SummaryBackground Regulated alteration of connexin expression has been shown to be integral to acute wound repair. Downregulation of the gap-junction protein connexin 43 at the wound edge has been correlated with keratinocyte and fibroblast migration, while abnormal overexpression of connexin 43 significantly perturbs healing, as shown in the streptozotocin diabetic rodent impaired healing model. Objectives To examine the protein expression levels of connexin 43, in addition to connexins 26 and 30, in a variety of human chronic wounds. Methods Wound-edge punch biopsies and a matched control from the arm were taken from a cohort of patients with venous leg, diabetic foot or pressure ulcers. Wound connexin expression in each patient was compared with that in a matched, nonwounded arm punch. Tissue was sectioned, stained and imaged by confocal microscopy using identical parameters per patient to permit quantification. Results Epidermal connexin 43, connexin 26 and connexin 30, and dermal connexin 43 were discovered to be strikingly upregulated in every ulcer from all three wound types, pointing to connexin upregulation as a common feature between chronic wounds. Conclusions This result supports efforts to target connexin 43 to promote cell migration and wound healing in chronic ulcers.

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Wound healing is a complex process requiring interaction between different cell types, each playing their part within the four main phases of wound healing. This process requires careful regulation, with communication between the different cell types via gap junction channels, which allow the passage of small molecules, including ions and second messengers, between cells. Gap junction protein (connexin) expression changes with the different stages of wound healing, playing important roles in regulating the process. The field of research looking into intercellular communication via gap junctions in skin and wound healing has shown encouraging results in experimental studies. As further developments and clinical studies are being carried out, practitioners should be introduced to this field, as a promising new wound treatment is currently in clinical trials. This paper aims to introduce practitioners to this field of study with a review of current available literature.

Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003–2014). A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM). Data analysed included patient demographics, indication for reconstruction, surgical details, and complications. Fifty-five female patients (mean 48.6 years [24–71 years]) had bilateral breast reconstruction. The majority (41, 74.5%) underwent immediate reconstruction and DIEP flaps were utilised on 41 (74.5%) occasions. Major surgical complications occurred in 6 (10.9%) patients, all of which were postoperative vascular compromise of the flap. Failure to salvage the reconstruction occurred on 3 (5.5%) occasions resulting in a total flap failure rate of 2.7%. Obesity (>30 kg/m2) and age > 60 years were shown to have a statistically increased risk of developing postoperative complications (P < 0.05). Our experience demonstrates that abdominal free flaps for bilateral breast reconstruction fares well, with a flap failure rate of 2.7%. Increased body mass index and patient age (>60 years) were associated with higher complication rates.

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