[Benefits of volumetric to facial rejuvenation. Part 1: Fat grafting]. / Apport de la volumétrie au rajeunissement facial. Partie 1 : greffe adipocytaire.

For a number of years, a volumetric approach using autologous fat injection has been implemented to improve cosmetic outcome in face-lift procedures and to achieve lasting rejuvenation. Autologous fat as filling tissue has been used in plastic surgery since the late 19th century, but has only recently been associated to face lift procedures. The interest of the association lies on the one hand in the pathophysiology of facial aging, involving skin sag and loss of volume, and on the other hand in the tissue induction properties of grafted fat, "rejuvenating" the injected area. The strict methodology consisting in harvesting, treating then injecting an autologous fat graft is known as LipoStructure® or lipofilling. We here describe the technique overall, then region by region. It is now well known and seems simple, effective and reproducible, but is nevertheless delicate. For each individual, it is necessary to restore a harmonious face with well-distributed volumes. By associating volumetric to the face lift procedure, the plastic surgeon plays a new role: instead of being a tailor, cutting away excess skin, he or she becomes a sculptor, remodeling the face to restore the harmony of youth.

Autologous Fat Grafting to the Breast Using REVOLVE System to Reduce Clinical Costs.

BACKGROUND: With the increasing popularity of fat grafting over the past decade, the techniques for harvest, processing and preparation, and transfer of the fat cells have evolved to improve efficiency and consistency. The REVOLVE System is a fat processing device used in autologous fat grafting which eliminates much of the specialized equipment as well as the labor intensive and time consuming efforts of the original Coleman technique of fat processing. This retrospective study evaluates the economics of fat grafting, comparing traditional Coleman processing to the REVOLVE System. METHODS: From June 2013 through December 2013, 88 fat grafting cases by a single-surgeon were reviewed. Timed procedures using either the REVOLVE System or Coleman technique were extracted from the group. Data including fat grafting procedure time, harvested volume, harvest and recipient sites, and concurrent procedures were gathered. Cost and utilization assessments were performed comparing the economics between the groups using standard values of operating room costs provided by the study hospital. RESULTS: Thirty-seven patients with timed procedures were identified, 13 of which were Coleman technique patients and twenty-four (24) were REVOLVE System patients. The average rate of fat transfer was 1.77 mL/minute for the Coleman technique and 4.69 mL/minute for the REVOLVE System, which was a statistically significant difference (P < 0.0001) between the 2 groups. Cost analysis comparing the REVOLVE System and Coleman techniques demonstrates a dramatic divergence in the price per mL of transferred fat at 75 mL when using the previously calculated rates for each group. CONCLUSIONS: This single surgeon's experience with the REVOLVE System for fat processing establishes economic support for its use in specific high-volume fat grafting cases. Cost analysis comparing the REVOLVE System and Coleman techniques suggests that in cases of planned fat transfer of 75 mL or more, using the REVOLVE System for fat processing is more economically beneficial. This study may serve as a guide to plastic surgeons in deciding which cases might be appropriate for the use of the REVOLVE System and is the first report comparing economics of fat grafting with the traditional Coleman technique and the REVOLVE System.

Surrogate human tissue temperatures resulting from misalignment of antenna and implant during recharging of a neuromodulation device.

OBJECTIVES: A synergistic experimental and numerical investigation has provided quantitative information on the response of surrogate human tissue temperatures to misalignment of the implant and antenna of neuromodulation devices during recharging. MATERIALS AND METHODS: The experimental phase of the work provided information on the rates of heat transfer from the implant and the antenna to their respective surroundings. The heat transfer data were used as input to a biothermal model from which tissue temperature distributions were obtained. RESULTS: It was found that misalignment increases tissue temperatures compared with those for the aligned case for all of the investigated devices. These increases ranged from 0.5°C to 5.3°C. CONCLUSION: Notwithstanding these increases, the lowest temperatures were attained by the Restore Ultra device for all operating conditions. The temperature levels achieved by the Precision Plus and Eon Mini devices were found to be greater than those for the Restore Ultra but their relative rankings depend on the thermal boundary conditions and the duration of the recharging period. The foregoing rank ordering was validated by a sensitivity study in which the heat transfer data inputted to the numerical simulation was varied systematically. The aforementioned comparisons correspond with identical recharging periods for all of the devices.

Microglia replacement by microglia transplantation (Mr MT) in the adult mouse brain.

Mutations in microglia may cause brain disorders. Replacement of dysfunctional microglia by allogeneic wild-type microglia from bone marrow transplantation (Mr BMT) or peripheral blood can correct the gene deficiency at the brain-wide scale but cannot achieve precise replacement at specific brain regions. Here, we introduce a strategy with potential clinical relevance-microglia replacement by microglia transplantation (Mr MT), combining tamoxifen-induced ablation of Mr BMT cells and intracranial injection of microglia to mouse brain, to achieve region-sepcific microglia replacement. The original abbreviation of this microglia replacement strategy is mrMT. We hereby change the name to Mr MT. For complete details on the use and execution of this protocol, please refer to Xu et al. (2020).

