Although with the reported versatility, vascular reliability, and easy harvesting and elevation of the gastrocnemius muscle flap, still it is used for a narrow aspect of reconstructions including only small and nearby defects. The flap is unfortunately full of limited applications, unreachable coverage, and soft tissue shortage. In this work, we are presenting 20 cases of gastrocnemius muscle flap of different etiologies, in which we applied a group of modifications to have a higher grade of applicability, more arc of rotation, and more tissue surface area. The validity of these modifications was intraoperatively tested in different defect sites and sizes to report if they are really meaningful. All flaps had survived with no complications. We have summarized these modifications in four golden rules, making these muscle flaps more versatile and more applicable. An algorithm is suggested as a leading tool for the best choice of the gastrocnemius muscle units in different situations.

Background The percentage of intact fat cells membrane obtained by even a well-known technique remains poorly studied. The purposes of this study were to evaluate and compare the structural effects of various harvesting, preparation, and injection methods on human fat cell integrity. Methods We enrolled 20 healthy females in this study, ages ranged from 20 to 41 yearswith an average age of 31±0.5 years. We harvested fat tissues from the abdomen and thigh of donors using two different methods: conventional and syringe liposuction; we treated the aspirated fat specimens within 30 min of harvesting by fine-mesh gauze or using centrifugation. We injected the prepared fat through small or large needle, and then obtained a specimen from each different method. We analyzed all fat graft samples by routine histological examination. Results There was a significant difference in the percentage of intact fat cells wall was observed in syringe aspiration (75.95 ±0.31 %) versus vacuum liposuction (56.43 %±0.67). There was a significant difference in the percentage of intact fat cells when using centrifugation versus fine-mesh gauze preparation. Also there was a significant difference in the percentage of intact fat cells observed when using large versus small needle for injection. Conclusions The highest intact adipocyte counts were in syringe suction, no centrifuge, and using large cannula, while the fewest intact adipocyte counts were in conventional liposuction, using centrifuge, and using small cannula.

Background The percentage of intact fat cells membrane obtained by even a well-known technique remains poorly studied. The purposes of this study were to evaluate and compare the structural effects of various harvesting, preparation, and injection methods on human fat cell integrity. Methods We enrolled 20 healthy females in this study, ages ranged from 20 to 41 yearswith an average age of 31±0.5 years. We harvested fat tissues from the abdomen and thigh of donors using two different methods: conventional and syringe liposuction; we treated the aspirated fat specimens within 30 min of harvesting by fine-mesh gauze or using centrifugation. We injected the prepared fat through small or large needle, and then obtained a specimen from each different method. We analyzed all fat graft samples by routine histological examination. Results There was a significant difference in the percentage of intact fat cells wall was observed in syringe aspiration (75.95 ±0.31 %) versus vacuum liposuction (56.43 %±0.67). There was a significant difference in the percentage of intact fat cells when using centrifugation versus fine-mesh gauze preparation. Also there was a significant difference in the percentage of intact fat cells observed when using large versus small needle for injection. Conclusions The highest intact adipocyte counts were in syringe suction, no centrifuge, and using large cannula, while the fewest intact adipocyte counts were in conventional liposuction, using centrifuge, and using small cannula.

Background: Hypochlorous acid is a highly microbiocidal active agent against a broad spectrum of microorganisms. It achieved a marked reduction in the bacterial burden in a septic wound. This study aimed to evaluate the efficacy of Hypochlorous acid as a wound care agent in a septic traumatic wound. Materials and Method: Design: The current study used a randomized clinical trial to investigate the effectiveness of Hypochlorous acid as a wound care agent in a septic traumatic wound. Setting: trauma unit at Assiut university hospital was the setting of the study. Subjects: A random selection of 60 patients was done. Then a random distribution of the subjects to study group and control group, (30 subjects each) was done. Methods: The 30 subjects of the study group received Hypochlorous Acid for daily washing a septic wound for 3 to 5 minute, while the 30 subjects of the control group received Povidine Iodine and the results were compared. Bacterial count and culture were done before start washing, after one week, and two weeks in the two groups. Results: wound pain, odor, discharge and bacterial count were dramatically reduced by using as a disinfectant agent compared to the use of Povidine Iodine. Conclusion: Hypochlorous Acid appears to be inexpensive, easy to perform, painless and effective as a potent wound care dressing against a wide range of microorganisms. Hypochlorous Acid controls the tissue bacterial bio-burden without inhibiting the wound healing process, rapidly relieves pain and the area well prepared to skin flap or graft. Recommendation: The study recommended the use of Hypochlorous Acid as a potent wound care dressing. Further research is needed on a larger scale to validate the effectiveness of Hypochlorous acid as a wound care agent in a septic traumatic wound.

