Estimation of Mastectomy Volume Using Preoperative Mastectomy Simulation Images Acquired by the Vectra H2 System.

Preoperative prediction of breast volume is very important in planning breast reconstruction. In this study, we assessed the usefulness of a novel method for preoperative estimation of mastectomy volume by comparing the weight of actual mastectomy specimens with the values predicted by the developed method using the Vectra H2. Methods: All patients underwent skin-sparing mastectomy and immediate autologous breast reconstruction. Preoperatively, the patient's breast was scanned using the Vectra H2 and a postmastectomy simulation image was constructed on a personal computer. The estimated mastectomy volume was calculated by comparing the preoperative and postmastectomy three-dimensional simulation images. Correlation coefficients with the estimated mastectomy volume were calculated for the actual mastectomy weight and the transplanted flap weight. Results: Forty-five breasts of 42 patients were prospectively analyzed. The correlations with the estimated mastectomy volume were r = 0.95 (P < 0.0001) for actual mastectomy weight and r = 0.84 (P < 0.0001) for transplanted free-flap weight. The mastectomy weight estimation formula obtained by linear regression analysis using the estimated mastectomy volume was 0.98 × estimated mastectomy volume + 5.4 (coefficient of determination R2 = 0.90, P < 0.0001). The root-mean-square error for the mastectomy weight estimation formula was 38 g. Conclusions: We used the Vectra H2 system to predict mastectomy volume. The predictions provided by this method were highly accurate. Three-dimensional imaging is a noncontact, noninvasive measurement method that is both accurate and simple to perform. Use of this effective tool for volume prediction is expected to increase in the future.

Minimal Scar Autologous Breast Reconstruction with Skin-sparing Mastectomy.

A skin paddle severely impairs the appearance of the reconstructed breast. We have established a new technique called "minimal scar autologous breast reconstruction" involving delayed nipple reconstruction using a local flap designed on the skin paddle and simultaneous resection of the residual skin paddle. Methods: We analyzed 20 patients with unilateral breast cancer who underwent skin-sparing mastectomy followed by immediate breast reconstruction using a free flap (deep inferior epigastric perforator flap in 13 patients and profunda artery perforator flap in seven). Approximately 1 year after primary reconstruction, nipple reconstruction using an arrow flap designed on the skin paddle and resection of the residual skin paddle were performed. Several months later, medical areola tattooing was performed. Bilateral breast symmetry scores, obtained from the distances between anatomic landmarks, were compared before and after breast reconstruction. Results: Postoperative complications such as necrosis of the reconstructed nipple were not observed after two-stage reconstruction, and all procedures including total resection of the skin paddle, nipple reconstruction, and medical tattooing were performed successfully in all cases. Aesthetic outcomes were excellent: comparison of symmetry scores showed no significant differences in any parameters between before surgery and after reconstruction of the nipple-areola complex. Conclusions: We have established step-by-step strategies for mastectomy, autologous breast reconstruction, and then nipple reconstruction, keeping in mind that the skin paddle would later be totally resected in nipple reconstruction, and thereby achieved breast reconstruction with markedly reduced postoperative scarring compared with conventional autologous breast reconstruction.

Efficacy of the pedicle trapezius muscle flap for the multisurgical removal of pediatric posterior fossa anaplastic ependymoma.

OBJECTIVE: Exceedingly refractory, pediatric anaplastic ependymoma in many cases requires multisurgical removal. The high risk of poor wound healing and CSF leakage especially at the posterior fossa make this tumor difficult to treat. CASE: A 9-year-old girl has had 4th ventricular anaplastic ependymoma since the age of 3. She experienced tumor removal 8 times including 4 posterior fossa craniotomies because tumors were disseminated not only to the posterior fossa but also to the cerebral hemispheres. She also underwent a dermal graft using a free flap. She experienced CSF leaks and meningitis frequently because the wound healing was poor. We performed a dermal flap closure using a pedicle trapezius muscle flap with a plastic surgeon when we performed the 5th tumor removal. RESULT: We achieved complete wound closure in spite of broad deficiencies in subcutaneous and epidermal tissues. After that, recurrences of posterior fossa tumors presented within a short term, and tumor removal via an incision of a pedicle trapezius muscle flap was performed without recurrence of CSF leaks and meningitis. DISCUSSION AND CONCLUSION: For the first time, we are able to report on the efficacy of using the pedicle trapezius muscle flap for multisurgical removal of pediatric posterior fossa anaplastic ependymoma. The muscle flap was found to be effective because of the multiple surgeries expected, and the pedicle trapezius muscle flap was found to be resilient to multiple surgical procedures. Although advantageous, the dorsal scapular artery which is required for flap creation is actually difficult to harvest. Compared to a flee flap, the pedicle trapezius muscle flap maintains vascular supply. Furthermore, this technique has the possibility of being applied to defective dura mater closure that cannot be watertight due to multiple surgeries. However, it is very important to inform the patient's family not only about the improved efficacy of surgery, but also to raise awareness on consequential cosmetic issues.

