Pilot Study for Isolation of Stromal Vascular Fraction with Collagenase Using an Automated Processing System.

There are many potential therapeutic applications for autologous adipose-derived stromal cells. These cells are found in a heterogeneous population isolated from adipose tissue called the stromal vascular fraction (SVF). Closed automated systems are available to release cells from the adherent stroma. Here, we test one system to evaluate the heterogeneous output for yield, purity, cellular characterization, and stemness criteria. The SVF was isolated from three donors using the Automated Cell Station (ACS) from BSL Co., Ltd., Busan, Republic of Korea. The SVF cellular output was characterized for cell yield and viability, immunophenotyping analysis, pluripotent differentiation potential, adhesion to plastic, and colony-forming units. Additionally, the SVF was tested for endotoxin and collagenase residuals. The SVF yield from the ACS system was an average volume of 7.9 ± 0.5 mL containing an average of 19 × 106 nucleated cells with 85 ± 12% viability. Flow cytometry identified a variety of cells, including ASCs (23%), macrophages (24%), endothelial cells (5%), pericytes (4%), and transitional cells (0.5%). The final concentrated product contained cells capable of differentiating into adipogenic, chondrogenic, and osteogenic phenotypes. Furthermore, tests for SVF sterility and purity showed no evidence of endotoxin or collagenase residuals. The ACS system can efficiently process cells from adipose tissue within the timeframe of a single surgical procedure. The cellular characterization indicated that this system can yield a sterile and concentrated SVF output, providing a valuable source of ASCs within the heterogeneous cell population.

Histopathological Study of Meshed Versus Solid Sheet Acellular Dermal Matrices in a Porcine Model.

BACKGROUND: Acellular dermal matrices (ADMs) are commonly used to support implant-based breast reconstruction. However, there is little comparative data on the incorporation process of different ADMs, and the value of meshing or fenestration versus solid sheet has not been established, although early clinical data suggest seroma rates may be reduced. This was a preclinical assessment of the incorporation process at optimal conditions in a pig model. METHODS: SurgiMend and AlloDerm matrices were implanted in subcutaneous pockets on the backs of 15-week-old female pigs. Half of the samples were meshed 1:2.5; the remainder was grafted as a fenestrated (SurgiMend) or solid sheet (AlloDerm). Tissues were harvested at 3 months. Histological slides were prepared for hematoxylin and eosin staining, and Masson trichrome and immunostaining with anticollagen type I fluorescein isothiocyanate stain. Histological parameters (inflammation, giant cell reaction, neovascularization, fibroplasias, and scar tissue formation) were graded blindly on a scale of 0 (no reaction) to 3 (severe reaction). RESULTS: All explanted ADMs (SurgiMend, n = 23; AlloDerm, n = 20) were firmly incorporated within the host tissue. SurgiMend showed more fibroplasia (P = 0.029) compared with AlloDerm in meshed or solid sheet form. Meshed ADMs showed a trend toward increased inflammation (P = 0.074) and giant cell reaction (P = 0.053) compared with solid sheet/fenestrated ADM. CONCLUSIONS: Meshing ADM may allow cells to populate matrices more rapidly, promoting integration compared with solid sheet ADMs. This study sets the histological basis for further clinical investigations, with the aim of demonstrating lower complication rates (and particularly reduced seroma formation) with meshed ADMs.

Mastectomy Incision Design to Optimize Aesthetic Outcomes in Breast Reconstruction.

BACKGROUND: Choosing the optimal mastectomy incision must account for oncologic, reconstructive, and aesthetic considerations, including nipple preservation, mastectomy skin margins and potential for skin involvement, mastectomy skin perfusion and viability, mastectomy skin excess, previous breast scars, the reconstructive plan, and inconspicuous new scar placement. In the present study, we aimed to assess breast reconstruction aesthetics, as they are influenced by mastectomy incision design. METHODS: Nine commonly utilized mastectomy incision patterns were grouped into 3 categories: hidden scar, vertical scar, and transverse scar. Twenty plastic surgeons were asked to blindly grade before and after photographs of reconstructed breasts with regard to scar visibility and position and according to their influence on breast aesthetics. RESULTS: Statistically significant differences were observed between the study groups. Mastectomies and reconstructions performed through hidden incisions yield the most aesthetic results. Vertical scars are favorable to transverse scars. In the case of bilateral reconstructions, symmetric scar placement is paramount to optimizing aesthetic outcomes. CONCLUSIONS: The mastectomy incision pattern significantly affects the aesthetic outcomes in breast reconstruction. Patterns borrowed from cosmetic breast surgery consistently yield highly aesthetic outcomes. Surgeons must consider oncologic factors and patient characteristics in choosing an ideal incision for each patient.

Topical Nystatin Treatment for Candida Infection Following Wound Reconstruction.

INTRODUCTION: Wound infection is an important cause of nonhealing wounds and graft rejection. OBJECTIVE: A series of 5 patients (4 females, 1 male; median age, 50; age range, 1.5-83 years) with nosocomial Candida infection of burns and chronic wounds that were reconstructed with split-thickness skin grafts is presented. MATERIALS AND METHODS: This case series was carried out between February 2011 and June 2014. Based on tissue cultures, wounds were treated with 100 000 units/mL of nystatin and 25 mg in 500 cc normal saline of mafenide acetate, which resulted in regression of wound infection symptoms and improvement of skin graft take. CONCLUSIONS: The authors propose this simple, nontoxic, and economic topical treatment for wounds and skin grafts with positive Candida cultures.