Cost analysis of outpatient anterior cruciate ligament reconstruction: autograft versus allograft.

BACKGROUND: Prior studies suggest the cost of allograft anterior cruciate ligament (ACL) reconstruction is less than that for autograft reconstruction. Charges in these studies were influenced by patients requiring inpatient hospitalization. QUESTION/PURPOSE: We therefore determined if allograft ACL reconstruction would still be less costly if all procedures were performed in a completely outpatient setting. METHODS: We retrospectively reviewed 155 patients who underwent ACL reconstruction in an ambulatory surgery center between 2001 and 2004; 105 had an autograft and 50 had an allograft. Charges were extracted from itemized billing records, standardized to eliminate cost increases, and categorized for comparison. Surgeon and anesthesiologist fees were not included in the analysis. Groups were compared for age, gender, mean total cost, mean cost of implants, and several other cost categories. RESULTS: The mean total cost was $5465 for allograft ACL reconstruction and $4872 for autograft ACL reconstruction. There were no differences in complications between the two groups. CONCLUSIONS: Allograft ACL reconstruction was more costly than autograft ACL reconstruction in the outpatient setting. The cost of the allograft outweighs the increased surgical time needed for harvesting an autograft. LEVEL OF EVIDENCE: Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Comparison of tissue loss by different punches: A new A-design.

OBJECTIVES: To compare the amount of tissue loss using different FUE punches. MATERIALS AND METHODS: The study was conducted in 5 patients undergoing hair restoration surgery by FUE. Four different kinds of punches were used, that is, sharp, blunt, serrated, and new "A-design." All the punches had a total cutting edge of 0.8 mm. In each patient, 4 punches were used to make insertion at right angle with the skin. Immediately after the punch use, the diameter of the hole was measured. The same areas were also measured after 24 hours and after 1 month. The data were collected and analyzed by Multiple t test (with Bonferroni's correction). RESULTS: The average size of the wound immediately at the end of the procedure was 0.826 mm for sharp, 0.858 mm for blunt, 0.892 mm for serrated, and 0.932 mm for A-design. Similarly, the wounds decreased to 0.752, 0.778, 0.774, and 0.696 mm for sharp, blunt, serrated, and A-design, respectively, after 24 hours. The final wound/scar size was 0.640 mm for punch, 0.660 mm for blunt punch, 0.668 mm for serrated punch, and 0.598 mm for A-design punch after 1 month. CONCLUSION: The new A-design resulted in the minimum scar size after 1 month.

Effects of tissue culture on the biomechanical properties of porcine meniscus explants.

BACKGROUND: The meniscus is critical for the normal functioning of the knee joint. The specific aim of this study was to validate an in vitro culture model of meniscus explants for testing the impact of culture conditions on meniscus biomechanical properties. We hypothesized that culturing menisci in the presence of intermediate and high concentration of serum would have a positive effect on the compressive stiffness of the meniscus. METHODS: Unconstrained microindentation testing was performed on porcine meniscus explants cultured with varying concentrations 1%, 5%, or 10% of fetal bovine serum media. Meniscus explants that were not cultured were used as a control. These tests quantified the Young's Modulus of the listed groups of cultured and uncultured explant tissues. FINDINGS: The Young's modulus for 10% cultured explants were significantly higher compared to the control, 1%, and 5% cultured meniscus explants. There was no statistical significance when the Young's modulus between control, 1%, and 5% cultured explants were compared. INTERPRETATION: These results suggest that low concentrations of serum do not impart an anabolic effect on meniscus tissue explant biomechanical properties.

Insertion force of articular cartilage transplantation systems.

This study compared the insertion force, plug harvest consistency, and recipient site creation consistency of 4 different articular cartilage transplantation systems (COR, OATS, Mosaicplasty, and New COR2) during plug insertion using a single-impaction technique. Maximum insertion forces fell into 3 statistically different groups: group 1, OATS 8-mm (238 N) and 10-mm (215 N) systems; group 2, COR 6-mm (133 N) and 8-mm (176 N), Mosaicplasty, 6.5-mm (147 N) and 8.5-mm (134 N), and OATS 6-mm (137 N) systems; and group 3, New COR2 6-mm (68 N), 8-mm (55 N), and 10-mm (54 N) systems (P < or = .05). OATS compaction pressures were 172 N (6 mm), 353 N (8 mm), and 550 N (10 mm). COR, New COR2, and Mosaicplasty donor plugs were created consistently, but the Mosaicplasty system required toggling. OATS plugs had inconsistent lengths but required no toggling. Insertion forces with the New COR2 system were statistically the lowest. Compaction significantly increased surface forces.

