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INTRODUCTION: Traditionally, galeal flap or cranialization was often used to reconstruct the skull base defect caused by trauma or tumor removal. However, in the case of huge skull base defect, galeal flap is not enough to block the communication between nasal cavity and intracranial space. In this study, authors suggest combination flap of galea and reverse temporalis muscle as a method for reconstruction of huge skull base defect. MATERIALS AND METHODS: From 2016 to 2019, retrospective review was conducted, assessing 7 patients with bone defect which is not just opening of frontal sinus but extends to frontal sinus and cribriform plate. Reconstructions were done by combination of galeal flap and reverse temporalis muscle flap transposition. RESULTS: Defects were caused by nasal cavity tumor with intracranial extension or brain tumor with nasal cavity extension. There was no major complication in every case. During the follow up period, no patient had signs of complication such as ascending infection, herniation and CSF rhinorrhea. Postoperative radiologic images of all patients that were taken at least 6 months after the surgery showed that flaps maintained the lining and the volume well. DISCUSSION: Conventional reconstruction of skull base defect with galeal flap is not effective enough to cover the large sized defect. In conclusion, galeal flap in combination with reverse temporalis muscle flap can effectively block the communication of nasal cavity and intracranium.
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Cavidade Nasal/cirurgia , Procedimentos de Cirurgia Plástica , Base do Crânio/cirurgia , Adulto , Idoso , Feminino , Seio Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgiaRESUMO
An adenoviral vector (Ad) expressing a Wnt decoy receptor (sLRP6E1E2) is known to induce an anti-fibrotic effect by inhibiting Wnt signaling. We evaluated its effects in vivo using pig models and attempted to introduce an alginate gel-matrix system to prolong the effect of the Ad. Transduction efficiency as to the biological activity of Ad in different forms was evaluated. Then, 50 days after the formation of full-thickness skin defects on the backs of Yorkshire pigs, scars were treated with each form of Ad. Therapeutic efficacy and various factors influencing scar formation and collagen rearrangement were analyzed. Inflammatory cell infiltration within the scar tissues was also evaluated. Decoy Wnt receptor (sLRP6E1E2)-expressing adenovirus treatment improved scar quality in a pig model. Loading this construct in alginate gel allows sustained virus release into local tissues and prolongs Ad activity, thus maintaining its therapeutic effect longer in vivo.
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Adenoviridae/genética , Alginatos/química , Cicatriz/terapia , Terapia Genética/métodos , Receptores Wnt/genética , Animais , Colágeno/genética , Colágeno/metabolismo , Técnicas de Transferência de Genes , Hidrogéis/química , Receptores Wnt/metabolismo , Pele/metabolismo , Suínos , Via de Sinalização WntRESUMO
BACKGROUND: Recent advances in keloid management favor the administration of combination therapy over monotherapy. OBJECTIVE: The authors evaluated the safety and efficacy of combination therapy to treat keloids using fractional lasers, cryotherapy, and intralesional corticosteroids. MATERIALS AND METHODS: The authors performed a retrospective study involving 35 Korean patients. Each patient underwent treatment using the 1,550 nm nonablative fractional erbium-glass laser, followed by the 10,600 nm ablative fractional carbon dioxide laser. Laser treatment was immediately followed by the administration of superficial cryotherapy and intralesional triamcinolone injection. Therapeutic efficacy was assessed using the Vancouver Scar Scale (VSS) score and the 7-point patient self-assessment score. RESULTS: The mean total and subcategory VSS scores showed statistically significant improvements. The height and pliability scores showed the most significant and quickest responses to the combination therapy. The patients reported remarkable improvement in itching, pain, and limitations of motion after a single combination therapy session. Twenty patients were followed up for 1 year after the discontinuation of the combination treatment, and the recurrence was observed only in one patient. No significant adverse effects were observed throughout the follow-up period. CONCLUSION: Combination keloid therapy using fractional lasers, superficial cryotherapy, and intralesional triamcinolone injection is safe and more effective than individual monotherapies.
