The laying down of collagen and fibrous tissue is a key process in wound healing, however excessive collagen (and glycoprotein) deposition causes hypertrophic and keloid scars, eg after burns. Collagen synthesis is increased in these scars compared with normal healing, as is collagenase activity, which controls the degradation pathway of collagen. The processes of wound healing are inextricably linked to those of the acute-phase response (APR): alpha-1-acid glycoprotein (AGP), a plasma glycoprotein that undergoes both an increase in concentration and an alteration in its glycosylation pattern during the APR. This study determined that AGP isolated from the plasma of burns patients was of an increased concentration and altered glycosylation pattern compared with normal plasma and was capable of directly interacting with type I collagen. It also had a profound effect on both collagen fibril formation and collagenase activity, to a degree dependent upon the percentage body surface area burned. Additionally, the results obtained provided the basis for predicting the formation of hypertrophic scars.

The Z plasty is a common procedure used in scar revision. It is used to break the line of a scar. It can also be used to change the direction of a scar. This article presents a mathematical model to help select an appropriate angled Z to enable the planned change in the direction of the final scar.

The efficiency of using various formulations of the antiemetic ondansetron to prevent postoperative nausea and vomiting (PONV) in the surgical treatment of postburn scars and deformities in children with a family history of PONV was compared. The patients were randomized into 4 representative groups. Preoperative administration of ondansetron (zofran) as lingual tablets was shown to be most effective. When the drug was used as syrup, PONV developed 2 times more frequently (PONV in 20% of the patients and 3 times more commonly when the drug was intravenously injected as jets during induction to anesthesia (PONV in 30% of the patients. When antiemetics were not given (a control group), the incidence was 7.5 times greater (75% of cases).

The postoperative follow-up of 18 unilocated sacral pressure sores treated with modificated by authors bilateral V-Y advancement island gluteus maximus myocu- taneous flap plasty was performed. No early flap necrosis occurred. The complications observed were minor and not jeopardising. The authors consider V-Y plasty modificated technique to be safe and allow the adequate coverage of sacral defect but despite of it, decubitus ulcer recurrence of is not to be precluded. The late pressure sore recurrence rate in analyzed material came up 33% during 9-24 months postoperatively. 11 flaps presented the diminished pressure resistance of tissues and thus the patinets underwent special conservative multidisciplinary approach to preserve flaps. The choice of flap in authors' opinion is important as well as proper qualification, operative planning, pre- and postoperative care including rehabilitation. Authors performed the critical evaluation of musculocutaneous flaps in sacral pressure sores surgery.

In the internal cytoplasm of interphase cells the density of microtubules is the highest in the centrosome area and decreases to the cell periphery. As a rule, the quantity of fluorescent microtubules cannot be counted up in the internal cytoplasm, but it is possible to estimate microtubules quantity using measuring of their optical density. In living 3T3 and CHO cells the microtubules optical density decreased according to different mathematical dependences that apparently reflected the differences of their microtubule system organization. To determine appropriateness that circumscribe the reduction of microtubules optical density from the centrosome region to the direction of cell margin, we modeled cell contours with the certain ratio and interposition of centrosome-attached and free microtubules in vector schedules CorelDraw program. The decrease of optical density was analyzed in MetaMorph program as it was described earlier (Smurova et al., 2002). It was shown that fluorescent microtubules optical density decreased exponentially (y = ae(-bx)) if the system joined only microtubules growing from the centrosome up to the cell margin. The curve became smoother in the case of not all radial centrosome-attached microtubules reached the margin, and adding of free microtubules into the system led to the sharp fall in optical density in the centrosome area and to its gradual decrease at the cell periphery. The increase in free microtubules quantity changed the character of the curve describing the reduction of optical density microtubule system which included free and centrosome-attached microtubules in proportions of 5 : 1 was described by the equation of linear regression (f= k . x + b). Thus, the mathematical dependence describing the microtubules distribution from the centrosome to the cell periphery, depends on the ratio of microtubules and their relative positioning in the cell volume. The data obtained using model systems have coincided with the results of experiments. The graphs which described the increase in microtubules optical density during microtubule repolymerization after nocodazole treatment, corresponded to the graphs for model cells. Thus, the method we used allows to analyze the microtubule system in the cases when the direct observation of individual microtubules is difficult.

BACKGROUND: The multiple Y-V plasty is often used in the release of burn scar contracture bands. Although there are established views regarding its design, no attempts have yet been made to describe the mathematical principles upon which it is based. An understanding of the mathematics, however, should incur a greater ability to "fine tune" or "tailor" the outcome. METHOD: Our standard method of design and execution is presented, and the mathematical properties underlying the technique are elucidated, using a simple trigonometric model. RESULTS: In a Euclidian plane, the equation describing the gain in length for a rectangular scar or contracture of length l and width a, to which the technique of multiple Y-V plasty has been applied, can be simplified to lx/a, where x is the only variable and represents the distance by which the component triangular V-shaped flaps have been advanced relative to one another. CONCLUSION: This equation illustrates that (a) neither the angles of the Ys nor the number of triangles in the design play a role in the ultimate length gained and (b) the distance of advancement of the individual triangular flaps is the sole determinant of final length.

