The formation mechanism of the bilayer capsular contracture after an augmentation mammoplasty with a rough-surface prosthesis and its prevention and treatment.

BACKGROUND: The present study aimed to explore the formation mechanism of the bilayer capsular contracture after augmentation mammoplasty with a rough-surface prosthesis and its prevention and treatment. METHODS: The nursing process, clinical signs, intraoperative findings, and pathological data after an augmentation mammoplasty with rough-surface prosthesis were observed and collected, the formation mechanism of the bilayer capsular contracture was analyzed, and the prevention and treatment were also discussed. RESULTS: A total of 18 patients were included into the present study, among which 15 patients underwent capsule relaxation plus secondary augmentation mammoplasty and three patients encountered a single-layer capsular contracture after the operation; the recurrence rate was 16%. All patients were followed up for 1-13 years without a presentation of recurrence. CONCLUSIONS: The formation of the bilayer capsular contracture after augmentation mammoplasty is correlated with the formation of the inner capsule, inadequate separation of cavities, foreign body reaction, and an improper massage of the breasts, and the effective preventive measures include removing new cavities, resecting the capsular contracture capsule, stopping bleeding, replanting a rough-surface or smooth prosthesis, and correcting breast massaging.

The effect of liposome-delivered prednisolone on collagen density, myofibroblasts, and fibrous capsule thickness around silicone breast implants in rats.

Capsular contracture is a potential adverse effect of breast implants. An inflammatory reaction is most likely the origin of fibrosis around the implant. It is possible that some substances may act to prevent this inflammatory reaction. Thus, our goal was to evaluate the effectiveness of local depot prednisolone phosphate-liposomes (PPL) on fibrous capsule formation around textured silicone breast implants. Shell prostheses (2 mL) were implanted in the right (plus PPL group) and left (plus saline solution, saline group) subcutaneous dorsum of 18 rats. In another 18 rats, the implants were positioned in the left of the back without any drug instillation (control group). In the PPL group, the capsule thickness (microm) and density (%) of collagen were significantly (p<0.0001) lower compared with the control group on days 35 and 90 postsurgery. Furthermore, in the PPL group, a significant reduction in myofibroblast count was observed on day 90 postsurgery (p<0.0001). In conclusion, a single dose of depot liposome-delivered prednisolone was effective at impairing capsule formation around the silicone implant. The results suggest a strong local and weak systemic effect of PPL on the fibrous tissue around silicone implants. To our knowledge, no study has yet assessed the effect of PPL on silicone breast implants.

Effects of hyaluronan and iodine on wound contraction and granulation tissue formation in rat skin wounds.

BACKGROUND: Hyaluronan (HA) plays an important role in the repair of damaged skin and has been used for the treatment of wounds. Iodine is a mild topical antiseptic. AIM: A mixture of high molecular weight HA with the iodine complex KI(3) (hyiodine) was reported to accelerate wound healing in patients with diabetes and patients after surgery. We investigated how this mixture affects wound contraction, granulation tissue (GT) and wound edges in excision skin wounds in rats. METHODS: Hyiodine was applied to full-thickness wounds made on the back of rats. The areas of the contracting wounds were calculated from digital photographs. The moving edges of the wound were studied by histological methods. The properties of GT were studied in wounds in which contraction was prevented by the insertion of plastic rings. The effects of hyiodine were compared with those of high molecular weight (1200 kDa) HA, low molecular weight (11 kDa) HA and KI(3) solution. RESULTS: Hyiodine accelerated wound contraction significantly in the first 5 days of healing. On day 3, hyiodine-treated wounds had reduced to 63% of the original area, whereas the wound area in saline-treated animals was 75% of the original size. The proliferating epidermis was thicker in hyiodine-treated animals on day 7. In the wounds with inserted rings, hyiodine caused little change in GT, but the weight of the crust/exudate formed on the top of the wound was increased by 351% compared with only minor changes caused by the hyiodine components alone. CONCLUSIONS: Hyiodine supports wound healing by stimulating wound contraction and epidermal proliferation and by keeping the wound moist through increased exudation.

Pentoxifylline modifies three-dimensional collagen lattice model contraction and expression of collagen types I and III by human fibroblasts derived from post-burn hypertrophic scars and from normal skin.

Fibroblasts are thought to be partially responsible for the persisting contractile forces that result in burn contractures. Using a monolayer cell culture and fibroblast populated collagen lattice (FPCL) three-dimensional model we subjected hypertrophic scar and non-cicatricial fibroblasts to the antifibrogenic agent pentoxifylline (PTF - 1mg/mL) in order to reduce proliferation, collagen types I and III synthesis and model contraction. Fibroblasts were isolated from post-burn hypertrophic scars (HSHF) and non-scarred skin (NHF). Cells were grown in monolayers or incorporated into FPCL's and exposed to PTF. In monolayer, cell number proliferation was reduced (46.35% in HSHF group and 37.73% in NHF group, p<0.0001). PTF selectively inhibited collagen III synthesis in the HSHF group while inhibition was more evident to type I collagen synthesis in the NHF group. PTF also reduced contraction in both (HSHF and NHF) FPCL.

