107 results on '"Shafighi, M"'
Search Results
2. Lack of strong evidence with regard to the depth of thick melanoma excision
- Author
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Jafari, Seyed S.M., Hunger, R. E., and Shafighi, M.
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- 2015
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3. Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome
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Hunger, R. E., Seyed Jafari, S. M., Angermeier, S., and Shafighi, M.
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- 2014
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4. High expression of FOXP3 in primary melanoma is associated with tumour progression
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Gerber, A. L., Münst, A., Schlapbach, C., Shafighi, M., Kiermeir, D., Hüsler, R., and Hunger, R. E.
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- 2014
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5. Interrelation of peri-operative morbidity and ASA class assignment in patients undergoing gynaecological surgery
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Voney, G., Biro, P., Roos, M., Frielingsdorf, B., Shafighi, M., and Wyss, P.
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- 2007
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6. Dekubitalulkusdeckung durch mikrochirurgische Lappenplastiken
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Schoeller, T., Shafighi, M., Huemer, G. M., Wechselberger, G., and Piza-Katzer, H.
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- 2003
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7. Association of Vascular Endothelial Growth Factor Subtypes with Melanoma Patients’ Characteristics and Survival: A Semantic Connectivity Map Analysis
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Cazzaniga, S, primary, Wiedmer, C, additional, Frangež, �, additional, Shafighi, M, additional, Beltraminelli, H, additional, Weber, B, additional, Simon, D, additional, Naldi, L, additional, Simon, H, additional, Hunger, R, additional, and Jafari, S, additional
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- 2020
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8. An unusual case of thigh adductor weakness: obturator nerve ganglion
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Schwabegger, A H, Shafighi, M, and Gurunluoglu, R
- Published
- 2004
9. Improvement of flap necrosis in a rat random skin flap model by in-vivo electroporation mediated HGF gene transfer
- Author
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Jafari, M, Shafighi, M, Beltraminelli, H, Geiser, T, Hunger, R, and Gazdhar, A
- Subjects
ddc: 610 ,610 Medical sciences ,Medicine ,eye diseases - Abstract
Introduction: Despite great understanding of underlying mechanisms for flap necrosis and advances in surgical techniques, flap necrosis remains a critical issue. In the present study, we investigated the efficacy of electroporation mediated HGF gene delivery to random dorsal skin flap (McFarlane) to[for full text, please go to the a.m. URL], 48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie, 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)
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- 2017
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10. Einsatz von frischer humaner Haut zum Erlernen von Hauttransplantationsfertigkeiten: Etablierung eines Curriculums für Medizinstudenten
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Rothenberger, J., Tschumi, C., Jafari, M., Constantinescu, M. A., and Shafighi, M.
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Das Erlernen von chirurgischen Fertigkeiten ist von großer Bedeutung für Medizinstudenten um den zukünftigen Herausforderungen des Arbeitsalltags stand zu halten. Die chirurgische Lehre ist jedoch beeinflusst von Effizienz-, Produktivitäts-, finanziellen und ethischen[for full text, please go to the a.m. URL], 33. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2015)
- Published
- 2015
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11. Prognostic value of sentinel lymph node biopsy in melanomas of different Breslow’s thickness
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Seyed, Jafari, primary, Jäckle, P, additional, Michel, A, additional, Angermeier, S, additional, Hunger, R, additional, and Shafighi, M, additional
- Published
- 2016
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12. Einsatz von frischer humaner Haut zum Erlernen von Hauttransplantationsfertigkeiten: Etablierung eines Curriculums für Medizinstudenten
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Rothenberger, J, Tschumi, C, Jafari, M, Constantinescu, MA, Shafighi, M, Rothenberger, J, Tschumi, C, Jafari, M, Constantinescu, MA, and Shafighi, M
- Published
- 2015
13. Einsatz von frischer humaner Haut zum Erlernen von chirurgischen Fertigkeiten: Entwicklung eines Curriculums für Medizinstudenten
- Author
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Rothenberger, J, Tschumi, C, Jafari, M, Constantinescu, M, Shafighi, M, Rothenberger, J, Tschumi, C, Jafari, M, Constantinescu, M, and Shafighi, M
- Published
- 2015
14. Lack of strong evidence with regard to the depth of thick melanoma excision
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Seyed Jafari, S.M., primary, Hunger, R.E., additional, and Shafighi, M., additional
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- 2015
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15. No clinical benefit for 2 cm excision margins compared to 1 cm in tumor melanoma thicker than 2 mm
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Hunger, RE, Angermeier, S, Seyed Jafari, SM, Shafighi, M, Hunger, RE, Angermeier, S, Seyed Jafari, SM, and Shafighi, M
- Published
- 2014
16. An unusual case of galactorrhea in a postmenopausal woman complicating breast reduction
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Majdak-Paredes, E.J., Shafighi, M., During, V., and Sterne, G.D.
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- 2009
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17. Unilateral hypoplastic breast in a male-to-female transsexual with Poland syndrome after gender reassignment – reconstructive considerations
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Majdak-Paredes, E.J., Shafighi, M., and Fatah, F.
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- 2009
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18. The bilateral DIEP flap: A method of bipedicled anastomosis to a single internal mammary artery and venae comitantes
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Barabás, A.G., Shafighi, M., Sassoon, E.M., and Haywood, R.M.
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- 2008
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19. A chair leg as the rare cause of a transabdominal impalement with duodenal and pancreatic involvement.
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Golder SK, Friess H, Shafighi M, Kleeff JH, and Buchler MW
- Published
- 2001
20. Effect of electromagnetic fields on structure and pollen grains development in Chenopodium album L
- Author
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Leila Amjad and Shafighi, M.
- Subjects
otorhinolaryngologic diseases ,food and beverages - Abstract
The role of the pollen grain, with to the reproductive process of higher plants, is to deliver the spermatic cells to the embryo sac for egg fertilization. The aim of this project was study the effect of electromagnetic fields on structure and pollen grains development in Chenopodium album. Anthers of Chenopodium album L. were collected at different stages of development from control (without electromagnetic field) and plants grown at 10m from the field sources. Structure and development of pollen grains were studied and compared. The studying pollen structure by Light and Scanning electron microscopy showed that electromagnetic fields reduction of pollen grains number and male sterility, thus , in some anthers, pollen grains were attached together and deformed compared to control ones. The data presented suggest that prolonged exposures of plants to magnetic field may cause different biological effects at the cellular tissue and organ levels.
21. NEUROLOGICAL PICTURE: An unusual case of thigh adductor weakness: obturator nerve ganglion.
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Schwabegger, A. H., Shafighi, M., and Gurunluoglu, R.
- Subjects
- *
THIGH , *TUMORS , *DIAGNOSIS , *AXONAL transport , *THERAPEUTICS , *NEUROLOGY - Abstract
The article focuses on the unusual case of thigh adductor weakness. A 34 year old sportsman suffered from thigh adduction weakness and moderate adductor muscle atrophy with unspecific pain at the pelvic region. After deterioration of the symptoms and exclusion of muscle lesion by ultrasound, neurological examination and EMG diagnosed an isolated obturator motor neuropathy. Obturator neuropathy due to a ganglion is a rare entity that requires a continuing investigation to verify the exact diagnosis. Surgical treatment is usually successful when performed early, tumour growth may cause irreversible axonal injury and muscle palsy.
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- 2004
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22. Efficacy of Combined in-vivo Electroporation-Mediated Gene Transfer of VEGF, HGF, and IL-10 on Skin Flap Survival, Monitored by Label-Free Optical Imaging: A Feasibility Study.
