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Tissue Perfusion and Organ Regeneration
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Tissue Perfusion and Organ Regeneration

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (15 October 2021) | Viewed by 15458

Special Issue Editor

Prof. Dr. Lukas Prantl

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Guest Editor
Prof. Dr. med. Lukas Prantl, MD, PhD, MHBA, University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Applied Stem Cell Research Center, Regensburg, Germany
Interests: tissue engineering; stem cells; adipose stem cells, tissue perfusion; organ and tissue regeneration; organ and tissue transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Tissue perfusion plays a central role in the regeneration of tissue, the integration of cell therapeutics, and the efficiency of drugs. For example, neoangiogenesis can be stimulated by the application of mesenchymal stem cells, blood cells, and growth factors. There are many other factors besides vascular endothelial growth factor (VEGF) that stimulate neoangiogenesis. In addition to the direct mechanisms through special cells, there are also numerous secretion factors that have a positive and negative influence.

In this Special Issue, we will discuss the opportunities to improve tissue perfusion and regeneration. We will also attempt to understand better the flow properties of blood and the relationship to normal physiology, including the rheology of fluid in the perviascular and interstitial spaces as well as the lymphatic system. In addition, we will look at the latest methods for monitoring tissue perfusion.

Prof. Dr. Lukas Prantl
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • issue perfusion
  • imaging of microcirculation
  • neonagiogenesis
  • mesenchymal stem cells
  • blood cells
  • growth factors

Published Papers (6 papers)