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Queloide/terapia , Terapia Combinada , Crioterapia , Fracionamento da Dose de Radiação , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais , Terapia com Luz de Baixa Intensidade , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Triancinolona Acetonida/administração & dosagemRESUMO
Previous studies described the involvement of extracellular signal-related kinase (ERK) in systemic fibrotic diseases, but the role of ERK in cutaneous scarring is unknown. Although hypoxia drives tissue fibrosis by activating hypoxia-inducible factor-1α (HIF-1α), the specific roles of hypoxia and associated ERK phosphorylation in abnormal fibroblast activity during cutaneous scarring are unclear. Here, we investigated whether pathologic myofibroblast-like keloid fibroblast activity is promoted by hypoxia-induced epithelial-mesenchymal transition mediated by ERK activation. ERK phosphorylation was significantly increased in keloid tissue and fibroblasts. Human dermal fibroblasts cultured under hypoxia (1% O2) expressed phosphorylated ERK and exhibited activation of p38 mitogen-activated protein kinase signaling. Hypoxic human dermal fibroblasts showed increased protein and mRNA levels of epithelial-mesenchymal transition markers. Furthermore, administration of an ERK inhibitor (SCH772984) reduced the hypoxia-induced elevation of collagen type I levels in human dermal fibroblasts. Therefore, ERK may be a promising therapeutic target in profibrogenic diseases.
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Transição Epitelial-Mesenquimal , Fibroblastos/metabolismo , Queloide/metabolismo , Sistema de Sinalização das MAP Quinases , Oxigênio/metabolismo , Cicatrização , Hipóxia Celular , Células Cultivadas , Fibroblastos/patologia , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Queloide/patologia , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
BACKGROUND: For implant-based breast reconstruction, inadequate tissue perfusion may cause devastating complications. Tissue tension by inadequate implant volume may reduce tissue perfusion by stretching and collapsing the capillaries. The SPY system is used to perform intraoperative fluorescence angiography with indocyanine green to assess visually the blood flow and evaluate tissue perfusion. However, there is no report yet about how mastectomy flap perfusion changes with the expander-filling volume. Therefore, to analyse the changes of tissue perfusion of the mastectomy flap according to the tension level, we used the SPY system and adjusted the filling volume of the tissue expander to change the tension on the skin flap. METHODS: Ten breasts of ten patients who underwent immediate two-stage, implant-based breast reconstructions were included. The expander-filling volume just before mastectomy flap blanching was set as 100%. Based on this, the expander-filling volume was reduced to 50% and increased to 150%. Ingress and egress rates were evaluated using the SPY system at each condition and analysed by a linear mixed model using least square means. RESULTS: The mean ingression rates were 138, 100, and 65%, and the mean egression rates were 145, 100, and 66% at 50, 100, and 150% inflation, respectively. CONCLUSIONS: It was objectively proven that tissue perfusion deteriorates as the tension applied on the flap increases. On the basis of this finding, we can control the amount of inflation volume of the expander or remove the skin in the pre-ischaemic condition to reduce complications of implant-based breast reconstruction.
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Angiografia/métodos , Implante Mamário , Neoplasias da Mama/patologia , Verde de Indocianina , Lasers , Mamoplastia/métodos , Retalhos Cirúrgicos/patologia , Adulto , Idoso , Neoplasias da Mama/irrigação sanguínea , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Corantes , Feminino , Seguimentos , Humanos , Mastectomia , Pessoa de Meia-Idade , Necrose , Perfusão , Complicações Pós-Operatórias , Prognóstico , Retalhos Cirúrgicos/irrigação sanguínea , Dispositivos para Expansão de TecidosRESUMO
BACKGROUND: Asian noses are relatively small and flat compared to Caucasians; therefore, rhinoplasty procedures often focus on dorsal augmentation and tip projection rather than reduction in the nasal framework. Various autologous and alloplastic implant materials have been used for dorsal augmentation. Recently, human acellular dermal matrices have been introduced as an implant material for dorsal augmentation, camouflaging autologous implants without an additional donor site. Here, we introduce a cross-linked human acellular dermal matrix as an implant material in augmentation rhinoplasty and share the clinical experiences. METHODS: Eighteen patients who underwent augmentation rhinoplasty using acellular dermal matrix from April 2014 to November 2015 were reviewed retrospectively. Clinical outcomes and complications were assessed at the outpatient clinic during the follow-up period ranging from 8 to 38 months. Contour changes were assessed through comparison of preoperative and postoperative photographs by two independent plastic surgeons. Patient satisfaction was assessed at the outpatient clinic by six questions regarding aesthetic and functional aspects. RESULTS: Postoperative photographs demonstrated the height of the nasal dorsum did not decrease over time except two patients whose ADM was grafted into a subperiosteal pocket. Others who underwent supraperiosteal implantation showed acceptable maintenance of dorsal height. No major complication was reported. Overall, patient satisfaction scored 81.02 out of 100. CONCLUSIONS: Cross-linked human ADM has advantages of both autogenous and alloplastic materials. The surgical results remain stable without complications. Therefore, it is a suitable alternative implant material for dorsal augmentation in rhinoplasty. 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 .
