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  • 1. Clarkson, James
    et al.
    Probst, Fey
    Niranjan, Niri
    Meuli, Claudia
    Vogt, Paul
    Lidman, Disa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Andersson, Lena
    Our experience using the vertical rectus abdominis muscle flap for reconstruction in 12 patients with dehiscence of a median sternotomy wound and mediastinitis2003Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 37, nr 5, s. 266-271Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The vertical rectus abdominis (VRAM) flap has been used for reconstruction of sternal defects, particularly in the interior third, since it was first described 20 years ago. We describe 12 patients with mediastinitis or chronic sternal osteomyelitis after sternotomy treated between 1994 and 1997, nine performed at the Royal Hospitals Trust, London. Sternal osteomyelitis and mediastinitis after median sternotomy is an uncommon (0.4%-8.4%) but often fatal condition. Vascularised pedicles are the treatment of choice, and VRAM flaps were used in all cases. We report good long-term outcome with a follow up of 2-5 years, and no long-term morbidity relating to the VRAM reconstruction. We had only one partial failure of a flap. The operations were largely done in hospitals away from the plastic surgical unit in extremely sick patients, which illustrates the importance of multidisciplinary management to reduce hospital stay, mortality, and morbidity. We argue that early involvement of plastic surgical specialists in the treatment of sternal dehiscence is essential to ensure a successful outcome.

  • 2.
    Jergovic, Davor
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Krysander, Lennart
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Microsurgical treatment of facial palsy: 10 years of clinical experienceManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The aim of this study is to analyse retrospectively the outcome of microsurgical treatment of patients with facial palsy at the University Hospital of Linköping during the period 1990-2000. Ten patients with facial palsy during 1 year or more completed the evaluation.

    Patients subjected to cross facial nerve grafting (CFNG) only included 3 females. The CFNGs appeared to be fimctional in all patients. The measurements revealed good symmetry of the eye rim at rest and at eye closure. All three patients had an asymmetric angle of the mouth with a mean dropping of 2.3 mm at rest and 5.5 mm when smiling. The House-Brackmann grade was 4-5. The average Facial Grading System score was 33. The mean decrease in quality of life was 34%. The mean improvement after treatment was 48%. The degree of post-lesional impairment and the degree of postoperative satisfaction were inversely related. All patients were aware of their disability but they had not completely accepted the current facial status.

    The group of patients with CFNG and a free muscle flap transfer included six females and one male. The transferred muscle flaps were activated by the CFNGs. Symmetry of the eye rims at rest was observed in 4 cases and with closure in 3 cases. In asymmetric cases, the mean difference was 1. 8 mm at rest. With eyes closed the mean difference was 4.4 mm. The angle of the mouth was asymmetric in all patients, the mean lowering being 3 mm at rest and 7.5 mm at smile. The House Brackmann grade was 4-5 and the average Facial Grading System score was 31. Four patients with early or congenital facial palsy could not provide data on impairment of quality of life. In the others, the post-lesional impairment was 63%. For all patients in this group the average postoperative improvement was 76%. The patients expressed a rather good acceptance of the achieved status after reconstruction.

    Surgical methods to correct facial paresis should be directed towards achieving a symmetric resting tone on the injured side as well as symmetric movements. At present, our methods, when utilised on proper indications and with a precise timing, can give the patient a reasonably good but not perfect result. Further refinements of the technique are needed and should be sought through experimental studies.

