Microbiologic Profile of Nipple Swab Culture and its Association With Postoperative Complications in Prosthetic Breast Reconstruction.

BACKGROUND: In breast surgeries, a lactiferous duct leading to lactic glands of breast parenchyma allows direct contamination by normal bacterial flora of the nipple-areola complex. Complete blockage of nipple flora from the intraoperative field is almost impossible. OBJECTIVES: We aimed to analyze the microbiological profile of nipple flora of breast cancer patients who underwent an implant-based immediate breast reconstruction after a total mastectomy, and to evaluate the association of nipple bacterial flora with postoperative complications. METHODS: A retrospective chart review was performed of patients who underwent an implant-based immediate breast reconstruction after a total mastectomy. A nipple swab culture was performed preoperatively. Patient demographics, surgical characteristics, and complications were compared between positive and negative nipple swab culture groups. Microbiological profile data including antibacterial resistance were collected. RESULTS: Among 128 breasts, 60 cases (46.9%) had positive preoperative nipple swab culture results. Staphylococcus epidermidis accounted for 41.4% of microorganisms isolated. A multivariate logistic regression analysis of postoperative complications revealed that the presence of nipple bacterial flora was a risk factor for capsular contracture. Seven cases of postoperative infection were analyzed. In 2 cases (40% of pathogen-proven infection), the causative pathogen matched the patient's nipple bacterial flora, which was methicillin-resistant S. epidermidis in both cases. CONCLUSIONS: Nipple bacterial flora was associated with an increased risk of capsular contracture. Preoperative analysis of nipple bacterial flora can be an informative source for treating clinically diagnosed postoperative infections. More studies are needed to determine the effectiveness of active antibiotic decolonization of the nipple.

An Analysis of the Demographics and Clinical Characteristics of Transgender and Intersex Populations in Korea: A Retrospective Study Using HIRA Database.

BACKGROUND: Transgender and intersex populations have long remained under-documented in South Korea, largely due to the absence of comprehensive epidemiological data. With increasing societal acknowledgment, there's an urgent need to understand the demographics and health challenges faced by these communities. METHODS: This retrospective, large-scale data study included people who received the F64 codes from the Korean Health Insurance Review & Assessment Service between January 2007 and December 2021. Demographics, gender-affirmative treatments, and psychiatric related medications were examined. RESULTS: Between 2007 and 2021, 8,602 patients were diagnosed with "gender identity disorder" and 45 with "intersex." A steadily increasing annual prevalence was observed, peaking at 986 cases in 2021. The majority (79.8%) were aged between 10 and 30. Nearly half (53.2%) exhibited mental and behavioral disorders. Two-thirds had been prescribed anxiolytics or sedatives either before or after diagnosis. Merely 12.1% received hormone therapy covered by health insurance. CONCLUSION: This is the first large-scale study highlighting the demographics and clinical characteristics of the transgender and intersex populations in Korea. The study reveals a consistent growth of these communities over the past 15 years, with a significant proportion under 30 years of age facing mental and behavioral challenges. Findings underscore the need for targeted healthcare interventions, early psychological support, and comprehensive insurance coverage tailored to the specific needs of these individuals in Korea.

The Efficacy of CT-Based Conformal Electron Beam Radiation Therapy After Keloid Excision.

BACKGROUND: Adjuvant computed tomography-based conformal electron beam radiation therapy (RT) for patients with keloids enables radiation oncologists to customize the target volume with precision and deliver the maximal prescription dose while sparing normal surrounding tissues. OBJECTIVE: To report treatment and cosmetic outcomes by the patient's self-assessment survey. METHODS: Medical records of patients with keloids, who were treated with postoperative electron beam RT between January 2015 and December 2020, were reviewed. A total of 85 consecutive patients with 136 keloids were included in this study. Subjective cosmetic outcomes were scored by each patient using a 5-point Likert scale survey. RESULTS: The median follow-up time was 29.0 months (range, 12.1-77.9 months), and local recurrence was observed in 10 lesions (7.4%). The recurrence rate of keloids occurring in the ear was 5.4%, whereas the recurrence rate of keloids occurring at other body sites was 11.4%. Among the patients who responded to the questionnaire about the cosmetic outcome, 70.2% of patients declared being either very satisfied (44.7%) or satisfied (25.5%). CONCLUSION: Surgical excision, followed by CT-based conformal electron beam RT, for patients with keloids ensures a high degree of local control resulting in good cosmetic outcomes.