Nipple Shield Made from a Thermoplastic with Aluminum Properties.

Here, we report the preparation of a nipple shield from an inexpensive and re-formable thermoplastic with metallic properties as well as its favorable outcomes when used for patients who had undergone nipple reconstruction. The nipple shield was prepared from a material made of a mixture of a thermoplastic resin and special aluminum pellets (aluminum content, 70%). Each patient wore the nipple shield for 3 months after nipple reconstruction. The material was re-softened for re-forming into an adequate shape as required during this 3-month period. All reconstructed nipples were securely protected, with no complications (eg, ulceration, wound dehiscence, and wound infections) during the 3-month period. Also, there were no skin complications such as contact dermatitis or cellulitis in the area where the nipple shield was in contact with the skin. None of the patients stopped using the nipple shield because it came off frequently, or was uncomfortable or painful to wear, and there were no cases in which the nipple shield had to be remade due to damage. The thermoplastic material used in this study appeared to be extremely useful as a nipple protection material because of its good breathability, attributed to its nonwoven form, its low thermal conductivity and resulting cooling effect attributed to its aluminum content, its suitability for rapid re-forming, and its washability.

Preoperative estimation of vertical profunda artery perforator flap weight using computed tomography angiography for breast reconstruction.

BACKGROUND: The vertical profunda artery perforator (v-PAP) flap is limited in terms of the tissue volume that can be harvested but is a suitable graft for Japanese patients with relatively small breast sizes. The objectives of this study were to identify the parameter most closely correlated with v-PAP flap weight on computed tomography angiography (CTA) images and to create an easy-to-use v-PAP flap weight estimation formula by linear regression analysis using the identified parameter. PATIENTS AND METHODS: Thirty v-PAP flaps in 25 patients who underwent breast reconstruction were retrospectively analyzed. Mean age was 46.1 (range: 32-73) years, and mean BMI was 20.0 (range: 15.3-23.6) kg/m2 . On a CT horizontal section of the thigh taken at level of the center of the long axis of the flap, the following parameters were measured from the anterior margin of the gracilis muscle to the posterior margin of the semimembranosus muscle using image processing software: fat area, fat thickness, thigh circumference, and skin paddle area. Linear regression analysis was then performed with the weight of the harvested v-PAP flap as the objective variable and the above parameters as explanatory variables to predict skin flap weight. RESULTS: Correlations with v-PAP flap weight of each parameter were as follows: r = 0.66 (p < .0001) for fat thickness, r = 0.32 (p = .081) for total thigh area, r = 0.36 (p = .054) for thigh circumference, r = 0.27 (p = .153) for skin paddle area, and r = 0.84 (p < .0001) for fat area. Thus, the fat area had the strongest correlation with v-PAP flap weight. The v-PAP flap weight estimation formula obtained by linear regression analysis including fat area was as follows: 7.3 × fat area + 114 (coefficient of determination: R2  = 0.70, p < .0001, RMSE = 24). The engraftment rate of the 30 v-PAP flaps was 100%. One patient developed postoperative venous thrombosis at the vascular anastomosis site, but underwent successful microsurgical revision, leading to flap salvage. During the >6-month follow-up period, there were no notable complications in the reconstructed breasts and donor sites. CONCLUSIONS: The v-PAP flap weight estimation formula we developed in this study showed a high correlation with measured values, allowing for easy estimation using only a single CTA horizontal section of the thigh.

