Comparison of a coupling system and the suture method in end-to-side microvascular anastomosis in head and neck reconstruction.

BACKGROUND: Use of coupling devices in microvascular anastomosis continues to increase, but it is not yet actively used in end-to-side (ETS) anastomosis because there is no standard method. Therefore, we propose an easy and time-saving ETS micro-anastomosis method using coupling devices in head and neck reconstruction and compare it with the conventional suture method. MATERIALS AND METHODS: We retrospectively reviewed 30 consecutive cases (43 anastomoses) of ETS anastomosis in head and neck reconstruction from 2018 to 2022. Patient characteristics, operative details, and anastomosis time were evaluated. When using the coupling device, a cross incision was created in the recipient vessel to form vascular flaps. By pulling the flaps out of the ring, the intact vessel lining was fixed. Other procedures were the same as for a traditional anastomosis. RESULTS: The mean anastomosis time was 12.81 min (range, 6.7-24.87) for the suture and 4.96 min (range, 2.02-9.4) for the coupling device, a statistically significant difference (p-value <.00005). There was no venous insufficiency or flap failure with either method. CONCLUSIONS: ETS venous anastomosis using the coupling device is an easy-to-use, safe, and timesaving procedure for head and neck reconstruction.

Transverse division of the rectus abdominis muscle in deep inferior epigastric perforator flap elevation: A rescue technique to include more than one perforator.

BACKGROUND: It is important to include as many perforators as possible in order to enhance the vascularity of a deep inferior epigastric perforator (DIEP) flap. However, the rectus muscle must be transected transversely, which prevents suturing and can cause a defect along the same line as the muscle-sparing procedure. When harvesting the DIEP flap, no specific method was suggested to solve these muscle defects. We found that by transecting the rectus muscle transversely, the muscle could be sutured in the tendinous area more easily while maintaining muscle function. The purpose of this study is to confirm the long-term recovery of the rectus abdominis muscle through the volume change after DIEP flap using this tendinous transection and suture method. PATIENTS AND METHODS: A retrospective review of 28 patients who underwent unilateral breast reconstruction using a DIEP flap and the tendinous transection method for multiple perforators between May 2018 and April 2020 was conducted. The preoperative and postoperative volumes of the rectus abdominis muscle were estimated both the harvest and opposite sides. RESULTS: The preoperative and postoperative muscle volumes from the harvest side were 50.08 ± 8.71 cm3 and 48.56 ± 8.61 cm3, respectively. The volume difference was 1.522 cm3 decrease, which was not statistically significant (p = .070). The preoperative and postoperative muscle volumes from the opposite side were 50.50 ± 8.15 cm3 and 50.08 ± 8.18 cm3, respectively. The volume difference was 0.434 cm3 increase and was not statistically significant (p = .064). Postoperative volume changes in the rectus muscle were not statistically significant on either side. CONCLUSION: The tendinous transection method in the DIEP flap procedure did not significantly affect postoperative rectus muscle volume. Therefore, we expect this harvest method to allow DIEP flap reconstruction that includes multiple perforators and complete donor muscle recovery.

Frontal Sinus Displacement of Silicone Implant After Previous Rhinoplasty.

Rhinoplasty, a historic surgical procedure for facial esthetics, has been actively performed in Asia. The use of autologous tissues or artificial materials, such as silicone, Gore-Tex, and Medpore, is common in achieving cosmetic improvements. However, artificial material poses risks of inflammation and foreign body reactions, leading to complications like infection and necessitating material removal and antibiotic treatment. According to previous reports, various clinical aspects appear across inflammation, skin necrosis, and, in severe cases, systemic symptoms caused by implants. In this case study, the goal is to share a rare case of silicone implant migration into the frontal sinus after augmentation rhinoplasty. A 38-year-old female patient who had previously undergone rhinoplasty surgery visited the outpatient clinic complaining of headaches and a deviated nose. On computed tomography, the silicone implant moved upward, penetrating the nasoethmoid bone and invading the frontal sinus. Fortunately, there was no intracranial invasion. The authors planned the implant removal and performed the complete implant removal with capsulectomy. The patient has been undergoing follow-up without any complications after surgery. Augmentation rhinoplasty with implants, while common, carries long-term risks. This case highlights the severity of complications, emphasizing infection and migration into the frontal sinus and, in extreme cases, the brain cavity. Therefore, surgeons must continually refine operation techniques to minimize iatrogenic causes and consider modifying surgical procedures to prevent potential complications.

