Fat Grafting and Regenerative Medicine in Burn Care.

Regenerative therapies such as fat grafting and Platelet Rich Plasma (PRP) have emerged as new options to tackle burn-related injuries and their long-term sequelae. Fat grafting is able to promote wound healing by regulating the inflammatory response, stimulating angiogenesis, favoring the remodeling of the extracellular matrix, and enhancing scar appearance. PRP can enhance wound healing by accelerating stages including hemostasis and re-epithelization. It can improve scar quality and complement fat grafting procedures. Their cost-effectiveness, minimal invasiveness, and promising results observed in the literature have made these tools as therapeutic candidates. The current evidence on fat grafting and PRP in acute and reconstructive burns is described and discussed in this study.

Arterial Embolism After Facial Fat Grafting: A Systematic Literature Review.

BACKGROUND: While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. OBJECTIVE: To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation. MATERIALS AND METHODS: Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology. RESULTS: 61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms. CONCLUSIONS: AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established. LEVEL OF EVIDENCE III: 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 .

Two-stage Reconstruction of Hand Extensor Tendons Using Silicon Rods.

The extensor system of the hand is an intricate complex component that involves a working balance between the extrinsic and intrinsic muscles of extension. Injuries to the extensor tendons are typically repaired primarily or by tendon transfers or grafts at a second stage. A 16-year-old boy sustained a right hand crush injury following an all-terrain vehicle accident, resulting in the loss of dorsal skin and extensor tendons of digits 3, 4, and 5 involving extensor zones 4-6, and oblique fractures in the second and third metacarpal bones. Primary surgery involved fixation of aforementioned fractures utilizing K-wires along with superficial circumflex iliac artery flap coverage for the raw areas post debridement. Following this, primary extensor tendon reconstruction was performed using silicon Hunter rod implants and autologous tendon grafts via a two-stage approach. Over a 2-year postoperative period, the patient demonstrated active functional extension of all four fingers with some limitations to range of motion. This case report supports the hypothesis that the pseudo-synovial sheaths created by silicone rod implants assist the easy gliding motion of tendon grafts in the second stage of reconstruction, reducing the risk of tendon adhesions, shortening, and extension lag.

Fat Grafting for Treatment of Facial Burns and Burn Scars.

This article presents the authors' experience with the use of fat grafting via the Coleman technique, for the adjuvant treatment of facial burn wounds and their sequelae. It demonstrates the regenerative effects of fat injected under the wound and/or the scar as well as of fat delivered to the debrided surface of the wound and to the surface of the scar after laser treatment or microneedling.

Introducing the International Confederation of Plastic Surgery Societies: ICOPLAST.

This article describes the formation of the International Confederation of Plastic Surgery Societies (ICOPLAST) as a novel, transparent, dynamic, and proactive confederation of national plastic surgery societies. ICOPLAST aspires to provide a voice for the entire international community of plastic surgeons. ICOPLAST has been designed to benefit the patient, plastic surgery as a profession, and each individual plastic surgeon. Its principal objective is to enhance international communication, education, and advocacy processes to ultimately improve patient outcomes for plastic surgery patients globally. The new ICOPLAST's focus is to add true value for patients. ICOPLAST's evolution, philosophy, governance, and bylaws are explained and all societies worldwide are encouraged and cordially invited to join. An open and warm invitation is provided. Additional information is found at www.ICOPLAST.org.

Characterization of the microbiota of the skin and oral cavity of Oreochromis niloticus / Caracterização da microbiota da pele e cavidade oral de Oreochromis niloticus

Introduction: Fish are usually exposed to higher microbial loads than land or air animals. The microbiota of fish mostly consists of Pseudomonas spp., Aeromonas spp., Shewanella putrefasciens, Acinetobacter spp. and Moraxella spp. Objective: to analyze the oral cavity, and skin tissue microbiota on the Nile tilapia (Oreochromis niloticus), a fish species raised commercially in Brazil. Methods: Samples were collected from the oral cavity and skin of 20 Nile tilapia specimens (Oreochromis niloticus), each weighing approximately 1,000 grams. The samples were cultures for quantitative analysis on sheep blood agar (SBA) and chromID™ CPS® agar (CPS). Results: Eleven different bacterial species were identified on CPS and SBA plates. Gram-negative species were the most prevalent, while gram-positive Globicatella spp, Streptococcus spp and Enterococcus faecalis were also found. Pseudomonas aeruginosa species were isolated from all samples. Gram-positive Enterococcus faecalis was found in 70 and 60% of the skin and oral samples, respectively. Conclusion: For all samples studied, the microbial load was less than 100,000 colony-forming units - CFU/g of tissue. This value is a cutoff standardized for the American Society of Microbiology to differentiate the causal agent from the colonizers. In light of this result and considering the absence of infectious signs in the fish samples, we conclude that the CFU values found in this study reflect a normal, non-infectious colonization/microbiota. (AU)