  • 3.
    Jergovic, Davor
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Hildebrand, Claes
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Repair of the mandibular branch of the rat facial nerve through transmedian grafting in one or two stages: Morphological evaluation1997Inngår i: Journal of the peripheral nervous system, ISSN 1085-9489, E-ISSN 1529-8027, Vol. 2, nr 2, s. 181-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study examined by electron microscopy the normal fibre composition of the mandibular branch (MB) of the rat facial nerve and the outcome of axon regeneration in the MB after transmedian grafting in one or two stages. The average normal MB contained 2,185 axons, 17 % of which were unmyelinated. The myelinated axons had a unimodal diameter distribution (range 1.5-9.5 μm, mode 4.5 μm). After superior cervical ganglionectomy, the MB lost 1/3 of the C-fibres and 10% of the myelinated axons. In neonatally capsaicin-treated rats the occurrence of unmyelinated axons was reduced by about 50%. After repair in one or two stages the MB contained more myelinated and unmyelinated axons than normal. The myelinated axons showed a unimodal size distribution with a subnormal diameter range. Statistical comparisons showed that MBs from both experimental groups were significantly abnormal with respect to total axon number as well as numbers of unmyelinated and myelinated axons. In these respects the grafted MBs did not differ significantly from each other. However, the myelinated axons in MBs from one-stage cases showed larger mean and maximum diameters compared to MBs from two-stage cases. These data suggest that the normal MB of the rat contains myelinated and unmyelinated sympathetic axons and that about half the C-fibres in the normal MB come from capsaicin-sensitive sensory neurons. The comparison of the two reparative procedures used provides evidence in favor of the one-stage alternative.

  • 4.
    Jergovic, Davor
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Stål, Per
    Department of Integrative Medical Biology, Section for Anatomy, Faculty of Medicine and Odontology, University of Umeå, Umeå, Sweden.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lindvall, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Hildebrand, Claes
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Changes in a rat facial muscle after facial nerve injury and repair2001Inngår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 24, nr 9, s. 1202-1212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study describes changes in a rat facial muscle innervated by the mandibular and buccal facial nerve branches 4 months after nerve injury and repair. The following groups were studied: (A) normal controls; (B) spontaneous reinnervation by collateral or terminal sprouting; (C) reinnervation after surgical repair of the mandibular branch; and (D) chronic denervation. The normal muscle contained 1200 exclusively fast fibers, mainly myosin heavy chain (MyHC) IIB fibers. In group B, fiber number and fiber type proportions were normal. In group C, fiber number was subnormal. Diameters and proportions of MyHC IIA and hybrid fibers were above normal. The proportion of MyHC IIB fibers was subnormal. Immediate and delayed repair gave similar results with respect to the parameters examined. Group D rats underwent severe atrophic and degenerative changes. Hybrid fibers prevailed. These data suggest that spontaneous regeneration of the rat facial nerve is superior to regeneration after surgical repair and that immediacy does not give better results than moderate delay with respect to surgical repair. Long delays are shown to be detrimental.

  • 5.
    Karlander, Lars-Erik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Gustavsson, Urban
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Lidman, Disa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Sjöberg, Folke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Severe contusion of the femoral vessels in rats alters tissue oxygenation and microvascular blood flow regulation in the skeletal muscles of the limb2000Inngår i: Journal of Trauma - Injury, Infection and Critical Care, ISSN 1079-6061, Vol. 48, nr 2, s. 286-291Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Severe contusion of an artery often presents clinical problems in that it affects flow distal to the injury. However, the effect of a contusion on the microvascular flow regulation in the distal part of the limb is still largely unknown. Methods: A multipoint microelectrode technique was used to assess both tissue oxygenation (P(t)O2) and microflow (hydrogen clearance) on the skeletal muscle surface in a standard contusion injury to the femoral vessels in rats. Results: A significant increase in and an altered distribution of (P(t)O2) as well as a reduction in and altered distribution of microflow on the muscle surface distal to the injury was found in all animals (n = 27) compared with the uninjured control leg. These findings could not be reproduced experimentally by sympathectomy or when the adjacent skeletal muscle alone was injured. Conclusion: The results suggest that the changes observed distal to the injury are of vascular origin, possibly as a result of endothelial damage at the site of the contusion.

  • 6.
    Lidman, Disa
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Danielsson, Pär
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Abdiu, Avni
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Fåhraeus, Bengt
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    The functional result two years after a microsurgical penile replantation1999Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 33, nr 3, s. 325-328Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the technique of microsurgical penile replantation and a case followed up after two years. The patient was a young man with decompensated schizophrenia who emasculated himself with a kitchen knife. A particularly good functional result was achieved including restoration of sensation in the penile shaft and in the glans, and return of erectile capacity.