Evaluation of low intensity laser's action on silicone mammary implant pseudocapsules in rats / Avaliação do laser de baixa intensidade sobre a pseudocápsula de implantes mamários de silicone em ratos

PURPOSE: To evaluate the effect of low intensity laser on the pseudocapsula contraction that occurs around silicone implants. METHODS: 60 male rats divided in two experimental groups received a silicone implant in the subcutaneous of the dorsal region. Group I: animals received implants in the subcutaneous dorsal region and did not receive any treatment; Group II: animals received seven irradiation sessions with low intensity laser after they had received subcutaneous implants. Thirty, 60 and 180 days after the surgery, tonometric evaluation of the implants was conducted. After that, the animals were sacrificed, study material was removed and prepared for histological examination. The thickness of the pseudocapsule and the inflammatory reaction were morphometrically quantified. Data obtained were statistically analyzed using the Variance method, and Tukey's Test(P<0.0 5). RESULTS: Group II animals had significant lower pressure. The histological study did not show a significant difference between the groups, but only a higher number of swollen vessels in Group II. The thickness of pseudocapsule around Group II's implants lower than in Group I. CONCLUSION: The low intensity laser modify tissue's reparation process around the implants suggesting it may be useful to model contractures that are formed around silicone implants.

OBJETIVO: Avaliar o efeito do laser de baixa intensidade sobre a contração da pseudocápsula que ocorre ao redor de implantes de silicone. MÉTODOS: 60 ratos machos divididos em dois grupos receberam implante de silicone. Grupo I: implante no subcutâneo da região dorsal, sem tratamento após a cirurgia; Grupo II: animais receberam sete sessões de irradiação com laser de baixa intensidade após o implante. Trinta, 60 e 180 dias após a cirurgia, foi feita a tonometria dos implantes, Em seguida, os animais foram sacrificados, removendo-se o material de estudo que foi preparado para exame histológico, avaliando-se morfometricamente a espessura da pseudocápsula e a reação inflamatória. A análise estatistica pela técnica da Análise de Variância e Teste de Tukey (P<0.0 5). RESULTADOS: Pressões significativamente menores foram encontradas nos animais do grupo Grupo II. O estudo histológico não mostrou diferença significativa entre os grupos, destacando-se apenas maior quantidade de vasos intumescidos no Grupo II. A espessura da pseudocápsula foi menor no Grupo II. CONCLUSÃO: O laser de baixa intensidade altera o processo de reparação tecidual ao redor dos implantes, sugerindo que o mesmo possa ser útil para a modelação das contraturas que se estabelecem ao redor dos implantes de silicone.

Evaluation of low intensity laser's action on silicone mammary implant pseudocapsules in rats.

PURPOSE: To evaluate the effect of low intensity laser on the pseudocapsule contraction that occurs around silicone implants. METHODS: 60 male rats divided in two experimental groups received a silicone implant in the subcutaneous of the dorsal region. Group I: animals received implants in the subcutaneous dorsal region and did not receive any treatment; Group II: animals received seven irradiation sessions with low intensity laser after they had received subcutaneous implants. Thirty, 60 and 180 days after the surgery, tonometric evaluation of the implants was conducted. After that, the animals were sacrificed, study material was removed and prepared for histological examination. The thickness of the pseudocapsule and the inflammatory reaction were morphometrically quantified. Data obtained were statistically analyzed using the Variance method, and Tukey's Test(P<0.0 5). RESULTS: Group II animals had significant lower pressure. The histological study did not show a significant difference between the groups, but only a higher number of swollen vessels in Group II. The thickness of pseudocapsule around Group II's implants lower than in Group I. CONCLUSION: The low intensity laser modify tissue's reparation process around the implants suggesting it may be useful to model contractures that are formed around silicone implants.

Disabling pansclerotic morphea of childhood--unusual case and management challenges.

Morphea, also known as localized scleroderma is a chronic disease of unknown etiology, characterized by fibrous deposition and obliteration of vessels in the skin. This disease has a wide clinical spectrum, ranging from mild hyperpigmented plaques to severe, invalidating generalized and pansclerotic forms. Disabling pansclerotic morphea of childhood is a rare and debilitating variant of localized scleroderma, characterized by a rapid progression of deep cutaneous fibrosis that involves the dermis and the subcutaneous adipose tissue but also fascia, muscles, and bone. Contractures and musculoskeletal atrophy develop and the disease has an invalidating and even fatal course. We present an unusual case of severe morphea in a 19-year-old girl, with a polymorphous clinical picture consisting of plaques, linear and pansclerotic, circumferential lesions, with symmetric, invalidating involvement of all limbs and explosive evolution with centripetal progression. This case emphasizes the unpredictable character of morphea evolution, the possible severe prognosis and the therapeutic challenges raised by the generalized, disabling forms of this disease.

Tranilast as an additional treatment with conservative therapy for concave deformity following traumatic hematoma.

Fibrotic scar tissue resulting from a cheek hematoma sometimes seriously contracts to form a concave deformity, despite conservative therapy. We used Tranilast as an additional treatment with conservative therapy for four patients who were resistant to massage and compression therapy. Four months after oral administration of Tranilast, all the deformities were resolved. Tranilast is used for the treatment of allergic diseases and keloids. It inhibits the release of transforming growth factor b-1, interleukin-1 b, and prostaglandin E2. It also suppresses collagen synthesis by fibroblasts.

A different strategy in the surgical treatment of capsular contracture: leave capsule intact.

The authors present their experience with the surgical treatment of capsular contracture to achieve better results in a safe, predictable, and practical way, and discuss the possible treatment modalities. They simply advise leaving the capsule intact, even if it is calcified, and create another pocket, rarely in the front or, more typically, at the back of the capsule. If the breast tissue is also ptotic, a mastopexy procedure may be added to the procedure, in addition to augmentation, with a rather small prosthesis placed in the new pocket or, occasionally, in the old one. External, forceable massage is not advisable to treat the capsule. Open capsulotomy and/or partial capsulectomy can be applied to release the capsule. However, it is not advisable since recurrence is usually inevitable. The purpose of this paper is to present a series of surgical procedures to avoid the problems created by the capsule and present different cases with good results.