A Comparative Study of Breast Sensibility and Patient Satisfaction After Breast Reconstruction: Autologous, 2-Stage Implant-Based, and Prepectoral Direct-to-Implant Reconstruction.

BACKGROUND: Currently, a variety of treatment modalities are implemented for breast reconstruction. However, clinical prognosis regarding sensory regeneration of the breast and patient-reported satisfaction remains underexamined. In this study, we aimed to compare breast sensibility after various reconstruction. METHODS: We conducted a retrospective comparative study of all patients who underwent breast reconstruction between August 2016 and October 2019 at our institution. Acellular dermal matrixes were used to cover the implant inferolaterally in a dual-plane subpectoral approach and to wrap the implant in prepectoral direct to implant (DTI). The cutaneous tactile pressure threshold and patient satisfaction outcome were tested. RESULTS: A total of 105 breasts were assessed, 30 breasts reconstructed with deep inferior epigastric perforator (DIEP) flap, 40 breasts reconstructed with 2-stage subpectoral implant, and 35 breasts reconstructed with prepectoral DTI. In the specific group-to-group analysis, DIEP and implant groups showed significant differences in sensory recovery, mainly in lateral areas of the reconstructed breast. In 2-stage reconstruction and DTI groups, there were no statistically significant differences. When comparing patient groups using only patients with follow-up lengths of more than 12 months, the difference was more clearly indicated (P = 0.049). Better sensory recovery predicted high satisfaction scores in patient-reported outcomes (P = 0.007). CONCLUSIONS: We found that subpectoral implant reconstruction and DTI show no statistically significant differences in sensory recovery, and autologous DIEP flap reconstruction results in a better prognosis than prosthesis implant reconstruction. Furthermore, the clarity of the differences increased when the follow-up length was longer than 12 months. Better patient-reported satisfaction was associated with good breast sensibility.

Reconstruction of Extensive Oromandibular Defect With Simultaneous Dual Free Flap Transfer.

ABSTRACT: Complex oromandibular defects are usually too extensive or complex to be reconstructed with a single free flap. In this situation, dual free flaps can provide an adequate amount of tissues and a three-dimensional structure for large composite defects.In our institution, a total of 6 patients underwent immediate dual free-flap reconstruction between December 2013 and February 2020. In all patients, oromandibular defects were reconstructed with a combination of a fibula free flap and a vertical rectus abdominis myocutaneous, anterolateral thigh, or radial forearm free flap. All 6 patients showed tolerable flap status without any major complications, and could transit a diet from a dysphagia diet to a general diet on the final visit. Dual free flaps can be considered an optimal reconstructive option with favorable functional and aesthetic outcomes for complex oromandibular defects involving the bone, oral lining, external skin, or soft tissue.

Early Treatment Effects of Nonablative Fractional Lasers (NAFL) on Hypertrophic Scars in an Animal Model.