Correction of Temporal Hollowing With the Superior Gluteal Artery Perforator Free Flap.

ABSTRACT: Temporal hollowing is most frequently an acquired deformity and can be caused by volume defects of bone, soft tissue, or both. Recently, surgical reconstruction with autogenous fat or allografts has been introduced, but these materials can be resorbed over time and may also lead to infection. Herein, the authors present 2 cases demonstrating the treatment of temporal hollowing with a superior gluteal artery perforator (SGAP) free flap. Both patients had a history of traffic accidents and subsequent craniectomy because of subdural hemorrhage, followed by cranioplasty. An SGAP free flap was selected to reconstruct the soft tissue temporal defect in both patients. Pre-operatively, computed tomography (CT) angiography was used to locate the superior temporal artery (STA). A preauricular incision provided surgical access to the STA, and a subcutaneous pocket was created. The STA and SGAP artery and vein anastomoses were performed. Before flap insetting, it was de-epithelized, and its volume and shape trimmed to fit into the temporal defect. The patients' post-operative courses were without complications, and facial symmetry was achieved. This is the first case report describing the microvascular reconstruction of temporal hollowing with an SGAP free flap. The SGAP free flap is permanent and highly vascularized with no risk of infection. These case reports illustrate a unique reconstruction technique that resulted in a satisfactory outcome for the patients.

Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant.

The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.

Medical data science in rhinology: Background and implications for clinicians.

BACKGROUND: An important challenge of big data is using complex information networks to provide useful clinical information. Recently, machine learning, and particularly deep learning, has enabled rapid advances in clinical practice. The application of artificial intelligence (AI) and machine learning (ML) in rhinology is an increasingly relevant topic. PURPOSE: We review the literature and provide a detailed overview of the recent advances in AI and ML as applied to rhinology. Also, we discuss both the significant benefits of this work as well as the challenges in the implementation and acceptance of these methods for clinical purposes. METHODS: We aimed to identify and explain published studies on the use of AI and ML in rhinology based on PubMed, Scopus, and Google searches. The search string "nasal OR respiratory AND artificial intelligence OR machine learning" was used. Most of the studies covered areas of paranasal sinuses radiology, including allergic rhinitis, chronic rhinitis, computed tomography scans, and nasal cytology. RESULTS: Cluster analysis and convolutional neural networks (CNNs) were mainly used in studies related to rhinology. AI is increasingly affecting healthcare research, and ML technology has been used in studies of chronic rhinitis and allergic rhinitis, providing some exciting new research modalities. CONCLUSION: AI is especially useful when there is no conclusive evidence to aid decision making. ML can help doctors make clinical decisions, but it does not entirely replace doctors. However, when critically evaluating studies using this technique, rhinologists must take into account the limitations of its applications and use.

Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years.

BACKGROUND: Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction. PATIENTS AND METHODS: A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3-year period were retrospectively reviewed. Primary microvascular anastomoses were performed to the thoracodorsal vessels in both unipedicled and bipedicled DIEP groups. In bipedicled DIEP flap cases, additional secondary microvascular anastomoses were performed either by extraflap or intraflap options. Clinical characteristics and outcomes were recorded. RESULTS: Unipedicled (n = 89; 53%) and bipedicled flaps were used. Both groups were comparable for mean age, diabetes mellitus, hypertension, smoking, and chemotherapy. BMI was 24.9 ± 3.6 in the unipedicled group and 22.8 ± 2.9 in the bipedicled group (p < .001). The surgical duration was longer in bipedicled group (367 ± 86.5 minu vs 403.7 ± 65.6 min, p < .05) but incidence of fat necrosis decreased in the bipedicle group (24 patients [27%] vs. 7 patients [8.9%] p < .05). There was no flap loss or instance of abdominal hernia in any group. CONCLUSIONS: The bipedicled DIEP flaps may be a feasible option for large breast reconstruction in thin patients. However, the additional microsurgical technical complexity and longer operative time must be considered.

