Effect of Platelet-Rich Plasma on Ischemia-Reperfusion Injury in a Skin Flap Mouse Model.

Background: Ischemia-reperfusion (I/R) injury is a leading cause of surgical skin flap compromise and organ dysfunction. Platelet-rich plasma (PRP) is an abundant reserve of various growth factors. Activated platelets play a role in endothelial damage during I/R injury; however, exogenous PRP could inhibit the production of reactive oxygen species. The goal of this study was to investigate the effect of PRP on I/R injury. Methods: Four groups (n=30) of C57BL/6N mice with lateral thoracic artery island flaps were used. Group A, the control group, received flap elevation and repositioning. Group B received PRP and repositioning. Group C had 4 hours of ischemia and then were reperfused. Group D received PRP, had 4 hours of ischemia, and then were reperfused. The survival area of flap tissue and blood perfusion were assessed. Histological evaluation included neutrophil counts. Reactive oxygen species and proinflammatory cytokines were measured to evaluate I/R injury. Protein expression of phosphorylated apoptosis signaling regulating kinase-1 (pASK-1), p38MAPK, and pNF-κB was measured by western blot. Results: PRP treatment enhanced the survival area and perfusion of the flap, reduced neutrophil accumulation in mice subjected to I/R injury. PRP treatment also showed a protective effect, with decreases in nitric oxide, myeloperoxidase, malondialdehyde concentrations. Additionally, PRP suppresses monocyte chemotactic protein-1, TNF-α, IL-1ß, and IL-6. Finally, PRP decreased ASK-1 and NF-κB expression in tissues with I/R injury. Conclusion: PRP acts as a protective factor during flap I/R injury by reducing reactive oxygen species level and proinflammatory cytokines via decreased expression of pASK-1 and pNF-κB.

Successful eradication of helical rim keloids with surgical excision followed by pressure therapy using a combination of magnets and silicone gel sheeting.

Extremely limited data are available for the treatment of helical rim keloids. The purpose of the present study was to demonstrate the successful treatment of helical rim keloids using surgical exicison followed by a newly designed pressure therapy device. We treated 40 pure helical rim keloids in 36 patients with surgical excisions followed by pressure therapy using a combination of magnets and silicone gel sheeting for 12 hours over a period of 2 years, from May 2012 to February 2014, at tertiary medical centre. The follow-up period was 18 months. Primary outcome was recurrence of keloids. Secondary outcome was patient satisfaction as assessed by the Patient Observer Scar Assessment Scale (POSAS). The overall recurrence-free rate was 95·0% after a follow-up period of 18 months. Scores obtained from the POSAS showed that most items were reported to be improved. This adjuvant therapy protocol resulted in excellent outcomes in cases of helical rim keloids compared to previously published protocols.

Presurgical Botulinum Toxin A Treatment Increases Angiogenesis by Hypoxia-Inducible Factor-1α/Vascular Endothelial Growth Factor and Subsequent Superiorly Based Transverse Rectus Abdominis Myocutaneous Flap Survival in a Rat Model.

To date, there have been several experimental studies to assess tissue viability of transverse rectus abdominis myocutaneous (TRAM) flaps. Botulinum toxin A (BoTA) has gained popularity in many clinical fields, for a variety of therapeutic and aesthetic purposes. In addition, there have been reports regarding the positive effect of BoTA on flap survival by various mechanisms. In this study, we hypothesized that pretreatment with BoTA could augment the survival of TRAM flaps via increased hypoxia-inducible factor (HIF)1α/vascular endothelial growth factor (VEGF)-dependent angiogenesis.Twenty-four Sprague-Dawley rats were randomly divided into 2 groups: a control group and a BoTA group. Five days before superiorly based TRAM flap elevation, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Gross flap survival rates were assessed, and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) and Western blotting were performed for the evaluation of angiogenesis-related factors (CD34, HIF-1α, and VEGF).In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral (92.78.3 ± 5.05% vs 86.8 ± 3.88%, P = 0.009) and contralateral (91.57 ± 5.79% vs 74.28 ± 11.83%, P < 0.001) sides.The relative mRNA expression of CD34 and VEGF was significantly higher in the BoTA group than that in the control group in every zone, whereas the relative mRNA expression of HIF-1α was significantly higher in the BoTA group than that in the control group on contralateral sides. The relative protein expression of CD34, VEGF, and HIF-1α was significantly higher in the BoTA group than that in the control group in every zone.In conclusion, we demonstrate that presurgical BoTA treatment might increase angiogenesis by HIF-1α/VEGF, subsequently increase superiorly based TRAM flap survival in a rat model.

