Tzong-Bor Sun
Division of Plastic Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital and Institute of Physiological and Anatomical Medicine, Tzu Chi University, Hualien, Taiwan
Abstract
Plastic surgery is a specialized branch of surgery treating various kinds of defects without limitations of anatomic boundaries. The foundation of this medical specialty does not rely on fractional techniques derived from divided human body parts, but is an integration of basic and clinical medical sciences, as well as the humanities and social and behavioral sciences. The core is the interactive regulation between various peripheral target organs and central modulation. Power spectral analysis of variability in heart rate, blood pressure, and cutaneous blood flow has been used to explore wound healing in diabetic patients, ischemia and hypoxia, free flap transplantation, and the interaction between central regulation and peripheral circulation. Cardiac neural regulation was found to be generally decreased in diabetic patients with foot complications. Simultaneous management of diabetic neuropathy and problem wound healing would be the key for successful treatment. Sympathetic activity is excited during and after a hypoxic episode. It should be avoided in patients with critical conditions, especially after microvascular reconstructions. Sympathetic denervation and reactive hyperemia are associated with a decreased fractional power contribution in the very low frequency range and an increased high frequency component in power spectral analysis of cutaneous perfusion signals during forearm flap transplantation. Phenylephrine and other α-adrenoceptor agonists are not adequate in reconstructive micro-surgery because they reduce flap perfusion, cardiac sympathetic functions, and sympathetic vasomotor activities. In conclusion, the plastic surgical sciences demonstrate the interaction of systemic physiologic function and peripheral perfusion/oxygenation. The autonomic nervous system plays a major regulatory role in this interaction. Power spectral analyses of heart rate, blood pressure, and cutaneous microcirculation are useful in exploring the integration between central neural regulation and peripheral circulation.
Keywords
Diabetic foot; Free forearm flap; Plastic surgical sciences; Power spectral analysis; Reconstructive microsurgery