Trochanteric area reconstruction with free flap using perforators as recipients: An alternative and effective option.

BACKGROUND: Reconstructing soft tissue defect on the trochanteric area is challenging. Due to the significant complications associated with regional flap, free tissue transfer is an appropriate option. However, this area has poor recipient vessels. Therefore, we present perforators as suitable recipient vessels to facilitate the use of free flap coverage for the successful reconstruction of defects in the trochanteric area. PATIENTS AND METHODS: From 2013 to 2017, 10 patients underwent free flap reconstruction for soft tissue defects of the trochanteric area. After preoperative computed tomography or magnetic resonance imaging images confirmed the enhanced perforating artery, the skin site was identified by Doppler. If the vessel was confirmed as reliable, the operation was performed in the same manner as for other free flaps. RESULTS: All of the flaps survived, and the perforators selected for surgery included four superficial circumflex iliac artery perforators, four tensor fasciae latae artery perforators, and two inferior gluteal artery perforators. The average diameter of the recipient artery was 0.97 mm and that of the vein was 0.94 mm. One case exhibited arterial insufficiency caused by compression of hematoma; however, complete flap survival was achieved in this case with revised surgery. CONCLUSION: Reconstructing soft tissue defects in the trochanteric area is limited in recipient vessels. However, using a perforator vessel as a recipient facilitates the reconstruction by free flap coverage. This method leads to acceptable flap survival and sufficient padding, with reduced morbidity and collateral injury.

Reconstruction of wide soft tissue defects with extended anterolateral thigh perforator flap turbocharged technique with anteromedial thigh perforator.

BACKGROUND: The necrotic change may sometimes occur in peripheral parts of the flap when harvesting a wide flap in a patient with a relatively thin thigh in anterolateral thigh (ALT) flap. Here, we explore the prophylactic measure of turbocharging the ALT flap with anteromedial thigh (AMT) perforator based on the circumference of the patient's thigh to reduce the risk of partial flap necrosis for the reconstruction of wide defects. PATIENTS AND METHODS: From January 2015 to December 2017, extended ALT perforator turbocharged flaps were done in nine patients. The majority of patients had post oncological or traumatic defects of upper & lower extremities and groin. The age group ranged from 22 to 86 years. The flap size ranged from 12 × 20 cm to 15 × 28 cm. To augment the viability of the ALT flap, we performed an additional microvascular augmentation of the distal or descending branch of the lateral circumflex artery (LCFA) with the sizable AMT perforator. RESULTS: The extended ALT turbocharged flaps survived completely without peripheral necrosis. The average flap width to circumference ratio of the deep tissues including muscles of thigh was 0.379, and the patients' average harvested flaps width and thigh circumference were 14.3 cm and 40.2 cm, respectively. The mean follow-up was 9.3 months. No complications were recorded during the follow-up. CONCLUSION: We believe that augmentation of the ALT and AMT perforator flaps by turbocharging can repair wide soft tissue defects. This method may be another promising option when reconstructing wide defects in the supine position.

Cryopreservation of lipoaspirates: in vitro measurement of the viability of adipose-derived stem cell and lipid peroxidation.