The Protective Effects of Botulinum Toxin A Against Flap Necrosis After Perforator Twisting and Its Underlying Molecular Mechanism in a Rat Model.

PURPOSE: The purpose of this study was to examine our hypotheses that botulinum toxin A (BoTA) protect necrosis of perforator flap from perforator twisting. METHODS: Twenty-four rats were randomly divided into 2 groups. Twelve International Units of BoTA versus 1.2 mL normal saline was injected subdermally 3 days before flap elevation. In each group, bilateral before deep inferior epigastric perforator (DIEP) flaps, 5 × 3 cm in size, were created. The right and left (180 and 360 degrees of perforator twisting) DIEP flaps were separated. At 1 and 3 days postoperatively, skin above the perforator of the DIEP flaps was harvested to examine the degrees of gene expressions. Final survival percentage of flap and histology were assessed at postoperative day 5. RESULTS: The survival percentage of flap was significantly higher in the BoTA group than in the control group at both DIEP flaps after 180 and 360 degrees of perforator twisting at postoperative day 5 (95.23 ± 2.85% vs 91.00 ± 3.77%; P = 0.021 and 91.59 ± 2.87% vs 30.03 ± 6.91%; P < 0.001, respectively).Higher fibroblast density, enhanced epithelial necrosis, and inflammation were noted in the control group than in the BoTA group. In 180 degrees of perforator twisting group, BoTA may augment angiogenesis possibly via nuclear factor-κB-induced destabilization and the nuclear factor-κB/hypoxia-inducible factor 1-α/vascular endothelial growth factor pathway, whereas in the 360 degrees of perforator twisting group, the mechanistic target of rapamycin/hypoxia-inducible factor 1-α/vascular endothelial growth factor pathway may participate in BoTA-induced effective angiogenesis. CONCLUSIONS: We demonstrated that pretreatment with BoTA protects perforator flap caused by perforator at the pathological and molecular level using an experimental rat model.

Establishment of Patient-Derived Keloid Xenograft Model.

Recent advances on preclinical model based on patient-derived tumor xenografts have new insight into many clinical fields. According to our literature review, many authors believe that immunodeficient animals such as athymic rats and mice should be used to prevent tissue loss caused by acute rejection to establish patient-derived tumor xenografts models.However, recent advances showed that the microenvironment has gained attention as an important factor responsible for disease progression. Additionally, researchers attempt to come up with novel findings in chemotherapy drugs and immune modulator to control development of keloid. For these reasons, establishment of reliable animal model of keloids is very important.In this new model using an immunocompetent animal as a humanized-xenografts model, human keloid scar has been maintained for as long as 4 months. Results of migration assay have demonstrated that typical morphology of keloid fibroblast was preserved based on multiple time point observations despite its aging change. Quantitative real time polymerase chain reaction findings suggested that after implantation, there has been significant increase of vascular endothelial growth factor, CD34, and transforming growth factor beta 1 expression despite insignificant changes of hypoxia inducible factor 1 an matrix metallopeptidase 1, and matrix metallopeptidase 9 gene expression. These findings suggested that implantation of keloids within the immunocompetent animals yields is very useful experimental model in terms of fibrosis.In summary, the authors have successfully established and propagated patient-derived keloid model using the immunocompetent animals. This model could be used to test novel materials as well as combination therapies and is superior to the conventional cell line experiment models. In addition, the biology of the keloids can easily be assessed to identify predictive markers for responses to treatment regimens that are currently actively under research in various centers.

Botulinum Toxin A Upregulates Rac1, Cdc42, and RhoA Gene Expression in a Dose-Dependent Manner: In Vivo and in Vitro Study.