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Derme Acelular , Nariz/cirurgia , Desenho de Prótese/métodos , Implantação de Prótese/métodos , Rinoplastia/métodos , Adulto , Povo Asiático/genética , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Nariz/anatomia & histologia , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia , Adulto JovemRESUMO
High-mobility group box protein-1 (HMGB-1) plays a central role in the inflammatory network, and uncontrolled chronic inflammation can lead to excessive scarring. The aim of this study was to evaluate the anti-inflammatory effects of polydeoxyribonucleotide (PDRN) on scar formation. Sprague-Dawley rats (n = 30) underwent dorsal excision of the skin, followed by skin repair. PDRN (8 mg/kg) was administered via intraperitoneal injection for three (PDRN-3 group, n = 8) or seven (PDRN-7 group, n = 8) days, and HMGB-1 was administered via intradermal injection in addition to PDRN treatment for three days (PDRN-3+HMGB-1 group; n = 6). The scar-reducing effects of PDRN were evaluated in the internal scar area and by inflammatory cell counts using histology and immunohistochemistry. Western blot, immunohistochemistry and immunofluorescence assays were performed to observe changes in type I and type III collagen and the expression of HMGB-1 and CD45. Treatment with PDRN significantly reduced the scar area, inflammatory cell infiltration and the number of CD45-positive cells. In addition, the increased expression of HMGB-1 observed in the sham group was significantly reduced after treatment with PDRN. Rats administered HMGB-1 in addition to PDRN exhibited scar areas with inflammatory cell infiltration similar to the sham group, and the collagen synthesis effects of PDRN were reversed. In summary, PDRN exerts anti-inflammatory and collagen synthesis effects via HMGB-1 suppression, preventing scar formation. Thus, we believe that the anti-inflammatory and collagen synthesis effects of PDRN resulted in faster wound healing and decreased scar formation.
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Cicatriz/prevenção & controle , Polidesoxirribonucleotídeos/farmacologia , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Animais , Cicatriz/metabolismo , Cicatriz/patologia , Colágeno Tipo I/biossíntese , Colágeno Tipo III/biossíntese , Modelos Animais de Doenças , Proteína HMGB1/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Ferimentos e Lesões/metabolismo , Ferimentos e Lesões/patologiaRESUMO
Emerging studies have revealed the involvement of high-mobility group box 1 (HMGB1) in systemic fibrotic diseases, yet its role in the cutaneous scarring process has not yet been investigated. We hypothesized that HMGB1 may promote fibroblast activity to cause abnormal cutaneous scarring. In vitro wound healing assay with normal and keloid fibroblasts demonstrated that HMGB1 administration promoted the migration of both fibroblasts with increased speed and a greater traveling distance. Treatment of the HMGB1 inhibitor glycyrrhizic acid (GA) showed an opposing effect on both activities. To analyze the downstream mechanism, the protein levels of extracellular signal-regulated kinase (ERK) 1/2, protein kinase B (AKT), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) were measured by western blot analysis. HMGB1 increased the expression levels of ERK1/2, AKT, and NF-κB compared to the control, which was suppressed by GA. HMGB1 promoted both normal and keloid fibroblasts migration to a degree equivalent to that achieved with TGF-ß. We concluded that HMGB1 activates fibroblasts via the receptor for advanced glycation end product (RAGE)-mitogen-activated protein kinases (MAPK) and NF-κB interaction signaling pathways. Further knowledge of the relationship of HMGB1 with skin fibrosis may lead to a promising clinical approach to manage abnormal scarring.
