RESUMO
INTRODUCTION: Because of the obesity epidemic, more obese patients are on liver transplant (LT) waiting lists. The diseases associated with obesity may increase complications and limit survival after LT. However, there is no established measure or cut-off point to determine this impact and aid decision making. The aim of the present study is to evaluate obesity in patients undergoing LT via BMI and CT-based measurement of adipose tissue (AAT). These parameters will be used to predict the risk of postoperative complications and 5-year survival. METHODS: A retrospective, single-center study was carried out at a tertiary Spanish hospital, including all patients who received LT between January 2012 and July 2019 (n = 164). The patients were adults who underwent LT using the 'piggyback' technique, preserving the recipient vena cava. Visceral adipose tissue (VAT) and BMI were calculated to examine correlations with postoperative complications and 5-year survival. RESULTS: No significant association was found between postoperative complications by Comprehensive Complication Index, BMI, AAT/height, subcutaneous fat/height and VAT/height. Kaplan-Meier curves for 5-year survival compared LT recipients with BMI < 30.45 versus ≥30.45, with an estimated survival of 58.97 months versus 43.11 months, respectively (P < .001) (Fig. 3) and for LT recipients with an AAT/height <27.35 mm versus ≥27.35 mm, with an estimated survival of 57.69 months versus 46.34 months (P = .001). CONCLUSIONS: This study does not show a higher rate of postoperative complications in obese patients. There is a significantly lower long-term survival in patients with AAT/height ≥27.35 mm and BMI ≥ 30.45. BMI is a valid estimate of obesity and is predictive of survival.
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Índice de Massa Corporal , Transplante de Fígado , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Obesidade/complicações , Gordura Abdominal/transplante , Gordura Abdominal/diagnóstico por imagem , Adulto , Taxa de Sobrevida , Idoso , Tomografia Computadorizada por Raios X , Estimativa de Kaplan-Meier , Gordura Intra-Abdominal/diagnóstico por imagemRESUMO
Los grandes defectos torácicos requieren generalmente procedimientos complejos para su reparación; en la mayoría de los casos es necesaria la combinación de tejidos autólogos y materiales protésicos, por lo que constituye un desafío para el cirujano plástico. En nuestra experiencia se presenta una herida compleja de la pared torácica secundaria a exéresis tumoral. En general se dispone de varias opciones reconstructivas para cubrir los defectos resultantes de las amplias escisiones y poder aportar colgajos vascularizados, amplios y voluminosos. A pesar de no disponer en nuestro caso con los tejidos regionales más comúnmente usados, hemos podido dar cobertura a todo el defecto y se ha garantizado una adecuada estabilidad de la pared torácica. Se tuvo como objetivo mostrar la forma en que se realizó la reconstrucción inmediata con la combinación de colgajo de rotación y material protésico. En este artículo se revisa el hemicolgajo dermograso abdominal, la técnica de elevación y sus ventajas e inconvenientes. Se trata de una técnica de gran seguridad, versátil, con pocas secuelas en la zona donante, de tiempo quirúrgico relativamente corto.
Large thoracic defects require complex procedures for repair, in most cases it requires the combination of autologous tissues and prosthetic materials. A complex wound secondary to tumor exeresis was presented in our service. Among the multiple reconstructive options, a rotation and advancement abdominal dermofat hemicolgajo was chosen. Resulting in a technique of great safety, versatile, with little sequel in the donor area, and short surgical time
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Humanos , Feminino , Pessoa de Meia-Idade , Próteses e Implantes , Neoplasias da Mama/cirurgia , Parede Torácica/cirurgia , Gordura Abdominal/transplante , Retalho Miocutâneo/transplante , Mastectomia/métodosRESUMO
OBJECTIVES/HYPOTHESIS: Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. METHODS: Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. RESULTS: For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. CONCLUSIONS: This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:E124-E131, 2021.
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Gordura Abdominal/transplante , Atenção , Tecnologia de Rastreamento Ocular , Face , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição AleatóriaAssuntos
Doença de Hodgkin/cirurgia , Linfoma de Células T/cirurgia , Neoplasias Parotídeas/cirurgia , Gordura Abdominal/transplante , Adolescente , Feminino , Doença de Hodgkin/diagnóstico por imagem , Humanos , Linfoma de Células T/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias Parotídeas/diagnóstico por imagemRESUMO
BACKGROUND: Radiation therapy for intracranial lesions is constrained by dose to neurologic organs at risk. CASE DESCRIPTION: We report 2 cases, a newly diagnosed chondrosarcoma and a previously irradiated meningioma, with tumors that abutted the optic chiasm following subtotal resection. Definitive radiotherapy would have required either undercoverage of the tumor or treatment of the chiasm with doses posing an unacceptable risk of blindness. Therefore, the patients underwent open surgery with placement of an abdominal fat autograft to provide space between the tumor and the optic structures at risk. Patients received definitive fractionated stereotactic radiotherapy. For each patient, we retrospectively compared the treated plan (with fat autograft) to a second plan generated using the pre-autograft imaging, maintaining similar tumor coverage. For the chondrosarcoma, the fat autograft reduced the optic chiasm maximum dose by 21% (70.4 Gy to 55.3 Gy). For the reirradiated peri-optic meningioma, the optic chiasm maximum dose was reduced by 10% (50.8 Gy to 45.9 Gy), the left optic nerve by 17% (48.9 Gy to 40.4 Gy), and the right optic nerve by 30% (32.3 Gy to 22.6 Gy). CONCLUSIONS: We demonstrate the utility of abdominal fat autograft placement to maximize coverage of tumor while minimizing dose to intracranial organs at risk.
