Publications by authors named "Mihai A Constantinescu"

Introduction: Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited.

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Unlabelled: : Isolated defects of the posterior hypopharyngeal/upper esophageal wall are rare, typically arising after cancer resection or complications following cervical spine osteosynthesis. Various local and free flaps are available for reconstruction, but we opted for a double-island anterolateral thigh (ALT) flap in this case. : A scoping review was conducted (June 2024) following PRISMAScR 2018 guidelines in order to examine the coverage options available in the literature for posterior hypopharyngeal/upper esophagus wall defects while also presenting a case where such a defect was covered with a double-island anterolateral thigh (ALT) flap.

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Seroma formation is a common postoperative complication. Fibrin-based glues are typically employed in an attempt to seal the cavity. Recently, the first nanoparticle (NP)-based treatment approaches have emerged.

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Article Synopsis
  • The study focuses on the osteocutaneous variants of the superficial circumflex iliac perforator (SCIP) flap, which offer benefits like customizability and low donor site issues, yet haven't been widely adopted.
  • A retrospective review of six patients who received osteocutaneous SCIP flaps shows successful surgical, functional, and aesthetic outcomes, despite one case requiring emergency revision.
  • The conclusion highlights that these flaps provide effective tissue reconstruction options with minimal complications, emphasizing their potential for broader use in osteoplastic surgeries.
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  • Sentinel lymph node (SLN) biopsy using radiocolloid and blue dye is standard for early-stage melanoma but has drawbacks like radiation exposure and allergic reactions.
  • Indocyanine green (ICG) is a promising alternative fluorescent dye that can be detected with near-infrared imaging, showing high sensitivity in identifying SLNs.
  • The study involving 93 melanoma patients found ICG's overall SLN detection sensitivity to be 96.1%, and suggests that ICG/NIRFI could replace traditional methods for certain patients, especially considering factors like body mass index.
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Introduction: The emphasis on aesthetic outcomes and quality of life (QoL) has motivated surgeons to develop skin-sparing or nipple-sparing mastectomy (SSM/ NSM) for breast cancer treatment or prevention. During the same operation, a so-called immediate breast reconstruction is performed. The breast can be reconstructed by positioning of a breast implant above (prepectoral) or below (subpectoral) the pectoralis major muscle or by using the patients' own tissue (autologous reconstruction).

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  • Seroma formation is a common issue after surgeries, but current treatments are not effective.
  • A new study tested a nano-bridging technique in rats to see if it could reduce seroma formation after surgical procedures.
  • Results showed that the nanoparticle treatment led to complete remission of seromas, while traditional fibrin glue only partially reduced fluid volume, suggesting nanoparticles could be a promising solution for treating seromas without adverse side effects.
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  • A thin skin flap is crucial for achieving functional and aesthetic outcomes in surgical reconstruction, particularly utilizing perforator flaps from the superficial circumflex iliac artery (SCIA).
  • The study involved dissection and imaging of SCIA branches in cadavers, revealing that both branches have multiple perforators, with the deep branch providing larger flaps and longer pedicles.
  • The findings suggest that the SCIP flap has a reliable blood supply, with the deep branch being optimal for situations requiring larger flaps.
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  • The study aimed to create a reliable rat model for hindlimb transplantation that incorporates the local lymphatic system to better understand its role in vascularized composite allotransplantation (VCA).
  • Thirty transplantations from Brown Norway to Lewis rats were conducted, preserving key lymphatic structures and utilizing a combination of microsurgical and cuff techniques for the surgery.
  • Results indicated a high transplant survival rate of 93.3%, confirming the success in including inguinal lymph nodes and vascular integrity through various analyses, paving the way for future research on lymphatic contributions in VCA.
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The common limitation of surgical revascularization procedures for severe tissue ischemia due to cardiovascular diseases is the need to interrupt blood flow during the intervention. We aim to introduce a new technique that allows a sutureless, non-occlusive revascularization. A 3-step technique was developed using rabbit's aorta to simulate a side-to-side anastomosis model.

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  • Metal oxide nanoparticles are powerful tools in biomedical applications, but a lack of understanding regarding their interaction with tissues hampers their development as effective nanomedicines.
  • This study focuses on complex metal oxide nanoparticle hybrids, specifically cerium oxide and bioglass, using advanced analytical methods to track their distribution in tissues after application.
  • The findings reveal that when applied topically, these nanoparticles mainly stay at the application site, are taken up by macrophages, help form apatite, and increase lipid accumulation, highlighting the importance of detailed characterization for designing safer nanomedicine systems.
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  • The study investigates the impact of increasing blood flow in a perforator flap on its survival, aiming to reduce the occurrence of flap necrosis commonly faced in reconstructive surgery.
  • In an experiment with 30 male Lewis rats, three groups were tested: a control group, a group with acute inflow, and a group with arterial preconditioning, with results measured on flap survival and blood flow post-surgery.
  • The findings revealed that the group with acute inflow had the highest flap survival rate and improved blood flow in specific areas, indicating that optimizing arterial inflow can enhance the survival of perforator flaps.
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  • Defects in the distal leg often require complex reconstruction techniques like propeller flaps as alternatives to free tissue transfer, but complications can be a concern.
  • Between 2014 and 2017, a study was conducted on 26 patients who underwent propeller flap reconstruction to assess complication rates and outcomes.
  • Results showed that flaps based on the posterior tibial artery had fewer complications compared to those based on the peroneal artery, and patients with higher comorbidity scores faced more risks, suggesting that careful patient selection is crucial for successful outcomes in lower-limb reconstructions.
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Background: Distal flap necrosis is a frequent complication of perforator flaps. Advances in nanotechnology offer exciting new therapeutic approaches. Anti-inflammatory and neo-angiogenic properties of certain metal oxides within the nanoparticles, including bioglass and ceria, may promote flap survival.

