Micro-Autologous Fat Transplantation for Treating a Gummy Smile.

BACKGROUND: A gummy smile is treated using many techniques, including botulinum toxin injection and various surgical interventions. Micro-autologous fat transplantation (MAFT) is a potentially advantageous alternative approach that has not been previously evaluated. OBJECTIVES: This study sought to determine the long-term results of MAFT in patients with a gummy smile. METHODS: Seven patients with gummy smiles were evaluated for MAFT treatment between October 2015 and April 2017. Centrifuged purified fat was micro-transplanted into the nasolabial groove, ergotrid, and upper lip areas using the MAFT-GUN while the patients were under total intravenous anesthesia. RESULTS: The mean age of the 7 patients was 31 years (range, 23-40 years). The mean operating time for MAFT was 52 minutes (range, 40-72 minutes), and the mean volume of fat delivered to the nasolabial groove, ergotrid, and upper lip was 16.1 mL. The mean decreases of gingival display in the right canine incisor, left canine incisor, right canine, and left canine teeth were 4.9, 4.6, 3.8, and 4.4 mm, respectively. The smiles of the 7 patients showed significant improvement at an average follow-up time of 12.9 months. CONCLUSIONS: Gummy smile treatment using MAFT is an effective, reliable, and relatively simple method, with high patient satisfaction and minimal risk of complications.

Simultaneous double free radial forearm flaps combined with coronoidectomy and myotomy to release bilateral severe trismus: A case report.

Oral cancers associated with submucosal fibrosis-induced trismus are common. They may affect the patients' quality of life, cause nutritional deficits, and interfere with postoperative cancer surveillance. In such cases, locating desirable recipient vessels in the head and neck can be difficult. This report presents a 47-year-old man with severe trismus caused by recurrent head and neck cancer, who had received multiple free-flap reconstructions after cancer ablation. Reconstruction was successfully achieved for the bilateral defects and releasing the trismus by using simultaneous double free radial forearm flaps as a chained flow-through pattern with one residual recipient vessel combined with the bilateral myotomy of the medial pterygoid and masseter muscles, and coronoidectomy. Both flaps survived without any postoperative complication. The maximal mouth opening measured by interincisal distance was 38 mm intraoperative and 32 mm during the 3-year follow-up period. This approach may be an effective option for releasing trismus when recipient vessels are lacking.

Angular artery cutaneous flap for reconstruction of difficult oronasal fistulas.

BACKGROUND: Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer. MATERIALS AND METHODS: An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect. CASE REPORTS: Two oronasal fistula cases were reported in this series. Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm. Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period. CONCLUSION: Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.

Fat Grafting for Facial Contouring (Nose and Chin).

The concept of microautologous fat transplantation (MAFT), proposed by Lin and colleagues in 2007, emphasized that the volume of each delivered parcel should be less than 0.01 mL to avoid potential fat grafting morbidities. The MAFT-GUN facilitates control of the parcel volume and therefore substantially avoids central necrosis and associated complications. In this article, the authors present a simple, reliable, and consistent procedure based on MAFT for profiloplasty. Favorable outcomes with sustainable long-term effectiveness were obtained, further confirming that the MAFT technique is an alternative for facial contouring in the nose and chin.

Hyaluronic Acid-Povidone-Iodine Compound Facilitates Diabetic Wound Healing in a Streptozotocin-Induced Diabetes Rodent Model.