As the storage time of the fat tissue passes by, lipid peroxidation and creation of by-products may take place. The objective of this study was to evaluate the cell viability and functional changes of adipose-derived stem cells (ADSCs) in the cryopreserved lipoaspirates at different temperatures in accordance with lipid peroxidation. Lipoaspirates acquired from liposuction were divided into four different temperature groups and stored at 4°C, -20°C, -80°C, and -196°C. After isolating ADSC from each sample, gross cell morphology and cell viability were compared with doubling time and colony-forming unit (CFU) formation ability. Acid value, that is, thiobarbituric acid value was measured to assess lipid peroxidation. No viable ADSC was observed in -20°C and -196°C samples for past 1 week and a superior number of the live cells were detected in the 4°C group compared with the -80°C group. However, the persistence of cell division and CFU formation after 1 week was only observed in adipocytes stored at -80°C. Lipid peroxidation mainly occurred at 4°C and -20°C storage samples. If the lipoaspirates were planned to be cryopreserved, it is advised to store at -80°C. However, the number of actually functional ADSCs is very low. Furthermore, even in the cryopreserved status, continuous lipid peroxidation and by-product creation took place, suggesting shorter preservation period as possible in the clinics.

Reconstruction of radiation-induced ulcers with free flaps using the perforating vessel as a recipient vessel.

BACKGROUND: Free flaps can be options for coverage of radiation ulcers. However, due to radiation damage, it may be hard to find and dissect a reliable recipient vessel for microsurgical anastomosis. When the radiation fields are targeted for deep tissues, superficial tissues may be less affected by radiation. Therefore, damage to perforator vessels near the skin may be lesser than that to the major vessels in deeper structures. We would like to introduce our experiences of using these less injured perforating vessels within or near the wound as recipient vessels for free flap coverage. PATIENTS AND METHODS: From 2013 to 2015, 11 patients underwent free flap coverage for the treatment of radiation-induced ulceration. The location of ulcers were three cases of thigh, two cases of inguinal area, axilla, trochanteric area, chest wall, lower leg, perineal area, and back. Eleven cases were reconstructed using the anterolateral thigh (ALT) perforator flap, and in one case, the thoracodorsal artery perforator (TDAP) flap was used for inguinal area defect. With preoperative computed tomography, we found perforating vessels around the radiation ulcer. The perforating vessels that were identified before the operation were detected by hand-held Doppler during the operation and meticulous dissection was performed. In all-cases, the perforating vessels were accompanied by vena commitantes. A reliable perforator is one with visible pulsation, strong sound detected on Doppler, and sufficient diameter, preferably larger than 0.6 mm. Anastomosis was performed after confirming that the blood vessel was reliable. RESULTS: The flap sizes ranged from 7 × 6 cm to 24 × 10 cm. No flap total necrosis developed. Patients were followed in the outpatient clinic for 21 to 31 months postoperatively. No patients experienced recurrence of ulceration during the follow-up. CONCLUSIONS: In free flap reconstruction of radiation ulcers, using perforating vessels within or outside the ulcer as recipient vessels provided less damaged vessels and healthier flaps for the defects with minimal wound complications. These perforating vessels can be a good option as recipient vessel for free flap coverage of radiation ulcers.

Comparison of the efficacy and safety of povidone-iodine foam dressing (Betafoam), hydrocellular foam dressing (Allevyn), and petrolatum gauze for split-thickness skin graft donor site dressing.

We evaluated the efficacy and safety of a povidone-iodine (PVP-I) foam dressing (Betafoam) for donor site dressing versus a hydrocellular foam dressing (Allevyn) and petrolatum gauze. This prospective Phase 4 study was conducted between March 2016 and April 2017 at eight sites in Korea. A total of 106 consenting patients (aged ≥ 19 years, scheduled for split-thickness skin graft) were randomised 1:1:1 to PVP-I foam, hydrocellular, or petrolatum gauze dressings for up to 28 days after donor site collection. We assessed time to complete epithelialisation, proportion with complete epithelialisation at Day 14, and wound infection. Epithelialisation time was the shortest with PVP-I foam dressing (12.74 ± 3.51 days) versus hydrocellular foam dressing (16.61 ± 4.45 days; P = 0.0003) and petrolatum gauze (15.06 ± 4.26 days, P = 0.0205). At Day 14, 83.87% of PVP-I foam dressing donor sites had complete epithelialisation, versus 36.36% of hydrocellular foam dressing donor sites (P = 0.0001) and 55.88% of petrolatum gauze donor sites (P = 0.0146). There were no wound infections. Incidence rates of adverse events were comparable across groups (P = 0.1940). PVP-I foam dressing required less time to complete epithelialisation and had a good safety profile.

