Synergistic Effects of Autologous Platelet-Rich Plasma and Hyaluronic Acid Injections on Facial Skin Rejuvenation.

BACKGROUND: Many therapeutic options are currently available for facial skin rejuvenation, but little evidence exists about the efficacy of combining such procedures. OBJECTIVES: The aim of this study was to assess and investigate the synergistic effect of hyaluronic acid (HA) and autologous platelet-rich plasma (a-PRP) injections on facial skin rejuvenation. METHODS: For this randomized controlled prospective study, 93 eligible patients were enrolled and randomized into 3 intervention groups to undergo a series of 3 treatment sessions with either a-PRP, HA, or a mixture of a-PRP and HA (Cellular Matrix; Regen Lab) injected into facial cheeks. RESULTS: A total of 93 patients were included. Treatment with Cellular Matrix led to a very significant improvement in the overall facial appearance compared with treatment with a-PRP or HA alone (P < 0.0001). Participants treated with Cellular Matrix showed a 20%, 24%, and 17% increase in FACE-Q score at 1, 3, and 6 months posttreatment, respectively. For the HA group, the improvement in FACE-Q score was 12%, 11%, and 6% at 1, 3, and 6 months posttreatment, respectively, whereas for the a-PRP group the improvement was 9%, 11%, and 8% at 1, 3, and 6 months posttreatment, respectively. Biophysical measurements showed significantly improved skin elasticity for the Cellular Matrix group compared with the groups receiving a-PRP or HA alone. No serious adverse events were reported. CONCLUSIONS: Combining a-PRP and HA seems to be a promising treatment for facial rejuvenation with a highly significant improvement in facial appearance and skin elasticity compared with a-PRP or HA alone.

Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients.

INTRODUCTION: Conventional liposuction has provided good outcome for years. Abdominal etching (or abdominal high definition liposuction) allows the surgeon to shape and enhance the abdominal muscles by removing specific grooves of subcutaneous fat. The aim of this study is to describe the technique and the complications and to assess patients' satisfaction rate. MATERIALS AND METHODS: Between January 2015 and January 2017, 25 patients (21 men and 4 women) underwent abdominal etching procedures in our department. The authors describe the technique and the specific key points of the procedure. All patients were seen at day 5, 10, 30, and 180. At day 180, everyone answered a modified Likert scale survey relating to their satisfaction. RESULTS: No hematoma, infection, or seroma was reported. One patient experienced a superficial pressure wound caused by an improper positioning of the final dressing. Almost all patients (96%) were happy or very happy with the overall outcome of their abdominal etching. CONCLUSION: The number of requests for abdominal liposculpture should increase in the coming years, and plastic surgeons specialized in silhouette surgery should be able to master this technique in order to add it to their therapeutic arsenal. 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.

Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study.

OBJECTIVE: Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy (VVA). For those who cannot take hormone therapy, autologous platelet-rich plasma combined with hyaluronic acid (A-PRP-HA) may provide a new alternative therapy for the treatment of VVA in postmenopausal women with history of breast cancer. METHODS: We enrolled 20 postmenopausal breast cancers survivors with VVA and a score of <15 on the Gloria Bachman Vaginal Health Index (VHI) comprised of five items including: vaginal pH, elasticity, fluid volume (secretions), epithelial integrity, and moisture.We administered intramucosal injections of A-PRP combined with HA (Regenkit) and performed clinical evaluations at 0, 1, 3, and 6 months. Primary endpoint: evaluation of vulvovaginal mucosa changes using the VHI; secondary endpoint: evaluation of dyspareunia and sexual dysfunction based on the Female Sexual Distress (FSD) score. RESULTS: All participants (20 women) showed improvement in the clinical symptoms of vaginal dryness and dyspareunia. The VHI score showed a significant increase at 6 months, going from a total baseline score (pretreatment) of 10.7 ±â€Š2.12 to 20.75 ±â€Š4.8 (P < 0.0001) at 6 months. Improvement in hydration and vaginal epithelial integrity was reported. A VHI score of > 15 showed a successful treatment outcome. The FSD score decreased significantly during the study, from a baseline score of 36.35 ±â€Š2.53 pretreatment to 30.15 ±â€Š2.47 6 months after treatment, representing improvement of 17% (P < 0.0001, respectively). No adverse events were reported. CONCLUSIONS: The injection of A-PRP-HA appeared to be a promising method to improve the trophicity and hydration of vaginal mucosa for the treatment of VVA in postmenopausal breast cancer survivors with contraindications to hormone therapy.