Prevention of denervated muscle atrophy with accelerated nerve-regeneration by babysitter procedure in rat facial nerve paralysis model.

PURPOSE: The "babysitter" procedure is a reconstruction technique for facial nerve complete paralysis and uses the movement source from the healthy facial nerve with a cross-nerve graft. First, an end-to-side neurorrhaphy is performed between the affected facial nerve trunk and hypoglossal nerve for continuously delivering stimuli to the mimetic muscles for preventing the atrophy of mimetic muscles. Despite favorable clinical results, histological and physiological mechanisms remain unknown. This study attempted to establish a model for the "babysitter" procedure and find its efficacy in rats with facial nerve complete paralysis. MATERIALS AND METHODS: A total of 16 Lewis rats were used and divided into 2 groups; cross nerve graft (n = 8) and babysitter groups (n = 8). The facial nerve trunk was transected in both groups. Babysitter group underwent a two-stage procedure. Cross nerve graft group underwent only the transfer of nerve graft from the healthy side to affected side. The animals were assessed physiologically by compound muscle action potential (CMAP), and the regenerated nerve tissues were evaluated histopathologically at 13 weeks after surgery. RESULTS: Facial nucleus stained with retrograde tracers proved the re-innervation of affected facial muscle by the babysitter procedure. In CMAP, the amplitude of babysitter group was significantly higher than that of the cross-facial nerve graft group (p < .05). Histological examination found a significant difference in myelin g-ratio between two groups (p < .05). CONCLUSION: This study investigated the "babysitter" procedure for rat facial nerve palsy. Babysitter procedure shortened the denervation period without mimic muscle atrophy.

Reconstruction of the Necrotic Scrotum with Hydrosurgery System and Pedicle DIEP Flap: A Case Report of Fournier Gangrene.

Despite medical advances, the mortality rate associated with Fournier gangrene has remained largely unchanged and extremely high. In addition, conventional surgical treatment of Fournier gangrene of the scrotum requires excision of the testicles in some cases, which can result in loss of fertility. We report herein the favorable results of reconstruction of the scrotum following Fournier gangrene, using the hydrosurgery system and pedicled deep inferior epigastric perforator flap. A 60-year-old male patient was urgently transported to our hospital for fever, lower abdominal pain, and scrotal pain for several days. He was diagnosed with Fournier gangrene and underwent an emergency debridement procedure on the same day. Later, we performed a 2-phase reconstruction with a hydrosurgery system and pedicled deep inferior epigastric perforator flap under general anesthesia for the postoperative tissue defect. At 6 months postoperatively, there was no ulceration or scar contracture, and the results were aesthetically pleasing. There are no reported cases of reconstruction of the scrotum following Fournier gangrene using this procedure, and it might be an effective treatment option.

Reconstruction of Lower Limb Necrotizing Fasciitis by Hydrosurgical Debridement and Multiperforator Anterolateral Thigh Flap.

The authors describe a surgical treatment that optimally combined the use of the hydrosurgical system and a free multiperforator anterolateral thigh flap to prevent lower limb amputation in a severe case of necrotizing fasciitis. A 43-year-old woman was diagnosed with necrotizing fasciitis, and amputation was performed at the level of the metatarsal shafts with an emergency debridement using the hydrosurgical system. In the second reconstructive surgery, a free anterolateral thigh flap measuring 28 × 8 cm2 was harvested using the left thigh as the donor site and the vascular pedicle was made up of a total of 3 vessels, 2 perforating arteries from the descending branch of the lateral circumflex femoral artery, and 1 oblique branch from the lateral circumflex femoral artery. To thin the flap, we first resected as much subcutaneous fat as possible in the distal part of the flap (which would eventually cover the ankle joint) and ensured adequate residual volume of the proximal part of the flap (which would cover the metatarsal stumps). We then sutured the flap to the tissue defect on the left foot and then end-to-side anastomosing the lateral femoral circumflex artery and posterior tibial artery while the 2 veins were anastomosed to the posterior tibial veins under a microscope. Six months after the surgery, adequate flap volume was maintained over the metatarsal stumps with no postoperative complications such as infection or ulcer formation, and there were no other complications such as motor dysfunction at the donor site on the left thigh.

Hydrosurgical Debridement Allows Effective Wound Bed Preparation of Pressure Injuries: A Prospective Case Series.