- Author
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Seyed Jafari SM, Blank F, Ramser HE, Woessner AE, Shafighi M, Geiser T, Quinn KP, Hunger RE, and Gazdhar A
- Abstract
Preventing surgical flaps necrosis remains challenging. Laser Doppler imaging and ultrasound can monitor blood flow in flap regions, but they do not directly measure the cellular response to ischemia. The study aimed to investigate the efficacy of synergistic in-vivo electroporation-mediated gene transfer of interleukin 10 (IL-10) with either hepatocyte growth factor (HGF) or vascular endothelial growth factor (VEGF) on the survival of a modified McFarlane flap, and to evaluate the effect of the treatment on cell metabolism, using label-free fluorescence lifetime imaging. Fifteen male Wistar rats (290-320 g) were randomly divided in three groups: group-A (control group) underwent surgery and received no gene transfer. Group-B received electroporation mediated hIL-10 gene delivery 24 h before and VEGF gene delivery 24 h after surgery. Group-C received electroporation mediated hIL-10 gene delivery 24 h before and hHGF gene delivery 24 h after surgery. The animals were assessed clinically and histologically. In addition, label-free fluorescence lifetime imaging was performed on the flap. Synergistic electroporation mediated gene delivery significantly decreased flap necrosis ( P = 0.0079) and increased mean vessel density ( P = 0.0079) in treatment groups B and C compared to control group-A. NADH fluorescence lifetime analysis indicated an increase in oxidative phosphorylation in the epidermis of the group-B ( P = 0.039) relative to controls. These findings suggested synergistic in-vivo electroporation-mediated gene transfer as a promising therapeutic approach to enhance viability and vascularity of skin flap. Furthermore, the study showed that combinational gene therapy promoted an increase in tissue perfusion and a relative increase in oxidative metabolism within the epithelium., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Seyed Jafari, Blank, Ramser, Woessner, Shafighi, Geiser, Quinn, Hunger and Gazdhar.)
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- 2021
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23. Correlation of Vascular Endothelial Growth Factor subtypes and their receptors with melanoma progression: A next-generation Tissue Microarray (ngTMA) automated analysis.
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Seyed Jafari SM, Wiedmer C, Cazzaniga S, Frangež Ž, Shafighi M, Beltraminelli H, Weber B, Simon HU, and Hunger RE
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- Adult, Aged, Automation, Disease-Free Survival, Female, Humans, Image Interpretation, Computer-Assisted, Kaplan-Meier Estimate, Logistic Models, Male, Melanoma mortality, Melanoma pathology, Middle Aged, Neoplasm Metastasis, Nevus, Pigmented diagnosis, Nevus, Pigmented pathology, Principal Component Analysis, Protein Isoforms metabolism, Biomarkers, Tumor metabolism, Melanoma diagnosis, Receptors, Vascular Endothelial Growth Factor metabolism, Tissue Array Analysis methods, Vascular Endothelial Growth Factors metabolism
- Abstract
Introduction: Finding new markers to assess prognosis of melanoma without the necessity to perform a surgical interventions is an important goal in melanoma research. The current study aimed to assess the correlation of clinical course and prognosis of primary and metastatic melanoma with expression of VEGF family and their receptors., Methods: A ngTMA block was made from the randomly selected paraffin tissue blocks of the patients with melanocytic nevi, primary and metastatic melanoma. Then sections cut from ngTMA-block were immunohistochemically stained with proper antibodies. Expression of these proteins was investigated using automated image analysis and compared among the study groups., Results: We analyzed the tissue of 238 patients with following diagnoses: 101 (42.4%) with a diagnosis of nevus, 86 (36.1%) Malignant melanoma and 51 (21.4%) metastasis. Median follow-up time for the malignant lesions was 5.71 years. Among the tested antigen, VEGF-C (p = 0.016), VEGF-R2 (p<0.001) and VEGF-R3 (p = 0.002) were significantly higher expressed in the metastatic tissues. When these scores were assessed in multiple regression models, the only independent factor linked to patient's diagnosis was VEGF-R2 (p<0.001). In addition, groups of highly correlated variables (VEGF-C and VEGF-R3, VEGF-A and VEGF-R1) were found to form separate sub-clusters. On the other side, high values of VEGF-C were associated with both overall and disease-free survival with a statically significant HR of 2.76 (95% CI: 1.27, 5.98; p = 0.01) and 2.82 (95%CI: 1.62, 4.91; p<0.001), respectively., Conclusions: This study shows that VEGF-C and VEGF-R2 might represent new prognostic marker in MM. However, further prospective studies are warranted to test their real efficacy as a prognostic marker., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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24. Laser doppler imaging as additional monitoring after digital replanting: A prospective study.
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Schmid M, Seyed Jafari SM, Haug L, Surke C, Hunger RE, Van De Ville D, Juon Personeni B, Shafighi M, and Voegelin E
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- Adult, Amputation, Traumatic diagnostic imaging, Amputation, Traumatic physiopathology, Female, Finger Injuries physiopathology, Humans, Male, Microcirculation physiology, Middle Aged, Prospective Studies, Young Adult, Amputation, Traumatic surgery, Finger Injuries diagnostic imaging, Finger Injuries surgery, Laser-Doppler Flowmetry, Microsurgery, Replantation
- Abstract
Background: Despite various exisiting monitoring methods, there is still a need for new technologies to improve the quality of post-operative evaluation of digital replantation. The purpose of the study is using a laser Doppler imaging device (Easy-LDI) as an additional tool to assess perfusion. In this method, the changes in the frequency of the laser ligth provide information regarding perfusion of the monitored tissue., Patients and Methods: This study included seven patients (10 fingers; age of patients: 21-57 years) who suffered from a total (n = 6) or subtotal amputation (n = 4) due to accidents. In addition to hourly standard monitoring with clinical evaluation and skin thermometry, revascularized fingers were hourly monitored with Easy LDI for 48 h., Results: LDI measurement values ranged between 0.8 and 223 (mean 90.62 ± 21.42) arbitrary perfusion units (APU). The mean LDI values before and after revascularization were 7.1 ± 2.85 and 65.30 ± 30.83 APU, respectively. For the successful revascularized fingers (8 of 10 fingers) values from 19 to 223 APU (mean 98.52 ± 15.48) were demonstrated. All of the replants survived, but due to venous occlusion two digits required revision 12 and 35 h after revascularization, respectively. In the two cases, Easy-LDI also showed a constant and slow decline of the perfusion values. Furthermore, Pearson normalized correlation coefficient showed a positive significant correlation between temperatures of the replants and LDI-values (P < .001, r = +0.392) and a negative significant correlation between Δtemperature and LDI-values (P < .001, r = -0.474)., Conclusion: The LDI-device might be a promising additional monitoring technique in detection of perfusion disturbance in monitoring digital replantations., (© 2018 Wiley Periodicals, Inc.)
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- 2018
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25. Application of electrochemotherapy in the management of primary and metastatic cutaneous malignant tumours: a systematic review and meta-analysis.
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Seyed Jafari SM, Jabbary Lak F, Gazdhar A, Shafighi M, Borradori L, and Hunger RE
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- Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Bleomycin administration & dosage, Bleomycin adverse effects, Bleomycin therapeutic use, Cisplatin administration & dosage, Cisplatin adverse effects, Cisplatin therapeutic use, Drug Administration Schedule, Humans, Injections, Intralesional, Injections, Intravenous, Neoplasm Metastasis, Skin Neoplasms pathology, Antineoplastic Agents therapeutic use, Electrochemotherapy adverse effects, Electrochemotherapy instrumentation, Electrochemotherapy methods, Skin Neoplasms drug therapy
- Abstract
Electrochemotherapy is becoming a promising technique for the management of malignancies of skin and non-skin origin. The current review aims to clarify current knowledge on administration of electrochemotherapy for the treatment of various skin tumours. A systematic literature search was performed, up to the end of 2016, on studies in which the application of electrochemotherapy for management of primary and metastatic cutaneous malignant tumours was assessed. Having selected appropriate studies, pooled estimates of mean objective (complete) responses, with 95% confidence intervals (CIs), were calculated to assess treatment efficacy. Finally, the main emerging themes from the papers were discussed in more detail. From 465 records identified through database searching, a total of 128 studies were screened, of which 70 were included for review. After a pooled analysis, the estimate for mean objective response following electrochemotherapy was 84.02% (95% CI: 80.08-87.61). Furthermore, the pooled estimate of objective treatment response of evaluated studies was 83.91% (95% CI: 79.15-88.17%) for bleomycin and 80.82% (95% CI: 66.00-92.36%) for cisplatin. Electrochemotherapy is a feasible, inexpensive, fast and easy technique to perform local treatment, regardless of tumour type, with a low level of adverse effects and patient discomfort. This method can be applied alone for patients with primary cutaneous lesions, or local or locoregional metastases, or as an additional treatment modality in patients with distant metastases.
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- 2018
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26. Efficacy of In Vivo Electroporation-Mediated IL-10 Gene Delivery on Survival of Skin Flaps.
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Seyed Jafari SM, Shafighi M, Beltraminelli H, Weber B, Schmid RA, Geiser T, Gazdhar A, and Hunger RE
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- Animals, Genetic Therapy, Male, Necrosis genetics, Necrosis metabolism, Rats, Rats, Wistar, Surgical Flaps, Wound Healing genetics, Wound Healing physiology, Electroporation methods, Interleukin-10 genetics, Interleukin-10 metabolism, Skin Transplantation
- Abstract
Despite advances in understanding the underlying mechanisms of flap necrosis and improvement in surgical techniques, skin flap necrosis after reconstructive surgery remains a crucial issue. We investigated the efficacy of electroporation-mediated IL-10 gene transfer to random skin flap with an aim to accelerate wound healing and improve skin flap survival. Nine male Wistar rats (300-330 g) were divided in two groups (a) control group (n = 5), only surgery no gene transfer, and (b) experimental group, received electroporation-mediated IL-10 gene transfer 24 h before the surgery as prophylaxis (n = 4). Random skin flap (McFarlane) was performed in both groups. Planimetry, Laser Doppler imaging, and immunohistochemistry were used to evaluate the effect of IL-10 gene transfer between study groups at day 7. Electroporation-mediated IL-10 gene transfer decreased percentage of flap necrosis (p value = 0.0159) and increased cutaneous perfusion compared to the control group (p value = 0.0159). In addition, Spearman's rank correlation showed a significant negative correlation between percentage of flap necrosis and Laser Index (p value = 0.0083, r -0.83, respectively). Furthermore, significantly higher mean CD31
+ vessel density was detected in the experimental group compared to the control group (p value = 0.0159). Additionally, semi-quantitative image analysis showed lower inflammatory cell count in experimental group compared to control group (p value = 0.0317). In vivo electroporation-mediated IL-10 gene transfer reduced necrosis, enhanced survival and vascularity in the ischemic skin flap.- Published
- 2018
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27. Improvement of Flap Necrosis in a Rat Random Skin Flap Model by In Vivo Electroporation-Mediated HGF Gene Transfer.
- Author
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Seyed Jafari SM, Shafighi M, Beltraminelli H, Geiser T, Hunger RE, and Gazdhar A
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- Animals, Male, Models, Animal, Necrosis therapy, Rats, Rats, Wistar, Electroporation, Gene Transfer Techniques, Hepatocyte Growth Factor genetics, Surgical Flaps pathology, Wound Healing
- Abstract
Background: Despite great understanding of underlying mechanisms for flap necrosis and advances in surgical techniques, flap necrosis remains a critical issue. In the present study, the authors investigated the efficacy of electroporation-mediated hepatocyte growth factor (HGF) gene delivery to random dorsal skin flaps (McFarlane) to accelerate wound healing and reduce flap necrosis., Methods: Fifteen male Wistar rats (290 to 320 g) were divided randomly into three groups. Group a, the control group (n = 5), underwent surgery and received no gene transfer. Group b received electroporation-mediated HGF gene delivery 24 hours after surgery as a treatment. Group c received electroporation-mediated HGF gene delivery 24 hours before surgery as prophylaxis (n = 5). Planimetry, laser Doppler imaging, and immunohistochemistry were used to assess the efficacy of HGF gene therapy among the groups., Results: Electroporation-mediated HGF gene delivery significantly decreased flap necrosis percentage compared with the control group in prophylactic and treatment groups (p = 0.0317 and p = 0.0079, respectively) and significantly increased cutaneous perfusion compared with the control group (p = 0.0317 and p = 0.0159, respectively). Moreover, Spearman rank correlation showed a significant negative correlation between flap necrosis percentage and laser index (p = 0.0213 and r = -0.5964, respectively). Furthermore, significantly higher mean CD31 vessel density was detected in treatment and prophylactic groups (p = 0.0079 and p = 0.0159, respectively). In addition, quantitative image analysis revealed significantly higher HGF protein expression in groups b and c (p = 0.0079 and p = 0.0079, respectively)., Conclusion: These findings suggested in vivo electroporation-mediated HGF gene delivery enhanced viability and vascularity of the ischemic skin flap.
- Published
- 2017
- Full Text
- View/download PDF
28. Quality of information for women seeking breast augmentation in the Internet.
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Palma AF, Zuk G, Raptis DA, Franck S, Eylert G, Frueh FS, Guggenheim M, and Shafighi M
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- Female, Humans, Quality Control, Consumer Health Information standards, Internet, Mammaplasty
- Abstract
Background Recently published data show that many women interested in breast augmentation (BA) actively search the Internet for information. The Internet is currently the main source of information on this topic. Objectives Little is known about the quality of available information on the Internet concerning BA. The goal was to evaluate this in a systematic manner using a validated and reproducible tool. Methods Women (n = 96) unrelated to medicine were asked which keywords they would use to search the Internet if they were interested in BA. Five keywords were used. Qualitative and quantitative assessment was performed with the modified Ensuring Quality Information for Patients (EQIP) tool. A total of 2500 websites containing information on BA were identified using Google, Bing, Yahoo, Ask, and AOL. Results Out of 623 eligible websites, only 153 (25%) addressed more than 20 EQIP items. Scores were higher for encyclopaedias and academic websites compared to hospital and practitioner websites. The median EQIP score was only 15 (IQR = 12-20), and quantitative postoperative morbidity and mortality risk estimates were available in only 38% and 25% of the websites, respectively. Major complications (e.g. capsular contraction, implant safety) were mentioned in only 156 (25%) of the websites. Conclusions This is the first assessment of online patient information on BA using the EQIP tool. This analysis demonstrated several shortcomings in the quality of information provided to BA candidates. There is an immediate need for better informative and educational websites regarding BA procedures that are compatible with international quality standards for plastic surgery.
- Published
- 2016
- Full Text
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29. New approach for virtual surgical planning and mandibular reconstruction using a fibula free flap.
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Mottini M, Seyed Jafari SM, Shafighi M, and Schaller B
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- Fibula transplantation, Humans, Mandible surgery, Mandibular Neoplasms surgery, Printing, Three-Dimensional, Tomography, X-Ray Computed, Computer-Aided Design, Free Tissue Flaps transplantation, Mandibular Reconstruction methods, Plastic Surgery Procedures, Surgery, Computer-Assisted
- Abstract
Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
- Full Text
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30. Systematic Review of Quality of Patient Information on Liposuction in the Internet.