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Antígenos de Neoplasias/genética , Fibroblastos/metabolismo , Proteína HMGB1/genética , Proteína Quinase 1 Ativada por Mitógeno/genética , Proteína Quinase 3 Ativada por Mitógeno/genética , Proteínas Quinases Ativadas por Mitógeno/genética , NF-kappa B/genética , Proteínas Proto-Oncogênicas c-akt/genética , Anti-Inflamatórios/farmacologia , Antígenos de Neoplasias/metabolismo , Bioensaio , Movimento Celular/efeitos dos fármacos , Rastreamento de Células , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Regulação da Expressão Gênica , Ácido Glicirrízico/farmacologia , Proteína HMGB1/antagonistas & inibidores , Proteína HMGB1/metabolismo , Humanos , Queloide/genética , Queloide/metabolismo , Queloide/patologia , Queloide/prevenção & controle , Proteína Quinase 1 Ativada por Mitógeno/antagonistas & inibidores , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/antagonistas & inibidores , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Proteínas Quinases Ativadas por Mitógeno/antagonistas & inibidores , Proteínas Quinases Ativadas por Mitógeno/metabolismo , NF-kappa B/antagonistas & inibidores , NF-kappa B/metabolismo , Cultura Primária de Células , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Cicatrização/efeitos dos fármacosRESUMO
Background The coronavirus disease 2019 (COVID-19) outbreak has had a major impact worldwide. Several countries have implemented restrictions on social interaction ("social distancing"). Several studies have reported that the epidemiology of trauma patients, such as those with facial bone fractures, has changed after COVID-19 pandemic. This study aimed to further explore these specific changes. Methods This was a retrospective study of patients who presented to a single institution with facial bone fractures between January 1, 2016, and December 31, 2020. Baseline patient demographics, clinical information, type of fracture, etiology, and operative management were compared before and after COVID-19. Results Of all cases, 3,409 occurred before COVID-19, and 602 occurred after COVID-19. Since the outbreak of COVID-19, the number of patients with facial fractures has not decreased significantly. A significant increase was noted in fractures that occurred outdoors ( p < 0.001). However, a decrease was observed in operative management between the groups ( p < 0.001). There was no significant difference in the proportion of assault, fall-down, industrial accident, or roll-down. In contrast, the proportion of traffic accidents and slip-down categories increased significantly ( p < 0.05). Moreover, a significant decrease was found in the proportion of the sports category ( p = 0.001) Conclusions It was confirmed through this study that COVID-19 pandemic also affected epidemiology of facial fractures. Focusing on these changes, it is necessary to develop safety measures to reduce facial fractures.
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An epidermal cyst, also known as an epidermoid cyst or epidermal inclusion cyst, is the most prevalent type of cutaneous cyst. This noncancerous lesion can appear anywhere on the body, typically presenting as an asymptomatic dermal nodule with a visible central punctum. In the case presented herein, an epidermal cyst with uncommon features was misdiagnosed as a lymphatic malformation based on preoperative magnetic resonance imaging (MRI). A 61-year-old man came to us with a swollen left cheek that had been present for 11 months. The preoperative MRI revealed a 3 × 3.8 × 4.6 cm lobulated cystic lesion with thin rim enhancement in the left masticator space. The initial differential diagnosis pointed toward a lymphatic malformation. We proceeded with surgical excision of the lesion via an intraoral approach, and the specimen was sent to the pathology department. The pathological diagnosis revealed a ruptured epidermal cyst, indicating that the initial diagnosis of a lymphatic malformation based on preoperative MRI was incorrect. Epidermal cysts located under the muscle with no visible central punctum are uncommon, but should be considered if a patient presents with facial swelling.
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EZH2, a histone methyltransferase, contributes significantly to cancer cell survival and proliferation. Although various EZH2 inhibitors have demonstrated promise in treating lymphoma, they have not fully managed to curb lymphoma cell proliferation despite effective reduction of the H3K27me3 mark. We used MS1943, an EZH2 selective degrader, which successfully diminishes EZH2 levels in lymphoma cells. Additionally, lapatinib, a dual inhibitor of the epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) tyrosine kinases, targets a receptor protein that regulates cell growth and division. The overexpression of this protein is often observed in lymphoma cells. Our study aims to combine these two therapeutic targets to stimulate apoptosis pathways and potentially suppress Burkitt's lymphoma cell survival and proliferation in a complementary and synergistic manner. We observed that a combination of MS1943 and lapatinib induced apoptosis in Daudi cells and caused cell cycle arrest at the S and G2/M phases in both Ramos and Daudi cells. This strategy, using a combination of MS1943 and lapatinib, presents a promising therapeutic approach for treating lymphoma and potentially Burkitt's lymphoma.