BACKGROUND: Pressure injuries (PIs) are common in hospitalized patients, with incidence exceeding 50% in high-risk patients. Immobilization causes a prolonged compression of vascular networks in tissues overlying bony prominences, leading to ischemia and ulceration. Traditionally, PIs are treated with a combination of surgical debridement and reconstruction. This approach can be invasive for debilitated patients who cannot tolerate prolonged surgeries and extensive tissue resection. Hydrosurgery uses high-pressure irrigation to low-invasively debride and cleanse wounds; its use has shown positive outcomes in burn and chronic wounds care. Here, we hypothesize that hydrosurgery allows low-invasive yet effective wound bed preparation in truncal PIs. METHODS: We conducted a single-center, prospective, uncontrolled case series. Inclusion criteria for this study were presence of a truncal PI (stage III or IV) and an American Society of Anesthesiologists physical status of ≥2 (no exclusion criteria). Measured outcomes included duration of hydrosurgery, postsurgical local (dehiscence, infection, seroma) or systemic complications in the first 30 days, and PI recurrence rate (6-month follow-up). RESULTS: Seven patients (3 sacral, 2 greater trochanteric, and 2 ischial tuberosity PIs) were enrolled for this study. Average duration of hydrosurgery was 12 minutes (±3.1). No local or systemic complications were observed at a 30-day follow-up (0/7, 0%). All flaps (6/7, 86%) and graft (1/7, 14%) reconstructions successfully survived, and no PI recurrence was reported within a 6-month follow-up (0/7, 0%). CONCLUSIONS: Hydrosurgery seems to allow safe, low-invasive, and effective wound bed preparation in truncal PIs. Larger controlled trials are needed to confirm this preliminary evidence, to guide its broader adoption for improved care of high-risk patients with PIs.

Accelerated outgrowth in cross-facial nerve grafts wrapped with adipose-derived stem cell sheets.

In this study, we devised a novel cross-facial nerve grafting (CFNG) procedure using an autologous nerve graft wrapped in an adipose-derived stem cell (ADSC) sheet that was formed on a temperature-responsive dish and examined its therapeutic effect in a rat model of facial palsy. The rat model of facial paralysis was prepared by ligating and transecting the main trunk of the left facial nerve. The sciatic nerve was used for CFNG, connecting the marginal mandibular branch of the left facial nerve and the marginal mandibular branch of the right facial nerve. CFNG alone, CFNG coated with an ADSC suspension, and CFNG wrapped in an ADSC sheet were transplanted in eight rats each, designated the CFNG, suspension, and sheet group, respectively. Nerve regeneration was compared histologically and physiologically. The time to reinnervation, assessed by a facial palsy scoring system, was significantly shorter in the sheet group than in the other two groups. Evoked compound electromyography showed a significantly higher amplitude in the sheet group (4.2 ± 1.3 mV) than in the suspension (1.7 ± 1.2 mV) or CFNG group (1.6 ± 0.8 mV; p < .01). Toluidine blue staining showed that the number of myelinated fibers was significantly higher in the sheet group (2,450 ± 687) than in the suspension (1,645 ± 659) or CFNG group (1,049 ± 307; p < .05). CFNG in combination with ADSC sheets, prepared using temperature-responsive dishes, promoted axonal outgrowth in autologous nerve grafts and reduced the time to reinnervation.

Venous Thromboembolism after the Repair of Abdominal Incisional Hernia with a Pedicled Anterolateral Thigh Flap.

Incisional hernia often complicates kidney transplant. However, there are few reports showing pitfalls after the repair of incisional hernia following living-donor kidney transplant. A 55-year-old man underwent living-donor kidney transplant from his wife at the Department of Urology at the authors' hospital. He noticed abdominal distension 6 months postoperatively and was diagnosed with incisional hernia by computed tomography (CT) imaging. Clinical examination revealed the extensive distension of the right abdomen; noncontrast abdominal CT showed transverse colon, descending colon, and mesenteric prolapse through a hernial orifice measuring 11 × 14 cm, located slightly cranial to the anterior superior iliac spine. Repair was performed under general anesthesia the following day; the right thigh was the donor site. A pedicled anterolateral thigh flap from the donor site was used for abdominal wall reconstruction. He developed fever, and pain and swelling were noted in the right leg on postoperative day 14. Contrast-enhanced thoracic CT confirmed a diagnosis of pulmonary embolism (PE) and deep vein thrombosis. He was quickly started on an oral factor Xa inhibitor (edoxaban) and continuous intravenous heparin; contrast-enhanced thoracic CT on postoperative day 23 showed that PE had disappeared. At 6 months postoperatively, there was no recurrence of the venous thromboembolism or incisional hernia. The authors reported a case of incisional hernia repair after living-donor kidney transplant with a pedicled anterolateral thigh flap, complicated by deep vein thrombosis and PE. Adequate preoperative evaluation was required to determine optimal surgical techniques and preventive measures in cases with myriad thrombogenic risk factors.