UNLABELLED: Angiogenesis is the development of new capillaries from existing blood vessels and is a prerequisite for the wound-healing process. Many lines of scientific evidences have shown that complicated roles of small guanosine triphosphatases (GTPases) (ras-related C3 botulinum toxin substrate 1 [Rac1], cell division control protein 42 [Cdc42], and ras homolog gene family, member A [RhoA]) in regulation of signal transduction pathways exist to transmit distinct cellular effects on the modulation of actin cytoskeleton remodeling such as cell cycle progression, cell survival, and cell motility. In addition, these small GTPases activate mitogen-activated protein kinase kinase kinases (MAP3Ks) leading to activated mitogen-activated protein kinase kinases (MAPKK), mitogen-activated protein kinase (MAPK), and various transcription factors such as vascular endothelial growth factor with involvement of MAPK signaling pathways.In this study, the authors hypothesized that botulinum toxin A increases angiogenesis via the expression of small GTPases in vivo and in vitro studies.In vivo experiment, 24 Sprague-Dawley rats were randomly divided into 2 groups: a control group and a botulinum toxin A group. Five days prior to superiorly based transverse rectus abdominis myocutaneous flap elevation, the botulinum toxin A (BoTA) group was pretreated with BoTA, while the control group was pretreated with normal saline. quantitative real-time polymerase chain reaction was performed to evaluate the expression of Rac1, RhoA, and Cdc42.The angiogenic effects of botulinum toxin A on human dermal fibroblasts were measured in vitro experiment. To understand the mechanism of botulinum toxin A on small GTPases production of fibroblasts, Rac1, Cdc42, and RhoA were measured using qRT-PCR.The relative messenger ribonucleic acid expression of Rac1, RhoA, and Cdc42 was significantly higher in the BoTA group than in the control group, in every zone and pedicle muscle, on postoperative days 1, 3, and 5. Levels of these molecules increased significantly in human dermal fibroblasts grown in the presence of BoTA compared with control group over 5 IU.Our in vivo and in vitro studies suggest that administration of BoTA upregulates the expression of RhoA, Rac1, and Cdc42 in a dose-dependent manner. MAPK signaling pathway might be involved in BoTA-induced angiogenesis mechanism. LEVEL OF EVIDENCE: N/A.

Quantitative Mandibular Angle Ostectomy Facilitated by Oscillating-Blade Saw With Scalable Guide.

BACKGROUND: Although various techniques of mandibular angle ostectomy have been devised to correct overly prominent bony contours, none have incorporated methods to delineate the surgical line with precision. Herein, the authors describe one means of marking an ostectomy line more easily, using a specially designed oscillating-blade saw. METHODS: Between July 2013 and June 2014, a total of 75 patients underwent quantitative mandibular angle ostectomy using a custom oscillating-blade saw equipped with a scalable guide. Corticectomy, also done routinely to improve frontal appearance, called for a reciprocating saw only. Aesthetic outcomes gauged subjectively by the questionnaire about satisfaction and symmetry after postoperative 6 months. RESULTS: Satisfaction score was 4.9 and symmetric score was 4.7. No major complications, such as persistent nerve injury or fracture, were encountered. CONCLUSIONS: Use of an oscillating-blade saw equipped with a scalable guide facilitated quantitative mandibular angle ostectomy, enabling precise, and reproducible surgery with satisfactory outcomes with less complications.

Comparing the Effect of Nonactivated Platelet-Rich Plasma, Activated Platelet-Rich Plasma, and Bone Morphogenetic Protein-2 on Calvarial Bone Regeneration.

