According to the Mathes and Nahai classification, sartorius is:
A Type IV muscle flap. The supply is segmental, and this is of relevance when using this flap such as for coverage of the femoral vessels during groin lymphadenectomy with a ‘sartorius switch’. Some have suggested the proximal part of this flap is not viable during the switch procedure which simply scars and fibroses.
Heparin activates antithrombin III. The intrinsic and extrinsic coagulation pathways converge at Factor X. The antithrombotic effect of dextran is mediated through its binding of erythrocytes, platelets, and vascular endothelium, increasing their electronegativity and thus reducing erythrocyte aggregation and platelet adhesiveness. Dextrans also reduce Factor VIII-Ag von Willebrand Factor, thereby decreasing platelet function. Low-dose, long-term aspirin use irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation. Aspirin inhibits collageninduced platelet aggregation and ADP-induced platelet aggregation, as well as blocking the release of ADP from platelets. ADP is known to be a potent platelet-aggregating substance. Aspirin acts on cyclo-oxygenase by causing irreversible acetylation of the enzyme, and therefore the effect is irreversible for the life of that platelet (7-10 days). Other non-steroidal antiinflammatory analgesics have a reversible action on that enzyme, and hence only act until the drug is cleared from the circulation.
The groin flap is usually based on:
The superficial circumflex iliac artery. However, Taylor’s work argued for the advantages of raising the free groin flap based on the deep vessel 1, 2.
Is an opium alkaloid. It is extracted from poppies but differs in both structure and pharmacological action from the other opiates. It acts through increasing cAMP levels via inhibition of phosphodiesterase leading to smooth muscle relaxation and vasodilation.
The following key paper is not appropriately attributed:
Rohrich (2003, Ann Plast Surg) - classification of gynaecomastia in relation to suction-assisted lipectomy. This is incorrect; Rohrich published his classification of gynaecomastia in Plastic Reconstructive Surgery in relation to ultrasound-assisted lipectomy. The other papers are correctly attributed and all these papers would be a valuable addition to the reading list of readers.
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