The hybrid approach for reconstruction of severely destructed lower eyelids: combination of skin grafting, temporary tarsorrhaphy, and autologous fat grafting for cicatricial ectropion after injection of commercial grade silicone.

BACKGROUND: Although silicone injections for permanent soft tissue augmentation were popular in the past, their use has become unduly controversial because of severe complications, mainly caused by injection of illegal silicones by unlicensed practitioners. The delicate local anatomy of the lower eyelid region makes this region particularly susceptible for complications after silicone augmentation including local inflammation, tissue retraction, and consecutive cicatricial ectropion leading to lagophthalmus and ocular surface irritation. CLINICAL REPORT: This is a case of a 47-year-old patient demonstrating severe lower eyelid destruction with consecutive ectropion after injection of commercial grade silicone in Thailand 5 years prior, leading to chronic granulomatous infections requiring multiple surgical interventions.Our hybrid approach included radical debridement with complete elimination of silicone residues, lateral canthopexy, reconstruction of the entire lower eyelid esthetic unit using a supraclavicular full-thickness skin graft, and temporary tarsorrhaphy followed by 2 sessions of autologous fat graft injections.Although many previous publications mainly focus on individual aspects of lower eyelid reconstruction, we describe a staged reconstructive approach for correction of severely destructed lower eyelid defects with consecutive lower eyelid ectropion. CONCLUSIONS: The hybrid approach presented here has proven to be a viable surgical strategy for lower eyelid reconstruction, with esthetically appealing results.

Noncovalent dimerization of paclitaxel in solution: evidence from electrospray ionization mass spectrometry.

Paclitaxel, a unique antimitotic chemotherapy agent that inhibits cell division by binding to microtubules and prevents them from "depolymerizing," has received widespread interest because of its efficacy in fighting certain types of cancer, including breast and ovarian cancer. Paclitaxel undergoes aggregation at millimolar concentrations in both aqueous media and solvents of low polarity (mimicking hydrophobic environments). Its aggregation may have impact on its aqueous stability and its ability to stabilize microtubules. Here, we investigated the dimerization phenomenon of paclitaxel by electrospray ionization mass spectrometry (ESI-MS). Paclitaxel dimers were stable in solutions of acetonitrile/aqueous ammonium acetate (80/20) and aqueous sodium acetate/acetonitrile (92/8 or 95/5) at various pH values. Additional experiments using solution-phase hydrogen/deuterium exchange were employed to ascertain whether or not the observed dimers were formed in solution or as an artifact of the ESI process by ion-molecule reaction. The evidence supports formation of the dimer in solution, and the approach used can be extended to investigation of other types of drug-drug interactions.

Microsurgical advances in extremity salvage.

The main goal of reconstructive microsurgery must be an optimal functional and esthetic reconstruction meeting the individual trauma site requirements with minimal donor site morbidity. The authors discuss new microsurgical options for extremity salvage: indications for reconstruction versus amputation, timing of free tissue transfer, reconstruction of soft tissue and bone, and functional muscle transfer. They discuss indications and contraindications for these procedures, along with emphasizing the important points of each.