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Zuk G, Palma AF, Eylert G, Raptis DA, Guggenheim M, and Shafighi M
- Abstract
Background: A large number of patients who are interested in esthetic surgery actively search the Internet, which represents nowadays the first source of information. However, the quality of information available in the Internet on liposuction is currently unknown. The aim of this study was to assess the quality of patient information on liposuction available in the Internet., Methods: The quantitative and qualitative assessment of Web sites was based on a modified Ensuring Quality Information for Patients tool (36 items). Five hundred Web sites were identified by the most popular web search engines., Results: Two hundred forty-five Web sites were assessed after duplicates and irrelevant sources were excluded. Only 72 (29%) Web sites addressed >16 items, and scores tended to be higher for professional societies, portals, patient groups, health departments, and academic centers than for Web sites developed by physicians, respectively. The Ensuring Quality Information for Patients score achieved by Web sites ranged between 8 and 29 of total 36 points, with a median value of 16 points (interquartile range, 14-18). The top 10 Web sites with the highest scores were identified., Conclusions: The quality of patient information on liposuction available in the Internet is poor, and existing Web sites show substantial shortcomings. There is an urgent need for improvement in offering superior quality information on liposuction for patients intending to undergo this procedure.
- Published
- 2016
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31. Post-operative monitoring of free muscle transfers by Laser Doppler Imaging: A prospective study.
- Author
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Tschumi C, Seyed Jafari SM, Rothenberger J, Van de Ville D, Keel M, Krause F, and Shafighi M
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- Adult, Aged, Female, Free Tissue Flaps transplantation, Graft Survival, Humans, Ischemia etiology, Male, Microcirculation, Middle Aged, Monitoring, Physiologic methods, Muscle, Skeletal transplantation, Prospective Studies, Free Tissue Flaps blood supply, Ischemia diagnosis, Laser-Doppler Flowmetry, Muscle, Skeletal blood supply, Postoperative Care methods, Postoperative Complications diagnosis, Plastic Surgery Procedures methods
- Abstract
Purpose: Despite different existing methods, monitoring of free muscle transfer is still challenging. In the current study we evaluated our clinical setting regarding monitoring of such tissues, using a recent microcirculation-imaging camera (EasyLDI) as an additional tool for detection of perfusion incompetency., Patients and Methods: This study was performed on seven patients with soft tissue defect, who underwent reconstruction with free gracilis muscle. Beside standard monitoring protocol (clinical assessment, temperature strips, and surface Doppler), hourly EasyLDI monitoring was performed for 48 hours. Thereby a baseline value (raised flap but connected to its vascular bundle) and an ischaemia perfusion value (completely resected flap) were measured at the same point., Results: The mean age of the patients, mean baseline value, ischaemia value perfusion were 48.00 ± 13.42 years, 49.31 ± 17.33 arbitrary perfusion units (APU), 9.87 ± 4.22 APU, respectively. The LDI measured values in six free muscle transfers were compatible with hourly standard monitoring protocol, and normalized LDI values significantly increased during time (P < 0.001, r = 0.412). One of the flaps required a return to theatre 17 hours after the operation, where an unsalvageable flap loss was detected. All normalized LDI values of this flap were under the ischaemia perfusion level and the trend was significantly descending during time (P < 0.001, r = -0.870)., Conclusion: Due to the capability of early detection of perfusion incompetency, LDI may be recommended as an additional post-operative monitoring device for free muscle flaps, for early detection of suspected failing flaps and for validation of other methods., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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32. Sentinel lymph node biopsy in thick malignant melanoma: A 16-year single unit experience.
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Hunger RE, Michel A, Seyed Jafari SM, and Shafighi M
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Disease-Free Survival, Female, Hospitals, University, Humans, Kaplan-Meier Estimate, Male, Melanoma therapy, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness pathology, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Sentinel Lymph Node Biopsy statistics & numerical data, Skin Neoplasms therapy, Statistics, Nonparametric, Survival Analysis, Switzerland, Melanoma mortality, Melanoma pathology, Neoplasm Recurrence, Local mortality, Sentinel Lymph Node Biopsy methods, Skin Neoplasms mortality, Skin Neoplasms pathology
- Abstract
Background: The role of sentinel lymph node biopsy (SLNB) and its benefits in patients with thick melanoma is still controversial., Objectives: We evaluated the clinical effect of SLNB in patients with thick melanoma., Methods: We performed a retrospective cohort review (1996-2012) of thick melanomas. Collected data included the patient and tumour characteristics. Locoregional recurrence, distant metastases, disease free and overall survival were compared between the patients with positive and negative SLNB., Results: 126 thick melanomas with a mean age of 64.09 years were included in the study. Positive SLNB were found in 47 (37.3%) patients. Significantly more locoregional recurrence (P = 0.002) and distant metastases (P = 0.030) were detected in the patients with positive SLNB. Furthermore, the patients with negative SLNB showed significantly better disease free survival (P = 0.021)., Conclusions: Positive SLNB might be prognostic factor in thick melanoma and aggravates the outcome of thick melanomas.
- Published
- 2015
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33. Evaluation of Medical Students' Attitudes and Performance of Basic Surgery Skills in a Training Program Using Fresh Human skin, Excised During Body Contouring Surgeries.
- Author
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Rothenberger J, Seyed Jafari SM, Schnabel KP, Tschumi C, Angermeier S, and Shafighi M
- Subjects
- Adult, Female, Humans, Male, Young Adult, Attitude of Health Personnel, Bariatric Surgery, Dermatologic Surgical Procedures education, General Surgery education, Skin, Students, Medical psychology
- Abstract
Background: Learning surgical skills in the operating room may be a challenge for medical students. Therefore, more approaches using simulation to enable students to develop their practical skills are required., Objectives: We hypothesized that (1) there would be a need for additional surgical training for medical students in the pre-final year, and (2) our basic surgery skills training program using fresh human skin would improve medical students' surgical skills., Design: We conducted a preliminary survey of medical students to clarify the need for further training in basic surgery procedures. A new approach using simulation to teach surgical skills on human skin was set up. The procedural skills of 15 randomly selected students were assessed in the operating room before and after participation in the simulation, using Objective Structured Assessment of Technical Skills. Furthermore, subjective assessment was performed based on students' self-evaluation. The data were analyzed using SPSS, version 21 (SPSS, Inc., Chicago, IL)., Setting: The study took place at the Inselspital, Bern University Hospital., Participants: A total of 186 pre-final-year medical students were enrolled into the preliminary survey; 15 randomly selected medical students participated in the basic surgical skills training course on the fresh human skin operating room., Results: The preliminary survey revealed the need for a surgical skills curriculum. The simulation approach we developed showed significant (p < 0.001) improvement for all 12 surgical skills, with mean cumulative precourse and postcourse values of 31.25 ± 5.013 and 45.38 ± 3.557, respectively. The self-evaluation contained positive feedback as well., Conclusion: Simulation of surgery using human tissue samples could help medical students become more proficient in handling surgical instruments before stepping into a real surgical situation. We suggest further studies evaluating our proposed teaching method and the possibility of integrating this simulation approach into the medical school curriculum., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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34. A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm.