BACKGROUND: This study investigated whether a hyaluronic acid-povidone-iodine compound can enhance diabetic wound healing. METHODS: A dorsal skin defect (6 × 5 cm) in a streptozotocin-induced diabetes rodent model was used. Seventy male Wistar rats were divided into seven groups: I, normal control; II, diabetic control, no treatment; III, diabetic rats, lower molecular weight (100 kDa) hyaluronic acid; IV, rats, higher molecular weight (1000 kDa) hyaluronic acid; V, rats, 0.1% povidone-iodine; VI, rats, lower molecular weight hyaluronic acid plus povidone-iodine; and VII, rats, higher molecular weight hyaluronic acid plus povidone-iodine. Histologic examination was performed with hematoxylin and eosin staining. CD45, Ki-67, prolyl 4-hydroxylase, and vascular endothelial growth factor were evaluated with immunohistochemical staining. RESULTS: Compared with the control, higher molecular weight hyaluronic acid plus povidone-iodine-treated rats had significantly reduced wound area (p < 0.001). Higher molecular weight hyaluronic acid plus povidone-iodine increased wound healing time when compared with higher molecular weight hyaluronic acid, povidone-iodine, or lower molecular weight hyaluronic acid plus povidone-iodine. Histology revealed significantly increased neovessels and suppressed inflammatory response in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the control group. Immunohistochemical staining revealed significantly increased Ki67, prolyl 4-hydroxylase, and vascular endothelial growth factor expression, and suppressed CD45 expression in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the other groups. CONCLUSION: Higher molecular weight hyaluronic acid plus povidone-iodine complex dressing significantly facilitated diabetic wound healing via increasing neovascularization and tissue regeneration and suppressing a proinflammatory response.

Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap.

The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.

Engineered adipose tissue of predefined shape and dimensions from human adipose-derived mesenchymal stem cells.

Human adipose-derived mesenchymal stem cells (hAD-MSCs) were cultured in growth medium of low calcium concentration to which antioxidants had been added. Large numbers of hAD-MSCs could be obtained within 2 weeks. Scaffolding was made with 3 commonly used biomaterials. Gelatin sponges and polyglycolic acid meshes were cut into small pieces and put into the scaffold pocket, which was made of polypropylene mesh and measured 1.5 x 1.0 x 0.5 cm3. Immune-deficient mice were divided into 3 groups. In Group I, only hAD-MSCs were injected. In Group II, the scaffold alone was implanted and harvested after 2 months in vivo. In Group III, scaffolds were cultured with hAD-MSCs in adipogenic medium for 2 weeks before implantation, and 2 implanted scaffolds were harvested after 2, 4, and 6 months in vivo. All of the successfully harvested scaffolds were filled with newly formed adipose tissue and had retained their predefined shape and dimensions. New blood vessels had also grown into the newly formed adipose tissue. Adipose tissue of specific shape and 3 dimensions was regenerated in vivo using tissue engineering of hAD-MSCs and scaffolding made with 3 common biomaterials.

Anterolateral thigh flaps for reconstruction of head and neck defects.

PURPOSE: This article presents our clinical experience with head and neck reconstruction using a free anterolateral thigh (ALT) flap and describes the morbidity of the donor site. MATERIALS AND METHODS: From October 2001 to October 2003, 20 free ALT flaps were transferred for reconstructing soft tissue defects of the head and neck. The age and gender of the patients, the site of the primary tumor, tumor stage, previous operative condition, types of associated operation, results of flap transfer, donor site morbidity, and clinical course were analyzed. RESULTS: Of 20 cases, 19 free flaps were successfully performed. The success rate was 95%. The size of the ALT flaps ranged from 6 to 10 cm in width and 9 to 20 cm in length (54 to 200 cm2 in area). Sixteen of the 20 donor sites were closed primarily, whereas 4 cases required a split-thickness skin graft to cover the donor site. Complications and morbidity of the donor site were minimal. CONCLUSION: The ALT flap has some advantages over other free flaps, including a long pedicle with a suitable diameter for anastomoses, the availability of different tissues with large amounts of skin, the ease of closing the donor site, and the ability for 2 teams to simultaneously perform the operation.

Use of the orbicularis oculi muscle flap for severe Marcus Gunn ptosis.

The authors present a 22-year-old man with severe unilateral congenital blepharoptosis associated with Marcus Gunn (jaw-winking) syndrome. The best conventional treatment was levator excision to eliminate the synkinetic reflex and fascia lata brow suspension. However, the previous surgery had some disadvantages. Therefore, the authors report the use of the orbicularis oculi muscle flap to elevate dynamically the ptotic eyelid and to eliminate the synkinetic reflex without levator resection. The postoperative result was both functionally and cosmetically satisfactory after 1 year of follow-up.