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Research

10 pages, 1366 KiB  
Article
The LRINEC Score—An Indicator for the Course and Prognosis of Necrotizing Fasciitis?
by Vanessa Hoesl, Sally Kempa, Lukas Prantl, Kathrin Ochsenbauer, Julian Hoesl, Andreas Kehrer and Talia Bosselmann
J. Clin. Med. 2022, 11(13), 3583; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133583 - 22 Jun 2022
Cited by 7 | Viewed by 2168
Abstract
Background: The Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC) is a simple tool used to support early diagnosis of Necrotizing Fasciitis (NF). The aim of this study was to investigate whether the LRINEC is suitable as a progression and prognosis parameter in [...] Read more.
Background: The Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC) is a simple tool used to support early diagnosis of Necrotizing Fasciitis (NF). The aim of this study was to investigate whether the LRINEC is suitable as a progression and prognosis parameter in patients with NF. Methods: In this retrospective study, laboratory data of 70 patients with NF were analyzed. The LRINEC was calculated for every patient at the time of hospital admission and postoperatively after surgical interventions. Furthermore, the LRINEC was examined as a prognostic factor for survival. Results: The overall lethality of our series was 20 out of 70 (28.6%). A highly significant LRINEC decrease was found for serial debridements. The largest decrease was observed after the first debridement. There was a significant difference between the initial LRINEC of deceased and surviving patients. A cut off value of >6.5 (7 LRINEC points) resulted in an optimal constellation of sensitivity (70%) and specificity (60%) to predict lethality in patients with NF. Conclusions: The LRINEC significantly decreases after surgical debridement. An initial LRINEC equal or greater than seven is an independent prognostic marker for lethality and can help to identify high-risk patients. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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11 pages, 1091 KiB  
Article
Cerebral Oximetry-Monitored Nitroglycerin Infusion and Tissue Perfusion during Rewarming of Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial
by Jia-Lin Chen, Yung-Chi Hsu, Go-Shine Huang, Chih-Yuan Lin, Hung-Yen Ke, Po-Shun Hsu, Chi-Hsiang Chung, Chien-Sung Tsai and Tso-Chou Lin
J. Clin. Med. 2022, 11(3), 712; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030712 - 28 Jan 2022
Cited by 1 | Viewed by 2720
Abstract
Background: Nitroglycerin facilitates microcirculation and oxygen delivery through vasodilation. The purpose of this study was to clarify the effects of nitroglycerin-induced vasodilation and potential hypotension on tissue perfusion under cerebral oximetry monitoring during rewarming in cardiopulmonary bypass. Methods: Elective cardiac surgical patients were [...] Read more.
Background: Nitroglycerin facilitates microcirculation and oxygen delivery through vasodilation. The purpose of this study was to clarify the effects of nitroglycerin-induced vasodilation and potential hypotension on tissue perfusion under cerebral oximetry monitoring during rewarming in cardiopulmonary bypass. Methods: Elective cardiac surgical patients were randomly assigned to either a nitroglycerin group (n = 32) with an intravenous infusion of 1–5 mcg/kg/min or a control group (n = 31) with 0–0.1 mcg/kg/min infusion, since the initiation of rewarming. Perioperative arterial blood gas data were collected in addition to hemodynamic variables, cerebral oximetry values, urine output, and postoperative outcomes. Results: Nearly one-fifth (6/32) of patients in the nitroglycerin group experienced transient (≤5 min) profound hypotension (mean arterial blood pressure ≤40 mmHg) after the initiation of infusion. There were no significant differences between groups in terms of perioperative levels of cerebral oximetry, cardiac index, plasma glucose, lactate, bicarbonate, base excess, or post-bypass activated coagulation time. In the nitroglycerin group, urine output was nonsignificantly higher during cardiopulmonary bypass (p = 0.099) and within 8 h after surgery (p = 0.157). Perioperative transfused blood products, postoperative inotropic doses, extubation time, and intensive care unit stay were comparable for the two groups. Conclusions: Initiation of intravenous nitroglycerin infusion (at 1–5 mcg/kg/min) during rewarming in hypothermic cardiopulmonary bypass resulted in transient profound hypotension in one-fifth of patients and did not improve perioperative cerebral oxygenation, tissue perfusion, and coagulation in cardiac surgery. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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12 pages, 4053 KiB  
Article
Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP)
by Daniel Schiltz, Jasmin Lenhard, Silvan Klein, Alexandra Anker, Daniel Lonic, Paul I. Heidekrueger, Lukas Prantl, Ernst-Michael Jung, Natascha Platz Batista Da Silva and Andreas Kehrer
J. Clin. Med. 2021, 10(11), 2427; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112427 - 30 May 2021
Cited by 7 | Viewed by 4042
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe [...] Read more.
The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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11 pages, 1964 KiB  
Article
Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking
by Talia Bosselmann, Jonas Kolbenschlag, Ole Goertz, Peter Zahn, Lukas Prantl, Marcus Lehnhardt, Björn Behr and Alexander Sogorski
J. Clin. Med. 2021, 10(10), 2114; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102114 - 14 May 2021
Cited by 2 | Viewed by 1680
Abstract
Background: Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects [...] Read more.
Background: Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects in most peripheral vascular compartments is available. Methods: A total of 30 patients who were to receive axillary plexus blockade (APB) were included. Microcirculatory assessment of the dependent extremity was conducted utilizing combined laser-Doppler flowmetry and white light spectroscopy. Two probes (1–2 and 7–8 mm penetration depth) were used to assess changes in microcirculation. Results: APB resulted in significant changes to both superficial and deep cutaneous microcirculation. Changes in blood flow were most prominent in superficial layers with a maximum increase of +617% compared to baseline values. Significantly lower values of +292% were observed in deep measurements. Consecutively, a significant enhancement in tissue oxygen saturation was observed. Further analysis revealed a significant impairment of perfusion characteristics due to reported nicotine consumption (max Bf: +936% vs. +176%). Conclusion: Cutaneous microcirculation is strongly affected by APB, with significant differences regarding microvascular anatomy and vascular physiology. Smoking significantly diminishes the elicited improvements in perfusion. Our findings could influence reconstructive strategies as well as dependent perioperative anesthetic management. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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12 pages, 261 KiB  
Article
Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions
by Paul I. Heidekrueger, Nicholas Moellhoff, Raymund E. Horch, Jörn A. Lohmeyer, Mario Marx, Christoph Heitmann, Hisham Fansa, Matthias Geenen, Christian J. Gabka, Steffen Handstein, Lukas Prantl and Uwe von Fritschen
J. Clin. Med. 2021, 10(5), 1016; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051016 - 02 Mar 2021
Cited by 17 | Viewed by 2167
Abstract
While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons [...] Read more.
While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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11 pages, 4518 KiB  
Article
Tissue Viability of Free Flaps after Extracorporeal Perfusion Using a Modified Hydroxyethyl Starch Solution
by Christian D. Taeger, Oliver Friedrich, Raymund E. Horch, Caroline Distler, Annika Kengelbach-Weigand, Carina Wenzel, Lukas Prantl and Konstantin Präbst
J. Clin. Med. 2020, 9(12), 3929; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9123929 - 03 Dec 2020
Cited by 3 | Viewed by 1737
Abstract
Background: In free flap surgery, tissue is stored under hypothermic ischemia. Extracorporeal perfusion (EP) has the potential to extend storage time and the tissue’s perspective of survival. In the present study, the aim is to improve a recently established, simplified extracorporeal perfusion system. [...] Read more.
Background: In free flap surgery, tissue is stored under hypothermic ischemia. Extracorporeal perfusion (EP) has the potential to extend storage time and the tissue’s perspective of survival. In the present study, the aim is to improve a recently established, simplified extracorporeal perfusion system. Methods: Porcine musculus rectus abdominis were stored under different conditions. One group was perfused continuously with a simplified one-way perfusion system for six hours, while the other received only a single flush but no further treatment. A modified hydroxyethyl starch solution was used as a perfusion and flushing solution. Vitality, functionality, and metabolic activity of both groups were analyzed. Results: Perfused muscles, in contrast to the ischemically stored ones, showed no loss of vitality and significantly less functionality loss, confirming the superiority of storage under continuous perfusion over ischemic storage. Furthermore, in comparison to a previous study, the results were improved even further by using a modified hydroxyethyl starch solution. Conclusion: The use of EP has major benefits compared to the clinical standard static storage at room temperature. Continuous perfusion not only maintains the oxygen and nutrient supply but also removes toxic metabolites formed due to inadequate storage conditions. Full article
(This article belongs to the Special Issue Tissue Perfusion and Organ Regeneration)
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