Usefulness of avulsed fingertip skin for reconstruction after digital amputation.

We present four cases of fingertip amputation treated with local flap where the avulsed fingertip skin could be effectively utilized for these donor sites. The avulsed finger skin may be utilized even when replantation is not possible. This approach may serve as a new treatment option after fingertip amputation.

Surgical anatomy of ovine facial and hypoglossal nerves for facial nerve reconstruction and regeneration research: An experimental study in sheep.

BACKGROUND: The lack of a clinically relevant animal model for facial nerve research is a challenge. The goal of this study was to investigate the anatomy of the ovine facial and hypoglossal nerves to establish a clinically relevant facial nerve research model. MATERIALS AND METHODS: Six cadaver female Merino sheep (33.5 ± 3 kg, approximately 3 years old) and three anesthetized female Merino sheep (30 ± 3 kg, approximately 3 years old) were used. In cadaver sheep, a right side preauricular to submandibular incision was made. Dimensions of the face, neck, and length of facial nerve were measured. In anesthetized sheep, each facial nerve branch and hypoglossal nerve in the right side was stimulated. The number of myelinated fibers was analyzed histologically. RESULTS: The facial nerve exited the stylomastoid foramen and divided into upper and lower branches. The lower branch then subdivided into buccal and marginal mandibular branches. The hypoglossal nerve was observed behind the digastric posterior belly. Stimulation revealed the temporal, zygomatic, buccal, marginal mandibular, and cervical branch innervated the forehead, orbicularis, upper lip and nasal, lower lip, and platysma, respectively. The number of myelinated fibers of the main trunk, upper, buccal, lower branch, and hypoglossal nerve was 11 350 ± 1851, 4766 ± 1000, 5107 ± 218, 3159 ± 450, and 7604 ± 636, respectively. The length of the main trunk was 9.2 ± 1.5 mm, and distance of the marginal mandibular branch to the facial artery was 94 ± 6.8 mm. CONCLUSIONS: Due to the similarity in nerve anatomy and innervation, the ovine model can be used as a clinically relevant and suitable model for facial nerve research.

Keratinocyte sheets prepared with temperature-responsive dishes show enhanced survival after in vivo grafting on acellular dermal matrices in a rat model of staged bi-layered skin reconstruction.

INTRODUCTION: Bi-layered skin reconstruction can be achieved by staged grafting of acellular dermal matrices (ADMs) and cultured epithelial keratinocyte sheets (KSs). Both KSs and ADMs have been used for long; yet, their combined use has shown poor effectiveness. This outcome has been related to the enzymatic treatment used in the preparation of KSs, which impairs their adhesion potential to ADMs and the formation of a basement membrane (BM). Temperature-responsive (TR) culture dishes allow for enzyme-free preparation of KSs with preservation of BMs and intercellular adhesion proteins; yet, their use has not been previously applied to staged bi-layered skin reconstruction. Using an in vivo rat model, we tested the hypothesis that TR cultures enhance KSs survival and BM preservation after sequential grafting on ADMs. METHODS: In nude rats (n = 9/group), a 9-cm [2] full-thickness dorsal skin defect was repaired with a commercial ADM. At 2 weeks after surgery, we grafted the ADM with KSs (circular, 25 mm diameter), prepared from human cells either by enzymatic Dispase treatment (DT control group) or a TR culture dish (TR experimental group). KSs survival and BMs preservation was assessed one week later by digital imaging, histology (hematoxylin & eosin), immunohistochemistry (collagen IV, pancytokeratins) and immunofluorescence (cytokeratin 1-5-6, laminin). RESULTS: The TR group showed a significantly higher KSs survival (120 ± 49 vs. 63 ± 42 mm2; p < 0.05) and epidermal thickness (165 ± 79 vs. 65 ± 54 µm; p < 0.01) compared with the control DT group, as well as higher epidermal maturation (cytokeratin) and a denser laminin and Collagen IV expression in the BMs in vitro and in vivo. CONCLUSION: These findings suggest that KSs prepared with TR culture dishes have significantly enhanced survival when grafted on ADMs; these outcomes could help improve current clinical strategies in wound care by skin reconstruction.

