Biomaterials patterned with discontinuous microwalls for vascular smooth muscle cell culture: biodegradable small diameter vascular grafts and stable cell culture substrates.

The medial layer of small diameter blood vessels contains circumferentially aligned vascular smooth muscle cells (vSMC) that possess contractile phenotype. In tissue-engineered constructs, these cellular characteristics are usually achieved by seeding planar scaffolds with vSMC, rolling the cell-laden scaffold into a tubular structure, and maturing the construct in a pulsatile bioreactor, a lengthy process that can take up to two months. During the maturation phase, the cells circumferentially orient, their contractile protein expression increases, and they obtain a contractile phenotype. Generating cell culture platforms that enable the rapid production of directionally oriented vSMC with increased contractile protein expression would be a major step forward for blood vessel tissue engineering and would greatly facilitate the in vitro study of vSMC biology. Previously, we developed a micropatterned cell culture surface that promotes orientation and contractile protein expression of vSMC. Herein, we explore two potential applications of this technology. First, we fabricate tubular and biodegradable scaffolds that possess the micropatterning on their exterior surface. When vSMC are seeded on these scaffolds, they initially proliferate in order to fill the microchannels and as confluence is reached the cells align in the direction of the micropatterning resulting in a biodegradable scaffold that is inhabited by circumferentially aligned vSMC within a week. Second, we illustrate that we can generate biostable cell culture surfaces that allow the in vitro study of the cells in a more contractile state. Specifically, we explore contractile protein expression of cells cultured on the micropatterned surfaces with the addition of soluble transforming growth factor beta one (TGFß1).

Swiveling a Single Expanded Forehead Flap: A Novel Effective Economical Approach to Total Bilateral Upper and Lower Eyelid Reconstruction.

In our novel approach, a single expanded forehead flap was used to reconstruct bilateral upper and lower eyelids in orbital trauma. A 40-year-old man sustained blast injury resulting in bilateral orbital exenteration and need for bilateral socket and eyelid reconstruction. The sockets were each resurfaced with a temporalis flap. A subgaleal forehead tissue expander was expanded during several weeks until enough tissue was obtained. The single expanded forehead flap was swiveled in stages to reconstruct both upper and lower eyelids beginning with the left eye then the right. With this method, the authors recreated the bilateral upper and lower eyelids with a single pedicled flap and ensured secure retention of prostheses to give an acceptable appearance. The novel approach of swiveling a single expanded pedicled forehead flap to reconstruct bilateral upper and lower eyelids is easy and effective providing adequate like for like autologous tissue, and economical requiring only 1 donor site.

Mycobacterium abscessus Hand Infections in Immunocompetent Fish Handlers: Case Report.

Mycobacterium abscessus hand infections are rare and usually occur in immunocompromised patients or after injection with contaminated injectables. This article describes 2 cases of M abscessus infection of the hand in otherwise healthy fish handlers. Mycobacterium abscessus can cause severe chronic tenosynovitis even in immunocompetent patients and should be suspected alongside the more common M marinum as a cause of nontuberculous mycobacterial hand infections in patients with aquatic and fish exposure.

Forty-one cervicofacial vascular anomalies and their surgical treatment--retrospection and review.

INTRODUCTION: Haemangiomas in children usually involute spontaneously and surgical treatment is exceptional. Vascular malformations do not regress spontaneously and resection may become necessary. We present a series of surgically treated face and neck vascular anomalies during a 9-year period, assessing the epidemiology, presenting signs and symptoms, diagnostic modalities, indications for surgery, treatment methods and clinical outcome post-treatment. MATERIALS AND METHODS: The medical and pathological records of all patients with cervicofacial vascular anomalies treated surgically at our department from 1997 to 2005 were retrospectively reviewed in relation to current evidence. RESULTS: Forty-one patients were identified. Of these, 9 patients had haemangiomas and the remaining 32 had a variety of vascular malformations. Cervicofacial vascular anomalies were most commonly located at the lip. Atypical looking vascular anomalies like masseteric intramuscular haemangiomas and parotid malformations were diagnostic problems. All 41 had surgical excision of their vascular anomalies for troubling symptoms, cosmesis or diagnostic purpose. For cervicofacial arteriovenous malformations, 28% were classified as Schobinger stage I, 50% stage II, and the remainder stage III. Combined embolisation-resection was used to treat 6 arteriovenous malformations (stage II to III) and of these, 3 required flap reconstruction. CONCLUSIONS: Accurate diagnosis distinguishing between cervicofacial haemangiomas and vascular malformations is key to best treatment. The diagnosis can usually be made by history and physical examination aided by early magnetic resonance imaging (MRI). Although cervicofacial haemangiomas can be managed conservatively or with medical therapy, surgery is indicated for preventing psychological distress and in cases of chronic aesthetic alteration resulting from partial regression. Aesthetic concerns and prevention of psychosocial distress point to early excision of venous malformation as the treatment of choice. Lymphatic malformations are best treated by excision. Outcome after excision of localised cervicofacial haemangiomas and low-flow vascular malformations is excellent. Large extensive low-flow malformations as well as those located at the lips may require multiple procedures including reconstruction; patients should be informed that the outcome is generally not as good. Combined embolisation-resection is definitive treatment for arteriovenous malformations and flap reconstruction may prevent their recurrence. Tissue expansion is a useful reconstructive tool after the excision of large vascular anomalies.

Vacuum-assisted closure of a large palmar defect after debriding a midpalmar tuberculous abscess.

A rare case of tuberculous deep palmar abscess of the hand was treated with radical excisional debridement, resulting in a large palmar skin and soft tissue defect that was successfully closed with a vacuum dressing followed by split skin grafting. Vacuum dressings are useful adjuncts to treat large soft tissue defects in patients who are unsuitable for complex reconstruction. The moist wound environment prevents desiccation of exposed vital structures and decreases pain, allowing early mobilisation in the hand. The wound granulates and contracts rapidly, allowing earlier skin grafting or faster healing by secondary intention. The closed system vacuum dressing is particularly useful in managing debrided tuberculous soft tissue infections. The dressing is perfectly sealed and requires less frequent changing, decreasing contamination and transmission of tuberculosis to other patients and health care staff, while minimising the risk of secondary nosocomial bacterial infection of the wound.

Extracranial non-vestibular head and neck schwannomas: a ten-year experience.

INTRODUCTION: We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome. MATERIALS AND METHODS: Clinical records of all patients with head and neck schwannomas treated at our department from April 1995 to July 2005 were retrospectively reviewed. RESULTS: There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred. CONCLUSION: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment.