Clinical Hemorheology and Microcirculation - Volume 86, issue 1-2

Authors: Ernert, Carsten | Kielstein, Heike | Azatyan, Argine | Prantl, Lukas | Kehrer, Andreas

Article Type: Research Article

Abstract: BACKGROUND: Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE: This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS: Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common …surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS: Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS: By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap. Show more

Keywords: Latissimus dorsi myocutaneous flap, deep sternal wound infection, circumflex scapular artery, microsurgery, single flap reconstruction, sternal reconstruction, sternal defect

DOI: 10.3233/CH-238115

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 225-236, 2024

Authors: Diesch, Sophia T. | Prantl, Lukas | Anders, Marvin | Eigenberger, Andreas | Wiesmeier, Anna | Brix, Eva | Griesbeck, Theresa | Brébant, Vanessa

Article Type: Research Article

Abstract: BACKGROUND: Asymmetry and scar formation of the nipple-areola complex (NAC) after reduction mammoplasty with periareolar suture are common complications and can significantly affect patient satisfaction. OBJECTIVE: The aim of this study was to investigate possible procedure-specific influencing factors on asymmetry and shape disturbances of the nipple-areola complex to optimize postoperative outcome and thus improve patient satisfaction. METHODS: 78 patients were followed-up after a 5-year period as part of a retrospective cohort study. Objective parameters as areolar diameter, symmetry, scar patterns, dimensions of the breast, and anthropometric measurements were recorded. All patients underwent surgery according to an …established treatment algorithm depending on the preoperative measurements. Follow up was 1 week, 6 week, 6 months and 3 years postoperatively. RESULTS: The periareolar suture-technique significantly influenced the symmetry and shape of the NAC. Compared to the intraoperative determined diameter and the postoperative diameter, the net-suture technique showed the highest NAC symmetry and minimal divergence. Patients who underwent Hall-Findlay mammoplasty showed significantly higher rates of asymmetry and deformity of the NAC with teardrop formation in comparison to Lejour mammoplasty. Scar formation was affected by periareolar ruffle formation especially after purse string suture. CONCLUSIONS: Regardless of what reduction mammoplasty techniques and periareolar suturing-technique are used, a tension-free suture of the NAC is crucial for shape, symmetry and scar formation. The net suture technique resulted in significantly higher symmetry of the NAC. Show more

Keywords: Nipple-areola complex symmetry, reduction Mammoplasty, postoperative symmetry NAC, NAC symmetry, operative influence factors

DOI: 10.3233/CH-238116

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 237-243, 2024

Authors: Brun, Jean-Frédéric | Varlet-Marie, Emmanuelle | Myzia, Justine | Vachoud, Laurent | Marion, Bénédicte | Roques, Céline | Raynaud de Mauverger, Eric | Mercier, Jacques

Article Type: Research Article

Abstract: The size of body compartments is a determinant of several factors of blood viscosity. Red cell aggregation is proportional to fat mass while hematocrit is proportional to both fat-free mass and abdominal adiposity, but which parts of these body components are involved in this relationship is not known. Segmental bioelectrical impedance analysis (sBIA) provides a possibility to delineate the relationships more precisely between various subdivisions of the body and blood viscosity factors, going farther than preceding studies using non segmental BIA. In this study we investigated in 38 subjects undergoing a standardized breakfast test with mathematical modelling of glucose …homeostasis and a segmental bioelectrical impedance analysis (sBIA) the relationships between the various compartments of the body and viscosity factors. Blood and plasma viscosity were measured with the Anton Paar rheometer and analyzed with Quemada’s model. The parameters better correlated to hematocrit are fat free mass (r  = 0.562) and its two components muscle mass (r  = 0.516) and non-muscular fat-free mass (r  = 0.452), and also trunk fat mass (r  = 0.383) and waist-to hip ratio (r  = 0.394). Red cell aggregation measurements were correlated with both truncal and appendicular fat mass (r ranging between 0.603 and 0.728). Weaker correlations of M and M1 are found with waist circumference and hip circumference. This study shows that the correlation between lean mass and hematocrit involves both muscle and non-muscle moieties of lean mass, and that both central and appendicular fat are determinants of red cell aggregation. Show more

Keywords: Fat mass, fat-free mass, muscle, red cell, viscosity, hemorheology

DOI: 10.3233/CH-238118

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 245-252, 2024

Authors: Diesch, Sophia T. | Schiltz, Daniel | Kammermeier, Julian | Prantl, Lukas | Taeger, Christian D.

Article Type: Research Article

Abstract: CONTEXT: Global sales of compression garments have risen sharply in recent years. Due to the availability of a wide range of compression garments, this study aims to evaluate the effect of two types of compression garments and kinesio tape on edema formation and tissue perfusion in the lower extremities. Over-the-counter compression knee stockings and kinesio tape were compared with a prototype of high-end compression stockings that combine kinesio tape and a common knee bandage. The high-end compression stockings were designed by Cube with the aim of combining the positive effects of kinesio tape and compression garments on edema formation and …tissue perfusion. DESIGN: Clinical cross-over study. METHODS: Before and after a 6-hour compression period, the knee regions on both, the treated and non-treated leg, of participants were examined using a 3-D scan to detect changes in volume. Also measured were local temperature (°C), oxygen saturation (SpO2), perfusion index (Pi), blood pressure (mmHg), compression pressure (mmHg), range of motion, body-mass-index (BMI) and limb-circumference (cm). Two different types of compression garments were examined: a novel high-end compression stocking (A) and a common compression stocking (B). In addition, kinesio tape was compared to compression garments (C). After each experimental day, a one-day break was taken to prevent an unwanted overlay effect. Male and female participants between the ages of 18 and 60 were randomly selected. RESULTS: The high-end compression garment (A) showed a statistically significant (P  = 0.009) reduction of edema intraindividually. Comparing the three treatment groups, compression (A) lead to a reduction of edema. However, the reduction was not statistically significant (P  = 0.585). The compression garment B and kinesio tape showed an increase in edema in the lower limb. There was a positive correlation between the highest compression pressure (A: 9.8 mmHg) and volume decrease over the period of 6 hours. Lighter compression (B: 8.2 mmHg) led to an increase in leg volume after compression application over 6 hours. There was no significant difference in tissue oxygen saturation with the two types of compression and kinesio tape. The tissue temperature below the compression garment was highest in the compression group A. Nevertheless, we could not demonstrate a statistically significant correlation between tissue temperature and volume difference. The range in motion of the lower limb decreased after 6 hours with both compression A and B and with kinesio tape. CONCLUSION: The novel bandage showed a statistically significant reduction in edema when compared intraindividually, but no statistically significant advantage was found when compared with the other compression garment B and kinesio tape. Despite the widespread use of kinesio tape, we did not find any improvement in the range of motion, edema prevention and circulation in the lower limb after application of kinesio tape. Show more

Keywords: Tissue perfusion, edema, microcirculation, sport medicine, rehabilitation, sports rehabilitation imaging

DOI: 10.3233/CH-238111

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 253-261, 2024