  • 7.
    Lidman, Disa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Ek, Anna-Christina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Akutkliniken.
    Lindgren, Margareta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Trycksår - Decubitalsår2005Inngår i: Bokkapitel i Svårläkta sår - Vårdprogram för Sydöstra sjukvårdsdistriktet / [ed] Landstinget i Jönköpings län,Landstinget i Kalmar län och Landstinget i Östergötland, Linköping: LiÖ , 2005, s. 50-61Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 8.
    Lidman, Disa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Niklasson, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Survival and function in patients with tumours of the head and neck operated on and reconstructed with free flaps2008Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 42, nr 2, s. 77-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    From 1983 to 2003, 131 patients were operated on in the head and neck region with 139 free flaps. They were operated on using a team approach of ear, nose, and throat surgeons and plastic surgeons, and sometimes maxillofacial surgeons. The tumours were squamous cell carcinoma (SCC) 104 (80%), salivary gland cancer 13 (10%), sarcoma 5 (4%), basal cell carcinoma 4 (3%), and others 4 (3%). The staging of the primary intraoral SCC tumours (n=79) was 42% in stage II, 28% in stage III, and 30% in stage IV. The survival of patients with primary oral SCC was compared with a previously treated previous series that gave an increase in tumour-related five-year survival from 48% to 58%. Most flaps were radial forearm flaps (73%). Fifteen percent were vascularised bone transfers. A questionnaire was sent to patients who had had oral/oropharyngeal tumours to measure function and satisfaction, to which 47/49 responded. The results including ability to chew and swallow, speech was good, with a median score of 0.78 (range 1-0).

  • 9.
    Lutz, Barbara
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi.
    Lidman, Disa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Morphological and functional evaluation of leg-muscle reinnervation after coupler coaptation of the divided rat sciatic nerve2005Inngår i: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 25, nr 3, s. 235-240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mechanical couplers are successfully used for microvascular venous anastomoses. The advantages include a simple and fast technique and a high patency rate. Couplers offer a secluded coaptation site, and might also be of use in peripheral nerve repair. The present study was designed to investigate coupler coaptation of the rat sciatic nerve, evaluating the number and locations of motor and sensory neurons projecting to the selected muscles as well as stimulation-induced muscle contraction force. Adult rats underwent either suture or coupler repair after left sciatic nerve transection. In all rats, the experimental side was compared to the healthy right side. Evaluation after 20 weeks included retrograde labeling of motoneurons and dorsal root ganglion neurons projecting to the tibial anterior muscle and to the tibial posterior muscle, histology, muscle contraction force (tibial anterior muscle and gastrocnemius muscle), and a pinch reflex test. The results show that the suture and the coupler groups did not differ significantly regarding the examined parameters, except for discrete signs of nerve compression at the coaptation site after coupler repair due to fibrous tissue ingrowth. However, this did not impair axonal regeneration. Importantly, axonal outgrowth from the repair site to the surrounding tissue was not observed after coupler coaptation, but it was observed after suture repair. These results suggest that couplers may be of value for repair of nerves in adjacency to avoid axonal crisscrossing between nerves during regeneration. © 2005 Wiley-Liss, Inc.

  • 10.
    Lutz, Barbara S.
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Ma, S.-F.
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Chuang, D. C. C
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Wei, F.-Ch.
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency: an experimental study in the rat2001Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 143, nr 4, s. 393-399Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Non-specific re-innervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome after peripheral nerve transsection and repair. This study investigates the rate of aberrant re-innervation and its influence on motor recovery in the rat sciatic nerve using artificial sheets as barrier between tibial and peroneal nerves.

    The sciatic nerve was transsected and repaired as follows: epineural sutures (A × 6), fascicular repair of tibial and peroneal nerves respectively (B × 8), and the same as in group B, but separating both nerves using an Integra®-sheet with silicone (C × 8), or Integra® without silicone (D × 8). As control, solely the tibial nerve was transsected and repaired (E × 5).

    Final investigations after 4 months revealed that in group C, 50% of the Integra®-silicone sheets were dislocated. No dislocation was found in group D. Muscle contraction force of the gastrocnemius muscle was significantly higher in group E as compared to all other groups. However although not significant, group D showed a consistently higher muscle contraction force than groups A, B, and C. Histology in groups A, B, and C with dislocated sheets demonstrated multiple axons growing from the tibial to the peroneal nerve and vice versa. In groups D and E, no such axonal growth was visible. These findings were confirmed by a significantly higher rate of specific re-innervation of the soleus muscle using sequential retrograde double labelling technique.