BACKGROUND AND OBJECTIVES: Recently, there have been several attempts to apply the laser therapy to hypertrophic scars (HTS). In particular, the fractional laser is in the spotlight for its usefulness in rapid wound healing and dermal remodeling. However, most previous studies have focused on the ablative fractional laser (AFL), and there are no studies on the mechanism of the nonablative fractional laser (NAFL) effect in HTS treatment. In this study, we aimed to evaluate the changes in histology and molecular chemistry to provide scientific evidence for the early treatment of HTS with NAFL. STUDY DESIGN/MATERIALS AND METHODS: A total of 40 hypertrophic burn scars were made on the abdomens of two female pigs. After epithelialization, the HTS were randomly subdivided into four groups-control, AFL, NAFL (low energy), and NAFL (high energy). Laser treatment was initiated 1 week after the crust fell and the epithelium became covered, and it was repeated for six sessions over an interval of 2 weeks. Five excisional biopsies were obtained for histologic analysis and biomarker assessment. RESULTS: Histologically, dermal remodeling with thin coil-shaped collagen fibers was observed in the NAFL groups. It also showed a significant increase of matrix metalloproteinase-2 (MMP-2) and Decorin at 16 weeks in an enzyme-linked immunosorbent assay. The reverse-transcription polymerase chain reaction analysis showed a tendency that high-pulse energy of NAFL led to higher messenger RNA expression than did the low-energy group. CONCLUSION: The NAFL-treated groups showed characteristic collagen re-arrangement and a significant increase in MMP-2 and Decorin. These molecular changes suggest that MMP-2 and Decorin play a significant role in dermal remodeling. Early NAFL treatment for HTS could be supported with both histological and molecular evidence. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

The Hybrid Latissimus Dorsi Flap in Immediate Breast Reconstruction: A Comparative Study With the Abdominal-Based Flap.

PURPOSE: The implant-enhanced latissimus dorsi (LD) flap, or a hybrid LD flap, is widely used in certain indications, even though abdominal-based flaps are now considered the gold standard of autologous breast reconstruction. However, few articles distinguish the hybrid LD flap from traditional LD flaps, and not many articles have compared the surgical outcomes, with the abdominal-based flap procedure, especially in the area of immediate breast reconstruction. In addition, it is often overlooked that the reported esthetic comparisons are based on different populations and contralateral balancing procedures (CBPs). Thus, this study aimed to review the reconstruction outcomes and to compare the variable-matched esthetic outcomes between 2 groups. METHODS: A retrospective review of patients who underwent immediate breast reconstruction with either a hybrid LD flap or an abdominal-based free flap and had completed at least 2 years of follow-up visits was carried out. The patient demographics, oncologic data, breast parameters, and postoperative outcomes were compared across the entire patient group. The body mass index (BMI)- and CBP-matched cohort was randomly selected and assessed using the Aesthetic Outcome parameter of the Aesthetic Item Scale. RESULT: Thirty-eight hybrid LD flap and 51 abdominal-based free flap procedures were included. The hybrid LD group showed a shorter operation time (330 ± 260 minutes vs 550 ± 480 minutes, respectively; P < 0.01), and fewer patients in the hybrid LD group underwent additional revision surgeries (7 [18.4%] vs 20 [39.2%], respectively; P < 0.01). Other complication rates were not significantly different between groups. A BMI- and CBP-matched esthetic analysis revealed that the hybrid LD group showed superior results in symmetry (Mann-Whitney U test, P = 0.047). CONCLUSIONS: The LD flap in combination with an implant remains a viable option in immediate breast reconstruction and had a similar complication profile while having a shorter operative time compared with the abdominal-based autologous breast reconstruction procedure. If properly used in certain populations, hybrid LD flaps may offer superior results regarding symmetry over the abdominal-based flap procedure.

Scalp Reconstruction in Delayed Diagnosed Dermal Leiomyosarcoma Mimicking Keloid Scar.

ABSTRACT: Leiomyosarcoma (LMS) of the skin is a rare smooth muscle neoplasm of all soft tissue sarcoma. Because of its prognostic importance, early diagnosis is critical for successful treatment. Since several features and clinical manifestations are similar to those of a keloid scar, the differential diagnosis between these two diseases is difficult, especially in the early stages of cancer that do not show any remarkable features in appearance, or when the patient has a history of previous wounds or surgery.In our case report, a 71-year-old female patient who underwent a scalp reconstruction using an anterolateral thigh flap turned out to have, because of delayed diagnosis, a dermal LMS mimicking a keloid scar. The case emphasizes careful physical examination for early intervention, even if a lesion looks like a typical keloid scar. After resection, the appropriate reconstruction method can be selected based on the complexity of the defect site.