Background: Successful treatment of vascular anomalies represents a challenging problem despite using various treatments. Intralesional injection of bleomycin has been successfully used in treatment of macrocystic lymphatic malformations and hemangiomas, based specifically on a high sclerosing effect on vascular endothelium. Methods: In a prospective study of 75 patients, there were 47 women and 28 men. Their ages ranged from 3 to 35 years with a mean age of 14 years. The effectiveness of intralesional bleomycin injection in hemangiomas and vascular malformations was evaluated. Dosage regimens used were as follows: - In children younger than 1 year, the maximum dose per injection is limited to 0.5 to 1 mg/kg and varied according to the size of the lesion. - In children older than 1 year and adult, a dose of 1 to 15 mg was injected intralesionally per session. A single dose of 15 mg per session was never exceeded. The interval between each session was 3 to 4 weeks. Results: Complete resolution (cured) in 18 (24%) patients, marked improvement occurred in 35 (47%) patients, mild improvement in 14 (18.5%) patients, and no cure in 8 (10.5%) cases. Local complications were superficial ulceration in 5 patients and hyperpigmentation in 6 patients. Systemic complications were flu-like symptoms in 3 patients. None of the patients presented with toxic hematological effects or signs of pulmonary fibrosis and/or hypertension. Conclusions: Intralesional bleomycin injection is an effective and a safe method for treatment of hemangiomas and vascular malformations, decreasing the need for invasive primary surgery or systemic treatment in 71% of cases and decreasing the magnitude of secondary surgical procedures in cases with moderate results.

Background: Successful treatment of vascular anomalies represents a challenging problem despite using various treatments. Intralesional injection of bleomycin has been successfully used in treatment of macrocystic lymphatic malformations and hemangiomas, based specifically on a high sclerosing effect on vascular endothelium. Methods: In a prospective study of 75 patients, there were 47 women and 28 men. Their ages ranged from 3 to 35 years with a mean age of 14 years. The effectiveness of intralesional bleomycin injection in hemangiomas and vascular malformations was evaluated. Dosage regimens used were as follows: - In children younger than 1 year, the maximum dose per injection is limited to 0.5 to 1 mg/kg and varied according to the size of the lesion. - In children older than 1 year and adult, a dose of 1 to 15 mg was injected intralesionally per session. A single dose of 15 mg per session was never exceeded. The interval between each session was 3 to 4 weeks. Results: Complete resolution (cured) in 18 (24%) patients, marked improvement occurred in 35 (47%) patients, mild improvement in 14 (18.5%) patients, and no cure in 8 (10.5%) cases. Local complications were superficial ulceration in 5 patients and hyperpigmentation in 6 patients. Systemic complications were flu-like symptoms in 3 patients. None of the patients presented with toxic hematological effects or signs of pulmonary fibrosis and/or hypertension. Conclusions: Intralesional bleomycin injection is an effective and a safe method for treatment of hemangiomas and vascular malformations, decreasing the need for invasive primary surgery or systemic treatment in 71% of cases and decreasing the magnitude of secondary surgical procedures in cases with moderate results.

Adiponectin is a collagen-like protein that is solely secreted by adipocytes. Different studies showed that it plays an important role in the pathophysiology of insulin resistance, diabetes and dyslipidemia and thus affects risk for cardiovascular disease and obesity. In the present study the role of adiponectin in pathogenesis of type 2 diabetes mellitus was evaluated. The current study was carried on 51 diabetic patients with documented NIDDM and 22 age and sex matched healthy controls. Diabetic patients were subdivided into 2 subgroups according to BMI where 40 were obese and 11 were non obese and according to the presence of cardiovascular disease with obesity where 16 were obese with CVD and 24 were obese with no CVD. Controls were subdivided according to BMI where 7 were non obese and 15 were obese. The levels of plasma adiponectin, insulin, c-peptide, fasting blood glucose, glycated hemoglobin, lipid profile, NO and lipid peroxides. The results of the present study showed that adiponectin was significantly lower in all groups with variations compared to controls, in obese patients with CVD than those without CVD. NO and MDA levels were higher in diabetic patients than in controls and the highest levels of MDA were observed in patients with cardiovascular disease. Lipid profile was altered in diabetic patients showing higher levels than in controls. In the diabetic patients, adiponectin was significantly positively correlated with NO and HDL, while it was significantly negatively correlated with glucose, HbA1C, Cholesterol,LDL, insulin and c-peptide. The ability of adiponectin to increase insulin sensitivity in conjunction with its anti-inflammatory and anti-atherogenic properties have made this novel adipocytokine a promising therapeutic tool for the future.