    Results of this study suggest that an artificial sheet such as Integra® bears the potential of preventing aberrant re-innervation between repaired adjacent nerves resulting in improved motor recovery. Clinically, this technique may be of importance for brachial plexus, sciatic nerve, and facial nerve repair.

  • 11.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Ragnemalm, Bengt
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    A pressure-controlled alarm and monitoring device for pressure ulcer prophylaxis in patients with traumatic spinal cord injury: a prototypeManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Patients with spinal cord injury are prone to develop pressure ulcers, especially around the pelvic girdle and in the buttocks. Treatment of pressure ulcer is demanding for the health care system in terms of personal and economic resources, and for the patient because of extensive conservative or surgical treatments to achieve healing. The prevention of pressure ulcers is therefore of major importance for this patient group. A contributing factor to the development of pressure ulcers is the lack of biosensory feedback below the level of injury, that results in a lack of impulses to the patient to change body position. In this paper we describe the construction of a technical device that monitors sitting pressures in a wheel chair cushion, and alerts the user when the pressure has reached a critical level for a period of time long enough to risk tissue damage. This device also saves pressure data continuously for retrospective analysis to evaluate the patients' sitting and unloading behaviour, and to study the effect of pressure relieving wheel chair cushions over longer periods of time.

  • 12.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Perfusion of buttock skin in healthy volunteers after long and short repetitive loading evaluated by laser Doppler perfusion imager2007Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 41, nr 6, s. 297-302Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Frequent unloading is vital to avoid pressure ulcers of the seat area in patients with injuries to the spinal cord. The duration of unloading is probably as important as that of the sitting period in the prophylaxis of pressure ulcers. The aim of this study was to investigate the microcirculatory reactions after occlusion of the buttock skin after repeated ischaemic provocation. The perfusion of buttock skin was studied with a laser Doppler perfusion imager (LDPI) in healthy people after short and long periods of sitting (repeated four times). The perfusion increased significantly during the consecutive loadings compared with the first loading, and this effect was more profound after the long load. Repeated periods of ischaemia of the buttock skin without allowing the tissues to recover resulted in increasing reactive hyperaemia, and are therefore probably more damaging than single loadings. This is important when establishing clinical guidelines for the prophylaxis of pressure ulcers in patients with spinal cord injuries.

  • 13.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sitting can cause ischaemia in the subcutaneous tissue of the buttocks, which implicates multilayer tissue damage in the development of pressure ulcers2009Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 43, nr 2, s. 82-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A better understanding of how pressure ulcers develop in the buttocks will improve prophylactic measures. Our aim was to investigate signs of reduced perfusion and ischaemia in the subcutaneous fat in the buttocks during sitting. A microelectrode was used to quantify oxygen (pO2). Metabolites that indicate aerobic or anaerobic metabolism (glucose, lactate, pyruvate, and glycerol) were quantified using microdialysis. Sixteen healthy people were studied while they sat on a wheel chair cushion, and a hard surface. Sitting pressures were mapped, and the thickness of the subcutaneous fatty layer was measured. The results showed that pO2 and glucose were significantly reduced during sitting, and for pO2 the effect is significantly more profound during sitting on a hard surface. After loading, both glucose and pO2 increased significantly. We conclude that the subcutaneous adipose tissue covering the ischial tuberosities becomes ischaemic during sitting. This finding supports the theory that not only is the skin involved in early development of pressure ulcers, but also the deeper tissues.

