Comparison between primary closure and skin grafts of the free fibula osteocutaneous flap donor site

Purpose

This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site.

Methods

Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints.

Results

The harvested skin paddles were significantly wider in the skin graft group than in the primary closure group (P?=?0.02), with no difference in length (P?=?0.1). The difference in time to resuming gait with a mobility aid was also significant (P?=?0.01), but not the time to self-ambulation (P?=?0.9). Two early donor site morbidities (5.7 %) and 12 late donor site complaints (34.3 %) were found. No significant difference in the incidence of early donor site morbidity was observed between two groups. Occurrence of late donor site complaints was not affected by any risk factors.

Conclusions

The width of the harvested skin paddle, but not the length, is one of factors involved in donor site closure. Resumption of gait with a mobility aid, but not self-ambulation, may be delayed in skin graft patients.

     

Imaging of Oxygen Saturation and Distribution of Erythrocytes in Microvessels

Objective : To construct images of oxygen saturation and the distribution of erythrocytes in a network of microvessels. Methods : The image of a small group of microvessels under an inverted microscope was incorporated into an image processor through a video camera and was digitized. Based on the information obtained through six visible interference filters of different wavelengths, oxygen saturation and the amount of erythrocytes in microvessels were calculated with a computer. The system was applied to a microvascular bed of isolated rabbit mesentery perfused with a suspension of human erythrocytes. Results : In a steady flow, with lowering of tissue oxygen tension by superfusion with nitrogen-bubbled isotonic saline containing 20 mmol/L sodium dithionite, the decrease of oxygen saturation of erythrocytes from arterioles to venules was imaged. Simultaneously, the distribution of erythrocytes in the microvessels was imaged and the marginal cell-free layer was profiled under high magnification. No significant alteration of the erythrocyte distribution on the deoxygenation of erythrocytes was observed. The exposure of erythrocytes to acidic pH and the decrease of the flow velocity of erythrocytes increased the release of oxygen from the erythrocytes in microvessels. Conclusions : The present method will be useful for the comprehensive analysis of oxygen transfer in the microvascular network, on the basis of both changes of the oxygen saturation and the flow behavior of erythrocytes.     

Mapping and ablation of clinical spontaneous perimitral atrial tachycardias using an ultra–high-resolution mapping system

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Relation of atrial fibrillation to glomerular filtration rate

Although both atrial fibrillation (AF) and decreasing glomerular filtration rate (GFR) are strongly related to advanced age and share common associated vascular risk factors, few studies have explored the relation between AF and GFR. From residents (age >or=40 years) in Kurashiki City, a total of 41,417 subjects (median age 72 years; 13,956 men) were enrolled in the Kurashiki City Annual Medical Survey from May to December 2006. The estimated overall prevalence of AF was 1.6% (2.8% in the low-GFR tertile, 1.2% in the middle tertile, and 0.9% in the high tertile, p <0.001). After all subjects were categorized into age tertiles (age thresholds 68 and 76 years), AF was identified in 0.9% in the low-GFR tertile, 0.6% in the middle tertile, and 0.5% in the high tertile in the low-age tertile (p = 0.018); 2.6% in the low-GFR tertile, 1.2% in the middle tertile, and 1.1% in the high tertile in the middle-age tertile (p <0.001); and 3.9% in the low-GFR tertile, 2.4% in the middle tertile, and 1.7% in the high tertile in the high-age tertile (p <0.001). The odds ratio for AF adjusted for age, gender, vascular risk factors, cardiac disease, and hemoglobin was 1.91 (95% confidence interval 1.54 to 2.38, p <0.001) for the low-GFR tertile versus the high tertile and 1.12 (95% confidence interval 0.88 to 1.42, p = 0.364) for the middle-GFR tertile versus the high tertile. The prevalence of AF gradually increased with decreasing GFR. In conclusion, AF appears to be associated with decreasing GFR.     

Circadian dynamics of heart rate and physical activity in patients with heart failure

The present study was designed to develop a method to continuously measure Holter electrocardiogram (ECG) and physical activity in terms of metabolic costs to examine circadian dynamics of RR intervals and physical activity in patients with heart failure. A total of 7 healthy subjects and 3 heart failure patients performed cardiopulmonary exercise test using four-stage graded treadmill walking at 0% grade to examine whether the acceleration signals in the vertical direction could reflect actual body energy expenditure during physical activity. Then, using this new method, 24-hr monitorings of ECG and physical activity were performed in 24 inpatients with heart failure while they were allowed to walk around freely. Our results showed the integral of rectified acceleration signals was closely correlated with actual metabolic cost in all subjects. Instantaneous changes in heart rate were quite concordant with physical activity. As compared with the asymptomatic patients (n = 12), the symptomatic patients (n = 12) had lower energy expenditure during 8-hr daytime periods but higher mean heart rate. Furthermore, a more prominent ultradian rhythm of circadian changes in heart rate and physical activity was found in 50% of all subjects studied. The simultaneous analysis of Holter ECG and physical activity as the same time series revealed that in patients with heart failure, sympathovagal balance shifted toward sympathotonic conditions and their physical activity could become subject to intrinsic ultradian dynamics of body's homeostasis.