Bony Changes in a Unilateral Maxillary Sinus Fungal Ball.

OBJECTIVES: In the paranasal sinus fungal ball (SFB), changes that occur in the underlying bone have not been well described. Recently, bacterial coinfection has been reported in patients with paranasal SFB. We evaluated whether bone changes occur in patients with unilateral maxillary SFB, and also how bacteria in an SFB affect the bony wall of the sinus. METHODS: A retrospective study of patients with a unilateral maxillary SFB undergoing endoscopic sinus surgery was conducted from July 2009 to December 2015. Preoperative computed tomography images of the patients were reviewed. Wall thickness (WT) and wall density (WD) of the diseased sinus were measured and compared to the normal sinus. Specimens of the sinus aspirates were obtained during surgery for aerobic and anaerobic cultures. RESULTS: Forty-three patients were included (mean, 55.7 ±â€Š12.8 years). Thirty-one cultures (72.1%) were positive for bacteria. Thickening was evident in the anterior, lateral, and posterior walls of the diseased sinus. The average WT was 1.69 ±â€Š0.45 mm on the diseased sinus and 1.14 ±â€Š0.31 mm on the normal sinus (P < 0.001). In the diseased sinus, the difference in the average WT between the culture-positive and culture-negative groups was not significant (P = 0.44). The average WD on the diseased sinus was higher than that on the normal sinus (P < 0.001). CONCLUSIONS: Osteitic change occurred in most patients with a unilateral maxillary SFB. The presence of bacteria in sinus secretions does not greatly affect the development of osteitic changes in unilateral maxillary SFB.

A perforator from the ulnar artery and cutaneous nerve of the hypothenar area: An anatomical study for clinical application.

PURPOSE: The hypothenar perforator flap is a recently introduced method for fingertip reconstruction, which offers excellent results but lacks adequate anatomic studies. The present study is aimed to clarify the anatomic characteristics of the hypothenar area to analyze the potential clinical application of sensate flaps and to access the reliability of hypothenar perforator arteries. MATERIALS AND METHODS: A total of 26 amputated forearms were used, and a percentage scattergram using an x-y-axis was created. The y-axis was a vertical line from the midpoint of pisiform base (0%) to the midvolar crease of the metacarpophalangeal joint (100%). The x-axis was a line perpendicular to the y-axis, and was quantified as a percentage value. We then studied the number of perforators, the diameter and length of the pedicle, and evaluated the differences between the zones and sexes. RESULTS: A reliable region for the hypothenar perforator flap, including more than two perforator arteries with an average diameter of over 1 mm, was mapped as 5%-20% on the x-axis and 10%-50% on the y-axis. The nerves appeared to occur more densely than the arteries, with 5%-15% on the x-axis and 25%-60% on the y-axis. CONCLUSION: The most consistent area for sensate flap elevation was the region around 5%-15% on the x-axis and 25%-50% on the y-axis. We expect that our data concerning perforator artery and cutaneous nerve branches in the hypothenar area of the hand will aid in establishing appropriate clinical usage of the hypothenar perforator flap. © 2014 Wiley Periodicals, Inc. Microsurgery 37:49-56, 2017.

Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation.

Background There are a few previous studies of the vascular anatomy of the fingertips. The aim of this study was to evaluate this anatomy and the distribution of fingertip arteries. Patients and Methods A total of 31 cadaveric hands were used for evaluation of the vascular pattern of the fingertips on X-ray images obtained using a radiopaque material. We analyze the anatomy of the fingertip arteries, and classified it into three types in Tamai zone I. If only one dominant artery branched off from the distal transverse palmar arch, it was classified as type I. If the fingertip had branches of two dominant arteries, it was classified as type II, and if the fingertip had branches of three or more dominant arteries, it was classified as type III. Results The incidence of type I was 27%, that of type II was 28%, and the incidence of type III was 45%, the latter being the most frequent. In addition, we analyzed the pattern in each finger. The frequency of type III decreased from the index finger to the little finger, and the frequencies of types I and II increased from the index finger to the little finger. Conclusion Type III was the most common type in fingers, and its frequency decreased from the index finger to the little finger.