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Gordura Abdominal/transplante , Neoplasias Encefálicas/radioterapia , Quiasma Óptico/efeitos da radiação , Lesões por Radiação/prevenção & controle , Radiocirurgia/métodos , Adulto , Autoenxertos , Condrossarcoma/radioterapia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Órgãos em Risco , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodosRESUMO
BACKGROUND: Abdominally based free tissue transfer (FTT) and latissimus dorsi and immediate fat transfer (LIFT) procedures are both fully autologous options for breast reconstruction. The former is specialized and requires comfort with microsurgical technique, whereas LIFT combines a common set of techniques familiar to all plastic surgeons. Comparing the two methods for clinical effectiveness and complications for equivalency in outcomes may help elucidate and enhance patient decision-making. METHODS: A retrospective review of a prospectively maintained database between March of 2017 and July of 2018 was performed to compare the LIFTs and FTTs performed by the senior surgeon. Outcomes of interest included postoperative complications, flap success, and follow-up revision and fat-grafting procedures. RESULTS: Sixty-five breasts were reconstructed by FTT; and 31 breasts were reconstructed with LIFT. Demographics were similar (p > 0.05). LIFT had a shorter length of operation time (343 ± 128 minutes versus 49 ± 137 minutes) (p < 0.0001) and a shorter length of stay (1.65 ± 0.85 days versus 3.83 ± 1.65 days) (p < 0.001). FTTs had a shorter time until drain removal (13.3 ± 4.3 days versus 24.0 ± 11.2 days) (p < 0.0001). The number of major (requiring operation) and minor complications were not statistically different (i.e., FTTs, 20.0 percent major and 27.7 percent minor; LIFT, 12.9 percent major and 19.35 percent minor) (p > 0.05). The need for revisions (FTTs, 0.80 ± 0.71; LIFT, 0.87 ± 0.71) and fat grafting (FTTs, 41.54 percent; LIFT, 58.8 percent) was not statistically different (p > 0.05). CONCLUSIONS: Both the LIFT and abdominally based FTT have similar outcomes and complication rates. However, LIFT may be preferred in patients who require shorter operation times. The LIFT may be the fully autologous breast reconstruction of choice for nonmicrosurgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos
Gordura Abdominal/transplante , Neoplasias da Mama/cirurgia , Mama/cirurgia , Retalhos de Tecido Biológico , Mamoplastia/métodos , Microcirurgia/métodos , Músculos Superficiais do Dorso/transplante , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Genitourinary atrophy is a menopausal pathological change determined by the definitive drop of ovarian hormones' production that can impact heavily on the health status of women, with important direct and indirect social costs. Unfortunately, available treatments are only symptomatic, and they are not able to reverse the atrophy and other related symptoms. Regenerative medicine, with single local injection of autologous micro-fractured fat tissue, could represent a viable new solution for these patients as it not only helps to relieve symptoms, but it also counteracts the mechanisms that lead to the menopausal genitourinary atrophy. The objective of this paper is to evaluate the long-term effectiveness of micro-fractured fat vulvar injection for genito-urinary atrophy in patients, affected by severe genitourinary atrophy (at least 4 symptoms lasting for at least 4 years). PATIENTS AND METHODS: We present a case series of 35 patients followed for 36 months to evaluate the effectiveness and safety of a single subcutaneous vulvar injection of autologous micro-fragmented fat tissue (MFAT). RESULTS: We have not observed any adverse effects in any patients. All symptoms, and especially pelvic pain and dyspareunia, improved in almost half of patients within 3 months. Ninety-nine percent of patients recovered completely from all symptoms after 9-12 months, reporting no relapse of the symptoms up to the third year of follow up. CONCLUSIONS: Our case series is the first case series, evaluating the long-term (3 years) safety and effectiveness of micro-fragmented adipose tissue graft for urogenital atrophy.
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Gordura Abdominal/transplante , Doenças Urogenitais Femininas/cirurgia , Dor Pélvica/cirurgia , Pós-Menopausa , Adulto , Idoso , Atrofia , Dispareunia/patologia , Dispareunia/fisiopatologia , Dispareunia/cirurgia , Feminino , Doenças Urogenitais Femininas/patologia , Doenças Urogenitais Femininas/fisiopatologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Dor Pélvica/patologia , Dor Pélvica/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Transplante Autólogo , Resultado do TratamentoRESUMO
Importance: Iatrogenic olfactory dysfunction after endoscopic transsphenoidal hypophysectomy (ETSH) is an overlooked complication without elucidated risk factors. Objective: To assess the independent prognostic role of demographic, comorbidity, cephalometric, intraoperative, histological, and postoperative parameters in patient-reported postoperative olfactory dysfunction, and to explore the association between anatomical measurements of the skull base and sinonasal cavity and postoperative olfactory dysfunction. Design, Setting, and Participants: This retrospective cohort study in a tertiary care medical center enrolled consecutive patients with primary sellar lesions who underwent ETSH between January 1, 2015, and January 31, 2019. Patients were excluded if they underwent multiple sinonasal surgical procedures, presented with a sellar malignant neoplasm, required an expanded transsphenoidal approach, had nasal polyposis or a neurodegenerative disease, or sustained traumatic brain injury. After undergoing medical record review and telephone screening, patients were asked to participate in a 3-item telephone survey. Main Outcomes and Measures: The primary outcome was the Clinical Global Impressions change in smell rating, a validated transitional patient-reported outcome measure. Patients rated their change in smell before and after ETSH on a 7-point Likert scale, with the following response options: (1) much better, (2) somewhat better, (3) slightly better, (4) neither better nor worse, (5) slightly worse, (6) somewhat worse, or (7) much worse. Responses of slightly worse, somewhat worse, and much worse were surrogates for postoperative olfactory dysfunction status. Patient medical records, preoperative imaging scans, operative notes, and pathology reports were reviewed. Results: Of the 147 patients (mean [SD] age, 54 [15] years; 79 women [54%]) who responded to the telephone survey, 42 (29%) reported olfactory dysfunction after ETSH. Median (interquartile range [IQR]) time between the ETSH completion and survey response was 31.1 (21-43) months. On multivariable analysis, abdominal fat grafting (adjusted relative risk [aRR], 2.95; 95% CI, 1.89-4.60) was associated with postoperative olfactory dysfunction, whereas smoking history (aRR, 1.54; 95% CI, 0.95-2.51) demonstrated a clinically meaningful but imprecise effect size. A more obtuse angle between the planum sphenoidale and face of the sella turcica on sagittal imaging was protective (aRR, 0.98; 95% CI, 0.96-0.99). Increased number of months after the ETSH was associated with patient-reported normosmia (aRR, 0.93; 95% CI, 0.91-0.95). In contrast, other comorbidities; intraoperative variables such as turbinate resection, nasoseptal flap, and mucosal or bone grafting; histological variables such as pathology and proliferative index; and postoperative variables such as adjuvant radiotherapy were not associated with postoperative olfactory dysfunction. Conclusions and Relevance: This study found that abdominal fat grafting, acute skull base angle, and smoking history appeared to be clinically significant risk factors for patient-reported postoperative olfactory dysfunction. Increased time after ETSH may be associated with better olfactory outcomes.
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Hipofisectomia/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Transtornos do Olfato/etiologia , Sela Túrcica/cirurgia , Gordura Abdominal/transplante , Variação Anatômica , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/cirurgia , Cefalometria , Feminino , Humanos , Hipofisectomia/métodos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/anatomia & histologia , Cavidade Nasal/diagnóstico por imagem , Cirurgia Endoscópica por Orifício Natural/métodos , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Sela Túrcica/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Base do Crânio/anatomia & histologia , Base do Crânio/diagnóstico por imagem , Fumar/efeitos adversosRESUMO
BACKGROUND: Body mass index (BMI) has long been the proxy for patient selection in obese patients presenting for abdominally based breast reconstruction. BMI, however, fails to accurately reflect the distribution of abdominal adipose tissue. This study aims to quantify the effect of abdominal wall thickness on the incidence of post-operative complications and contrast abdominal wall thickness and BMI as predictors of post-operative morbidity. METHODS: We performed a retrospective review of 106 consecutive patients who underwent abdominally based breast reconstruction. Abdominal wall thickness was quantified using preoperative CT angiograms. Primary outcomes included delayed wound healing (abdomen and/or breast), flap fat necrosis, return to OR in 30 days, infection, and flap loss. RESULTS: Patients experiencing delayed abdominal wound healing (n=38), delayed breast wound healing (n=27), and flap fat necrosis (n=24) had significantly thicker abdominal wall measurements (p<0.0015). Of the 24 patients with palpable fat necrosis, 11 required excision. Increasing abdominal wall thickness significantly increased the odds of delayed abdominal wound healing (p=0.0005), delayed breast wound healing (p=0.0009), flap fat necrosis (p=0.0028), and infection (p=0.0198). Compared to BMI, abdominal wall thickness proved to be a more accurate predictor of delayed breast wound healing, any delayed wound healing, flap fat necrosis, and infection. CONCLUSIONS: Our data indicate that as abdominal wall thickness increases, so does the risk of postoperative morbidity. Abdominal wall thickness outperformed BMI as a predictor of postoperative morbidity in several areas. This suggests that objective data obtained from preoperative CT scans may allow more accurate, individualized perioperative risk assessment.