A Comparison of Aesthetic Outcomes of Umbilicoplasty in Breast Reconstruction with Abdominal Flap: Inverted-U Versus Vertical Oval Incision.

BACKGROUND: The umbilicus is a key aesthetic unit of the abdominal wall. It contributes to the natural curvature of the abdomen and is now considered as one of the most important factors in the overall results and patient satisfaction. In this study, we present an inverted-U incisional technique for umbilicoplasty. This study aims to describe the senior author's approach to umbilicoplasty and compare the aesthetic outcomes of the inverted-U method with those of the vertical oval incisional technique. METHODS: In this retrospective cohort study, we analyzed a total of 109 patients including 51 who underwent umbilicoplasty with the inverted-U incisional technique and 58 who had surgery with the vertical oval incisional method. With the description of our operative technique, the aesthetic outcomes of both techniques were compared by two independent surgeons using a 5-point Likert scale in terms of shape, size, depth, natural appearance and periumbilical scarring. Also, the total scores of the five items were calculated to give a final score for each patient (range, from 5 to 25 points). RESULTS: On all measured parameters, the inverted-U incisional technique produced favorable outcomes compared with the vertical oval incisional technique. Also, the inverted-U incisional technique was given significantly higher total scores than was the vertical oval incisional technique (inverted-U 14.73 ± 2.47 vs. vertical oval 11.26 ± 3.02, p = 0.002). CONCLUSIONS: In this study, an inverted-U incisional technique produced significantly favorable outcomes in terms of shape, size, depth, natural appearance and overall score compared to a vertical oval incision (p < 0.05). We believe that this technique enables surgeons to achieve a better shape, natural retrusive appearance and superior hood. LEVEL OF EVIDENCE III: In this study, an inverted-U incisional technique produced significantly favorable outcomes in terms of shape, size, depth, natural appearance and overall score compared to a vertical oval incision (p < 0.05). We believe that this technique enables surgeons to achieve a better shape, natural retrusive appearance and superior hood.

Reliability of the Patient and Observer Scar Assessment Scale in Evaluating Linear Scars after Thyroidectomy.

OBJECTIVE: To compare the reliability of the Patient and Observer Scar Assessment Scale (POSAS) with the Vancouver Scar Scale (VSS) in evaluating thyroidectomy scars. METHODS: At 6 months after the operation, 112 patients who underwent thyroid surgery via collar neck incision were evaluated by two blinded plastic surgeons and two senior residents using the VSS and the observer component of the POSAS. In addition, the observer-reported VAS score and patient-reported Likert score were evaluated. Internal consistency, interobserver reliability, and correlations between the patient- and observer-reported outcomes were examined. RESULTS: The observer component of POSAS scores demonstrated higher internal consistency and interobserver reliability than the VSS. However, the correlations between the observer-reported VAS score and the patient-reported Likert score (0.450) and between the total sum of patient and observer component scores (0.551) were low to moderate. CONCLUSIONS: The POSAS is more consistent over repeated measurements; accordingly, it may be considered a more objective and reliable scar assessment tool than the VSS. However, a clinician's perspective may not exactly match the patient's perception of the same scar.

Predictors affecting complications and aesthetic outcomes in autologous breast reconstruction with free muscle-sparing transverse rectus abdominis myocutaneous flaps.