Should platelet-rich plasma be activated in fat grafts? An animal study.

BACKGROUND: The adjunction of platelet-rich plasma with graft fat has been the subject of a few clinical trials which have demonstrated its value in adipocyte survival. The aim of this study was to assess the different efficacies between activated and non-activated PRP on adipose cells in vitro and for adipose tissue graft survival in vivo. METHODS: The in vitro study assessed the effects of PRP on both the proliferation and adipocyte differentiation of adipose cells. For the in vivo study, 8 nude rats received 3 human fat injections as follows: 0.8 mL of fat + 0.2 mL of normal saline; 0.8 mL of fat + 0.2 mL of non-activated PRP; and 0.8 mL of fat + 0.2 mL of PRP activated with calcium chloride (CaCl2). The quantitative assessment of adipocyte survival was implemented after 3 months using histomorphometric analysis. Histological and immunohistochemical analysis were also performed to evaluate angiogenesis, inflammation and quality of adipocytes in the grafted tissue. RESULTS: We showed that activated PRP stimulated, in vitro, proliferation and differentiation of adipose cells. In vivo experiments indicated that CaCl2-activated PRP was more efficient than non-activated to prolong the survival of fat grafts in nude rats. The mean percentage areas occupied by viable adipocytes in the PRP-free group, non-activated PRP group and activated PRP group were 13%, 14% and 24% (p = 0.05%), respectively. Histological and immunohistochemical analysis revealed protective effect of activated PRP on inflammation and adipocyte death. CONCLUSION: This study showed that activation by CaCl2 improves the beneficial effects of PRP for fat graft maintenance.

A Distally Based Sartorius Muscle Flap for a Gustilo Grade-III Open Fracture of the Lateral Femoral Condyle and the Head of the Fibula with a Complex Soft-Tissue Defect: A Case Report and Review of the Literature.

CASE: We present a case of lower-limb trauma associated with an extensive soft-tissue defect around the knee joint, which led to the exposure of bone and the metalwork that was used for the management of the associated fractures. Coverage was performed with a distally based sartorius muscle flap in a single-stage procedure, allowing good recovery with a nice aesthetic and functional outcome at the 1-year follow-up. Additionally, we discuss alternative options for the coverage of severe soft-tissue defects based on the clinical context. CONCLUSION: A distally based sartorius muscle flap may be a suitable alternative for coverage of complex soft-tissue defects around the knee joint.

Indocyanine green applications in plastic surgery: A review of the literature.

INTRODUCTION: Use of indocyanine green (ICG) near-infrared fluorescence as a dye to assess tissue vascularization is now well standardized. The aim of this literature review was to review and resume the most recent recommendations for ICG use in its plastic surgery applications. METHODS: A systematic literature review was performed using Medline, EMBASE, and PubMed databases to obtain the latest recommendations for ICG in plastic surgery. Inclusion criteria were all articles written in English language that evaluated pre-, intra-, or postoperative ICG applications in surgical procedures usually performed by plastic surgeons. Case reports, reviews, meta-analyses, and experimental studies on animals or cadavers were excluded after title and abstract screening. RESULTS: Of the 1389 article titles retrieved, 41 full-text articles met the inclusion criteria. ICG applications in plastic surgery were ICG lymphangiography used in sentinel lymph node mapping for breast cancer and melanoma and in microsurgery for the staging and treatment of secondary chronic lymphedema. The latest updates of ICG angiography in assessing free flaps, pedicled flaps, or large skin paddles were also retrieved. CONCLUSIONS: Large prospective studies suggest that ICG lymphography could be used as a single tracer to reliably perform sentinel lymph node biopsy. In the case of cutaneous melanoma, ICG lymphography increases node detection sensitivity and accuracy in conjunction with lymphoscintigraphy. In chronic lymphedema, it is useful for pre- and postoperative staging and intraoperative anatomical location of lymphatic pathways when lymphovenous bypass is indicated. ICG angiography is used intraoperatively to assess free flap anastomosis and design skin paddles and postoperatively to monitor buried flaps. In pedicled perforator flaps or for large skin paddles, intraoperative ICG angiography is strongly correlated with postoperative outcomes. LEVEL OF EVIDENCE: 3.