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Gordura Abdominal/transplante , Parede Abdominal/patologia , Mamoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
Platelet-rich plasma (PRP) has been widely used to improve the fat retention rate in autologous fat transplantation since it possesses a good angiogenesis capability in vivo. However, due to the short half-life of growth factors released from PRP and its uneven distribution in injected fat tissue, the strategy of PRP in fat transplantation needs further improvement. Since the capillaries started to grow into fat grafts in 1 week and vascular growth peaks in the second week after transplantation, we hypothesized that delayed two-steps PRP injection into the interior of grafts, accompanied with the extent of neovascularization might theoretically promote microvessel growth inside transplanted adipose tissue. 24 nude mice were divided into three groups: Blank group (0.35 mL fat mixed with 0.15 mL saline, N = 8), Single step group (0.35 mL fat mixed with 0.15 mLPRP, N = 8), and Two steps group (0.35 mL fat (day 0) + 0.075 mL PRP (day 7) + 0.075 mL PRP (day 14), N = 8). At 6 and 14 weeks post-transplantation, grafts were dissected, weighted, and assessed for histology, angiogenesis, fat regeneration and inflammation level. The weight and volume of the fat samples revealed no statistical difference among the three groups at 6 weeks after fat transplantation. The weight and volume of the Two steps group fat samples showed significantly higher compared to that in Blank and Single step groups at 14 weeks after fat transplantation (weight: 137.25 ± 5.60 mg versus 87.5 ± 3.90 mg,106.75 ± 2.94 mg, respectively; volume: 0.13 ± 0.01 mL versus 0.08 ± 0.01 mL, 0.09 ± 0.01 mL, respectively). Histological assessments indicated that delayed two-steps PRP injection strategy helps to improve adipose tissue content and reduce the composition of fibrous connective tissue at 14 weeks after fat transplantation. At 6 weeks and 14 weeks after transplantation, CD31 immunofluorescence indicated that delayed two-steps PRP injection strategy helps to improve angiogenesis and significantly higher compared to that in Blank and Single step groups (6 weeks: 28.75 ± 4.54 versus 10.50 ± 2.06, 21.75 ± 1.85; 14 weeks: 21.75 ± 2.86 versus 9.87 ± 2.08, 11.75 ± 1.47, respectively). Preadipocyte count indicated delayed two-steps PRP injection strategy might promote fat regeneration and significantly higher compared to that in Blank and Single step groups at 14 weeks (129.75 ± 6.57 versus 13.50 ± 3.50, 17.12 ± 6.23, respectively). In this study, we demonstrated that the novel delayed two-steps PRP injection strategy remarkably enhanced the long-term fat retention rate and improved the neovascularization extent in the interior of the fat graft. Platelet-rich plasma, Delayed two-steps injection, Angiogenesis, Fat transplantation.
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Gordura Abdominal/irrigação sanguínea , Gordura Abdominal/transplante , Neovascularização Fisiológica/fisiologia , Plasma Rico em Plaquetas , Gordura Abdominal/citologia , Adipócitos/citologia , Adulto , Animais , Capilares , Sobrevivência Celular , Feminino , Meia-Vida , Humanos , Injeções , Macrófagos , Masculino , Camundongos Endogâmicos BALB C , Plasma Rico em Plaquetas/metabolismoRESUMO
Fat injections aid in the healing of radiation-induced skin damage. We hypothesized that the direct application of fat grafts to the surfaces of radiation-induced ulcers is also effective. Here, we aimed to evaluate the effectiveness of a combination treatment comprising fat injections around ulcers and fat grafts on ulcer surfaces. The dorsal skin of inbred rats was irradiated at a single dose of 20 Gy before producing ulcers. After the inguinal fat was harvested using the Coleman technique, the rats were divided into four groups: Group 1, ulcer wounds were covered using dressing materials and staples only; Group 2, fat was injected around the ulcers using a cannula; Group 3, fat was grafted onto ulcer surfaces; and Group 4, a combination of fat injection around the ulcers and fat grafts onto ulcer surfaces was employed. The mean healing time (± standard deviation) of each group was as follows: Group 1, 16.0 ± 2.2 days; Group 2, 14.5 ± 2.0 days; Group 3, 15.2 ± 1.7 days; and Group 4, 13.4 ± 1.0 days. The healing time of Group 4 was significantly shorter than that of Group 1 (p = .0005) and Group 3 (p = .023). In both groups that received fat grafts, fat tissue was observed in the dermis on hematoxylin-eosin-stained slides at 4 and 8 weeks after the ulcers were created. In conclusion, the combination treatment of fat grafted onto ulcer surfaces and injected around ulcers was effective in accelerating the epithelization of radiation-induced ulcers.
Assuntos
Gordura Abdominal/transplante , Injeções , Úlcera Cutânea/terapia , Retalhos Cirúrgicos , Cicatrização , Animais , Modelos Animais de Doenças , Epiderme/patologia , Lesões Experimentais por Radiação , Ratos Endogâmicos F344 , Úlcera Cutânea/etiologia , Fatores de TempoRESUMO
BACKGROUND: Autologous fat transfer has been widely used in breast augment surgery. The breast fat graft is different form facial, it needs megavolume grafts. However, most Asian women are thin, who often encounter the fat resource insufficiency during breast augmentation. In fact, some processing methods do contribute to great loss of potential fat that could have been grafted. How to choose a best processing method to achieve optimal transfer in patients with insufficient fat resources is fairly important. METHODS: Lipoaspirate was obtained from 10 healthy female patients who underwent liposuction from abdomen. According to the processing methods, 10-mL initial fat grafts divided into 4 groups: decantation (group A), centrifugation (group B), cotton pad (group C), and cell-assisted lipotransfer (CAL) (group D). Lipoaspirate from each group was compared in the vitro and vivo experiments. The content and function of stromal vascular fraction (SVF) were compared as well as lipoaspirate survival after grafting in nude mice. RESULTS: The SVFs were counted in decantation group 4.32 ± 0.75 × 10/mL, centrifuge group 3.48 ± 0.78 × 10/mL, cotton pad group 1.64 ± 0.84 × 10/mL, CAL group 4.08 ± 0.73 × 10/mL. The decantation group was higher than the cotton pad group (P < 0.05). All the groups' SVFs had capability of multilineage differentiation. The fat graft weight in decantation group: 0.3908 ± 0.023 g, centrifuge group 0.3073 ± 0.015 g, cotton pad group 0.1726 ± 0.019 g, and CAL group 0.2396 ± 0.021 g. The weight of the fat graft in the decantation group was greater than that of the centrifugation group, cotton pad group and CAL group (P < 0.05). There was no significant difference in cell integrity, necrotic cysts and fibrosis between the groups. The vascularization degree in the cotton pad group was lower than that in the decantation group (P < 0.05). CONCLUSIONS: Decantation processing can achieve optimal transplantation in patients who have insufficient fat resources.
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Gordura Abdominal/transplante , Lipectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Animais , Biópsia por Agulha , China , Modelos Animais de Doenças , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Voluntários Saudáveis , Humanos , Imuno-Histoquímica , Técnicas In Vitro , Camundongos , Camundongos Endogâmicos BALB C , Transplante Autólogo/métodosRESUMO
INTRODUCTION: In reconstructive surgery, fat volume augmentation is often necessary for esthetic or functional reasons. As an alternative to synthetic and xenogeneic materials, autologous fat grafting (AFG) based on liposuction is gaining popularity, yet successful transplantation and long-term volume maintenance are difficult. Standard tumescent solution formulations neglect adipocyte and stromal vascular fraction (SVF) cell survival during extraction, as well as SVF differentiation into adipocytes thereafter, all of which are crucial for the success of AFG. Here we hypothesized that addition of ascorbic acid (AA) to the tumescent solution could prevent liposuction-induced cell damage. MATERIALS AND METHODS: The effect of 0.1 mmol/L AA in tumescent solution was investigated in a previously described ex vivo model of AFG. Briefly, excision fat was infiltrated with tumescent solution, with or without AA, and incubated for 20 minutes at 37°C. Hand-assisted liposuction was then performed with a blunt cannula. Total cell viability, clonogenicity, and differentiation capacity of the SVF cells were assessed. RESULTS: With AA, 10.3% more cells and in particular 14.9% more adipocytes survived liposuction. Clonogenicity, adipocyte and osteoblast differentiation by SVF cells remained unchanged. CONCLUSIONS: Addition of AA successfully improved survival of adipocytes during liposuction without affecting SVF growth and differentiation. This study therefore identified a useful supplement to the tumescent solution which may lead to improving AFG success.