- Author
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Hunger RE, Angermeier S, Seyed Jafari SM, Ochsenbein A, and Shafighi M
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Confidence Intervals, Databases, Factual, Dermatologic Surgical Procedures mortality, Disease-Free Survival, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Melanoma pathology, Middle Aged, Mohs Surgery methods, Mohs Surgery mortality, Neoplasm Invasiveness pathology, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Skin Neoplasms pathology, Survival Analysis, Time Factors, Treatment Outcome, Melanoma, Cutaneous Malignant, Dermatologic Surgical Procedures methods, Melanoma mortality, Melanoma surgery, Skin Neoplasms mortality, Skin Neoplasms surgery
- Abstract
Background: Most guidelines recommend at least 2-cm excision margin for melanomas thicker than 2 mm., Objective: We evaluated whether 1- or 2-cm excision margins for melanoma (>2 mm) result in different outcomes., Methods: This is a retrospective cohort study on patients with melanomas (>2 mm) who underwent tumor excision with 1-cm (228 patients) or 2-cm (97 patients) margins to investigate presence of local recurrences, locoregional and distant metastases, and disease-free and overall survival., Results: In all, 325 patients with mean age of 61.84 years and Breslow thickness of 4.36 mm were considered for the study with a median follow-up of 1852 days (1995-2012). There was no significant difference in the frequency of locoregional and distant metastasis between the 2 groups (P = .311 and .571). The survival analysis showed no differences for disease-free (P = .800; hazard ratio 0.948; 95% confidence interval 0.627-1.433) and overall (P = .951; hazard ratio 1.018; 95% confidence interval 0.575-1.803) survival., Limitations: The study was not prospectively randomized., Conclusions: Our study did not show any significant differences in important outcome parameters such as local or distant metastases and overall survival. A prospective study testing 1- versus 2-cm excision margin is warranted., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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35. Estrogen induces nitric oxide production via nitric oxide synthase activation in endothelial cells.
- Author
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Nevzati E, Shafighi M, Bakhtian KD, Treiber H, Fandino J, and Fathi AR
- Subjects
- Animals, Cell Line, Transformed, Endothelial Cells drug effects, Enzyme Activation drug effects, Enzyme Activation physiology, Estradiol pharmacology, Estrogen Receptor beta metabolism, Estrogens metabolism, Estrogens pharmacology, Human Umbilical Vein Endothelial Cells, Humans, Mice, Nitric Oxide metabolism, Endothelial Cells enzymology, Estradiol metabolism, Nitric Oxide Synthase Type III metabolism
- Abstract
Introduction: 17β-estradiol (E2) has been found to induce vasodilation in the cardiovascular system and at physiological levels, resulting in prevention of cerebral vasospasm following subarachnoid hemorrhage (SAH) in animal models. The goal of this study was to analyze the cellular mechanism of nitric oxide (NO) production and its relation to E2, in vitro in brain and peripheral endothelial cells., Methods: Human umbilical endothelial cells (HUVEC) and brain endothelial cells (bEnd.3) were treated with estradiol (E2, 0.1, 10, 100, and 1,000 nM), and supernatant was collected at 0, 5, 15, 30, 60, and 120 min for nitric oxide metabolome (nitrite, NO₂) measurements. Cells were also treated with E2 in the presence of 1400W, a potent eNOS inhibitor, and ICI, an antagonist of estradiol receptors (ERs). Effects of E2 on eNOS protein expression were assessed with Western blot analysis., Results: E2 significantly increased NO2 levels irrespective of its concentration in both cell lines by 35 % and 42 % (p < 0.05). The addition of an E2 antagonist, ICI (10 μM), prevented the E2-induced increases in NO2 levels (11 % p > 0.05). The combination of E2 (10 nM) and a NOS inhibitor (1400W, 5 μM) inhibited NO2 increases in addition (4 %, p > 0.05). E2 induced increases in eNOS protein levels and phosphorylated eNOS (eNOS(p))., Conclusions: This study indicates that E2 induces NO level increases in cerebral and peripheral endothelial cells in vitro via eNOS activation and through E2 receptor-mediated mechanisms. Further in vivo studies are warranted to evaluate the therapeutic value of estrogen for the treatment of SAH-induced vasospasm.
- Published
- 2015
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36. [The risk-reducing mastectomy: unnecessary hysteria or life-saving prophylaxis?].
- Author
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Olariu R, Shafighi M, and Constantinescu MA
- Subjects
- Evidence-Based Medicine, Female, Humans, Mastectomy statistics & numerical data, Prophylactic Surgical Procedures statistics & numerical data, Risk Assessment, Treatment Outcome, Breast Neoplasms mortality, Breast Neoplasms surgery, Mastectomy methods, Patient Selection, Primary Prevention methods, Prophylactic Surgical Procedures methods, Unnecessary Procedures
- Abstract
The prophylactic (risk-reducing) mastectomy is a world-wide recognized method for specifically treating the increased breast cancer risk in patients showing a BRCA1 and/or BRCA2 mutation as well as other patient groups at increased breast cancer risk. This option should be offered to all patients having the pertinent risk profile. Breast reconstruction is an integral part of the risk-reducing mastectomy procedure and all possible methods of breast reconstruction, especially autologous tissue reconstruction should be offered to all patients having a medical indication and desiring this surgical treatment. These patients are best managed in certified Breast Care Centres where the different medical and surgical specialists can address interdisciplinary all aspects of genetic counselling, preoperative counselling, mastectomy and reconstructive techniques as well as the necessary postoperative surveillance.
- Published
- 2014
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37. Relative indexes of cutaneous blood perfusion measured by real-time laser Doppler imaging (LDI) in healthy volunteers.
- Author
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Seyed Jafari SM, Schawkat M, Van De Ville D, and Shafighi M
- Subjects
- Adult, Blood Pressure, Diagnostic Imaging, Female, Forehead, Healthy Volunteers, Humans, Male, Reference Values, Regional Blood Flow physiology, Sex Factors, Skin blood supply, Young Adult, Laser-Doppler Flowmetry methods, Laser-Doppler Flowmetry standards, Microcirculation physiology, Perfusion standards
- Abstract
We used real-time LDI to study regional variations in microcirculatory perfusion in healthy candidates to establish a new methodology for global perfusion body mapping that is based on intra-individual perfusion index ratios. Our study included 74 (37 female) healthy volunteers aged between 22 and 30 years (mean 24.49). Imaging was performed using a recent microcirculation-imaging camera (EasyLDI) for different body regions of each volunteer. The perfusion values were reported in Arbitrary Perfusion Units (APU). The relative perfusion indexes for each candidate's body region were then obtained by normalization with the perfusion value of the forehead. Basic parameters such as weight, height, and blood pressure were also measured and analyzed. The highest mean perfusion value was reported in the forehead area (259.21APU). Mean perfusion in the measured parts of the body correlated positively with mean forehead value, while there was no significant correlation between forehead blood perfusion values and room temperature, BMI, systolic blood pressure and diastolic blood pressure (p=0.420, 0.623, 0.488, 0.099, respectively). Analysis of the data showed that perfusion indexes were not significantly different between male and female volunteers except for the ventral upper arm area (p=.001). LDI is a non-invasive, fast technique that opens several avenues for clinical applications. The mean perfusion indexes are useful in clinical practice for monitoring patients before and after surgical interventions. Perfusion values can be predicted for different body parts for patients only by taking the forehead perfusion value and using the perfusion index ratios to obtain expected normative perfusion values., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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38. Ankle dorsiflexion arthrodesis to salvage Chopart's amputation with anterior skin insufficiency.
- Author
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Krause FG, Pfander G, Henning J, Shafighi M, and Weber M
- Subjects
- Achilles Tendon surgery, Adolescent, Adult, Aged, Aged, 80 and over, Amputation, Surgical, Bone Neoplasms surgery, Diabetic Foot surgery, Female, Foot Injuries surgery, Free Tissue Flaps, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Skin Ulcer etiology, Skin Ulcer surgery, Soft Tissue Neoplasms surgery, Surgical Wound Dehiscence etiology, Surgical Wound Dehiscence surgery, Wound Healing, Young Adult, Amputation Stumps surgery, Ankle Joint surgery, Arthrodesis methods, Forefoot, Human surgery, Salvage Therapy
- Abstract
Background: In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients., Methods: Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale., Results: Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months)., Conclusion: Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing., Level of Evidence: Level IV, retrospective case series.