Efficacy of Autologous Platelet-rich Plasma Glue in Weight Loss Sequelae Surgery and Breast Reduction: A Prospective Study.

BACKGROUND: Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes. METHODS: Fifty-four patients were included in this study. They underwent breast reduction surgery, abdominoplasty, or limb lifting with A-PRP glue application on the entire surface of the subcutaneous tissue at the time of suture. Retrospective data were used for the control group. The primary endpoint was the incidence of postoperative seroma or hematoma. The secondary endpoint was the Patient and Observer Scar Assessment Scale score. RESULTS: Demographics and clinical characteristics were not statistically different between the A-PRP glue group and the control group regarding age, sex ratio, and body mass index. After abdominoplasty, 37.5% of patients (3/8) in the control group experienced seroma and hematoma complications versus 12.5% of patients (2/16) in the A-PRP glue group (P = 0.55 and P = 0.25, respectively). After limb lifting, 50% of patients experienced postoperative complications in the control group versus no patient in the A-PRP glue group (P = 0.03*; * indicates that the P value is significant). After breast reduction, no patient experienced complication in the A-PRP glue group versus 25% of patients in the control group who experienced hematoma (P = 0.04*). The scar quality assessed 12 months after surgery showed no statistical differences between the groups. CONCLUSIONS: A-PRP glue seems effective to prevent seroma formation after limb lifting and hematoma formation after breast reduction. Wound-healing quality did not seem to be improved.

Primary Fat Grafting to the Pectoralis Muscle during Latissimus Dorsi Breast Reconstruction.

BACKGROUND: Latissimus dorsi flap is one of the best options for immediate and delayed breast reconstruction. However, this technique is limited by the tissue volume provided by the flap. To improve breast volume while reducing complications, fat grafting is now very often used in addition to latissimus dorsi flap. To the best of our knowledge, fat grafting was always performed as a second-line surgery, at least a few months after the flap procedure. We aimed to report our experience with an associated breast reconstruction technique combining musculocutaneous latissimus dorsi flap with intrapectoral lipofilling for totally autologous breast reconstruction. METHODS: Between September 2014 and January 2015, 20 patients underwent this technique for unilateral autologous breast reconstruction (14 delayed and 6 immediate breast reconstructions). A mean harvested fat volume of 278 ml (range: 190-350 ml) and a mean injected fat volume of 228 ml (range: 170-280 ml) were used. RESULTS: None of the patients experienced complications, such as flap necrosis, breast skin necrosis, hematomas, or infection. One of the patients developed a seroma, which was treated with 3 drainage punctions. Only 2 patients underwent delayed fat grafting procedure. CONCLUSION: Totally autologous breast reconstruction combining latissimus dorsi flap and intrapectoral fat grafting in the same procedure is a new technique allowing increased breast volume in a single surgery.

Comparison between the efficacy and safety of platelet-rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study.

The article entitled "Comparison between the efficacy and safety of platelet-rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study" (Zeinab Abd El-Samad Ibrahim, et al.) is very interesting but the methodology is not robust. Our mains comments concerned the count of the cells, the activation of the PRP and the method of assessment.

Objective estimation of patient age through a new composite scale for facial aging assessment: The face - Objective assessment scale.

Most patients requesting aesthetic rejuvenation treatment expect to look healthier and younger. Some scales for ageing assessment have been proposed, but none is focused on patient age prediction. The aim of this study was to develop and validate a new facial rating scale assessing facial ageing sign severity. One thousand Caucasian patients were included and assessed. The Rasch model was used as part of the validation process. A score was attributed to each patient, based on the scales we developed. The correlation between the real age and scores obtained, the inter-rater reliability and test-retest reliability were analysed. The objective was to develop a tool enabling the assigning of a patient to a specific age range based on the calculated score. All scales exceeded criteria for acceptability, reliability and validity. The real age strongly correlated with the total facial score in both sex groups. The test-retest reliability confirmed this strong correlation. We developed a facial ageing scale which could be a useful tool to assess patients before and after rejuvenation treatment and an important new metrics to be used in facial rejuvenation and regenerative clinical research.