Although platelet-rich plasma (PRP) is widely used to enhance bone graft survival, the effect of PRP itself on bone regeneration is unclear. Because activated PRP releases many growth factors in a bolus, there are controversies regarding the effect of activation of the PRP on bone regeneration. Thus, we studied the effect of activated versus nonactivated PRP on bone regeneration and compared the effect with that of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a critical-sized cranial defect model. Forty New Zealand white rabbits were randomly divided into 4 groups. Defect sizing 15 × 15 mm(2) was created on the cranium of each rabbit, and then a collagen sponge soaked with normal saline, rhBMP-2, nonactivated PRP, or PRP activated with CaCl2 solution was immediately placed on the defect. After 16 weeks, using three-dimensional computed tomography and digital photography, the volume and new bone surface area were measured. The newly created bone was histologically analyzed. The experimental groups showed a significantly increased volume and surface area of new bone compared with the control group (P < 0.05), but no significant differences were found among the experimental groups. Histologic examination in the experimental groups showed newly created bone that had emerged in the center as well as the margin of the defect. Overall, these results indicate that PRP enhanced bony regeneration regardless of activation with an effect that was comparable to that of rhBMP-2. Thus, PRP has therapeutic effects on bone regeneration and may replace rhBMP-2, which is costly.

Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction.

BACKGROUND: The treatment of gynecomastia depends on multiple factors, and the best modality is controversial. In this study, we aimed to determine the best management approach by comparing outcomes of two groups of patients with gynecomastia who received subcutaneous mastectomy combined with liposuction and liposuction only. METHODS: We conducted a retrospective analysis of 64 patients who underwent surgery for gynecomastia. We divided the patients into two groups: group A, patients who underwent liposuction only; and group B, patients who underwent liposuction and subcutaneous mastectomy. The serial photographs of all patients were clinically evaluated with respect to size, shape, scarring, and overall outcome by three plastic surgeons, and patient satisfaction was surveyed with regard to palpable lumps, size, shape, scarring, and overall outcome. RESULTS: Of the 64 subjects, 16 received liposuction only, and 48 received the combination procedure. A total of 125 breasts were involved. The doctors' scores for size and overall outcome were significantly better in the combination group, whereas scarring was better in the liposuction-only group. Similarly, patient satisfaction regarding size was significantly higher in the combination group, and satisfaction regarding scarring was significantly higher in the liposuction-only group. The scores for scarring in the combination treatment group were acceptable. CONCLUSION: Our study shows that combination treatment with liposuction and subcutaneous mastectomy results in satisfactory outcomes, including the extent of scarring. We conclude that this combination treatment should be recommended as the standard surgical treatment for gynecomastia and can provide excellent results in cases where glandular tissue needs to be removed. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bilirubin provides perforator flap protection from ischaemia-reperfusion injury in a rat model: a preliminary result.

The use of bilirubin, a well-known and powerful antioxidant, has gained popularity in recent years because of its role in the prevention of ischaemic heart disease in patients with Gilbert's syndrome. We investigate the effects of bilirubin on ischaemia-reperfusion (I/R) injury using a rat perforator flap model. Forty-eight rats were randomly divided into two groups: experimental (bilirubin) group (n = 24) and control group (n = 24). In each group, elevated bilateral deep inferior epigastric perforator (DIEP) flaps were created. The right (no ischaemia side) and left (ischaemia side) DIEP flaps were separated according to the presence of ischaemia induction. Ischaemia was induced in anaesthetised rats by perforator clamping for 15 or 30 minutes. After surgery, the flap survival was assessed daily on postoperative days 0 to 5, and overall histological changes of DIEP flaps above the perforator were analysed at postoperative day 5. The flap survival rate in the bilirubin group was significantly higher than that in the control group at the ischaemia side following perforator clamping for 15 or 30 minutes (93·42 ± 4·48% versus 89·63 ± 3·98%, P = 0·002; and 83·96 ± 4·23% versus 36·46 ± 6·38%, P < 0·001, respectively). The difference in flap survival between the two groups was the most prominent on the ischaemic side following 30 minutes of perforator clamping. From a morphologic perspective, pre-treatment with bilirubin was found to alleviate perforator flap necrosis caused by I/R injury in this experimental rat model.

The effects of botulinum toxin A on survival of rat TRAM flap with vertical midline scar.