BACKGROUND: Identification and understanding of predictors for complications and aesthetic outcomes in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap are essential for successful breast reconstruction. The purpose of this study was to investigate predictors for complications and aesthetic outcomes in patients who underwent autologous breast reconstruction with free MS-TRAM flaps. PATIENTS AND METHODS: Between March 2003 and September 2017, a total of 214 patients who underwent breast reconstruction with MS-TRAM flaps were included in this study. Mean age of the patients was 43.2 years (range, 28-61 years). Four outcome data, including operation time, hospital stay, aesthetic scores, and complications; and 12 patient data, including recipient vessel type, age, body mass index [BMI] > 25, smoking status, neoadjuvant chemotherapy, radiotherapy, nipple-sparing mastectomy, contralateral breast surgery, history of hypertension, diabetes mellitus, cardiac disease, and endocrine disease were collected. RESULTS: Five and 52 patients experienced major complications, including partial flap loss, and minor complications, respectively. In stepwise multiple logistic analysis, risk factors for complications were BMI > 25 (P < 0.001), smoking status (P = 0.012), and neoadjuvant radiotherapy (P = 0.002). BMI > 25 (P < 0.001), smoking status (P < 0.001), contralateral breast surgery (P < 0.001), and history of cardiac (P = 0.001) and endocrine disease (P = 0.003) were predictors for aesthetic outcome. CONCLUSION: Predictors for complications and aesthetic outcomes determined in this study may facilitate microsurgeons engaged in the assessment of patients needing free MS-TRAM flaps.

Comparison of the Outcomes of Closed Reduction Nasal Bone Fractures With a Surgical Navigation System.

BACKGROUND: The most prevalent form of facial bone fractures is nasal fractures. The surgical procedures used for these fractures are relatively simple, but complete correction is not easy because the nasal bone is small and identifying the fracture site by palpation is difficult. This study aimed to investigate the efficacy of intraoperative surgical navigation systems in nasal bone fracture surgery through a prospective analysis. METHODS: Between February 2019 and July 2019, 25 navigation-assisted closed reductions of nasal fractures were performed. Preoperative computed tomography images were obtained at 1-mm intervals before surgery and the navigation was set by a simulation to have an error rate of less than 1. Then, the navigation system was used to identify the fracture site. Closed reduction was performed with Asch forceps and a Langenbeck elevator based on the previous markings made using the navigation system. RESULTS: The degree of reduction was evaluated by plain X-rays and computed tomography scans, which were performed 1 month after surgery. In the navigation group, the average distance between the fragment and normal bony alignment was decreased from 2.38 to 0.49 mm and the modified Motomura score was an average of 2.40 points. The decrease in the mean distance was significantly different (P = 0.038) compared with the conventional group. CONCLUSIONS: Surgical navigation systems could be a useful tool for localizing fracture sites and guiding closed reductions. In particular, the system could be recommended for nasal bone fracture reductions in the tip or pyriform regions, which are difficult to correct. LEVEL OF EVIDENCE: II.

Clinical Experience with Treatment of Aquafilling Filler-Associated Complications: A Retrospective Study of 146 Cases.

BACKGROUND: Aquafilling filler is used for breast and buttock augmentation, which are the most commonly performed cosmetic surgery procedures. However, complications after using Aquafilling filler for breast augmentation have been reported, and there are concerns regarding its use in large areas, such as the buttocks. We provide our experience with complications after breast augmentation and buttock augmentation using Aquafilling filler. METHODS: This observational cohort study analyzed the data of 399 patients treated for filler-related complications at our institutes from September 2015 to November 2019. Of these patients, 146 underwent surgery to remove Aquafilling filler from the breast or buttock. RESULTS: The mean time between Aquafilling filler use and complication onset was 38.5 ± 10.2 months. The average amount of filler material removed from one side of the breast or buttock was 285.5 ± 95.8 mL (range 150-750 mL). The most common complications were induration and masses (83.6%), followed by pain (52.1%), firmness (24.7%), asymmetry (10.3%), migration (8.2%), mastitis (6.8%), dimpling (6.2%), fever (3.4%), and sepsis (n = 1). After treatment, there was no recurrence of infection, and the patient satisfaction level based on the visual analogue scale was 8.0 ± 0.9. CONCLUSIONS: Although Aquafilling filler is easily injectable and has long-term clinical effects, complications can occur. Furthermore, there are concerns regarding its toxicity and influence on the surrounding tissues. Hence, further research studies on Aquafilling filler and evidence regarding its long-term safety are needed. 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 .