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Enhancer of zeste homolog 2 (EZH2) and Bruton's tyrosine kinase (BTK) are both key factors involved in the development and progression of hematological malignancies. Clinical studies have demonstrated the potential of various EZH2 inhibitors, which target the methyltransferase activity of EZH2, for the treatment of lymphomas. However, despite their ability to effectively reduce the H3K27me3 levels, these inhibitors have shown limited efficacy in blocking the proliferation of lymphoma cells. To overcome this challenge, we employed a hydrophobic tagging approach utilizing MS1943, a selective EZH2 degrader. In this study, we investigated the inhibitory effects of two drugs, the FDA-approved EZH2 inhibitor Tazemetostat, currently undergoing clinical trials, and the novel drug MS1943, on Burkitt's lymphoma. Furthermore, we assessed the potential synergistic effect of combining these drugs with the BTK inhibitor Ibrutinib. In this study, we evaluated the effects of combination therapy with MS1943 and Ibrutinib on the proliferation of three Burkitt's lymphoma cell lines, namely RPMI1788, Ramos, and Daudi cells. Our results demonstrated that the combination of MS1943 and Ibrutinib significantly suppressed cell proliferation to a greater extent compared to the combination of Tazemetostat and Ibrutinib. Additionally, we investigated the underlying mechanisms of action and found that the combination therapy of MS1943 and Ibrutinib led to the upregulation of miR29B-mediated p53-upregulated modulator of apoptosis PUMA, BAX, cleaved PARP, and cleaved caspase-3 in Burkitt's lymphoma cells. These findings highlight the potential of this innovative therapeutic strategy as an alternative to traditional EZH2 inhibitors, offering promising prospects for improving treatment outcomes in Burkitt's lymphoma.
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BACKGROUND: Wide surgical excision is the gold standard for basal cell carcinoma (BCC) treatment. Typically, resection requires a safety margin ≥ 4 mm. We aimed to confirm BCC excisions' cancer recurrence rate and safety on the facial region with new safety margins. METHODS: We included patients with primary BCC on the facial region who underwent wide excision with 2- or 3-mm safety margins at our institution between January 2010 and December 2018. Medical records were reviewed to confirm the epidemiology and surgical information. Recurrence was confirmed by physical examination through regular 6-month follow-up. RESULTS: We included 184 out of 233 patients in this study after applying the exclusion criteria. The mean age and follow-up period were 71.2± 10.2 years and 29.3± 13.5 months, respectively. The predominantly affected area was the nose (95 cases); a V-Y advancement flap was the most commonly used surgical method. There were two cases of recurrence in the 2 mm margin group and one recurrence in the group resected with 3 mm margins. CONCLUSION: In this large cohort study, we found 2-3 mm excision margins can yield enough safety in facial BCCs. The recurrence rates were found to be comparable with those reported after wider margins.
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Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.
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The soft tissue triangle is an easily recognizable subunit of the nose. Therefore, deformities in this region resulting from trauma or complications after cosmetic surgery can have serious cosmetic impacts. Various reconstruction choices exist for deformities such as depression of the soft triangle but choosing the most appropriate treatment in each case remains a challenge. In the case described herein, a patient underwent augmentation rhinoplasty with a silastic implant and experienced implant exposure in the soft triangle area. After implant removal, the patient complained of depression in this area. The authors effectively solved this problem through a de-epithelialized composite tissue graft. In this report, we present this case and review similar cases of reconstruction of the soft triangle.
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BACKGROUND: Human adipose-derived mesenchymal stem cells (AMSCs) are an attractive resource for wound healing because their regenerative capacity improves injury repair. Recently, stem cell-derived exosomes have been shown to play a positive role in stem cell-based therapies. However, the effects of exosomes derived from AMSCs (AEXOs) on wound healing are unclear. In this study, we aimed to examine the role of AEXOs in attenuating inflammation and explore their effects in normal wound healing. METHODS: We isolated exosomes from AMSCs and established a cellular model of inflammation by treatment with the inflammatory cytokines, interferon gamma and tumor necrosis factor alpha, to determine whether AEXOs can inhibit inflammation. We examined the wound healing effects of AEXOs in in vitro wound healing models and performed a miRNA array to understand the role of AEXOs in inflammation and wound healing. RESULTS: A significant difference was observed in wound closure and the expression of anti-inflammatory and wound-healing-related factors between control and AEXO-treated cells. CONCLUSION: Our results showed that besides alleviating the inflammation response, AEXOs also promote wound healing. Thus, AEXOs represent a novel, stem-cell-based, therapeutic strategy for wound healing.