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Background: Improvement of skin microcirculation would be beneficial in transplanted tissues and thus, there is a demand for effective, reliable and harmless angiogenic treatments. The aim of this study was to assess the effect of capsaicin application (CA), the remote effect of capsaicin application (REC), the impact of remote ischemic conditioning (RIC), and the impact of combined remote ischemic conditioning with capsaicin application (Comb) on human skin microcirculation.

Methods: Perfusion changes were assessed using a laser Doppler device (easyLDI, Aimago Lausanne).

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Background: In pig-to-human xenotransplantation, interactions between human natural killer (NK) cells and porcine endothelial cells (pEC) are characterized by recruitment and cytotoxicity. Protection from xenogeneic NK cytotoxicity can be achieved in vitro by the expression of the non-classical human leukocyte antigen-E (HLA-E) on pEC. Thus, the aim of this study was to analyze NK cell responses to vascularized xenografts using an ex vivo perfusion system of pig limbs with human blood.

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Revascularization of an amputated limb within 4-6h is essential to avoid extensive ischemia/reperfusion (I/R) injury leading to vascular leakage, edema and tissue necrosis. I/R injury is a pathological inflammatory condition that occurs during reperfusion of an organ or tissue after prolonged ischemia. It is characterized by a complex crosstalk between endothelial cell activation and the activation of plasma cascades.

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Microvascular surgery is time consuming and requires high expertise. Laser-assisted vascular anastomosis (LAVA) is a promising sutureless technique that has the potential to facilitate this procedure. In this study, we evaluate the handling of our soldering material and the 1-week patency rate in a porcine model.

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Introduction: Various different learning methods are available for planning tuition regarding the introduction to surgical hand disinfection. These learning methods should help to organise and deal with this topic. The use of a video film is an alternative to conventional tuition due to the real presentation possibilities of practical demonstration.

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Skin reactions are known adverse effects of radiation therapy. Despite advances in skin care products, there is still a demand for optimal skin care products to improve the therapy of these lesions. The authors report the use of a polylactide-based copolymer (Suprathel, PolyMedics Innovations GmbH, Denkendorf, Germany) as a temporary skin substitute for covering the skin defects of a patient with moist desquamation due to radiation.

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Background: A huge number of procedures for forehead and brow rejuvenation have been described. Nevertheless, the surgical approach of brow aesthetics in terms of correction of brow fullness and symmetry has not been systematically evaluated in the literature. We recently proposed a 20-degree beveled brow incision technique for direct brow lifting.

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Background: Dysregulation of the coagulation system due to inflammatory responses and cross-species molecular incompatibilities represents a major obstacle to successful xenotransplantation. We hypothesized that complement inhibition mediated by transgenic expression of human CD46 in pigs might also regulate the coagulation and fibrinolysis cascades and tested this in ex vivo human-to-pig xenoperfusions.

Methods: Forelimbs of wild-type and hCD46/HLA-E double transgenic pigs were ex vivo xenoperfused for 12 hours with whole heparinized human blood.

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Background: Asialoglycoprotein receptor-1 (ASGR1) mediates capture and phagocytosis of platelets in pig-to-primate liver xenotransplantation. However, thrombocytopenia is also observed in xenotransplantation or xenoperfusion of other porcine organs than liver. We therefore assessed ASGR1 expression as well as ASGR1-mediated xenogeneic platelet phagocytosis in vitro and ex vivo on porcine aortic, femoral arterial, and liver sinusoidal endothelial cells (PAEC/PFAEC/PLSEC).

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The prophylactic (risk-reducing) mastectomy is a world-wide recognized method for specifically treating the increased breast cancer risk in patients showing a BRCA1 and/or BRCA2 mutation as well as other patient groups at increased breast cancer risk. This option should be offered to all patients having the pertinent risk profile. Breast reconstruction is an integral part of the risk-reducing mastectomy procedure and all possible methods of breast reconstruction, especially autologous tissue reconstruction should be offered to all patients having a medical indication and desiring this surgical treatment.

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Currently, systemic immunosuppression is used in vascularized composite allotransplantation (VCA). This treatment has considerable side effects and reduces the quality of life of VCA recipients. We loaded the immunosuppressive drug tacrolimus into a self-assembled hydrogel, which releases the drug in response to proteolytic enzymes that are overexpressed during inflammation.

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