Surgical anatomy of the ovine sural nerve for facial nerve regeneration and reconstruction research.

The lack of a clinically relevant animal models for research in facial nerve reconstruction is challenging. In this study, we investigated the surgical anatomy of the ovine sural nerve as a potential candidate for facial nerve reconstruction, and performed its histological quantitative analysis in comparison to the buccal branch (BB) of the facial nerve using cadaver and anesthetized sheep. The ovine sural nerve descended to the lower leg along the short saphenous vein. The length of the sural nerve was 14.3 ± 0.5 cm. The distance from the posterior edge of the lateral malleolus to the sural nerve was 7.8 ± 1.8 mm. The mean number of myelinated fibers in the sural nerve was significantly lower than that of the BB (2,311 ± 381vs. 5,022 ± 433, respectively. p = 0.003). The number of fascicles in the sural nerve was also significantly lower than in the BB (10.5 ± 1.7 vs. 21.3 ± 2.7, respectively. p = 0.007). The sural nerve was grafted to the BB with end-to-end neurorrhaphy under surgical microscopy in cadaver sheep. The surgical anatomy and the number of fascicles of the ovine sural nerve were similar of those reported in humans. The results suggest that the sural nerve can be successfully used for facial nerve reconstruction research in a clinically relevant ovine model.

Full-thickness skin reconstruction with basic fibroblast growth factor-impregnated collagen-gelatin sponge.

INTRODUCTION: This study examined the usefulness of basic fibroblast growth factor impregnated collagen-gelatin sponge (bFGF-CGS) in reconstructive surgery for various acute skin defects including deep dermal burns, facial full-thickness skin defects, and finger amputations as the first clinical application. METHODS: Reconstructive surgery was performed in two stages with bFGF-CGS in 8 male subjects, ranging in age from 6 to 84 years, with acute full-thickness skin defects. Following the adequate debridement of the defect, surgeons prepared a bFGF-CGS with bFGF solution at a dose of 7-14 mg/cm2 approximately 10 min just before application and then secured the bFGF-CGS in place with non-absorbable sutures. Second-stage wound closure was performed with autologous skin grafting following adequate dermis-like tissue regeneration at the site postoperatively. Follow-up was continued for 6 months. RESULTS: Of the 8 subjects, the mean duration from the adequate vascularization of the dermis-like tissue until the second-stage autologous skin graft was 22 ± 4 days. Wound closure was achieved in all cases; the mean duration until wound closure was 32 ± 8 days. During the 6-month follow-up period, no wound infection, recurrent skin ulceration, and no exposure of tendon, bone, and cartilage were observed, and there were no cases of indirectly restricted range of motion from postoperative scar contracture and none with disfiguring scars. CONCLUSION: The authors achieved favorable outcomes following reconstructive surgery with a hybrid artificial dermis impregnated with bFGF for treating acute full-thickness skin defects. bFGF-CGS serves as a convenient regenerative device requiring no specialized medical facilities.

Intramasseteric Schwannoma Derived from the Masseteric Nerve.