Use of the retrograde limb of the internal mammary vein to avoid venous congestion in DIEP flap breast reconstruction: Further evidences of a reliable and time-sparing procedure.

AIM: Venous congestion is a common cause of DIEP flap failure. When identified intraoperatively, an additional venous anastomosis can improve the venous outflow and prevent flap failure. The aim of this study was to assess if the retrograde limb of the internal mammary vein (IMV) could be considered a good recipient vessel to be used when persistent flap congestion is present, and a second venous anastomosis is required. PATIENTS AND METHODS: A retrospective study was conducted in 74 patients who had undergone DIEP flap breast reconstruction. Patients were classified into two groups: SVA (single venous anastomosis) and DVA (dual venous anastomosis). In the SVA group (n = 38), the IMV antegrade limb was used for venous drainage. A single DIEV (Deep Inferior Epigastric Vein) was anastomosed to the superior arm of the IMV. In the DVA group (n = 36), both the antegrade (superior) and retrograde (inferior) stumps of the IMV were used, connecting the larger DIEV to the antegrade IMV and the other DIEV or the SIEV (Superficial Inferior Epigastric Vein) to the IMV retrograde limb. RESULTS: No venous congestion or flap loss was observed when two venous anastomoses were performed using both the IMV antegrade and retrograde limbs (P = 0.3271). In the DVA group, no major complication occurred (P = 0.0453). Operative explorations were significantly reduced in the DVA group (P = 0.0242). CONCLUSION: These findings suggest that when an additional venous outflow is required, the use of the IMV retrograde limb may help to avoid flap venous congestion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:447-452, 2016.

Factors associated with postoperative complications in elderly patients with skin cancer: A retrospective study of 241 patients.

OBJECTIVES: The increasing frequency of skin tumors and longer life expectancy of the general population are likely to increase the frequency of dermatological surgery among elderly patients. The purpose of this study is to assess the rate of postoperative complications related to dermatological surgery in elderly patients and highlight the factors associated with these complications. METHODS: We conducted a retrospective monocentric study of patients aged >75 years who presented at our multidisciplinary consultation specialized for skin tumors from January 2008 to December 2010. The clinical characteristics, demographic information, and cancer history of these patients were analyzed. Postoperative complications (dehiscence, infection, hematomas, and other sequelae) were identified to establish the postoperative complication rate and determine risk factors. RESULTS: We included 241 patients. Basal cell carcinoma, squamous cell carcinoma, and melanoma accounted for 46%, 25%, and 28% of tumors, respectively. Skin carcinomas were mainly located on the face (93% of basal cell carcinomas and 72% of squamous cell carcinomas), and melanomas were mainly located on the limbs (50%). The average number of comorbidities was 3.0±1.5. The average postoperative complication rate was 20%. Multivariate analysis identified three independent risk factors: male gender (p<0.033), histological type (squamous cell carcinoma and melanoma) (p<0.008), and insufficient surgical resection (p<0.004). CONCLUSION: This study highlighted a high rate of postoperative complications in this elderly population. Three significant postoperative risk factors were identified. They may be used to assess a patient's operational risk as well as geriatric assessment tools.

Treatment of sphenoid dysplasia with a titanium-reinforced porous polyethylene implant in orbitofrontal neurofibroma: report of three cases.

Orbital manifestations occur in less than 1% of patients with neurofibromatosis type 1 (NF1). These manifestations are frequently associated with sphenoid wing dysplasia. The typical radiologic feature is partial or total loss of the greater wing of the sphenoid bone, which leads to herniation of the temporal lobe through the orbital cavity resulting in proptosis and pulsating exophthalmos. Traditional reconstruction of this bone defect involves split bone grafting or titanium mesh. However, these techniques have some limitations due to bone resorption and infection risk. We report the use of 0.85 mm titanium-reinforced porous polyethylene implant sheet in three cases of orbital neurofibromatosis with sphenoid dysplasia. The role of this material was to create a barrier between the brain and orbital cavity. The implant sheet was modeled intraoperatively to reconstruct the orbital cavity anatomy and fitted without any screws. The malleability of the implant allows quick reconstruction of the curved orbital skeleton. Furthermore, the implant doesn't interfere with postoperative imaging and may decrease risk infection.