Aesthetic Consideration in a Patient With Lipomatosis.

ABSTRACT: This is the first report of multiple parosteal lipomas as a late complication of aesthetic procedures. A 70-year-old woman presented with multiple frontal nodules that had grown slowly over 5 years. She underwent forehead-lifting surgery 30 years ago and botulinum toxin injection 3 years ago. Computed tomography showed six low-density nodules measuring 10 to 20 mm just above the frontal bone. The tumors were resected via a parietal coronal incision. Histopathological findings revealed parosteal lipoma with foreign bodies. At 1 year postoperatively, there has been no recurrence or complications. The multiple lesions corresponded to the sites of the aesthetic procedures. The mesenchymal cells in the periosteum seemed to be stimulated by cytokines released from a postoperative hematoma or damaged periosteum, resulting in tumorigenesis. When performing aesthetic procedures in the face, care should be taken to avoid unnecessary injury to the periosteum, given the possibility of tumor development.Level of evidence: Level V, case report.

Polyglycolic Acid Felt for Prevention of Frey Syndrome After Parotidectomy.

BACKGROUND: Frey syndrome is one of the important complications of parotid surgery. Placing a barrier between the parotid gland and the skin flap is considered to be effective for preventing this syndrome by blocking misdirected regeneration of nerve fibers. Neoveil is nonwoven polyglycolic acid (PGA) felt that is used as absorbable reinforcing material. The present study evaluated the effectiveness of this PGA felt as a barrier for preventing Frey syndrome. METHODS: A total of 19 patients who underwent superficial parotidectomy from 2012 to 2017 were retrospectively reviewed. Application of PGA felt (n = 9) or sternocleidomastoid flap (SCMF) transfer (n = 10) was performed to prevent Frey syndrome. The total operating time, intraoperative blood loss, operating time after parotidectomy, and postoperative drainage volume were compared between the 2 groups. RESULTS: The operating time after parotidectomy was significantly shorter in the PGA felt group than in the SCMF group (43.7 ± 10.7 vs 57.8 ± 15.7 minutes). The total operative time was shorter and the drainage volume was smaller in the PGA felt group than those in the SCMF group without statistical significance (210.1 ± 43.4 vs 234.3 ± 52.7 minutes and 80.6 ± 36.8 vs 118.8 ± 83.9 mL). Neither Frey syndrome nor other major complications occurred in either group. CONCLUSIONS: Use of PGA felt successfully prevented Frey syndrome, while being technically simpler and more rapid compared with SCMF transfer.

Sutureless Microvascular Anastomosis using Intravascular Stenting and Cyanoacrylate Adhesive.

BACKGROUND: Microvascular anastomosis using cyanoacrylate adhesive has a reputation among researchers as an alternative to conventional sutures. However, a degree of ingenuity is required to avoid the collapse of the vascular lumen for the duration of the anastomosis. The aim of this study was to determine the feasibility of intravascular stenting (IVaS) as a temporary stent during sutureless microvascular anastomosis with cyanoacrylate adhesive. METHODS: Sixty male Fisher 344 rats were evenly divided into two groups. The right superficial femoral arteries (RSFAs) were transected in each group. Microvascular anastomoses were then performed with the sutureless (SL) method in one group and conventional sutures (CS) in the other group. The diameter of the RSFA, duration of microvascular anastomosis, and the patency of the RSFA were evaluated immediately after anastomosis and 7 days after the surgery. Tissue samples were obtained for pathological consideration. RESULTS: There was no significant difference in the diameter of the RSFAs between the SL and the CS groups. There was no significant difference in the patency rates of the groups. The anastomosis time of the SL group was significantly shorter than that of the CS group, regardless of the experience of the surgeons. A histological analysis showed a comparable level of foreign body reactions in each group. CONCLUSION: IVaS plays a supportive role in sutureless microvascular anastomosis with cyanoacrylate adhesive. The short-term safety of this technique has now been confirmed at the experimental stage.

The efficacy of basic fibroblast growth factor-loaded poly(lactic-co-glycolic acid) nanosheet for mouse wound healing.

Although human recombinant basic fibroblast growth factor (bFGF) is widely used for wound healing, daily treatment with bFGF is required because of its short half-life. An effective controlled-release system of bFGF is, therefore, desired in clinical settings. To investigate the efficacy of a bFGF-loaded nanosheet for wound healing, focusing on the controlled-release of bFGF, bFGF-loaded poly(lactic-co-glycolic acid) (PGLA) nanosheets were developed, and their in vitro release profile of bFGF and their in vivo efficacy for wound healing were examined. A polyion complex of positively charged human recombinant bFGF and negatively charged alginate was sandwiched between PLGA nanosheets (70 nm thick for each layer). The resulting bFGF-loaded nanosheet robustly adhered to silicon skin by observation using a microscratch test. bFGF was gradually and continuously released over three days in an in vitro incubation study. Treatment with the bFGF-loaded nanosheets (every 3 day for 15 days) as well as with a conventional bFGF spray effectively promoted wound healing of mouse dorsal skin defects with accelerated tissue granulation and angiogenesis, although the dose of bFGF used in the treatment with the bFGF nanosheets was approximately 1/20 of the sprayed bFGF. In conclusion, we developed a bFGF-loaded nanosheet that sustained a continuous release of bFGF over three days and effectively promoted wound healing in mice.

In situ transplantation of adipose tissue-derived stem cells organized on porous polymer nanosheets for murine skin defects.

Stem cell transplantation is expected to be an effective early-phase treatment for deep burn injuries and intractable ulcers. Localizing and proliferating stem cells on the lesion utilizing engineered scaffolds is important for this treatment. In this study, we demonstrated in situ transplantation of adipose-tissue derived stem cells (ASCs) organized on free-standing porous polymer ultrathin films (referred to as "porous nanosheets") to a skin defect model in diabetic mice. Porous nanosheets were prepared by a combination of micro-gravure coating with macrophase separation of poly(d,l-lactic acid) and polystyrene under a roll-to-roll process and solvent etching process with cyclohexane. The permeable structure of porous nanosheets (thickness of 150 nm, average pore diameter of 4 µm) allowed for proliferation of ASCs and also provided sufficient nutrient inflow into multilayered ASC constructs. Then, transplantation of a trilayered ASC-laden porous nanosheet achieved homogeneous transference of ASCs onto the skin lesion. Transplanted ASCs contributed to wound healing in a dorsal skin defect model in diabetic mice. Thus, cell transplantation using porous nanosheets will be a new method for promoting wound healing in diabetic and other kinds of refractory ulcers. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1363-1371, 2019.

Application of poly-L-lactic acid nanosheet as a material for wound dressing.

The authors evaluated the efficacy of an ultrathin nanosheet consisting of poly-L-lactic acid (75 nm thick) as a wound dressing material. A full-thickness skin defect was made on the backs of mice and overlapped with or without the poly-L-lactic acid nanosheet. Wound healing was more rapidly improved by overlapping with the nanosheet, especially in the early healing period (at 4 to 6 days). The remaining wound area in the treatment group was significantly smaller at 4 days than in the control group. Histologically, a clear layer was observed over the granulation layer by the nanosheet therapy at 4 days. Thus, overlapping therapy with the poly-L-lactic acid nanosheet accelerated wound healing and formed a clear layer just above the granulation tissue. The poly-L-lactic acid nanosheet may have potential as a novel wound dressing to promote wound healing.