The effect of diabetes on the wound healing potential of adipose-tissue derived stem cells.

To investigate whether diabetes mellitus affects the wound-healing-promoting potential of adipose tissue-derived stem cells, we designed a wound-healing model using diabetic mice. We compared the degree of wound healing between wounds treated with normal adipose tissue-derived stem cells and wounds treated with diabetic adipose tissue-derived stem cells. We evaluated the wound-healing rate, the epithelial tongue distance, the area of granulation tissue, the number of capillary and the number of Ki-67-stained cells. The wound-healing rate was significantly higher in the normal adipose tissue-derived stem cells group than in the diabetic adipose tissue-derived stem cells group; it was also significantly higher in the normal adipose tissue-derived stem cells group than in the control group. Although the diabetic adipose tissue-derived stem cells group showed a better wound-healing rate than the control group, the difference was not statistically significant. Similar trends were observed for the other parameters examined: re-epithelisation and keratinocyte proliferation; granulation tissue formation; and dermal regeneration. However, with regard to the number of capillary, diabetic adipose tissue-derived stem cells retained their ability to promote neovasculisation and angiogenesis. These results reflect the general impairment of the therapeutic potential of diabetic adipose tissue-derived stem cells in vivo.

Expression of 11ß-hydroxysteroid dehydrogenase 1 and 2 in patients with chronic rhinosinusitis and their possible contribution to local glucocorticoid activation in sinus mucosa.

BACKGROUND: It has been suggested that glucocorticoids might act in target tissues to increase their own intracellular availability in response to inflammatory stimuli. These mechanisms depend on the local metabolism of glucocorticoids catalyzed by 11ß-hydroxysteroid dehydrogenase 1 (11ß-HSD1) and 11ß-hydroxysteroid dehydrogenase 2 (11ß-HSD2). OBJECTIVE: This study is to investigate the effect of chronic rhinosinusitis (CRS) on expression of 11ß-HSD1, 11ß-HSD2, steroidogenic enzymes (cytochrome P450, family 11, subfamily B, polypeptide 1 [CYP11B1] and cytochrome P450, family 11, subfamily A, polypeptide 1 [CYP11A1]), and endogenous cortisol levels in human sinus mucosa. Expression levels were compared with those of healthy control subjects. METHODS: The expression levels of 11ß-HSD1, 11ß-HSD2, CYP11B1, CYP11A1, and cortisol were measured in healthy control subjects, patients with CRS with nasal polyps, and patients with CRS without nasal polyps by using real-time PCR, Western blotting, immunohistochemistry, and ELISA. Expression levels of 11ß-HSD1, 11ß-HSD2, CYP11B1, CYP11A1, and cortisol were determined in cultured epithelial cells treated with CRS-relevant cytokines. The conversion ratio of cortisone to cortisol was evaluated by using the small interfering RNA technique, 11ß-HSD1 inhibitor, and measurement of 11ß-HSD1 activity. RESULTS: 11ß-HSD1, CYP11B1, and cortisol levels increased in patients with CRS with nasal polyps and those with CRS without nasal polyps, but 11ß-HSD2 expression decreased. In cultured epithelial cells treated with IL-4, IL-5, IL-13, IL-1ß, TNF-α, and TGF-ß1, 11ß-HSD1 expression and activity increased in parallel with expression levels of CYP11B1 and cortisol, but the production of 11ß-HSD2 decreased. The small interfering RNA technique or the measurement of 11ß-HSD1 activity showed that the sinus epithelium activates cortisone to cortisol in an 11ß-HSD-dependent manner. CONCLUSION: These results indicate that CRS-relevant cytokines can modulate the expression of 11ß-HSD1, 11ß-HSD2, and CYP11B1 in the sinus mucosa, resulting in increasing intracellular concentrations of bioactive glucocorticoids.