The Influence of Dissection Range of the Facial Nerve on Transient Postoperative Facial Palsy in Mandibular Condyle Fractures.

PURPOSE: This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach. MATERIALS AND METHODS: This retrospective study included 58 patients who underwent rigid fixation of condylar head and upper neck fractures. Patients were divided into 3 groups based on dissection range of the frontal and zygomatic branches. For group 1 (n = 22), the dissection range was extended anteriorly and posteriorly from the condylar borders through the retroparotid approach. The transparotid approach was used in groups 2 (n = 19) and 3 (n = 17) in which nerve dissection was limited to the condylar borders and was extended only anteriorly, respectively. Using multivariate correlation and multiple regression analyses, differences in duration of nerve traction and angle difference by traction from the natural course of the nerve were analyzed according to dissection range, and the recovery period for facial palsy was evaluated. RESULTS: The duration of nerve traction for group 2 was 77.53 minutes, which was longer than that for groups 1 (66.00 minutes) and 3 (65.41 minutes). The angle differences by traction were 62.42° and 58.00° for the frontal and zygomatic branches in group 2, respectively, which were considerably greater than those in groups 1 (23.32° and 20.14°) and 3 (37.24° and 28.88°). In consequence, group 2 showed the longest recovery, requiring 64.47 days for the frontal branch and 51.63 days for the zygomatic branch. The angle difference by traction had a greater influence on the recovery period than duration of nerve traction. CONCLUSIONS: Duration of nerve traction and angle difference by traction were quantitatively dependent on the dissection range of facial nerve branches and were related to the recovery period for transient facial palsy.

Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

Effect of Antiadhesion Barrier Solution and Fibrin on Capsular Formation After Silicone Implant Insertion in a White Rat Model.

INTRODUCTION: One of the most serious complications of breast reconstruction and augmentation using silicone implants is capsular contracture. Several preventive treatments, including vitamin E, steroids, antibiotics, and cysteinyl leukotriene inhibitors, have been studied, and their clinical effects have been reported. However, the problem of capsular contracture has not yet been completely resolved. This study was performed to compare anti-adhesion barrier solution (AABS) and fibrin in their ability to prevent fibrotic capsule formation and simultaneously evaluated their effect when used in combination by capsular thickness analysis and quantitative analysis of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and type I collagen within the fibrous capsule. MATERIALS AND METHODS: This study used female six-week-old Sprague-Dawley rats. Eighty rats were equally subdivided into the four following groups: AABS-treated, fibrin-treated, AABS and fibrin combined-treated, and untreated control groups. Each rat received two silicone chips under the panniculus carnosus muscle layer. The test materials were applied around the silicon chips. Four weeks later, the implantation sites including the skin and muscle were excised to avoid the risk of losing the fibrous capsule around the implants. The capsular thickness was analyzed by Masson's trichrome stain. Quantitative analysis of type I collagen, MMPs, and TIMPs was performed by real-time PCR, Western blot, and zymography. RESULTS: The mean capsular thickness was 668.10 ± 275.12 µm in the control group, 356.97 ± 112.11 µm in the AABS-treated group, 525.96 ± 130.97 µm in the fibrin-treated group, and 389.24 ± 130.51 µm in the AABS and fibrin combined-treated group. Capsular thickness was significantly decreased in all experimental groups (p < 0.05). Capsular thickness was greater in the fibrin-treated group than in the AABS-treated group (p < 0.05). There was no statistically significant difference in capsular thickness between the AABS and fibrin combined-treated group and the AABS- or fibrin-treated group (p > 0.05). Compared to the control group, the experimental groups had significantly lower expressions of type I collagen and MMP-1 (p < 0.05), but there was no statistically significant difference in expressions of type I collagen and MMP-1 between the AABS-, fibrin-, and AABS and fibrin combined-treated groups (p > 0.05). The expressions of MMP-2 and TIMP-2 were not significantly different between the control and the experimental groups (p > 0.05). CONCLUSION: AABS is more effective in reducing capsular thickness compared with fibrin treatment in a white rat model.

