The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1-4). The mean distance of the most distal branch was 35 mm (range 26-40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16-26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.Level of evidence: V.

• Klíčová slova
• Flexor digitorum superficialis, coverage, flap, median, nerve, partial, pedicled,
• MeSH
• arteria ulnaris * anatomie a histologie   MeSH
• chirurgické laloky * krevní zásobení   MeSH
• kosterní svaly * transplantace   krevní zásobení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola MeSH
• předloktí * chirurgie   MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Smoking poses a risk to flap viability, with nicotine being a major contributor to the formation of free radicals. Allopurinol, known for its antioxidant properties, has been shown to enhance tissue survival in ischemic conditions by reducing the production of reactive oxygen species (ROS). This study aims to assess the impact of allopurinol on the viability and success of skin flaps in Wistar rats exposed to nicotine. METHODS: This study examined skin flap survival in nicotine-exposed rats treated with allopurinol. Twenty-eight rats were separated into two groups. During 1 month of nicotine exposure, the treatment group received systemic allopurinol 7 days before and 2 days after the flap procedure, while the control group received no allopurinol. Pro-angiogenic factors, proinflammatory factors, anti-inflammatory factors, and oxidative markers were assessed on the 7th day after the flap procedure using enzyme-linked immunosorbent assay method. Macroscopic flap viability was evaluated on the 7th day using Image J photos. RESULTS: As an oxidative marker, malondialdehyde levels were significantly lower in rats given allopurinol than in controls (P < 0.001). The levels of interleukin 6 and tumor necrosis factor α, as markers of inflammatory factors, were significantly lower in the group of rats given allopurinol compared to controls (P < 0.001). The level of angiogenesis in rats given allopurinol, measured by vascular endothelial growth factor levels, was also higher in the treatment group compared to controls (P < 0.001). Macroscopically, the percentage of distal flap necrosis in Wistar rats given allopurinol was lower and statistically significant compared to controls (P < 0.001). CONCLUSIONS: Xanthine oxidoreductase is part of a group of enzymes involved in reactions that produce ROS. Allopurinol, as an effective inhibitor of the xanthine oxidase enzyme, can reduce oxidative stress by decreasing the formation of ROS. This reduction in oxidative stress mitigates the risk of ischemic-reperfusion injury effects and significantly increases the viability of Wistar rat flaps exposed to nicotine.

• Klíčová slova
• Angiogenesis, allopurinol, flap, flap necrosis, nicotine,
• MeSH
• alopurinol * farmakologie   MeSH
• chirurgické laloky * krevní zásobení   MeSH
• interleukin-6 * metabolismus   MeSH
• krysa rodu Rattus MeSH
• malondialdehyd * metabolismus   MeSH
• nikotin * aplikace a dávkování   farmakologie   MeSH
• oxidační stres účinky léků   MeSH
• potkani Wistar MeSH
• přežívání štěpu účinky léků   MeSH
• TNF-alfa * metabolismus   MeSH
• vaskulární endoteliální růstový faktor A * metabolismus   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• alopurinol * MeSH
• interleukin-6 * MeSH
• malondialdehyd * MeSH
• nikotin * MeSH
• TNF-alfa * MeSH
• vaskulární endoteliální růstový faktor A * MeSH

BACKGROUND AND AIMS: The aim of this study was to evaluate changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole (IMD) with macular peeling and flap. METHODS: A prospective study of 35 eyes in 34 patients who had undergone standard surgery. Evaluated parameters were best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CRT), macular volume (TMV) and vascular density of the superficial and deep capillary plexus. The follow-up period was one year. RESULTS: We divided the total group into two: temporal and circular flap and total group. We compared the values after surgery with the preoperative values. In the total group, BCVA increased from 48.38 to 71.44 letters (P≤0.05). IOP changed from 15.24 to 14.76 mmHg (P>0.05). CRT decreased from 432.27 to 323.64 µm (P≤0.05). TMV changed from 0.26 to 0.25 mm3 (P>0.05). The vascular density of the superficial plexus decreased from 32 to 28% (P≤0.05). The intercapillary space of the superficial plexus increased from 68 to 72% (P≤0.05). The vascular density of the deep plexus increased from 17 to 23%. The intercapillary space of the deep vascular plexus decreased from 83 to 77%. Changes in vascular density and intercapillary space of the deep plexus were statistically significant for certain months after operations (P≤0.05). There were no significant differences between subgroups. CONCLUSION: The superficial plexus vascular density is almost the same in the temporal flap and in the foveal-sparing flap is decreased, and the deep plexus vascular density increased statistically significantly during the follow-up period after surgery.

• Klíčová slova
• deep vascular plexus, foveal-sparing flap, macular hole, pars plana vitrectomy, superficial vascular plexus, temporal flap,
• MeSH
• chirurgické laloky * krevní zásobení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• macula lutea * krevní zásobení   MeSH
• mikrovaskulární denzita MeSH
• nitrooční tlak fyziologie   MeSH
• optická koherentní tomografie MeSH
• perforace sítnice * chirurgie   MeSH
• prospektivní studie MeSH
• retinální cévy MeSH
• senioři MeSH
• vitrektomie * metody   MeSH
• zraková ostrost * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Arterial variations of the upper limb may bear high importance for many clinical procedures, including the use of flaps in plastic surgery. We present a feasible way for visualization and confirmation of presence of these variations. METHODS: All variations were detected by ultrasonography and confirmed by Color Doppler Imaging. Proper documentation was taken in order to present our findings. RESULTS: We report a case of a 19-year-old female who showed two concomitant arterial variations of the forearm and the hand bilaterally. These two variations were the persistent median artery and the superficial dorsal branch of the radial artery which both significantly contributed to the blood supply of the hand. All examinations were performed by the same investigator and all findings were reviewed by an experienced sonographist. CONCLUSION: An unusual arrangement of the arterial system can be easily detected. We present a feasible way to prevent iatrogenic injuries and increase utilization of anatomical variants knowledge in surgery by using ultrasound prior to planning surgical procedures.

• Klíčová slova
• Anatomical variation, Color, Doppler, Median artery, Plastic, Radial artery, Surgery, Ultrasonography,
• MeSH
• arteria radialis * diagnostické zobrazování   chirurgie   MeSH
• chirurgické laloky krevní zásobení   MeSH
• lidé MeSH
• mladý dospělý MeSH
• paže MeSH
• ruka diagnostické zobrazování   krevní zásobení   MeSH
• zápěstí * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The reconstruction of oral tongue and floor of mouth defects after resections of squamous cell carcinoma is a challenging task in reconstructive surgery aiming for appropriate restoration of oral function and quality of life improvement. In this study, the authors introduce the innovative reconstruction technique of medium-sized defects consisting of tunnelized facial artery myomucosal island flap and submandibular gland flap as the local chimeric flap pedicled on facial vessels. A retrospective case series evaluation of 4 patients suffering from oral cavity cancer (stages III and IVa), who underwent transoral tumor excision with neck dissection and immediate reconstruction in the time period September 2020 to July 2021, was conducted. No flap losses or flap-related complications were identified. No recurrences occurred during the follow-up at 11.0±4.5 months (range: 6-16 mo, median=11 mo). Tunnelized facial artery myomucosal island flap and submandibular gland flap local chimeric flap expands the reconstruction options of medium-sized defects after ablative oral cancer surgery in carefully selected patients primarily not suitable for free flap reconstructions.

• MeSH
• arterie MeSH
• chirurgické laloky krevní zásobení   MeSH
• dlaždicobuněčné karcinomy hlavy a krku MeSH
• kvalita života MeSH
• lidé MeSH
• nádory hlavy a krku * MeSH
• nádory úst * chirurgie   patologie   MeSH
• podčelistní slinná žláza chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• spinocelulární karcinom * chirurgie   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The pedicled pectoralis major flaps are still harvested and mainly indicated for reconstruction in the polymorbid patient. Other indications are combinations of pedicled pectoralis major flaps with free microvascular flap, salvage reconstruction following complications, free flap failure and recurrent or extended primary disease. MATERIALS AND METHODS: We describe the pedicled pectoralis major flap in 18 patients operated on at the Department of Oral and Maxillofacial Surgery, Olomouc from 1st January 2014 to 1st December 2016. RESULTS: Fifteen oropharyngeal defect reconstructions were performed using pedicled pectoralis major flap (including 1 submandibular defect of the neck). Indications were primary resection in polymorbid patients in 10 cases and recurrent diseases after previous neck dissection and radiotherapy in 5 cases. Pedicled pectoralis major flap was used for secondary reconstruction in 3 cases. Complications occurred in 50 % of patients, 28 % were major and 22 % minor. Major complications included a total flap failure (defect was successfully treated with free tissue transfer of latissimus dorsi myocutaneous flap) in 1 case, plate exposure in 2 cases, large dehiscence and large hemorrhage 1 case each. Minor complications included only small dehiscences (22 %). One was associated with fluidothorax after rib harvesting (6%). There were no cases of neck contracture or supraclavicular bulge. CONCLUSION: Even today, usage the pedicled pectoralis major flap in head and neck reconstruction surgery cannot be considered as an obsolete reconstructive procedure that has been completely replaced by a free microvascular flap. Innovations of flap harvesting techniques and high rate of flap survival are the main reasons why pedicled pectoralis major flap can still be primarily indicated for high-risk patients, non-cooperative patients and also for patients with extensive neck dissection. The pedicled pectoralis major flap has been the first choice in salvage surgery, in cases of a complication or free flap failure or a recurrence of a primary disease.