Assuntos
Gordura Abdominal/transplante , Tecido Adiposo/transplante , Ácido Ascórbico/farmacologia , Sobrevivência Celular/fisiologia , Lipectomia/métodos , Adipócitos/transplante , Adulto , Idoso , Anestésicos Locais , Diferenciação Celular , Estudos de Coortes , Feminino , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Células Estromais/transplante , Transplante Autólogo/métodosRESUMO
IMPORTANCE: Adipose-derived mesenchymal stem cells (ASCs) have been used commonly in regenerative medicine and increasingly for head and neck surgical procedures. Lipoaspiration with centrifugation is purported to be a mild method for the extraction of ASCs used for autologous transplants to restore tissue defects or induce wound healing. The content of ASCs, their paracrine potential, and cellular potential in wound healing have not been explored for this method to our knowledge. OBJECTIVE: To evaluate the characteristics of lipoaspirates used in reconstructive head and neck surgical procedures with respect to wound healing. DESIGN, SETTING, AND PARTICIPANTS: This case series study included 15 patients who received autologous fat injections in the head and neck during surgical procedures at a tertiary referral center. The study was performed from October 2017 to November 2018, and data were analyzed from October 2017 to February 2019. MAIN OUTCOMES AND MEASURES: Excessive material of lipoaspirates from subcutaneous abdominal fatty tissue was examined. Cellular composition was analyzed using immunohistochemistry (IHC) and flow cytometry, and functionality was assessed through adipose, osteous, and chondral differentiation in vitro. Supernatants were tested for paracrine ASC functions in fibroblast wound-healing assays. Enzyme-linked immunosorbent assay measurement of tumor necrosis factor (TNF), vascular endothelial growth factor (VEGF), stromal-derived factor 1α (SDF-1α), and transforming growth factor ß3 (TGF-ß3) was performed. RESULTS: Among the 15 study patients (8 [53.3%] male; mean [SD] age at the time of surgery, 63.0 [2.8] years), the stromal vascular fraction (mean [SE], 53.3% [4.2%]) represented the largest fraction within the native lipoaspirates. The cultivated cells were positive for CD73 (mean [SE], 99.90% [0.07%]), CD90 (99.40% [0.32%]), and CD105 (88.54% [2.74%]); negative for CD34 (2.70% [0.45%]) and CD45 (1.74% [0.28%]) in flow cytometry; and negative for CD14 (10.56 [2.81] per 300 IHC score) and HLA-DR (6.89 [2.97] per 300 IHC score) in IHC staining; they differentiated into osteoblasts, adipocytes, and chondrocytes. The cultivated cells showed high expression of CD44 (mean [SE], 99.78% [0.08%]) and CD273 (82.56% [5.83%]). The supernatants were negative for TNF (not detectable) and SDF-1α (not detectable) and were positive for VEGF (mean [SE], 526.74 [149.84] pg/mL for explant supernatants; 528.26 [131.79] pg/106 per day for cell culture supernatants) and TGF-ß3 (mean [SE], 22.79 [3.49] pg/mL for explant supernatants; 7.97 [3.15] pg/106 per day for cell culture supernatants). Compared with control (25% or 50% mesenchymal stem cell medium), fibroblasts treated with ASC supernatant healed the scratch-induced wound faster (mean [SE]: control, 1.000 [0.160]; explant supernatant, 1.369 [0.070]; and passage 6 supernatant, 1.492 [0.094]). CONCLUSIONS AND RELEVANCE: The cells fulfilled the international accepted criteria for mesenchymal stem cells. The lipoaspirates contained ASCs that had the potential to multidifferentiate with proliferative and immune-modulating properties. The cytokine profile of the isolated ASCs had wound healing-promoting features. Lipoaspirates may have a regenerative potential and an application in head and neck surgery. LEVEL OF EVIDENCE: NA.
