Remote Monitoring System for Condition Management of Patients in Free Flap Surgery.

INTRODUCTION: Free flap surgery is inconvenient because an attending physician must observe a patient's condition every day to ensure that normal tissue is restored within 72 h after the surgery. To address this problem, this paper proposes a remote monitoring technology to observe a patient's condition in real time. METHODS: To design a monitoring system, the camera consists of MCU board, DC-DC converter, alarm performance, Wi-fil module, and server, and the camera and MCU part is connected to the server through the wi-fi network. A camera obtains the images of the surgical site once every 2 s, and the images are transmitted to the attending physician or nurse via Wi-Fi communication. The working distance between camera and surgical site is 56 cm, and the viewing angle of a camera is 60° (radius). RESULTS: A video shooting test is also performed, in which the images are obtained once per hour between 17:00 and 08:00 the next day; the results show that high-quality images are obtained in the video shooting test. The imaging error is zero (0 GB) in the video shooting test results. DISCUSSION AND CONCLUSION: The imaging of the surgical site can be obtained by camera system, and the proposed method is that there no storage error occurs during the shooting process. In addition, the shooting performance has high velocity. It is possible to control the WD according to a patient's body via a holding manipulator used for the camera. The new method is expected to be used for remote patient management, for a wide range of procedures, in the medical field.

A Study on 3D Deep Learning-Based Automatic Diagnosis of Nasal Fractures.

This paper reported a study on the 3-dimensional deep-learning-based automatic diagnosis of nasal fractures. (1) Background: The nasal bone is the most protuberant feature of the face; therefore, it is highly vulnerable to facial trauma and its fractures are known as the most common facial fractures worldwide. In addition, its adhesion causes rapid deformation, so a clear diagnosis is needed early after fracture onset. (2) Methods: The collected computed tomography images were reconstructed to isotropic voxel data including the whole region of the nasal bone, which are represented in a fixed cubic volume. The configured 3-dimensional input data were then automatically classified by the deep learning of residual neural networks (3D-ResNet34 and ResNet50) with the spatial context information using a single network, whose performance was evaluated by 5-fold cross-validation. (3) Results: The classification of nasal fractures with simple 3D-ResNet34 and ResNet50 networks achieved areas under the receiver operating characteristic curve of 94.5% and 93.4% for binary classification, respectively, both indicating unprecedented high performance in the task. (4) Conclusions: In this paper, it is presented the possibility of automatic nasal bone fracture diagnosis using a 3-dimensional Resnet-based single classification network and it will improve the diagnostic environment with future research.

Inframammary Fold Incision Can Reduce Skin Flap Necrosis in Immediate Breast Reconstruction With Implant and Conjoined Fascial Flap.

BACKGROUND: Immediate breast reconstruction with implant (IBRI) can produce good aesthetic results after nipple-sparing mastectomy (NSM). Various surgical incisions can be used for NSM. The purpose of this study is to compare outcomes of using an IBRI with dual-coverage fascial flap after NSM with an inframammary fold (IMF) or a radial (Rd) incision. METHODS: We retrospectively reviewed the records of 88 women who underwent IBRI with dual-coverage fascial flap from March 2015 to June 2018. Inframammary fold incision was used in 19 patients (22 breasts) and Rd incision in 69 patients (75 breasts). In the dual-coverage method, acellular dermal matrix covered the inferomedial quadrant of the breast, and conjoined fascial flap covered the remaining inferolateral quadrant. Patient-reported satisfaction was assessed using the Breast-Q questionnaire, and plastic surgeons assessed aesthetic postoperative scores. RESULTS: Complications and reoperation rates of 2 incisions were as follows: skin flap necrosis rate showed significant difference between 2 groups (IMF, 0.0% [0/22]; Rd, 16.0% [12/75]; P < 0.05). The other complication rates, hematoma, seroma, infection, capsular contracture, and total reoperations showed no significant difference. Postoperative Breast-Q scores were higher in the IMF group (331.9 ± 10.1) than in the Rd group (311.4 ± 11.0; P < 0.05), indicating higher satisfactory rate in the IMF group than in the Rd group. Surgeon-reported scores for breast symmetry, contour, and scar appearance were also higher in the IMF group (P < 0.05). CONCLUSIONS: Immediate breast reconstruction with implant with dual-coverage fascial flap after NSM with IMF incision was associated with a lower rate of postoperative skin flap necrosis and improved patient satisfaction, compared with Rd incision. Inframammary fold incisions were associated with improved scar and breast appearance.

