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Postoperative delirium (POD) is a major risk factor for an extended hospital stay and higher costs, and is associated with increased mortality. The incidence of POD is high in free flap procedures, and POD may also be a risk factor for flap loss and complications. Sarcopenia is a condition characterized by skeletal muscle mass (SMM) depletion and a decrease in muscle power or physical activity. The aim of this study was to investigate risk factors for postoperative delirium (POD), including SMM, in 122 patients undergoing free flap repair after oral cancer resection. All patients underwent preoperative abdominal-lumbar CT or PET-CT. Cross-sectional areas (cm2) of skeletal muscles at the third lumbar vertebra were measured on preoperative CT, normalized for height, and defined as the skeletal muscle index (SMI, cm2/m2). Risk factors for POD were investigated, including the value of SMI and taking the type of POD into consideration. POD occurred in 45 patients (36.9%), and was hyperactive in 28 (62.2%), mixed in 13 (28.9%), and hypoactive in 4 (8.9%). In multivariate analysis, high preoperative albumin (p = 0.046, adjusted odds ratio [OR] = 3.69) and postoperative insomnia (p < 0.001, OR = 6.79) were significant risk factors for POD. In a sub-analysis evaluating risk factors restricted to POD including the hypoactive type, lower SMI (p = 0.035, OR = 2.52 per 10-unit decrease) and postoperative insomnia (p = 0.003, OR = 6.37) were significant. We conclude that lower SMM increases the hypoactive and mixed types of POD. Increasing SMM by exercise and nutritional therapy preoperatively may prevent such POD in free flap repair for oral cancer. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), –6.4±10.9, and –15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is a severe soft tissue infection that can spread rapidly throughout the body, often resulting in fatal outcomes. Negative pressure wound therapy (NPWT) enhances wound healing by applying local negative pressure, and its effectiveness in managing NF has been documented. However, NPWT creates a semi-closed environment at the wound site, posing a risk of infection. Continuous local antibiotic perfusion (CLAP) is an innovative approach that uses localized infusion to deliver high concentrations of antibiotics continuously to the affected area via NPWT. CLAP includes intramedullary antibiotic perfusion (iMAP), which involves the intrathecal administration of antimicrobials, and intra-soft tissue antibiotic perfusion (iSAP), which targets the soft tissue. Previous studies have highlighted the efficacy of CLAP in controlling infections in both bone and soft tissue. Here, we present two cases of lower extremity NF treated with iSAP. In both cases, effective infection control and accelerated wound healing were achieved, leading to wound closure. These outcomes suggest that iSAP is a useful treatment modality for NF that offers a reduced treatment period and minimizes the procedural burden on patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tomaru et al.)

Cutaneous ischemia-reperfusion (I/R) injury is associated with the early pathogenesis of cutaneous pressure ulcers (PUs). The objective of this study was to investigate the effect of mesenchymal stem cells (MSCs) injection on the formation of PUs after I/R injury and determine the underlying mechanisms. We found that the subcutaneous injection of MSCs into areas of I/R injured skin significantly suppressed the formation of PUs. I/R-induced vascular damage, hypoxia, oxidative DNA damage, and apoptosis were decreased by MSCs injection. Oxidative stress signals detected after I/R in OKD48 (Keap1-dependent oxidative stress detector, No-48-luciferase) mice were decreased by the injection of MSCs. In cultured fibroblasts, MSCs-conditioned medium significantly inhibited oxidant-induced reactive oxygen species (ROS) generation and apoptosis. Furthermore, endoplasmic reticulum (ER) stress signals detected after I/R in ERAI (ER stress-activated indicator) mice were also decreased by the injection of MSCs. These results suggest that the injection of MSCs might protect against the development of PUs after cutaneous I/R injury by reducing vascular damage, oxidative cellular damage, oxidative stress, ER stress, and apoptosis.