Assuntos
Gordura Abdominal/citologia , Gordura Abdominal/transplante , Disfonia/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Células-Tronco Mesenquimais/fisiologia , Diferenciação Celular/fisiologia , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , RegeneraçãoRESUMO
BACKGROUND: Dural reconstruction after transpetrosal approaches is complicated because complete primary closure of presigmoid dura mater is difficult to achieve. To address this problem, we use biocompatible polyglycolic acid (PGA) felt (Durawave) to reconstruct dural defects. To evaluate the use of PGA felt in dural reconstruction, we compared these results with those after conventional duraplasty using autologous fascia grafts. METHODS: We retrospectively surveyed all cases involving a transpetrosal approach reported since 2013. In the conventional procedure, autologous fascia was fixed over the dural defect using stay sutures; any remaining dead space was obliterated by placing abdominal fat grafts. Since April 2017, we have used PGA felt instead of fascia. RESULTS: Of the 37 cases identified, 27 were reconstructed according to the conventional procedure, and the remaining 10 cases were reconstructed using PGA felt. Among the 27 conventional cases, 8 involved cerebrospinal fluid (CSF)-related complications, including 3 cases of rhinorrhea and 5 cases of subcutaneous fluid collection, and 2 cases (7%) required repair surgery. Of the 10 cases involving PGA felt, 1 case (10%) involved subcutaneous fluid collection and required repair surgery, and whereas the remaining 9 cases had no evidence of CSF leakage. In addition, the median dural reconstruction time using PGA felt was 9 minutes, significantly shorter than that when autologous fascia was used (median, 44 minutes). CONCLUSIONS: Using PGA felt for presigmoid dura simplifies dural reconstruction because it obviates the need to suture in a deep field. PGA felt has the potential to prevent CSF-related complications after transpetrosal approaches.
Assuntos
Gordura Abdominal/transplante , Materiais Biocompatíveis , Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/métodos , Osso Petroso/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Adesivo Tecidual de Fibrina , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ácido Poliglicólico , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Telas Cirúrgicas , Adulto JovemRESUMO
PURPOSE: To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. METHODS: This is a retrospective cohort study from September 2012 to December 2017 including 23 patients undergoing bilateral vocal fold injection with autologous fat (24 procedures) for vocal fold atrophy (15 procedures) or atrophy with sulcus (Ford type II or III) (9 procedures). Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time points according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptive, acoustic and aerodynamic parameters. Failure rate was defined as non-relevant improvement (< 10 points) in VHI-30 at 12 months and number of revisions within 12 months. RESULTS: There was a clinically relevant (≥ 15 points) and statistically significant improvement in the VHI-30 (preoperative: 49.1 points; postoperative at 12 months: 29.7 points). Change in dynamic range was also statistically significant over time (p = 0.028). There were no differences in voice parameters between patients with atrophy only and atrophy with sulcus, although grade tended to be lower in patients with atrophy only over all time points. CONCLUSION: This study shows that bilateral vocal fold injection with autologous fat is a beneficial treatment not only for patients with atrophy but also for patients with sulcus. A comparison of the results with those reported from other forms of sulcus surgery confirmed this finding. However, there is a need for further prospective studies comparing the short- and long-term effects of different techniques.
Assuntos
Gordura Abdominal/transplante , Doenças da Laringe , Prega Vocal , Qualidade da Voz , Adulto , Atrofia , Feminino , Humanos , Injeções/métodos , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Prega Vocal/cirurgiaRESUMO
BACKGROUND: This study was designed to assess the safety and efficacy of site-specific fat injection for the treatment of refractory migraine headaches following medical or surgical treatment. METHODS: A prospective cohort study was performed on consecutive patients who had migraine headaches with persistent symptoms after surgical decompression and were given therapeutic fat injections from September of 2012 to January of 2015 with 12 months' minimum follow-up. Clinical outcomes assessment included migraine frequency, intensity, duration, migraine headache index, and complications. A 50 percent or greater decrease in frequency, intensity, or duration was considered therapeutic success, whereas 10 percent or greater increase in migraine headache index was considered worsening of symptoms. Pairwise t tests were used to assess statistical significance (p < 0.05). RESULTS: Twenty-nine patients met inclusion criteria. All were female, with a mean age of 49.0 years (range, 21.5 to 72.5 years), and mean follow-up was 29.4 months (range, 12.3 to 49.5 months). Twenty patients (69.0 percent) experienced successful improvement; 12 (41.4 percent) experienced complete resolution. Five patients (17.2 percent) experienced subtherapeutic improvement, and four (13.8 percent) experienced worsening of symptoms. Mean improvement per patient at their last follow-up was 5.1 (39.3 percent) fewer attacks per month (p = 0.035); 3.1 (42.0 percent) lower intensity on a scale of 1 to 10 (p = 0.001); 31.8 (74.4 percent) fewer hours of duration (p = 0.219); and 52.8 percent lower migraine headache index (p = 0.012). There were no complications for any patient. CONCLUSIONS: Migraine headache symptoms were successfully reduced in the majority of cases with fat injection. A comprehensive surgical treatment algorithm including this novel procedure is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Gordura Abdominal/transplante , Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Cânula , Feminino , Seguimentos , Humanos , Injeções Subcutâneas/instrumentação , Injeções Subcutâneas/métodos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Bainha de Mielina/patologia , Medição da Dor , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Estudos Prospectivos , Transplante Autólogo/instrumentação , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Nanofat and fat graft survival is an important clinical problem. The authors of this study investigated whether PRP has an impact on fat and nanofat graft survival and vascularization in a mouse model. MATERIALS AND METHODS: Fat was harvested from a 50-year-old healthy woman by vacuum suction, and nanofat was obtained by emulsification and centrifugation procedures. PRP was collected after two rounds of centrifugation from an autologous blood sample. Twenty male nude mice were divided into four treatment groups: PRP/nanofat, PRP/fat, saline/nanofat and saline/fat. After 1 month and 3 months, the grafts were extracted and weighed. The microstructure of the fat and nanofat was examined with a scanning electron microscope. HE and immunohistochemical staining was applied to observe neovascularization. Western blot analysis was used to analyse the expression of CD31 and VEGF. RESULTS: In fat tissue, fat cells had normal connections; the fat structure was complete and fibre networks were visible. In nanofat, the extracellular matrix vascular components were visible and their structures were intact. At 1 month and 3 months, the graft weights in the PRP/fat group were significantly higher than those in the other groups. Further, a higher degree of neovascularization was observed in the PRP/nanofat group, and the expression of CD31 and VEGF in the PRP/nanofat group was higher than that in the other groups. CONCLUSION: PRP can promote nanofat and fat graft survival and vascularization. NO LEVEL ASSIGNED: 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 .