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Exossomos , Células-Tronco Mesenquimais , MicroRNAs , Tecido Adiposo , Humanos , MicroRNAs/genética , CicatrizaçãoRESUMO
The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi's original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.
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BACKGROUND: Neurosensory changes are frequently observed in the patients with mid-face fractures, and these symptoms are often caused by infraorbital nerve (ION) damage. Although ION damage is a relatively common phenomenon, there are no established and objective methods to evaluate it. The aim of this study was to test whether trigeminal somatosensory evoked potential (TSEP) could be used as a prognostic predictor of ION damage and TSEP testing was an objective method to evaluate ION injury. METHODS: In this prospective TSEP study, 48 patients with unilateral mid-face fracture (only unilateral blow out fracture and unilateral zygomaticomaxillary fracture were included) and potential ION damages were enrolled. Both sides of the face were examined with TSEP and the non-traumatized side of the face was used as control. We calculated the latency difference between the affected and the unaffected sides. RESULTS: Twenty-four patients recovered within 3 months, and 21 patients took more than 3 months to recover. The average latency difference between the affected side and unaffected side was 1.4 and 4.1 ms for the group that recovered within 3 months and the group that recovered after 3 months, respectively. CONCLUSION: Patients who suffered ION damage showed prolonged latency when examined using the TSEP test. TSEP is an effective tool for evaluation of nerve injury and predicting the recovery of patients with ION damage.
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PURPOSE: The creation of the nipple-areola complex is the final stage in breast reconstruction and highly affects patient satisfaction. The neo-nipple is well known to shrink over time, particularly in the nipple projection. Currently, no reconstruction technique is clearly superior in terms of nipple size maintenance. We evaluated nipple size changes among several methods of breast mound reconstruction. METHODS: Seventy-eight patients received nipple-areola complex reconstruction secondarily after breast reconstruction. C-V flap nipple reconstructions were performed using a free transverse rectus abdominis myocutaneous (TRAM) flap in 25 cases (TRAM group), a latissimus dorsi (LD) myocutaneous flap in 27 cases (LD group), and an implant in 26 cases (implant group). The circumference and projection of the neo-nipple were measured using a flexible ruler, immediately after reconstruction and average 10 months after surgery. RESULTS: The overall circumference and projection at the final measurement were 91.43% ± 7.11% and 62.16% ± 21.55%, respectively, of immediate postoperative values. The change in circumference did not significantly differ among the 3 groups. In contrast, the change in projection was significantly worse in implant group compared to that in TRAM and LD groups. In addition, among the patients in implant group, greater inflation was significantly associated with greater decrease in the nipple projection. CONCLUSION: Breast mound reconstruction with autologous musculocutaneous flap techniques achieves better long-term maintenance of the neo-nipple projection compared to that achieved with expanded tissue and implantation. Considering the prospective loss of long-term nipple dimension, the preoperative design should be oversized in accordance with its origin in mound reconstruction.
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BACKGROUND: Acellular dermal matrices (ADMs) have recently become widely used in breast reconstruction, but the correlation between the final expander volume and the surface area of the ADM is not well understood. In this study, the expansion of the surface area of ADM and the expander volume was studied retrospectively in cases of acellular dermis-assisted tissue expander breast reconstruction. METHODS: Twenty cases of immediate breast reconstruction using an ADM-assisted tissue expander from January 2015 to December 2015 were evaluated. In all 20 cases, CGCryoDerm was used as the matrix, with a thickness of 1-3 mm. No slit incisions were made. Finally, the proportional increase in the area of the fully expanded ADM was compared to that of the tissue expander volume. RESULTS: The proportional increase in the ADM surface area was calculated to be from 1.1 to 2.46, with a mean value of 1.7. Additionally, under the assumption that the expander had a spherical shape, the increase in its radius (the cube root of its volume) was assessed. The range of the proportional increase in the expander radius was 1.1 to 2.24, with a mean value of 1.66. The proportional increase in the radius of the expanded ADM surface area ranged from 1.04 to 1.34, with a mean ratio of 1.28. CONCLUSIONS: The results of this study confirmed that the ADM expanded when the tissue expander was inflated. However, the ADM expanded to a lesser extent than the tissue expander, indicating that the muscle and other tissues expanded more than the ADM when the tissue expander was inflated.