Comparison of Volume Retention and Biocompatibility of Acellular Dermal Matrix/Hyaluronic Acid Filler to Autologous Fat Grafts in a Mouse Model.

BACKGROUND: Although fat grafting has become a widely used technique in aesthetic and reconstructive surgeries, resorption is still a challenge. Micronized acellular dermal matrix (ADM) has been considered as a stable, biocompatible soft tissue coverage material that can be used as a volume filler. Here, we compared the bioacceptance and sustainability of ADM hyaluronic acid (HA) filler with human fat graft in a mouse model. METHODS: Harvested human fat and ADM/HA filler were injected randomly on the dorsal side of mice. Thirty-two mice were analyzed over a 7-week period with respect to volume, weight and microscopic evaluations with hematoxylin and eosin (H&E), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) staining. RESULTS: The volume and weight were maintained at 80% and 83%, respectively, in the ADM/HA filler group and 56.5% and 49.7%, respectively, in the fat-grafted group by the 7th week. There were no significant microscopic differences in inflammatory changes and granulation via H&E staining. At 1 and 2 weeks, EGF and VEGF immunostaining intensity scores were lower in the ADM/HA filler group. At 7 weeks, there were no significant differences in immunostaining intensity scores between the two groups. CONCLUSIONS: During the 7-week experimental period, the ADM/HA filler showed no foreign body reaction and the proper volume was well maintained. This suggests that the ADM/HA filler can possibly be used in small amounts as an alternative to autologous fat grafts. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authorshttp://www.springer.com/00266.

Merkel Cell Carcinoma of the Wrist: A Case Report.

PURPOSE: Merkel cell carcinomas are a rare type of neuroendocrine tumors of the head, neck, and extremities commonly found in older patients. Merkel cell carcinomas present as red-to-purple and nontender nodules with or without surface ulceration, usually measuring 2 cm in diameter. CASE PRESENTATIONS: An 83-year-old woman with a skin-colored nodule on the dorsal aspect of her right wrist was referred to our department for treatment. The regional lymph nodes were not palpable, and the positron emission tomography/computed tomography scan did not reveal any distant metastases. We conducted wide excision of the lesion and sentinel lymph node biopsy. The defect caused by the excision and partial bone resection was reconstructed using a radical forearm rotational flap and a split-thickness skin graft. Postoperatively, the patient received adjuvant radiation therapy. We observed wound healing and an absence of complications such as recurrence at 1-year follow-up. CONCLUSIONS: Merkel cell carcinomas are rare but aggressive neuroendocrine skin cancers, which rarely occur in the upper extremity. Our treatment of nonamputative wide excision and sentinel lymph node dissection, followed by postoperative radiation therapy, showed no local or distant recurrence. Here, we review the current literature on Merkel cell carcinomas and describe our approach of treatment.

Effect of Platelet-Rich Plasma on Ischemia-Reperfusion Injury in a Skin Flap Mouse Model.

Background: Ischemia-reperfusion (I/R) injury is a leading cause of surgical skin flap compromise and organ dysfunction. Platelet-rich plasma (PRP) is an abundant reserve of various growth factors. Activated platelets play a role in endothelial damage during I/R injury; however, exogenous PRP could inhibit the production of reactive oxygen species. The goal of this study was to investigate the effect of PRP on I/R injury. Methods: Four groups (n=30) of C57BL/6N mice with lateral thoracic artery island flaps were used. Group A, the control group, received flap elevation and repositioning. Group B received PRP and repositioning. Group C had 4 hours of ischemia and then were reperfused. Group D received PRP, had 4 hours of ischemia, and then were reperfused. The survival area of flap tissue and blood perfusion were assessed. Histological evaluation included neutrophil counts. Reactive oxygen species and proinflammatory cytokines were measured to evaluate I/R injury. Protein expression of phosphorylated apoptosis signaling regulating kinase-1 (pASK-1), p38MAPK, and pNF-κB was measured by western blot. Results: PRP treatment enhanced the survival area and perfusion of the flap, reduced neutrophil accumulation in mice subjected to I/R injury. PRP treatment also showed a protective effect, with decreases in nitric oxide, myeloperoxidase, malondialdehyde concentrations. Additionally, PRP suppresses monocyte chemotactic protein-1, TNF-α, IL-1ß, and IL-6. Finally, PRP decreased ASK-1 and NF-κB expression in tissues with I/R injury. Conclusion: PRP acts as a protective factor during flap I/R injury by reducing reactive oxygen species level and proinflammatory cytokines via decreased expression of pASK-1 and pNF-κB.

Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant.