The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used in various reconstructive surgeries. Recently, there have been reports regarding the positive effect of botulinum toxin A (BoTA) on flap survival. We hypothesized that pretreatment with BoTA could augment the survival of pedicled TRAM flaps with a vertical midline scar. Twenty-four Sprague-Dawley rats were randomly divided into 2 groups, namely, control group and BoTA group. Five days after a vertical midline incision, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Ten days after the initial incision, the TRAM flap was harvested. We evaluated the gross flap survival and analyzed the overall histologic change, lumen area of pedicle, and microvessel density with immunohistochemistry. Reverse transcription polymerase chain reaction was performed for the evaluation of angiogenesis-related factors. In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral and contralateral sides (P < 0.001). In the BoTA group, a significant increase in pedicle lumen area was observed (P < 0.001). In the control group, mild to moderate epidermal necrosis was seen; microvessels were relatively small compared with those of the BoTA group. According to immunohistochemistry, the number of CD31 positively stained vessels was significantly higher on the contralateral side in the control group compared to that in the BoTA group (P < 0.001). The relative messenger RNA (mRNA) expression of CD31 was significantly lower in the BoTA group than that in the control group on both ipsilateral and contralateral sides (P < 0.001). Meanwhile, the relative mRNA expression of VEGF was significantly higher in the BoTA group than in the control group on both ipsilateral and contralateral sides (P < 0.001).We believe that preoperative BoTA therapy is a feasible method to improve circulation of the rat TRAM flap with a vertical midline incision scar.

Botulinum toxin A affects early capsule formation around silicone implants in a rat model.

Capsular contracture is one of the most common complications resulting from implants placed during mammoplasty and rhinoplasty, and there is no definitive solution or a method for preventing it. Recent reports suggest that botulinum toxin A (BoTA) is effective at reducing keloid scars clinically. Peri-implant capsules are histologically similar to keloid scars and hypertrophic scars. Therefore, we hypothesized that BoTA may reduce peri-implant capsule formation.To test our hypothesis, we divided 24 male Sprague-Dawley rats into an experiment group and a control group. We created two 15 × 15-mm subpanniculus pockets in each rat. Botulinum toxin A (0.5 mL; 5 U) was injected into the carnosa layer of the experimental group's pockets and 0.5 mL normal saline was similarly injected in the control group. Hemispherical silicone implants, 15 mm in diameter, were inserted into the pockets. After 6 weeks, the peri-implant capsule was excised and examined by histologic evaluation, immunohistochemical stain, scanning electron microscope, and real-time polymerase chain reaction.Capsular thickness, number of inflammatory cells, number of vessels, and transforming growth factor ß1 expression were reduced in the experimental group compared to the control group (P < 0.01). The experimental group's collagen pattern was loose and well organized. The total myofibroblast content was lower in the experimental group than in the control group; however, this difference was not statistically significant (P = 0.32). Additionally, the experimental group had a smaller fibrosis index than the control group (P < 0.05).Our results suggest that BoTA may provide an alternative treatment for reducing capsule formation and preventing contracture, and further studies may reveal the mechanism of action.

Gene therapy using hepatocyte growth factor expressing adenovirus improves skin flap survival in a rat model.

Hepatocyte growth factor (HGF) is a potent angiogenic factor that can stimulate the production of blood vessels in ischemic tissue. We investigated whether gene therapy using HGF-expressing adenovirus could enhance skin flap survival. Sprague-Dawley rats were randomly divided into three groups. Rats were subdermally injected with HGF-expressing adenovirus (HGF virus group), recombinant HGF (rhHGF group), or phosphate buffered saline (PBS group) 2 days before and immediately after 3 × 9 cm caudal flap elevation. The survival area of the skin flap, the ratio of blood flow, CD31-positive vessels and, VEGF expression were examined. Skin flap viability was significantly increased in the HGF virus group compared to the rhHGF and PBS groups (71.4% ± 5.9%, 63.8%± 6.4%, and 39.2% ± 13.0%, respectively) (P = 0.025). Furthermore, the blood flow ratio was significantly increased in the HGF virus group. In the HGF virus group, the number of CD31-positive vessels and vascular endothelial growth factor (VEGF) expression were significantly increased. Gene therapy using HGF-expressing adenovirus increase VEGF expression, the number of viable capillaries, and blood flow to the flap, thereby improving skin flap survival.

Skin-fat composite grafts on full-thickness facial skin defects.