Novel experimental surgical strategy to prevent traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft.

OBJECTIVE Traumatic neuromas may develop after nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often resistant to therapy, and excision of the neuroma frequently leads to recurrence. In this study, the authors present a novel surgical strategy to prevent neuroma formation based on the principle of centro-central anastomosis (CCA), but rather than directly connecting the nerve ends to an autograft, they created a loop using a 3D-printed polyethylene Y-shaped conduit with an autograft in the distal outlets. METHODS The 3D-printed Y-tube with autograft was investigated in a model of rat sciatic nerve transection in which the Y-tube was placed on the proximal sciatic nerve stump and a peroneal graft was placed between the distal outlets of the Y-tube to form a closed loop. This model was compared with a CCA model, in which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended-arm Y-tube. Results were analyzed at 12 weeks of survival using nerve morphometry for the occurrence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the different surgical groups, the Y-tube with interposed autograft was the only model that did not result in neuroma formation at 12 weeks of survival. In addition, a 13% reduction in the number of myelinated axons regenerating through the interposed autograft was observed in the Y-tube with autograft model. In the CCA model, the authors also observed a decrease of 17% in the number of myelinated axons, but neuroma formation was present in this model. The closed Y-tube resulted in minimal nerve regeneration inside the tube together with extensive neuroma formation before the entrance of the tube. The extended-arm Y-tube model clearly showed that the majority of the regenerating axons merged into the Y-tube arm, which was connected to the autograft, leaving the extended plastic arm almost empty. CONCLUSIONS This pilot study shows that our novel 3D-printed Y-tube model with interposed autograft prevents neuroma formation, making this a promising surgical tool for the management of traumatic neuromas.

Excimer Laser Assisted Non-occlusive Anastomosis (ELANA). Our experience with a training model in vivo.

AIM: In this study the ELANA Technique has been reproduced in our experimental laboratory in order to verify its feasibility and reproducibility, the percentage of patent anastomosis in acute at different steps along the learning curve of the surgical team, specific problems related to the surgical technique. METHODS: In 20 rabbits New Zealand 4kg body weight the training model in vivo proposed by Tulleken and coworkers has been reproduced, realizing 40 ELANA anastomosis. The model consists in the realization of two different end-to-side anastomosis on the abdominal aorta of each experimental animal, assisted by a special designed suction/excimer laser catheter, then connected by an end-to-end suture. After a few hours the animals are sacrificed and the by-pass site withdrawn and examined in order to verify the percentage of patency in acute. RESULTS: In the first 5 animals (group A), the anastomosis were realized using a jugular vein graft and the procedure results successful in only 3 cases out of ten (30%). For the following experiments - groups B, C and D where an aorta artery graft was used, the percentage of arterial flap retrieval was respectively 50%, 60% and 80%. CONCLUSIONS: ELANA is a feasible fascinating microsurgical technique for the realization of high flow, non-occlusive anastomosis. The rate of success results progressively higher along the learning curve of the surgical team. In our opinion, before the application of the ELANA technique on humans, a period of propaedeutic training in vivo on laboratory animals is essential for the dedicated team.

Equine pericardium for dural grafts: clinical results in 200 patients.

AIM: Serous sheets are currently used in Neurosurgery as dural substitute. The aim of this study is to demonstrate that the horse pericardium, which has the essential charasteristics of reabsorbable membranes and moreover is BSE-free, is an excellent dural substitute. METHODS: 200 patients, 53 suffering from cranial traumatic conditions and 97 from cranial and craniospinal neoplastic pathologies, underwent a surgical procedure with the application of horse pericardium as a dural prosthesis. RESULTS: The follow-up controls of the patients included a neurosurgical visit and advanced diagnostic imaging (CT or MR). In the first 3 cases, an accumulation of CSF occurred under the surgical edge. Lumbar 7-days drainage was required in just one case. The use of Zero 5 suture seems to have obviated this problem, as it was never observed again in subsequent cases. The diagnostic imaging showed no alterated images and no clinical-neurological sequelae regarding the prosthesis in question were recorded. CONCLUSIONS: The Audiomesh Neuro prosthesis has all the characteristics of reabsorbable membranes: they are free from antigenic effects and do not produce any toxic catabolites. The membrane proved to be resistant to surgical suture, impermeable to CSF and is transparent. Yet the suture must be carried out carefully through a small non-traumatic needle. Audiomesh Neuro does not adhere to the underlying cerebral cortex and does not cause any clinical evidence or radiological artifacts.

Introduction of neurosupportive cells into processed acellular nerve allografts results in greater number and more even distribution when injected compared to soaking techniques.