Prevention of postsurgical scars: comparsion of efficacy and convenience between silicone gel sheet and topical silicone gel.

To date, few studies have compared the effectiveness of topical silicone gels versus that of silicone gel sheets in preventing scars. In this prospective study, we compared the efficacy and the convenience of use of the 2 products. We enrolled 30 patients who had undergone a surgical procedure 2 weeks to 3 months before joining the study. These participants were randomly assigned to 2 treatment arms: one for treatment with a silicone gel sheet, and the other for treatment with a topical silicone gel. Vancouver Scar Scale (VSS) scores were obtained for all patients; in addition, participants completed scoring patient questionnaires 1 and 3 months after treatment onset. Our results reveal not only that no significant difference in efficacy exists between the 2 products but also that topical silicone gels are more convenient to use. While previous studies have advocated for silicone gel sheets as first-line therapies in postoperative scar management, we maintain that similar effects can be expected with topical silicone gel. The authors recommend that, when clinicians have a choice of silicone-based products for scar prevention, they should focus on each patient's scar location, lifestyle, and willingness to undergo scar prevention treatment.

In vivo effects of adipose-derived stem cells in inducing neuronal regeneration in Sprague-Dawley rats undergoing nerve defect bridged with polycaprolactone nanotubes.

There have been many attempts for regeneration of peripheral nerve injury. In this study, we examined the in vivo effects of non-differentiated and neuronal differentiated adipose-derived stem cells (ADSCs) in inducing the neuronal regeneration in the Sprague-Dawley (SD) rats undergoing nerve defect bridged with the PCL nanotubes. Then, we performed immunohistochemical and histopathologic examinations, as well as the electromyography, in three groups: the control group (14 sciatic nerves transplanted with the PCL nanotube scaffold), the experimental group I (14 sciatic nerves with the non-differentiated ADSCs at a density of 7×10(5) cells/0.1 mL) and the experimental group II (14 sciatic nerves with the neuronal differentiated ADSCs at 7×10(5) cells/0.1 mL). Six weeks postoperatively, the degree of the neuronal induction and that of immunoreactivity to nestin, MAP-2 and GFAP was significantly higher in the experimental group I and II as compared with the control group. In addition, the nerve conduction velocity (NCV) was significantly higher in the experimental group I and II as compared with the control group (P=0.021 and P=0.020, respectively). On the other hand, there was no significant difference in the NCV between the two experimental groups (P>0.05). Thus, our results will contribute to treating patients with peripheral nerve defects using PCL nanotubes with ADSCs.

Efficacy and safety of porcine collagen filler for nasolabial fold correction in Asians: a prospective multicenter, 12 months follow-up study.

Recently, injectable dermal fillers have become important alternatives to surgical procedures for the correction of facial wrinkles. Bovine collagen is the first approved material for filler injection, and several studies have shown its efficacy. However, the risk of developing an allergic reaction and xenogenic transmission of bovine spongiform encephalopathy remain among its disadvantages. In this randomized, double-blinded, split-face study, we compared the efficacy and safety of a porcine collagen filler (TheraFill®) with that of a bovine collagen filler (KOKEN®) for nasolabial fold correction. A total of sixty one patients with mild to severe nasolabial fold were randomized to receive TheraFill® and KOKEN® on contralateral sides of the face. During the 12-month follow-up period, improvement in the Wrinkle-Severity Rating Scale score was slightly higher in TheraFill® group than KOKEN® group, although the difference was not statistically significant. No serious adverse reactions were observed and both materials were tolerable in most cases. In conclusion, the long-term effect of TheraFill® on nasolabial fold correction was comparable to that of KOKEN®, and it may be a good alternative to bovine collagen filler.