  • 14.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study2002Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, nr 5, s. 279-283Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The distribution of sitting pressure and ability to respond with reactive hyperaemia were studied in a group of paraplegic and tetraplegic patients (n = 8) with spinal cord lesions and healthy controls (n = 10) using a pressure sensitive plate and laser Doppler perfusion imager. The results show that the mean sitting pressure of the patients was 9.9 N/cm2 (left) and 11.7 N/cm2 (right) compared with 3.5 N/cm2 (left) and 3.6 N/cm2 (right) in controls. The differences were significant on both the left (p < 0.01) and right (p < 0.05) sides. The maximum pressure in patients was 42.9 N/cm2 (left) and 48.7 N/cm2 (right), and in controls 12.0 N/cm2 (left) and 12.9 (right) (p < 0.01). Both groups showed a reduction in skin perfusion in the seat area during sitting compared with unloaded resting, and in the controls it was significantly increased (p < 0.001 on both sides) during the reactive hyperaemic phase immediately after sitting. Compared with the preload values, the patients showed a similar but slightly weaker picture significant on the right side (p < 0.05), but not on the left. The hyperaemia was not uniformly distributed, but occurred where the pressure was greater than 2 N/cm2. There was no correlation between the amount of reactive hyperaemia and absolute values of sitting pressures. We conclude that tetraplegic and paraplegic patients have significantly higher sitting pressures than normal controls, and that the hyperaemic response in the buttock region in the upright position after pressure load is slightly weaker in the patients, which could be of importance for the development of decubitus ulcers.

  • 15.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöstrand, Lotta
    Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load2006Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 40, nr 3, s. 153-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In patients with spinal cord injuries (n=8) and healthy controls (n=8) the hyperaemic response in the buttock skin after sitting on a hard surface was studied using a laser Doppler perfusion imager. They sat for three minutes (short load), or 15 minutes (long load). An exponential mathematical function was used to compare the mean perfusion during the observed interval. The results showed that preloading perfusion is significantly higher among patients than healthy subjects. In both groups, the microcirculation of the skin increased significantly after loading, and peak perfusion was significantly lower after the short load. The mean perfusion was higher among the patients after both loadings, which suggests that there was stronger ischaemic provocation. The main outcome was that there was a dose-response relation between duration of loading and intensity of reactive hyperaemia, and that patients with spinal cord injuries have greater perfusion before and after loading than healthy controls.

  • 16.
    Zdolsek, Johann
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Droog, Erik
    Thorfinn, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Lidman, Disa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Laser Doppler perfusion imaging of the radial forearm flap: A clinical study2006Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 40, nr 2, s. 101-105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Laser Doppler perfusion imaging (LDPI) allows non-invasive assessment of blood flow in a predefined area of skin rather than at one single point. We have used LDPI to study the pattern of skin blood flow in the radial forearm flap before and after the flap has been raised. The data were collected from a consecutive series of 11 patients with cancer of the oral cavity or oropharynx in whom the radial forearm flap had been used during the reconstructive procedure. Reperfusion leads to an immediate hyperaemic response both in the flap and the surrounding skin. This hyperaemia remains for at least the first 30 minutes after reperfusion. The perfusion of the radial side of the forearm skin distal to the flap is significantly lower than that on the ulnar side after the skin island has been raised and the distal artery divided. We suggest that LDPI is useful for monitoring the perfusion of free skin flaps. © 2006 Taylor & Francis.

  • 17.
    Zdolsek, Johann
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Ledin, H
    Lidman, Disa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Are mechanical microvascular anastomoses easier to learn than suture anastomoses?2005Inngår i: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 25, nr 8, s. 596-598Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sutured anastomoses of small vessels are considered difficult to learn. Mechanical anastomosis systems allow a more rapidly performed anastomosis. In order to compare the process of learning to perform sutured and mechanical microvascular anastomoses, two surgeons, with limited microvascular experience, performed 30 aortic and 30 femoral vein anastomoses in 30 Wistar rats. The methods compared were conventional suture, vascular closure system (VCS), and microvascular anastomotic coupler system (MAC). There were no intersurgeon differences regarding patency or time to perform anastomoses. The average time to perform a suture anastomosis was 39 min (patency 80%). Anastomoses with the VCS system took 24 min (patency 25%), whereas the MAC couplers took 13 min to perform (patency 95%). There was a significant learning effect with sutures, but no obvious reduction in time to perform MAC coupler or VCS clip anastomoses was seen. MAC couplers were easiest to use, and allowed us to perform rapid anastomoses with high patency. © 2005 Wiley-Liss, Inc.

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