• Klíčová slova
• Oral cancer, pedicled pectoralis major flap, pectoralis muscle flap, head and neck reconstruction,
• MeSH
• chirurgická rána etiologie   chirurgie   MeSH
• chirurgické laloky krevní zásobení   transplantace   MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• prsní svaly krevní zásobení   transplantace   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The pedicled pectoralis major flap was the original workhorse flap for head and neck reconstruction. Over time, it became the secondary choice for oropharyngeal reconstruction with the implementation of free-soft tissue transfers. Nowadays, a polymorbid patient is primarily indicated for pedicled pectoralis major flap reconstruction, other indications include combinations of pedicled pectoralis major flap with free microvascular flap, salvage reconstruction due to complications, salvage reconstruction due to free flap failure and salvage reconstruction due to recurrent or extended primary disease. Pedicled pectoralis major flap can be successfully used for specific oropharyngeal defects, even primary resections, especially for less cooperative patients and patients after extensive neck dissection. Improving the flap harvesting techniques can reduce undesired complications in specific cases of oropharyngeal reconstruction. Flap morbidity in these cases remains comparable to morbidity of patients who had undergone free flap reconstruction. Pedicled pectoralis major flap remains valid reconstruction tool that should be included in the armamentarium of each surgeon dealing with reconstruction of the head and neck.

• Klíčová slova
• Oral cancer, pedicled pectoralis major flap, pectoralis muscle flap, head and neck reconstruction,
• MeSH
• chirurgické laloky krevní zásobení   transplantace   MeSH
• lidé MeSH
• nádory hlavy a krku chirurgie   MeSH
• odběr tkání a orgánů MeSH
• prsní svaly krevní zásobení   transplantace   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The effect of magnesium sulphate on mechanically provoked vasospasm of the flap pedicle on porcine model was not studied yet. Positive effect of magnesium sulphate on vasospasm was proved in previous studies on rat. METHODS: The bilateral pedicled flaps based on the caudal superficial epigastric arteries were raised on 8 pigs. Flaps on the right side were the treatment group; flaps on the left side were the control group. The vasospasm was provoked by the tension applied on the pedicle in the axial direction using 160g weight. The blood perfusion of the flap was monitored using laser-Doppler. The duration of the vasospasm was defined as the time from the release of the tension until the blood flow began to rise. These times were detected using an automated computerized detection. In the treatment group, magnesium sulphate was given topically on the vessel; saline was used in the control group. RESULTS: The duration of the vasospasm in the treatment group was significantly shorter than in the control group (P = 0.024). CONCLUSION: Magnesium sulphate 10% shortened significantly the mechanically provoked vasospasm on caudal superficial epigastric flap in a porcine model. Further clinical studies are needed to prove the effect in humans.

• MeSH
• chirurgické laloky krevní zásobení   MeSH
• modely u zvířat MeSH
• prasata MeSH
• síran hořečnatý aplikace a dávkování   MeSH
• vazodilatancia aplikace a dávkování   MeSH
• vazokonstrikce účinky léků   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• síran hořečnatý MeSH
• vazodilatancia MeSH

BACKGROUND: An experimental model for testing vasodilating drugs on vasospasm caused by standardized traumatisation of a pedicle has not been described yet. The aim of this study was to develop such model and to compare the effects of different types of surgical manipulations that can provoke vasospasm during flap dissection. MATERIAL AND METHODS: The pedicled groin flap was dissected in 185 male Wistar rats under standardised conditions. The blood perfusion curves of the flap were obtained using the Laser Doppler flow-meter. The vasospasm was provoked by the following manoeuvres: pulling on the pedicle; compression of the pedicle by vascular clamps; dissection of the vessels and by presence of blood around the pedicle. The perfusion recording curves were processed and two important time periods describing the progress of spasm were extracted. Combined non-parametrical ANOVA and WILCOXON tests were used to compare the time parameters between the groups. On the basis of statistical evaluation, we divided the factors responsible for vasospasm into categories labelled as strong and weak. The strong stimuli included dissection of the vessels; pulling on the pedicle using 15g, 20g and 25g weights and presence of blood around the pedicle. The weak stimuli included compression of the pedicle using vascular clamps and pulling on the pedicle using 10g weight. Pulling on the pedicle using 15g weight was chosen as the most appropriate stimulus for the experimental model. RESULTS: A new experimental model for studying vasospasm caused by tension on the pedicle was developed. This model is well defined, easily repeatable and reproducible, produces vasospasm of appropriate duration and permits standardized topical application of vasodilating drugs. DISCUSSION AND CONCLUSION: The finding that certain kind of surgical traumatisation causes vasospasm that is longer than the others may help microsurgeons to review their methods of surgical manipulation.

• MeSH
• analýza rozptylu MeSH
• chirurgické laloky krevní zásobení   MeSH
• mikrochirurgie MeSH
• modely u zvířat MeSH
• potkani Wistar MeSH
• stenóza MeSH
• svaly hladké cévní MeSH
• vazokonstrikce * MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• chirurgické laloky krevní zásobení   inervace   MeSH
• dějiny 21. století MeSH
• lebka krevní zásobení   inervace   chirurgie   MeSH
• lidé MeSH
• obličej krevní zásobení   inervace   chirurgie   MeSH
• stomatochirurgie dějiny   přístrojové vybavení   metody   MeSH
• transplantace obličeje dějiny   přístrojové vybavení   metody   MeSH
• zákroky plastické chirurgie dějiny   přístrojové vybavení   metody   MeSH
• Check Tag
• dějiny 21. století MeSH
• lidé MeSH
• Publikační typ
• historické články MeSH
• kongresy MeSH
• portréty MeSH
• Geografické názvy
• Česká republika MeSH