- Published
- 2013
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39. [Surgical therapy for reconstruction of body shape and contour following massive weight reduction].
- Author
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Constantinescu MA, Olariu R, and Shafighi M
- Subjects
- Humans, Aftercare methods, Bariatric Surgery adverse effects, Bariatric Surgery methods, Obesity surgery, Patient Education as Topic methods, Postoperative Care methods, Plastic Surgery Procedures methods
- Abstract
The consequences of massive weight loss through bariatric procedures as well as diet are overall positive. However, the sequelae of massive weight loss present themselves as soft tissue redundancies in the areas of the lower abdomen, upper thigh, upper arm and breast as well as face and neck. This condition presents significant mechanical, physical and social day-to-day limitations for the quality of life of these patients. Surgical techniques are indicated for the reconstruction of the body shape and therapy of the above named problems and the coexistent psychosocial component. These surgical techniques involve dermolipectomies in different body areas and can lead to significant improvement. In view of the worldwide increase of adipositas and the increasing need for bariatric surgery, a parallel increase in demand for such reconstructive post-bariatric interventions can be foreseen. Early and precise information is crucial for the patients before engaging in weight reduction, as is the coverage of the costs of the resulting secondary reconstructive body contouring interventions by the insurance companies.
- Published
- 2013
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40. The extended diep flap: extending the possibilities for breast reconstruction with tissue from the lower abdomen.
- Author
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Shafighi M, Constantinescu MA, Huemer GM, Olariu R, Bonel HM, Banic A, and Ramakrishnan V
- Subjects
- Adult, Aged, Epigastric Arteries, Feasibility Studies, Female, Graft Survival, Humans, Mammaplasty standards, Mastectomy, Middle Aged, Multidetector Computed Tomography, Prospective Studies, Quality Control, Subcutaneous Fat, Abdominal diagnostic imaging, Treatment Outcome, Breast Neoplasms surgery, Carcinoma, Ductal, Breast surgery, Carcinoma, Intraductal, Noninfiltrating surgery, Free Tissue Flaps transplantation, Mammaplasty methods, Perforator Flap transplantation, Subcutaneous Fat, Abdominal transplantation
- Abstract
Background: The classical DIEP-flap is considered state-of-the-art in microsurgical autologous breast reconstruction. Some patients may require additional volume to match the contralateral breast. This quality control study prospectively evaluates the feasibility and outcome of a surgical technique, which pursues the volumetric augmentation of the DIEP-flap by harvesting of additional subscarpal fat tissue cranial to the classical flap border., Patients and Methods: For radiologically based estimation of volumetric flap-gain potential, abdominal CT-scans of 10 Patients were randomly selected and used for computerized volumetric estimates. Surgical evaluation of the technique was prospectively performed between 09/2009 and 09/2010 in 10 patients undergoing breast reconstruction with extended DIEP-flap at two institutions. The outcome regarding size, volume, and symmetry was evaluated., Results: Radiologically, the mean computed volume gain of an extended DIEP was 16.7%, when compared with the infraumbilical unilateral flap volume. Clinically, the intraoperatively measured mean volume gain was of 98.6 g (range: 75-121 g), representing 13.8% of the flap volume. All 10 flaps survived without revision surgery. In three flaps, minor fat necrosis occurred in zone III and was treated conservatively. No fat necrosis was observed in the extended flap area., Conclusions: In this first prospective series, the extended DIEP-flap proved to be feasible, reliable and safe for its use in breast reconstruction. Both radiological estimation and intraoperative measurements demonstrated a statistically significant volume gain with no complications in the extended area. The technique is of benefit in selected patients requiring additional reconstructive volume than the one achieved with the classical DIEP-flap., Level of Evidence: Therapeutic Level IV., (Copyright © 2012 Wiley Periodicals, Inc.)
- Published
- 2013
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41. The role of androgens on hypoxia-inducible factor (HIF)-1α-induced angiogenesis and on the survival of ischemically challenged skin flaps in a rat model.
- Author
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Shafighi M, Olariu R, Brun C, Fathi AR, Djafarzadeh S, Jakob SM, Hunger RE, Banic A, and Constantinescu MA
- Subjects
- Animals, Biomarkers metabolism, Blotting, Western, Cells, Cultured, Human Umbilical Vein Endothelial Cells, Humans, Immunohistochemistry, Laser-Doppler Flowmetry, Male, Orchiectomy, Rats, Rats, Wistar, Surgical Flaps physiology, Wound Healing physiology, Androgens physiology, Dihydrotestosterone, Hypoxia-Inducible Factor 1, alpha Subunit metabolism, Ischemia, Neovascularization, Physiologic physiology, Surgical Flaps blood supply, Vascular Endothelial Growth Factor A metabolism
- Abstract
Background: Effects of androgens on angiogenesis are controversial. Hypoxia-inducible factor (HIF)-1α promotes expression of vascular endothelial growth factor (VEGF) that stimulates angiogenesis., Purpose: This study investigates whether androgens stabilize HIF-1α in endothelial cells, and androgen depletion decreases VEGF concentrations and skin flap survival., Materials and Methods: Male human umbilical vein endothelial cells (HUVECs) were exposed to dihydrotestosterone (DHT) and HIF-1α expression was measured. In male Wistar rats, standardized proximally based random pattern dorsal skin flaps (3 × 9 cm) were raised 4 weeks after orchiectomy and sham operation, respectively (n = 10, each). Flap VEGF concentrations (immunohistochemistry), perfusion (Laser Doppler), and viability (digital planimetry) were measured., Results: DHT induced HIF-1α expression in HUVECs. Androgen depletion induced decreased VEGF expression (P = 0.003), flap perfusion (P < 0.05), and survival (44.4% ± 5.2%) compared to controls (35.5% ± 4.5%; P = 0.003)., Conclusion: In vitro, androgens may stimulate HIF-1α under normoxic conditions. In rats, androgen depletion decrease VEGF expression and flap survival., (Copyright © 2012 Wiley Periodicals, Inc.)
- Published
- 2012
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42. Topical application of 17β-estradiol (E2) improves skin flap survival through activation of endothelial nitric oxide synthase in rats.
- Author
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Shafighi M, Fathi AR, Brun C, Huemer GM, Wirth R, Hunger R, Banic A, and Constantinescu MA
- Subjects
- Administration, Topical, Animals, Endothelium, Vascular drug effects, Endothelium, Vascular enzymology, Enzyme Activation drug effects, Female, Human Umbilical Vein Endothelial Cells drug effects, Humans, Nitric Oxide biosynthesis, Nitric Oxide Synthase Type III drug effects, Rats, Rats, Wistar, Endothelium, Vascular metabolism, Estradiol pharmacology, Human Umbilical Vein Endothelial Cells metabolism, Nitric Oxide metabolism, Nitric Oxide Synthase Type III metabolism, Surgical Flaps
- Abstract
This study investigates the influence of 17β-estradiol (E2) on nitric oxide (NO) production in endothelial cell cultures and the effect of topical E2 on the survival of skin flap transplants in a rat model. Human umbilical vein endothelial cells were treated with three different E2 concentrations and nitrite (NO2) concentrations, as well as endothelial nitric oxide synthase (eNOS) protein expressions were analyzed. In vivo, random-pattern skin flaps were raised in female Wistar rats 14 days following ovariectomy and treated with placebo ointment (group 1), E2 as gel (group 2), and E2 via plaster (group 3). Flap perfusion, survival, and NO2 levels were measured on postoperative day 7. In vitro, E2 treatment increased NO2 concentration in cell supernatant and eNOS expression in cell lysates (p < 0.05). In vivo, E2 treated (gel and plaster groups) demonstrated significantly increased skin flap survival compared to the placebo group (p < 0.05). E2 plaster-treated animals exhibited higher NO2 blood levels than placebo (p < 0.05) paralleling the in vitro observations. E2 increases NO production in endothelial cells via eNOS activation. Topical E2 application can significantly increase survival of ischemically challenged skin flaps in a rat model and may augment wound healing in other ischemic situations via activation of NO production., (© 2012 by the Wound Healing Society.)