OBJECTIVES: Processing necessary to remove immunogenic components of nerve allograft renders it acellular. Seeding with supportive cells may improve axon regeneration. We aim to identify the method associated with implantation of the greatest volume and most even distribution of cells. METHODS: Hypodermic needle injection was compared to soaking in solution under both normal and pressurized conditions after micropuncture of the allograft. Distribution within the allograft was measured using an in vitro model of fluorescent beads, as well as cultured Schwann cells. RESULTS: Injection treatment resulted in larger volumes and a more uniform cross-sectional distribution of implanted cells. Beads and cells behaved similarly relative to the measured outcomes. CONCLUSIONS: Injection instills more cells in a more uniform distribution. In vivo testing may evaluate whether these techniques vary relative to cell survival, cell migration, and clinical outcomes. Size- and concentration-matched fluorescent beads may represent a viable model for analyzing cell implantation.

Which mesh or graft? Prosthetic devices for abdominal wall reconstruction.

This article reviews the ever-increasing number of prosthetic devices--both synthetic mesh and biologic grafts--now in use for abdominal wall reconstruction. It also introduces a novel hybrid synthetic/biologic graft (Zenapro) and suture passer device (Novapass).

Endoscopic saphenous vein graft harvest for extracranial-intracranial bypass procedures.

BACKGROUND: The introduction of endoscopic harvest of saphenous vein grafts (SVGs) for coronary artery bypass procedures over the past few years has reduced the morbidity and enhanced patient satisfaction associated with this procedure. This report introduces the use of the endoscopic SVG harvest for extracranial-intracranial (EC-IC) bypass procedures. METHODS: Endoscopic SVG harvest has been performed in more than 4000 patients at Duke University Medical Center from 1998 to 2003. We have performed 4 such procedures for EC-IC bypass, including 3 for the treatment of large or giant cerebral aneurysms and 1 for symptomatic middle cerebral artery occlusion. A 2-cm transverse incision is made to harvest 25- to 30-cm segment of SVG using a VasoView graft harvest system (Guidant Cardiac and Vascular Surgery, Menlo Park, CA). Skin closure was performed using a 4-0 Vicryl subcuticular stitch. RESULTS: Endoscopic SVG harvest was possible in each of the 4 patients. No graft leaks were visualized microscopically with infusion pressure testing of the graft before graft anastomosis, and no postoperative graft harvest complications (infection, hematoma, dehiscence, etc) were encountered in either the immediate or long-term follow-up (mean, 14 months). CONCLUSIONS: The use of endoscopic SVG harvest presents an attractive alternative to open SVG harvest for EC-IC bypass procedures. A high-quality long graft may be harvested with apparent decreased morbidity via this minimally invasive technique.

Arthroscopic osteochondral autografting.

Arthroscopic osteochondral autografting is indicated for unipolar, full thickness articular cartilage lesions between 1 and 2.5 cm in diameter. A stable properly aligned knee is important to a good outcome. This procedure should not be performed in the presence of generalized osteoarthritis. Arthroscopic osteochondral autografting allows the restoration of hyaline articular cartilage with zonal matching of the graft. It is cost-effective, can be performed on an outpatient basis, and results in durable resurfacing with excellent long-term results.

The potential for the use of nanofeaturing in medical devices.

This review looks at potential developments in medical devices which may be based upon nanofeaturing implant and tissue engineering scaffolds, and describes the basic science upon which such expectations are based.

Bioactive composite materials for tissue engineering scaffolds.

Synthetic bioactive and bioresorbable composite materials are becoming increasingly important as scaffolds for tissue engineering. Next-generation biomaterials should combine bioactive and bioresorbable properties to activate in vivo mechanisms of tissue regeneration, stimulating the body to heal itself and leading to replacement of the scaffold by the regenerating tissue. Certain bioactive ceramics such as tricalcium phosphate and hydroxyapatite as well as bioactive glasses, such as 45S5 Bioglass, react with physiologic fluids to form tenacious bonds with hard (and in some cases soft) tissue. However, these bioactive materials are relatively stiff, brittle and difficult to form into complex shapes. Conversely, synthetic bioresorbable polymers are easily fabricated into complex structures, yet they are too weak to meet the demands of surgery and the in vivo physiologic environment. Composites of tailored physical, biologic and mechanical properties as well as predictable degradation behavior can be produced combining bioresorbable polymers and bioactive inorganic phases. This review covers recent international research presenting the state-of-the-art development of these composite systems in terms of material constituents, fabrication technologies, structural and bioactive properties, as well as in vitro and in vivo characteristics for applications in tissue engineering and tissue regeneration. These materials may represent the effective optimal solution for tailored tissue engineering scaffolds, making tissue engineering a realistic clinical alternative in the near future.