Only in half of all cases (7/14), more than 50% of the Doppler-identified points were reasonably close (<30 mm) to 3D-model ground-truth. HoloDIEP was twice as fast as Doppler ultrasound (76.9s vs. 150.4 s per abdomen).</p><p><strong>Conclusion: </strong> HoloDIEP allows for faster and more accurate intraoperative perforator mapping than Doppler ultrasound.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Potential Factors Associated with Cellulitis Following Lymphovenous Bypass Surgery in Breast Cancer Survivors.","authors":"Ricardo A Torres-Guzman, Francisco R Avila, Karla Maita, John P Garcia, Abdullah S Eldaly, Gioacchino D De Sario, Sahar Borna, Cesar A Gomez-Cabello, Sophia M Pressman, Syed Ali Haider, Olivia A Ho, Antonio Jorge Forte","doi":"10.1055/s-0044-1788345","DOIUrl":"https://doi.org/10.1055/s-0044-1788345","url":null,"abstract":"<p><strong>Background: </strong> Breast cancer is one of the most common types of cancer, with around 2.3 million cases diagnosed in 2020. One in five cancer patients develops chronic lymphedema caused by multifactorial triggers and treatment-related factors. This can lead to swelling, skin infections, and limb dysfunction, negatively affecting the patient's quality of life. This retrospective cohort study aimed to determine the associations between demographic and breast cancer characteristics and postoperative cellulitis in breast cancer survivors who underwent lymphovenous bypass surgery (LVB) at Mayo Clinic, Florida.</p><p><strong>Methods: </strong> We performed a retrospective chart review. Data were collected retrospectively from 2016 to 2022. Sixty adult breast cancer survivors who underwent LVB were included in the final analysis based on specific inclusion and exclusion criteria. Patients were excluded if they did not meet the inclusion criteria or had incomplete follow-up data. Demographic and surgical data were extracted, including body mass index (BMI), type of anastomosis, number of anastomoses, and preoperative cellulitis status. Lymphedema measurements were performed using tape measurements. Fisher's exact test was used to determine statistically significant associations between variables and postoperative cellulitis.</p><p><strong>Results: </strong> Postoperative cellulitis was more common in patients aged 60 to 69 years (43.2%), whites (75.0%), overweight or obese (90.9%), with one to four anastomoses (81.8%), and nonsmokers (79.5%). The mean International Society of Lymphology (ISL) criteria for both postoperative cellulitis and no postoperative cellulitis was 1.93. Statistically significant associations with postoperative cellulitis were found for the number of anastomoses (<i>p</i> = 0.021), smoking status (<i>p</i> = 0.049), preoperative cellulitis (<i>p</i> = 0.04), and the length of years with lymphedema diagnosis variable (<i>p</i> = 0.004).</p><p><strong>Conclusion: </strong> Our results suggest that a greater number of anastomoses, smoking, preoperative cellulitis, and years with lymphedema are significantly associated with an increased risk of postoperative cellulitis. Awareness of these risk factors is crucial for monitoring and early treatment of infections following surgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression.","authors":"Nikki Rezania, Kelly A Harmon, Reilly Frauchiger-Ankers, Okensama La-Anyane, Keid Idrizi, Jocelyn To, Ethan M Ritz, David E Kurlander, Deana Shenaq, George Kokosis","doi":"10.1055/s-0044-1788564","DOIUrl":"https://doi.org/10.1055/s-0044-1788564","url":null,"abstract":"<p><strong>Background: </strong> This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.</p><p><strong>Methods: </strong> A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.</p><p><strong>Results: </strong> The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, <i>p</i> = 0.0117), prior abdominal surgery (β = 0.0008, <i>p</i> = 0.046), and pregnancy history (β = -0.0015, <i>p</i> = 0<i>.</i>0001) were significantly associated with hernia. Active smoking (β = 0.0032, <i>p</i> = 0<i>.</i>0262) and pregnancy history (β = 0.0019, <i>p <</i> 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.</p><p><strong>Conclusion: </strong> Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Marrow Mesenchymal Stem Cells-derived Exosomes Promote Survival of Random Flaps in Rats through Nrf2-mediated Antioxidative Stress.","authors":"Lin Zhu, Qifang Niu, Delong Li, Mozi Li, Wenwen Guo, Zhengxue Han, Yang Yang","doi":"10.1055/a-2331-8046","DOIUrl":"10.1055/a-2331-8046","url":null,"abstract":"<p><strong>Background: </strong> Random flaps are the most used defect repair method for head and neck tumors and trauma plastic surgery. The distal part of the flap often undergoes oxidative stress (OS), ultimately leading to flap necrosis. Stem cells' exosomes exhibit potential effects related to anti-inflammatory, regenerative, and antioxidant properties. Nuclear factor erythroid-2-related factor 2 (Nrf2) is an important factor in regulating oxidative balance. Exosomes have been reported to monitor its transcription to alleviate OS. This study examined the impacts and underlying mechanisms of antioxidant actions of exosomes derived from bone marrow mesenchymal stem cells (BMSCs-Exo) on random flaps.</p><p><strong>Methods: </strong> BMSCs-Exo were injected into the tail veins of rats on days 0, 1, and 2 after surgery of random flaps. The rats were euthanized on day 3 to calculate the survival rate. Immunohistochemical staining, western blotting, dihydroethidium probe, superoxide dismutase, and malondialdehyde assay kits were used to detect the OS level. Human umbilical vein endothelial cells were cocultured with BMSCs-Exo and ML385 (an inhibitor of Nrf2) in vitro.</p><p><strong>Results: </strong> BMSCs-Exo may significantly improve the survival rate of the random flaps by reducing apoptosis, inflammation, and OS while increasing angiogenesis. Besides, BMSCs-Exo can also increase mitochondrial membrane potential and reduce reactive oxygen species levels in vitro. These therapeutic effects might stem from the activation of the Kelch-like enyol-CoA hydratase (ECH)-associated protein 1 (Keap1)/Nrf2 signaling pathway.</p><p><strong>Conclusion: </strong> BMSCs-Exo improved the tissue antioxidant capacity by regulating the Keap1/Nrf2 signaling pathway. BMSCs-Exo may be a new strategy to solve the problem of random flap necrosis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}