When used to cover facial skin defects, skin grafts and local flaps have limitations such as color mismatch, volume depletion, and long scar. We used skin-fat composite grafts harvested with enough fat tissue over the whole plane to cover full-thickness facial skin defects. This study enrolled 15 composite grafts, and the results were rated by 2 investigators on a scale of 1 to 5 based on skin texture, color, and volume. Skin color analysis using a spectrophotometer was performed on 9 grafts using the L*a*b* score. There were no major complications, but 1 partial loss. The clinical assessment score ranged from good to excellent. Color assessment using a spectrophotometer showed that there were no significant statistical differences in the L* and a* scores between the grafts and the adjacent skin. Skin and fat composite tissue grafts can be a good option for covering full-thickness facial skin defects.

Ischemic oculomotor nerve palsy and skin necrosis caused by vascular embolization after hyaluronic acid filler injection: a case report.

Hyaluronic acid filler injection is widely used for soft tissue augmentation. However, there can be disastrous complications by direct vascular embolization. We present a case of ischemic oculomotor nerve palsy and skin necrosis after hyaluronic acid filler injection on glabellar.blepharoptosis, exotropia and diplopia developed suddenly after the injection, and skin necrosis gradually occurred. Symptoms and signs of oculomotor nerve palsy continuously improved with steroid therapy. Skin defects healed with minimal scars through intensive wound care.Percutaneous filler injection of periorbital areas should be performed carefully by experienced surgeons, and the possibility of embolization should be considered promptly if symptoms develop.

Surgical considerations in secondary rhinoplasty for effective correction of an asymmetric nostril.

PURPOSE: Asymmetric nostrils that develop after rhinoplasty may result in nasal tip deformity and result in patient dissatisfaction. No systemic study on methods for the correction of transformed nostrils has been reported. In the current study, asymmetric nostrils were classified according to the degree of asymmetry and the authors' experiences on the correction of nostril deformities are described. METHODS: Thirty-nine patients who experienced asymmetric nostrils after primary rhinoplasty were selected for the current study. Nostril asymmetry was classified as types 1 to 3. All patients underwent secondary rhinoplasty, and 3-dimensional total alar cartilage dissection and reposition were performed on most patients. Patient satisfaction was assessed using a 5-level index. RESULTS: Of the 39 patients, 10 were classified as having asymmetry type 1; 13, asymmetry type 2; and 16, asymmetry type 3. The mean follow-up period after the secondary rhinoplasty was 17 months. Of the 39 patients, a total of 34 showed improvement in asymmetry after the surgery. Of the remaining 5 patients, 3 patients showed incomplete correction and 2 patients showed deteriorated asymmetry. In the patient satisfaction survey, 31 of the 39 patients answered "somewhat satisfied" or "very satisfied." CONCLUSIONS: Before the correction of asymmetric nostrils that developed after primary rhinoplasty, the cause of the asymmetry should be analyzed and appropriate procedures should be selected. Three-dimensional total alar cartilage dissection and reposition are both useful methods for the correction of alar cartilage asymmetry.

Eyelid dynamics and supratarsal crease appearance after double eyelid surgery.

BACKGROUND: Although double eyelid surgery is one of the most common cosmetic surgeries among Asians, there are few reports to confirm the physiology of eye blinking after such surgeries. This study analyzed eyelid dynamics and supratarsal crease appearance after double eyelid surgery using a high-speed digital camera to provide precise movement detection. METHODS: Twenty healthy volunteers and 15 patients who underwent double eyelid surgery with tarsodermal fixation were studied. Using the slow-motion replay setting of a high-speed digital camera, the patients' spontaneous eye blinking was analyzed for (1) blink duration, (2) peak eyelid velocity, (3) blink rate, and (4) supratarsal crease appearance. RESULTS: After double eyelid surgery, there were no significant differences in blink duration, peak eyelid velocity, or blink rate compared with the control group. Regarding supratarsal crease appearance, dynamic creases were created in 6 of 15 patients, whereas 9 patients showed static creases. CONCLUSIONS: Double eyelid surgery with tarsodermal fixation does not alter lid dynamics of spontaneous eye blinking. Furthermore, the tarsodermal fixation method, which is known to create a static crease, could also lead to the development of a dynamic crease.