Assuntos
Gordura Abdominal/transplante , Adipócitos/transplante , Sobrevivência de Enxerto/fisiologia , Plasma Rico em Plaquetas , Animais , Biópsia por Agulha , Western Blotting , Feminino , Humanos , Imuno-Histoquímica , Lipectomia/métodos , Masculino , Camundongos , Camundongos Nus , Microscopia Eletrônica , Pessoa de Meia-Idade , Modelos Animais , Sensibilidade e Especificidade , Coleta de Tecidos e ÓrgãosRESUMO
BACKGROUND: In this study, we present the first application of functional fat injection performed under local anesthesia in the treatment of severe dysphagia secondary to head and neck cancer surgery. METHODS: Functional fat injection was performed using a transcervical approach. Control of injection depth and site was performed through a transnasal flexible endoscope. The effect of surgery was evaluated through videofluoroscopy (VFS), Fiberendoscopic Evaluation of Swallowing (FEES), Functional Oral Intake Scale (FOIS), and Eating Assessment Tool-10 (EAT-10). RESULTS: Before the functional fat injection, the patient was dependent on permanent tube feeding; the VFS and FEES revealed a severe impairment of swallowing abilities. The EAT-10 scored 26. Twelve months after surgery, the patient was on oral diet, the VFS demonstrated mild to moderate dysphagia, the FEES demonstrated aspiration only with liquids and the EAT-10 improved. CONCLUSION: Functional fat injection under local anesthesia could be useful in the treatment of chronic dysphagia in selected patients.
Assuntos
Gordura Abdominal/transplante , Anestesia Local , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Laringectomia/efeitos adversos , Idoso , Procedimentos Cirúrgicos Ambulatórios , Anestésicos Locais/administração & dosagem , Humanos , Injeções Subcutâneas , Lidocaína/administração & dosagem , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapiaRESUMO
BACKGROUND: The transsphenoidal approach is the standard of care for the treatment of pituitary adenomas and is increasingly employed for many anterior skull base tumors. Persistent postoperative cerebrospinal fluid (CSF) leaks can result in significant complications. OBJECTIVE: To analyze our series of patients undergoing abdominal fat graft repair of the sellar floor defect following transsphenoidal surgery, describe and investigate our current, routine technique, and review contemporary and past methods of skull base repair. METHODS: A recent consecutive series (2008-2017) of 865 patients who underwent 948 endonasal procedures for lesions of the sella and anterior skull base was retrospectively reviewed. Three hundred eighty patients underwent reconstruction of the sellar defect with an abdominal fat graft. RESULTS: The diagnoses of the 380 patients receiving fat grafts were the following: 275 pituitary adenomas (72.4%), 50 Rathke cleft cysts (13.2%), 12 craniopharyngiomas (3.2%), and a variety of other sellar lesions. Fourteen patients had persistent postoperative CSF leak requiring reoperation and included: 5 pituitary adenomas (1.3%), 4 craniopharyngiomas (1.1%), 2 arachnoid cysts (0.53%), 2 prior CSF leaks (0.53%), and 1 Rathke cleft cyst (0.26%). Four patients (1.1%) developed minor abdominal donor site complications requiring reoperation: 1 hematoma, 2 wound complications, and 1 keloid formation resulting in secondary periumbilical infection. CONCLUSION: Minimizing postoperative CSF leaks following endonasal anterior skull base surgery is important to decrease morbidity and to avoid a prolonged hospital stay. We present an evolved technique of abdominal fat grafting that is effective and safe and includes minimal morbidity and expense.