Introdução: Os peixes são normalmente expostos a cargas microbianas mais elevadas do que os animais em terra ou ar. O perfil da microbiota em peixes compreende principalmente Pseudomonas spp., Aeromonas spp., Shewanella putrefasciens, Acinetobacter spp., e Moraxella spp. Objetivo: analisar a microbiota da cavidade oral e do tecido da pele no Tilápia do Nilo (Oreochromis niloticus), comercialmente criado no Brasil. Métodos: Vinte espécimes de Tilápia do Nilo (Oreochromis niloticus), cada uma pesando cerca de 1.000 gramas, foram submetidas a coleta de amostras da cavidade oral e da pele. Estas amostras foram cultivadas quantitativamente em ágar sangue de carneiro (SBA) e chromID® CPS® agar (CPS). Resultados: Foram identificadas 11 diferentes espécies de bactérias em placas CPS e SBA. Os resultados mostram que bacilos gram-negativos são os mais prevalentes. Cocos gram-positivos como Globicatella spp, Streptococcus spp e Enterococcus faecalis também foram encontrados. Espécies de Pseudomonas aeruginosa foram isoladas a partir de todas as amostras. Enterococcus faecalis foi encontrado em 70 e 60% das amostras de pele e por via oral, respectivamente. Conclusão: Os resultados deste estudo mostram, para todas as amostras estudadas, uma carga de CFU de menos de 100.000 unidades formadoras de colonias - UFC / g de tecido. Este valor é um cutoff padronizado pela Sociedade Americana de Microbiologia, a fim de diferenciar o agente causal dos colonizadores. Diante destes resultados e considerando a ausência de sinais infecciosos nas amostras de peixes, conclui-se que os valores CFU's encontrados neste estudo consistem em colonização/ microbiota. (AU)

Fat grafting for treatment of burns, burn scars, and other difficult wounds.

This article presents the authors' 3-year experience with the use of fat grafting, via the Coleman technique, for the adjuvant treatment of burn wounds, venous ulcers, diabetic ulcers, and burn scars. It demonstrates the regenerative effects of fat injected under the scar, and of fat injected under the wound, in the periphery of the wound, and within a bone fracture line or space, and of fat deposited over the wound.

Tumores cutâneos de face / Cutaneous tumors of the face

Os autores apresentam um levantamento amplo da incidência de tumoraçöes cutâneas em face, na Clínica Ivo Pitanguy. As lesöes benignas ganham importância por trazerem prejuízo estético ao paciente ou por represetarem lesöes potencialmente malignas. Maior ênfase é dada a apresentaçäo e discussäo das neoplasias da pele. Dentre estas, notamos uma prevalência muito grande dos carcinomas basocelulares, e a predominância destas lesöes nas regiöes mais expostas da face. As diferentes técnicas adotadas para o tratamento do tumor da pele säo comentadas, enfatizando-se o tratamento oncológico que garanta, ao mesmo tempo, resultados estéticos e funcionais satisfatórios

Utilizaçäo dos expansores cutâneos nas lesöes pós-traumaticas / The use of skin expander in post traumatic lesions

Foi empregado um total de 158 expansores em 141 pacientes. Os expansores utilizados foram os do tipo Radovan, com válvula remota, na sua grande maioria de formato retangular. O paciente deve ser esclarecido sobre a deformidade progressiva consequente ao aumento de volume do expansor, e que durante as infiltraçöes poderá sentir dor e desconforto transitório. O uso de expansores é indicado principalmente no tratamento de sequelas de queimaduras, nevus piloso, radiodermites, hamangiomas, mama, abdomem, alopecias, tratamento de deformidades de membros superiores e inferiores e ou lesöes congênitas. Säo feitas incisöes próximas paralelas ao limite da cicatriz, ganhando acesso ao tecido celular subcutâneo, criando-se a loja suficientemente ampla para inclusäo do expansor; a válvula é colocada em uma loja separada, tatuada a sua localizaçäo no período pós-operatório. A expansäo é iniciada cerca de a 2 semanas após a cirurgia, sendo repetida com um intervalo médio de seis dias. Ao se obter a expansäo máxima, ou quando já se tiver a quantidade suficiente de tecido para se realizar a reconstruçäo, o expansor é retirado cirurgicamente, fazendo uma rotaçäo e/ou avanço do retablho. O fato de dois procedimentos cirúrgicos serem necessários (inclusäo e retirada), pode parecer desvantagem principalmente para os que têm dificuldade de locomoçäo, e, as resseçöes parciais oferecem uma alternativa, obtendo-se uma melhora parcial da deformidade. A avaliaçäo do volume a ser infiltrado é eminentemente clínica, dependendo da área a ser reparada e do volume nominal do expansor. De um modo geral, näo se deve proceder a exérese da cápsula fibrosa que se forma em torno do expansor, excessäo nos retalhos de face e pescoço. As complicaçöes deste tipo de procedimento, säo geralmente imediatas, sendo a mais frequente o hematoma. Trata-se de um método de execuçäo relativamente fácil, e apesar da deformidade transitória consequente ao aumento do volume do expansor, a técnica é bem aceita pela obtençäo de tecido de boa qualidade, com um mínimo de complicaçöes

Reconstruçäo peniana parcial: apresentaçäo de um caso / Partial penile reconstruction: case report

Os autores relatam a sua experiência com um caso de automutilaçäo da porçäo distal do pênis, analisando os aspectos da preparaçäo psicológica e do tratamento cirúrgico, que correspondeu à confecçäo de um novo sulco balanoprepucial a partir de duas resseçöes segmentares laterais aos corpos cavernosos e de uma neo-glande com enxerto de pele da regiäo escrotal

Expansores cutâneos e ressecçöes parciais múltiplas / Tissue expanders and multiple partial resections

Os autores apresentam sua experiência com 30 casos consecutivos de expansores cutâneos em diferentes regiöes anatômicas, analisando os resultados obtidos e discutindo detalhes da técnica cirúrgica empregada

Ginecomastia / Gynecomastia

Apresenta-se uma revisäo de 25 casos de ginecomastia verdadeira, tratados cirurgicamente na Clínica Ivo Pitanguy e na 38ª Enfermaria da Santa Casa de Misericórdia do Rio de Janeiro. Tecem-se comentários sobre possíveis fatores etiológicos e descreve-se a técnica cirúrgica empregada, que consiste em uma incisäo transreolomamilar e confecçäo de dois retalhos retroareolares, podendo ou näo ser associados à lipoaspiraçäo