Improved scar appearance with combined use of silicone gel and vitamin C for Asian patients: a comparative case series.

BACKGROUND: In Asians, facial scars, even fine surgical scars, often can be conspicuous and uncomfortable. The authors used a topical silicone gel containing vitamin C on facial scars for the purpose of making the scar less distinct. METHODS: The study enrolled 80 patients. For the experimental group, the topical silicone gel mixture containing vitamin C was applied from the time of stitch removal to 6 months after the operation. The control group did not undergo any adjunctive treatment. Each participant was evaluated using the modified Vancouver Scar Scale (VSS) as well as erythema and melanin indices by spectrophotometer. RESULTS: With the modified VSS, the experimental group showed a significant decrease in scar elevation (p = 0.026) and erythema (p = 0.025). The hypo- or hyperpigmentation of the scars was more normalized in the experimental group. In the measured results via spectrophotometer, the experimental group showed a significant decrease in the melanin index (p = 0.045). The erythema index showed a statistically significant difference between the time of stitch removal and 6 months after the operation in the experiment group only. CONCLUSIONS: Topical use of silicone gel containing vitamin C has the effect of improving the appearance of fine surgical scars in Asian facial skin. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analysis of 15 cases of auricular keloids following conchal cartilage grafts in an asian population.

BACKGROUND: Recently, rhinoplasty techniques have advanced significantly and are frequently combined with columellar struts using conchal cartilage grafts to sufficiently reshape the nasal tip. For this reason, auricular keloids following harvesting of conchal cartilage grafts are expected to occur with greater frequency. The aim of this study was to share our experiences with auricular keloids and to suggest possible risk factors. METHODS: We conducted a retrospective review of patients with pathologically confirmed auricular keloids that were surgically excised with primary closure after conchal cartilage grafts were harvested. Starting between days 21 and 28 postoperatively, patients were instructed to use magnets for approximately 12 h a day for 6 months until adjuvant pressure therapy was completed. Recurrence after treatment was recorded. In all patients, a follow-up period of 18 months was required. RESULTS: Auricular keloids were successfully treated in 93.3 % of the cases and 6.7 % of the cases had recurrence. The postoperative course was uneventful without exception. There was a male predominance of auricular keloids after conchal cartilage graft harvesting. In addition, a high growth rate as a result of the short duration of the keloid before treatment was seen. CONCLUSIONS: Adjuvant pressure therapy using magnets is useful for treating auricular keloids following conchal cartilage graft harvesting. In addition, surgeons should be careful when performing conchal cartilage harvest to avoid needless injury to the adjacent skin flap. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of human adipose derived stem cells on scar formation and remodeling in a pig model: a pilot study.

BACKGROUND: Adipose-derived stem cells (ASCs) have positive effects in the wound healing process. OBJECTIVE: To clarify whether ASCs positively mitigate scar formation in the wound remodeling process. MATERIALS AND METHODS: Full-thickness skin defects were created on the dorsal skin of Yorkshire pigs. After the defects were transformed into early scars, ASCs were injected, and the same amount of phosphate buffered saline (PBS) was injected in the control group. Clinical and histologic examinations were performed. RESULTS: In the experimental group, the areas of scars were smaller than those of control groups. The color of scars was more similar to that of the surrounding normal tissue, and scar pliability was better. The number of mast cells decreased, and more-mature collagen arrangement was noted. In the early period of scar remodeling, the expression of transforming growth factor beta (TGF-ß)3 and matrix metalloproteinase 1 (MMP1) was greater in the experimental group than in control group. In the late period, the level of alpha smooth muscle actin and tissue inhibitor of metalloproteinase 1 were dramatically less, although the level of MMP1 was lower in the experimental group than in control group. CONCLUSIONS: Local injection of ASCs decreases scar size and provides better color quality and scar pliability. It decreases the activity of mast cells and inhibits the action of TGF-ß against fibroblasts and positively stimulates scar remodeling through greater expression of MMP molecules.