PURPOSE: Z-plasty is a well-known and commonly used local flap technique in the treatment of contracture bands. Double opposing rectangular advancement is a new and alternate local flap design which can be used in the treatment of wide and linear postburn scar contractures. The technique consists of opposition of two adjacent rectangular flaps by advancement. This experimental study compares lengthening provided by Z-plasty and double opposing rectangular advancement. MATERIALS AND METHOD: Lower extremities of 10 male Sprague-Dawley rats were strained by hanging 400g of weight to provide tension lines over both inguinal areas. We planned Z-plasty with 2cm central limb and with 60 degrees angles to the inguinal tension line on one side. On the other side, we sketched double adjacent rectangular flaps with 2cm long axis and 1cm short axis over the tension line. Triangular flaps were elevated over the muscle, transposed and sutured in Z-plasty. Rectangular flaps were incised down to the muscle, advanced and opposed to each other before suturing. The final lengthening provided by both techniques were measured and the results were statistically analysed. RESULTS: Both Z-plasty and double opposing rectangular advancement techniques were effective in relief of tension over both inguinal areas and in lengthening the tension lines. Z-plasties provided lengthening ranging between 4 and 4.6cm. The difference between pre- and post-operative (Delta) measurements in Z-plasty ranged between 2-2.6cm (mean+/-standard deviation=2.26+/-0.24cm). The lengthening provided by double opposing rectangular advancement were between 3.9 and 4.5cm and the Delta measurements ranged between 1.9 and 2.5cm (mean+/-S.D.=2.22+/-0.22cm). Statistical analysis revealed that the elongation provided by both techniques are not significantly different from each other (p>0.05). CONCLUSION: Double opposing rectangular advancement technique elongates a tension line as much as Z-plasty in the rat inguinal skin.

BACKGROUND:: Few concepts are as fundamental to plastic surgery as scarring, yet swelling within a scar and its adjacent tissues is a common observation which is not well understood. Mechanical forces, scar contracture, fibrosis, and lymph stasis have been considered as possible explanations for these edematous-appearing areas, but conclusive evidence of a cause of swelling has not been established. The purpose of this study was to evaluate the possible role of microlymphatic stasis or disruption as a causal factor. PATIENTS AND METHODS:: Eleven patients (mean age: 43; range: 15 to 70) with localized swelling in conjunction with linear or curvilinear scars were evaluated, 9 with facial scars and 2 with scars of the chest wall and abdomen. Swelling within the scar had been present for an average of 4.5 years (range: 9 months to 13 years). Two patients had undergone previous Z-plasty revisions to the limbs of their curvilinear scars. Radiocolloid lymphoscintigraphy with technetium-99m Sb2S3 was performed on all patients by single or multiple injection technique into the site of the scar corresponding to local edema. RESULTS:: Following injection, rapid egress of radiotracer was visualized along lymphatic pathways posterior to the scar, with continuation to locoregional nodes in all patients with U-shaped "trapdoor" or linear scar configuration. However, in 8 cases there was no evidence of lymphatic drainage traversing or bridging the scar. In 2 patients with multiple prior Z-plasty revisions to the limbs of curvilinear scars, no visualization of lymph channels across the Z-plasty flaps was apparent. In total, 8 patients were diagnosed with lymphedema of the area adjacent to or enclosed within the scar. CONCLUSIONS:: These findings suggest that undrained lymphatic fluid contributes to the pathogenesis of the raised and swollen tissues seen abutting a U-shaped scar. Furthermore, as lymphatic pathways do not reestablish themselves across scars, attempts at improving lymphatic flow with Z-plasty revisions may not succeed in patients with clinical trapdoor scar deformities. Determination of scar lymphedema can assist in the selection of proper management for patients seeking scar revision.

BACKGROUND:: Perforator flap surgery has gained great popularity in the last decade because surgeons can prepare freestyle flaps in anywhere on the body if they find a perforator supplied to the flap. One of the basic principles of reconstructive surgery is that superior results can be obtained for color and texture match if immediately adjacent soft tissue is used to repair a defect. V-Y advancement flaps are used successfully based on this principle, but the degree of mobility of a V-Y advancement flap is dependent on the laxity of the underlying subcutaneous tissue. This is an important disadvantage of traditional V-Y advancement flap and limits its use. METHODS:: We used V-Y advancement flaps as perforator-based to overcome mobility restriction problem. The authors used 26 perforator-based V-Y advancement flaps in 24 consecutive patients for coverage of defects located at sacral (4), thigh (6), abdominal wall (3), inguinal (3), back (4), leg (2), and trochanter (2) regions. There were 14 female and 10 male patients with a mean age of 48.3 years (range, 22-70 years). RESULTS:: The patients were followed up for a mean period of 14.2 months (range, 9-21 months). The size of the defects ranged from 3 x 5 cm to 15 x 20 cm. All flaps survived completely (92.4%) except 2 in which one of them had undergone total necrosis and the other had marginal necrosis. Fifteen flaps (57.6%) were elevated based on 2 perforators, 7 flaps (26.9%) were used with only one perforator, and the remaining 4 (15.5%) had 3 perforators. CONCLUSIONS:: Perforator-based V-Y advancement flaps are safe and very effective for coverage of defects in which closure is impossible with a standard V-Y advancement flap. Dissection of the perforator or perforators offers remarkable excursion to the V-Y flap with minimal donor site morbidity. These axial pattern flaps can be used successfully with good esthetic and functional results at various regions of the body if there is any detectable perforator.