Adiponectin is a collagen-like protein that is solely secreted by adipocytes. Different studies showed that it plays an important role in the pathophysiology of insulin resistance, diabetes and dyslipidemia and thus affects risk for cardiovascular disease and obesity. In the present study the role of adiponectin in pathogenesis of type 2 diabetes mellitus was evaluated. The current study was carried on 51 diabetic patients with documented NIDDM and 22 age and sex matched healthy controls. Diabetic patients were subdivided into 2 subgroups according to BMI where 40 were obese and 11 were non obese and according to the presence of cardiovascular disease with obesity where 16 were obese with CVD and 24 were obese with no CVD. Controls were subdivided according to BMI where 7 were non obese and 15 were obese. The levels of plasma adiponectin, insulin, c-peptide, fasting blood glucose, glycated hemoglobin, lipid profile, NO and lipid peroxides. The results of the present study showed that adiponectin was significantly lower in all groups with variations compared to controls, in obese patients with CVD than those without CVD. NO and MDA levels were higher in diabetic patients than in controls and the highest levels of MDA were observed in patients with cardiovascular disease. Lipid profile was altered in diabetic patients showing higher levels than in controls. In the diabetic patients, adiponectin was significantly positively correlated with NO and HDL, while it was significantly negatively correlated with glucose, HbA1C, Cholesterol,LDL, insulin and c-peptide. The ability of adiponectin to increase insulin sensitivity in conjunction with its anti-inflammatory and anti-atherogenic properties have made this novel adipocytokine a promising therapeutic tool for the future.

Adiponectin is a collagen-like protein that is solely secreted by adipocytes. Different studies showed that it plays an important role in the pathophysiology of insulin resistance, diabetes and dyslipidemia and thus affects risk for cardiovascular disease and obesity. In the present study the role of adiponectin in pathogenesis of type 2 diabetes mellitus was evaluated. The current study was carried on 51 diabetic patients with documented NIDDM and 22 age and sex matched healthy controls. Diabetic patients were subdivided into 2 subgroups according to BMI where 40 were obese and 11 were non obese and according to the presence of cardiovascular disease with obesity where 16 were obese with CVD and 24 were obese with no CVD. Controls were subdivided according to BMI where 7 were non obese and 15 were obese. The levels of plasma adiponectin, insulin, c-peptide, fasting blood glucose, glycated hemoglobin, lipid profile, NO and lipid peroxides. The results of the present study showed that adiponectin was significantly lower in all groups with variations compared to controls, in obese patients with CVD than those without CVD. NO and MDA levels were higher in diabetic patients than in controls and the highest levels of MDA were observed in patients with cardiovascular disease. Lipid profile was altered in diabetic patients showing higher levels than in controls. In the diabetic patients, adiponectin was significantly positively correlated with NO and HDL, while it was significantly negatively correlated with glucose, HbA1C, Cholesterol,LDL, insulin and c-peptide. The ability of adiponectin to increase insulin sensitivity in conjunction with its anti-inflammatory and anti-atherogenic properties have made this novel adipocytokine a promising therapeutic tool for the future.

Adiponectin is a collagen-like protein that is solely secreted by adipocytes. Different studies showed that it plays an important role in the pathophysiology of insulin resistance, diabetes and dyslipidemia and thus affects risk for cardiovascular disease and obesity. In the present study the role of adiponectin in pathogenesis of type 2 diabetes mellitus was evaluated. The current study was carried on 51 diabetic patients with documented NIDDM and 22 age and sex matched healthy controls. Diabetic patients were subdivided into 2 subgroups according to BMI where 40 were obese and 11 were non obese and according to the presence of cardiovascular disease with obesity where 16 were obese with CVD and 24 were obese with no CVD. Controls were subdivided according to BMI where 7 were non obese and 15 were obese. The levels of plasma adiponectin, insulin, c-peptide, fasting blood glucose, glycated hemoglobin, lipid profile, NO and lipid peroxides. The results of the present study showed that adiponectin was significantly lower in all groups with variations compared to controls, in obese patients with CVD than those without CVD. NO and MDA levels were higher in diabetic patients than in controls and the highest levels of MDA were observed in patients with cardiovascular disease. Lipid profile was altered in diabetic patients showing higher levels than in controls. In the diabetic patients, adiponectin was significantly positively correlated with NO and HDL, while it was significantly negatively correlated with glucose, HbA1C, Cholesterol,LDL, insulin and c-peptide. The ability of adiponectin to increase insulin sensitivity in conjunction with its anti-inflammatory and anti-atherogenic properties have made this novel adipocytokine a promising therapeutic tool for the future.