- Published
- 2012
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43. Effective wound closure with a new two-component wound closure device (Prineo™) in excisional body-contouring surgery: experience in over 200 procedures.
- Author
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Huemer GM, Schmidt M, Helml GH, Shafighi M, and Dunst-Huemer KM
- Subjects
- Adult, Aged, Humans, Middle Aged, Patient Satisfaction, Surgical Mesh, Wound Healing physiology, Cyanoacrylates administration & dosage, Lipectomy, Tissue Adhesives administration & dosage, Wound Closure Techniques instrumentation
- Abstract
Background: In excisional body-contouring surgery the surgeon is often confronted with time-consuming closure of long wounds. Recently, a new combination of a self-adhering mesh together with a liquid 2-octyl cyanoacrylate adhesive (Prineo™; Ethicon, Inc., Somerville, NJ, USA) has been introduced to replace intracutaneous running suture., Methods: An observational study was undertaken to evaluate the efficacy of the new wound closure device in excisional body-contouring procedures between January 2008 and November 2010. Wound characteristics were recorded in a prospectively maintained database., Results: During the study period, 224 procedures in 180 patients were undertaken. Twenty-seven patients had two subsequent operations and four patients had three subsequent operations. Application of the new device was easy and safe and patient satisfaction with the results was generally high. However, intense local allergic reactions were seen in 4 patients (1.8%), which necessitated early removal and topical corticosteroid treatment., Conclusions: Prineo™ enables the surgeon to perform a quick and smooth skin closure, especially in long incisions frequently encountered in excisional body-contouring surgery. The application is fast and easy if basic guidelines are respected. Operating time is saved by eliminating the need for time-consuming intracutaneous running sutures. Removal is easy and painless for the patient. However, there is a potential for local allergic adverse effects of which the surgeon must be aware.
- Published
- 2012
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44. Incorporation of a preexisting scar in the star-flap technique for nipple reconstruction.
- Author
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Gurunluoglu R, Shafighi M, Williams SA, and Kimm GE
- Subjects
- Female, Follow-Up Studies, Humans, Mammaplasty instrumentation, Mastectomy, Cicatrix, Mammaplasty methods, Nipples surgery, Surgical Flaps
- Abstract
Background: This report describes the authors' currently favored method of nipple reconstruction in cases of a pre-existing scar on the breast mound that passes through the intended site of nipple reconstruction., Methods: The star flap technique incorporating a previous scar is used at least 3 months after satisfactory implant-based breast reconstruction. If the intended site of nipple reconstruction bisects through a vertical mastectomy scar, the star flap is designed as medially or laterally based with its 2 lateral limbs lying adjacent to the scar and the transverse central component incorporating the vertical scar. On the other hand, if the selected site of nipple reconstruction passes into a horizontal scar, the flap is positioned as inferiorly or superiorly based along the scar with its 2 lateral limbs adjacent to the scar and vertical central limb including the scar. Upon ensuring viability, the limbs are inset for nipple reconstruction. The flap donor wounds of the lateral limbs are closed primarily along the previous scar, and all of the scars including that of the central limb are maintained within the area of the intended areola., Results: The procedure was used 16 times in 24 patients who have undergone bilateral implant-based breast reconstruction. All flaps were viable. One nipple reconstruction had an early complication of partial flap loss in the central flap that subsequently healed with wound care., Conclusions: It is possible to use a mastectomy scar in the star flap design for nipple reconstruction with no significant vascular compromise. This novel design enables positioning of the nipple in an optimal location on the breast mound in relation with the scar, use of existing scar, and inclusion of extra skin and subcutaneous tissue within the central limb. Nipple projection and volume have been satisfactory and consistently maintained.
- Published
- 2012
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45. Reconstruction of large supra-eyebrow and forehead defects using the hatchet flap principle and sparing sensory nerve branches.
- Author
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Gurunluoglu R, Shafighi M, Williams SA, and Glasgow M
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Basal Cell surgery, Carcinoma, Squamous Cell surgery, Cicatrix, Eyebrows, Female, Follow-Up Studies, Forehead innervation, Humans, Male, Melanoma surgery, Middle Aged, Neurons, Afferent, Patient Satisfaction, Plastic Surgery Procedures instrumentation, Facial Neoplasms surgery, Plastic Surgery Procedures methods, Skin Neoplasms surgery, Surgical Flaps
- Abstract
Background: To reconstruct a forehead defect, a plastic surgeon must be knowledgeable about the neural, vascular, and muscular anatomy. The position of fixed structures such as eyebrows and hairline should be respected. For the past 5 years, we have used double hatchet flaps for reconstruction of relatively large supra-eyebrow and forehead defects. Because this flap does not appear to be among the techniques used by young plastic surgeons, we thought that it would be valuable to report our experience., Methods: Supra-eyebrow and forehead defects ranging from 2.5 × 2.5 cm to 3.5 × 3.5 cm were reconstructed using double hatchet flaps in 10 patients. Pearls and pitfalls of the technique are discussed along with the presentation of 3 cases., Results: The reconstructions were uneventful and the flaps were highly viable in all patients. There was no significant distortion in the eyebrow or hairline due to reconstruction in any of the patients. All the flaps were sensate. A mild anesthesia in the distribution of supraorbital/trochlear nerve proximal to the flaps was noted only in 3 patients. This was associated with inevitable nerve damage during excision of malignant skin lesions and/or flap dissection. No recurrence was noted during the follow-up period which ranged from 6 to 36 months (mean, 13.5 months). Overall patient satisfaction score based on scar appearance and perceived degree of forehead anesthesia was 3 (neither satisfied nor dissatisfied) in 1 patient, was 4 (somewhat satisfied) in 4 patients, and was 5 (very satisfied) in 5 patients., Conclusion: Hatchet flaps have similar color and texture to that of the adjacent supra-eyebrow and forehead defects. The scarring is acceptable with reliable and reproducible results. Oftentimes, sensory nerve branches can be preserved with careful planning and tedious dissection. This type of reconstruction should be considered in the armamentarium of supra-eyebrow and forehead defects.
- Published
- 2012
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46. Dimethyloxalylglycine stabilizes HIF-1α in cultured human endothelial cells and increases random-pattern skin flap survival in vivo.