This report documents the intramasseteric onset of a schwannoma of the masseteric nerve, which is extremely rare. The patient was a 24-year-old woman who noticed an asymptomatic mass in the parotidomasseteric region 1 year before; a soft painless mass located near the angle of the left mandible was observed during the initial examination. No neuropathy, including sensory deficit, facial nerve paralysis, or trismus, was observed. Contrast-enhanced magnetic resonance imaging revealed an isolated neoplastic lesion within the body of the masseter muscle; the lesion exhibited low-signal intensity on coronal T1-weighted imaging and high-signal intensity on T2-weighted imaging with somewhat heterogeneous early uptake of contrast medium. The tumor was resected under general anesthesia and was found to be solid with distinct margins, enclosed within the masseter muscle, and continuous with a branch of the masseter nerve identified using intraoperative electrical stimulation. The lesion was a pale yellow solid mass encapsulated in a smooth membrane measuring 3.2 × 1.7 × 1.6 cm. Histopathological examination revealed a mixture comprising Antoni A pattern with Verocay bodies surrounded by oval nuclei exhibiting nuclear palisading, and an Antoni B pattern with loss of the characteristic cellular arrangement and separation of the cells, creating a more distinct individual tumor cell morphology. The final histopathological diagnosis was schwannoma. No complications, such as trismus or facial nerve paralysis, and no tumor recurrence were observed in the 1 year that has elapsed postoperatively.

A collagen-coated PGA conduit for interpositional-jump graft with end-to-side neurorrhaphy for treating facial nerve paralysis in rat.

PURPOSE: This study investigated the potential of collagen-coated polyglycolic acid (PGA) tube with interpositional jump graft (IPJG) in rat. MATERIALS AND METHODS: A total of 16 Lewis rats were used in this study. Facial nerve paralysis was created by ligating facial nerve trunk with a ligature clip. The rats were divided into 3 groups. Nerve conduit group (n = 6) were treated by IPJG with collagen-coated PGA tubes between the facial nerve trunks and the hypoglossal nerves. Autograft group (n = 6) were treated by IPJG with the greater auricular nerves. As the control group (n = 4), non-treated-model rats with facial nerve paralysis were used. The number of myelinated fibers, fiber diameter, axon diameter, myelin thickness, and g-ratio, were analyzed histologically at 13 weeks after surgery. Compound muscle action potential (CMAP) and retrograde tracing were measured. RESULT: Although the number of myelinated fibers in autograft group (1957 ± 775) had significantly higher than that of nerve conduit group (90 ± 41, P < .05), the nerve conduit group showed the regeneration of myelinated nerve axons. CMAP amplitude values of the autograft (4706 ± 1154 µV) and the nerve conduit groups (4119 ± 1397 µV) were significantly higher than that of the control group (915 ± 789 µV, P < .05). Retrograde tracing confirmed the double innervation of mimetic muscles by the facial and hypoglossal nucleus in both groups. CONCLUSION: This study showed histologically and physiologically the superior effectiveness of performing IPJG with a collagen-coated PGA conduit in a rat model.

Preclinical Optimization of a Shelf-Ready, Injectable, Human-Derived, Decellularized Allograft Adipose Matrix.

IMPACT STATEMENT: Trauma, disease, surgery, or congentital defects can cause soft tissue losses in patients, leading to disfigurement, functional impairment, and a low quality of life. In the lack of available effective methods to reconstruct these defects, acellular adipose matrices could provide a novel therapeutic solution to such challenge.

One-stage reconstruction by dual-innervated double muscle flap transplantation with the neural interconnection between the ipsilateral masseter and contralateral facial nerve for reanimating established facial paralysis: A report of 2 cases.

The authors developed a one-stage double-muscle reconstruction technique for facial paralysis using a latissimus dorsi (LD) flap and a serratus anterior (SA) flap, which were dually reinnervated by the contralateral facial nerve (FN) and ipsilateral masseter nerve (MN). The procedure was performed for 61-year-old man 3-years after resection of a malignant tumor and a 24-year-old woman 10-years after temporal fracture with facial paralysis. A double-muscle flap comprising left LD and SA flaps was harvested, a 15-cm thoracodorsal nerve (TN) section was attached to the LD flap, and 5-cm and 1-cm sections of the long thoracic nerve (LTN) were attached to the proximal and distal sides of SA flap. The LD flap and SA flap were sutured along the direction of motion of the zygomaticus major and risorius muscles, respectively. The contralateral FN and ipsilateral MN were interconnected by nerve suturing: the medial branch of TN to the distal end of LTN, the proximal end of LTN to the ipsilateral MN, and the buccal branch of contralateral FN to the main trunk of TN. After surgery, good contraction of the transferred flaps resulted in reanimation of a natural symmetrical smile; no complications were observed during the 12-month follow-up period.