Effects of platelet-rich plasma, adipose-derived stem cells, and stromal vascular fraction on the survival of human transplanted adipose tissue.

Traditional adipose tissue transplantation has unpredictable viability and poor absorption rates. Recent studies have reported that treatment with platelet-rich plasma (PRP), adipose-derived stem cells (ASCs), and stromal vascular fraction (SVF) are related to increased survival of grafted adipose tissue. This study was the first simultaneous comparison of graft survival in combination with PRP, ASCs, and SVF. Adipose tissues were mixed with each other, injected subcutaneously into the back of nude mice, and evaluated at 4, 8, and 12 weeks. Human adipocytes were grossly maintained in the ASCs and SVF mixtures. Survival of the adipose tissues with PRP was observed at 4 weeks and with SVF at 8 and 12 weeks. At 12 weeks, volume reduction in the ASCs and SVF mixtures were 36.9% and 32.1%, respectively, which were significantly different from that of the control group without adjuvant treatment, 51.0%. Neovascular structures were rarely observed in any of the groups. Our results suggest that the technique of adding ASCs or SVF to transplanted adipose tissue might be more effective than the conventional grafting method. An autologous adipose tissue graft in combination with ASCs or SVF may potentially contribute to stabilization of engraftment.

Precaruncular approach for the reconstruction of medial orbital wall fractures.

To reconstruct medial orbital wall fractures with a clear, least dissection, an alternative method, precaruncular approach, has been performed. We reviewed 36 patients with medial blowout fractures treated with this technique. The incision was made between the caruncle and medial canthal skin at the mucocutaneous junction, and was continued along the conjunctival fornix superiorly and inferiorly. An extended conjunctival incision was carried for additional access to the orbit floor. The dissection continued medially and proceeded along the preseptal plane. The clinical results were assessed by postoperative computed tomographic scan and by reviewing postoperative complications. Postoperatively, computed tomographic scans demonstrated adequate reduction of soft tissues and correct positioning of the inserted implant without surgical complications. In most cases, the edema resolved within 24 to 48 hours after surgery. The precaruncular approach is a good option in reconstructing medial orbital wall fractures because it provides satisfactory exposure with superior cosmetic result.

Correction of pectus excavatum with breast hypoplasia using simultaneous pectus bar procedure and augmentation mammoplasty.

Most women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.

Influence of smartphone Wi-Fi signals on adipose-derived stem cells.

The use of smartphones is expanding rapidly around the world, thus raising the concern of possible harmful effects of radiofrequency generated by smartphones. We hypothesized that Wi-Fi signals from smartphones may have harmful influence on adipose-derived stem cells (ASCs). An in vitro study was performed to assess the influence of Wi-Fi signals from smartphones. The ASCs were incubated under a smartphone connected to a Wi-Fi network, which was uploading files at a speed of 4.8 Mbps for 10 hours a day, for a total of 5 days. We constructed 2 kinds of control cells, one grown in 37°C and the other grown in 39°C. After 5 days of Wi-Fi exposure from the smartphone, the cells underwent cell proliferation assay, apoptosis assay, and flow cytometry analysis. Three growth factors, vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor-ß, were measured from ASC-conditioned media. Cell proliferation rate was higher in Wi-Fi-exposed cells and 39°C control cells compared with 37°C control cells. Apoptosis assay, flow cytometry analysis, and growth factor concentrations showed no remarkable differences among the 3 groups. We could not find any harmful effects of Wi-Fi electromagnetic signals from smartphones. The increased proliferation of ASCs under the smartphone, however, might be attributable to the thermal effect.