- Author
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Shafighi M, Olariu R, Fathi AR, Djafarzadeh S, Jakob SM, Banic A, and Constantinescu MA
- Subjects
- Animals, Cells, Cultured, Disease Models, Animal, Endothelial Cells cytology, Endothelial Cells drug effects, Endothelium, Vascular cytology, Endothelium, Vascular drug effects, Enzyme-Linked Immunosorbent Assay, Follow-Up Studies, Humans, Hypoxia-Inducible Factor 1, alpha Subunit drug effects, Laser-Doppler Flowmetry, Male, Rats, Rats, Wistar, Umbilical Veins cytology, Amino Acids, Dicarboxylic pharmacology, Endothelial Cells metabolism, Endothelium, Vascular metabolism, Graft Survival drug effects, Hypoxia-Inducible Factor 1, alpha Subunit metabolism, Skin Transplantation, Surgical Flaps blood supply
- Abstract
Background: The goal of this study was to evaluate in vitro and in vivo the effects of up-regulation of the proangiogenic hypoxia inducible factor (HIF)-1α induced by dimethyloxalylglycine on endothelial cell cultures and on skin flap survival., Methods: Human umbilical vein endothelial cell cultures were exposed to hypoxic conditions, to dimethyloxalylglycine, and to cobalt chloride for up to 24 hours. Expression of HIF-1α and vascular endothelial growth factor (VEGF) in cell culture media was analyzed. In vivo, 20 male Wistar rats were assigned randomly to either the treatment group (dimethyloxalylglycine intraperitoneal injection, n = 10) or the control group (saline intraperitoneal injection, n = 10). A dorsal skin flap was raised in all animals and sutured back into place. Flap survival was evaluated on postoperative day 7 by laser Doppler and digital planimetry., Results: In vitro treatment of human umbilical vein endothelial cells during a 24-hour period showed a significant elevation of VEGF expression with dimethyloxalylglycine exposure (92 ± 35 pg/mg total cellular protein) or hypoxia exposure (88 ± 21 pg/mg total cellular protein) compared with controls (23 ± 10 pg/mg total cellular protein) (p < 0.05 for both). In vivo experiments showed a significant decrease of flap necrosis in the treatment group animals versus controls (35.95 ± 5.03 percent versus 44.42 ± 5.18 percent, p < 0.05). The laser Doppler evaluation revealed significantly increased blood flow in the proximal two-thirds of the flap in the treatment group compared with the control group (p < 0.05)., Conclusion: Dimethyloxalylglycine treatment significantly increases VEGF and HIF-1α expression in endothelial cell cultures and enhances skin flap survival in vivo in a rat model.
- Published
- 2011
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47. Giulio Cesare Aranzio (Arantius) (1530-89) in the pageant of anatomy and surgery.
- Author
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Gurunluoglu R, Shafighi M, Gurunluoglu A, and Cavdar S
- Subjects
- Brain, Female, Fetus, Genital Diseases, Female, History, 16th Century, Humans, Italy, Publishing history, Uterus, Anatomy history, Books history, General Surgery history, Physicians history
- Abstract
Giulio Cesare Aranzio in Italian (Julius Caesar Arantius in Latin) has not received full acclaim for his achievements in the field of anatomy and surgery that remain unknown to most physicians. His anatomical books Observationes Anatomicas, and De Humano Foetu Opusculum and surgical books De Tumoribus Secundum Locos Affectos and Hippocratis librum de vulneribus capitis commentarius brevis printed in Latin and additional existing literature on Aranzio from medical history books and journals were analysed extensively. Aranzio became Professor of Anatomy and Surgery at the University of Bologna in 1556. He established anatomy as a distinguished branch of medicine for the first time in medical history. Aranzio combined anatomy with a description of pathological processes. He discovered the 'Nodules of Aranzio' in the semilunar valves of the heart. He gave the first description of the superior levator palpebral and the coracobrachialis muscles. Aranzio wrote on surgical techniques for a wide spectrum of conditions that range from hydrocephalus, nasal polyp, goitre and tumours to phimosis, ascites, haemorrhoids, anal abscess and fistulae, and much more. Aranzio had an extensive knowledge in surgery and anatomy based in part on the ancient Greek and his contemporaries in the 16th century but essentially on his personal experience and practice.
- Published
- 2011
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48. Response to article, The median artery: its potential complications for the radial forearm flap by Varley et al, JPRAS 61:693-695.
- Author
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Lloyd MS, Shafighi M, and Niranjan N
- Subjects
- Arteries abnormalities, Humans, Tissue and Organ Harvesting methods, Forearm blood supply, Surgical Flaps blood supply
- Published
- 2009
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49. Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis.
- Author
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Bleuler P, Shafighi M, Donati OF, Gurunluoglu R, and Constantinescu MA
- Subjects
- Bone Screws, Humans, Lunate Bone injuries, Prospective Studies, Scaphoid Bone injuries, Suture Anchors, Tendons surgery, Joint Instability surgery, Lunate Bone surgery, Scaphoid Bone surgery, Tenodesis
- Abstract
This study investigates the results of a technique using an extensor carpi radialis longus (ECRL) tenodesis for symptomatic scapholunate instability. Symptomatic scapholunate instability has been corrected so far either by limited wrist fusion or by various techniques of soft tissue repair. Limited wrist fusion greatly reduces wrist motion and increases the probability of osteoarthritis in the remaining mobile wrist segments. On the other hand, most types of soft tissue repair are technically difficult to perform and have disappointing results due to the inherent laxity. The presented dynamic approach was used in 20 wrists of 19 patients with static scapholunate instability. Preoperative evaluation included in all patients clinical examination, radiologic evaluation, and arthroscopy for establishing the diagnosis of static scapholunate instability. The technique involves the fixation of the ECRL tendon on the dorsal aspect of the scaphoid by means of a cancellous screw and a special washer. Dynamic ECRL tenodesis of the scaphoid is a safe and simple procedure that enhances the extension forces on the scaphoid in all wrist positions. The results of this preliminary report in 20 wrists showed dynamic ECRL tenodesis to be an effective treatment option for treating symptomatic static scapholunate instability.
- Published
- 2008
- Full Text
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50. Versatility of the abductor hallucis muscle as a conjoined or distally-based flap.
- Author
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Schwabegger AH, Shafighi M, and Gurunluoglu R
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Muscles surgery, Postoperative Complications, Foot surgery, Surgical Flaps
- Abstract
Soft tissue coverage of the medial ankle and foot remains a difficult, challenging, and often frustrating problem to patients as well as surgeons. To our knowledge, the abductor hallucis muscle flap is not frequently used and only a few well documented cases were found in literature. The purpose of this paper is to report and to present the long-term results of a series of four patients who underwent reconstruction of foot and ankle defects with the abductor hallucis muscle flap. In two cases, the abductor hallucis muscle flap was transposed in combination with a medialis pedis flap to cover a medial ankle defect, whereas in another case it was combined with a medial plantar flap. In this latter case, the muscle flap served to fill up a calcaneal dead space after osteomyelitis debridement, whereas the cutaneous flap was used to replace debrided skin at the heel. The abductor hallucis flap was used as a distally-based turnover flap to cover a large forefoot defect in a fourth case. Follow-up period ranged between 18 and 64 months (mean 43.3). In the early postoperative period, two flaps healed completely In two patients marginal flap necrosis occurred which was subsequently skin grafted. No donor-site complication occurred in any of the patients. In all cases, protective sensation of the skin was satisfactory as early as 6 months. In two cases mild hyperkeratosis at the skin graft border to the sole skin (non-weight bearing area of medial plantar and medialis pedis flap donor site) was present, but probably related to poor foot care. All patients were fully mobile as early as 3 months after treatment. In the long-term follow-up (43.3 months), all flaps provided with durable coverage. Functional gait deficit due to consumtion of the abductor hallucis muscle was not apparent. Our long-term results demonstrated that the abductor hallucis muscle flap is a versatile, and reliable flap suitable for the reconstruction of foot and ankle defects. Utilizing the abductor hallucis muscle as a pedicled flap (distally or proximally-based) with or without conjoined regional fasciocutaneous flaps offers a successful and durable alternative to microsurgical tree flaps for small to moderate defects over the calcaneus region, medial ankle, medial foot, and forefoot with exposed bone, tendon, or joint.
- Published
- 2005
- Full Text
- View/download PDF
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