BACKGROUND: Skin- or nipple-sparing mastectomy facilitates immediate one-stage reconstruction with an implant. Traditionally, an acellular dermal matrix or a muscle flap has been used because the inferolateral portion of the implant cannot be covered by the pectoralis major muscle. However, this method has drawbacks, including infection, cost, and donor-site morbidity. Therefore, we used an autologous conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia in patients with small-to-medium breasts. METHODS: A series of 11 immediate breast reconstructions in 11 patients was carried out from March 2010 to June 2011. The conjoined fascial flap and smooth round implants were used in all patients. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. Patient satisfaction was evaluated by a postoperative questionnaire that had five items designed to evaluate quality of life with the reconstruction. RESULTS: The mean body mass index was 23.2 kg/m(2), follow-up period was 30.9 months, and implant volume was 286.3 cc. Regarding complications, we observed one case of partial skin flap necrosis and one case of seroma accumulation in the axilla, both of which healed with conservative care. The mean overall breast satisfaction score was 3.18 ± 0.5. CONCLUSIONS: The conjoined fascial flap is a viable alternative for immediate one-stage breast reconstruction with an implant. We recommend appropriate patient selection with a body mass index greater than 20 kg/m(2) and small-to-medium sized nonptotic breasts. LEVEL OF EVIDENCE IV: 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 http://www.springer.com/00266 .

3D culture of adipose-tissue-derived stem cells mainly leads to chondrogenesis in poly(ethylene glycol)-poly(L-alanine) diblock copolymer thermogel.

Poly(ethylene glycol)-b-poly(L-alanine) (PEG-L-PA)s with L-PA molecular weights of 620, 1100, and 2480 Da and a fixed molecular weight of PEG at 5000 Da were synthesized to compare the thermosensitive behavior, and to investigate their potential as a three-dimensional (3D) culture matrix of adipose-tissue-derived stem cells (ADSCs). The sol-to-gel transition temperature and the concentration ranges where the transition was observed decreased as the L-PA molecular weight increased. ADSCs were cultured in the 3D matrixes of in situ formed PEG-L-PA hydrogels, which were produced by increasing the temperature of cell-suspended PEG-L-PA aqueous solutions. The spherical morphology was maintained in the PEG-L-PA hydrogel, while the cells underwent fibroblastic morphological changes in the Matrigel over 14 days of incubation. ADSCs exhibited high expression of type II collagen in the PEG-L-PA thermogel. In addition, they also moderately expressed the biomarker of myogenic differentiation factor 1 as the same mesodermal lineages, as well as the type III ß-tubulin as a cross-differentiation biomarker. Similar to the in vitro study, the ADSCs predominantly exhibited chondrogenic biomarkers in the in vivo study. The study demonstrates that the polypeptide thermogel of PEG-L-PA is promising as a 3D culture matrix of ADSCs and as an injectable tissue engineering biomaterial.

Reverse gracilis muscle flap: an alternative means of skin coverage for recurrent infection after TKA.

PURPOSE: Poor wound-healing and skin necrosis are serious but not unusual complications after total knee arthroplasty, and when skin or soft tissue necrosis occurs, reconstructions in the knee area need thin, pliable, tough skin flaps. METHODS: A 62-year-old man, who previously underwent multiple TKR operations due to recurrent infection, was transferred from another hospital after a gastrocnemius muscle rotation flap failed. We decided to treat the affected area with a reverse gracilis muscle flap. After confirming that the secondary pedicle was intact by Doppler sonography, muscle dissection was extended to the entry of the secondary pedicle. The proximal tendon of the gracilis muscle was transected, and the muscle was rotated 180° and placed at the recipient site. RESULTS: The aim is to report a case of reconstruction at the anterior knee using a reverse gracilis muscle flap that achieved an excellent final clinical result. CONCLUSION: This case suggests that the indications for a reverse gracilis muscle flap could be broadened when other flaps are not available for knee prosthesis coverage.

Heating Pretreatment of the Recipient Site Enhances Survival of Transplanted Fat in a Mouse Model.

BACKGROUND: Despite several studies about the preparation of the recipient site in fat grafting, optimizing techniques with clinical usefulness is still necessary. Through previous animal studies reporting that heat can increase tissue vascular endothelial growth factor and vascular permeability, the authors hypothesize that pretreatment heating of the recipient site will increase retention of grafted fat. METHODS: Twenty 6-week-old female BALB/c mice had two pretreatment sites on their back, one for the experimental temperatures (44°C and 48°C) and the other for the control. A digitally controlled aluminum block was used to apply the contact thermal damage. Human fat (0.5 mL) was grafted on each site and harvested on days 7, 14, and 49. The percentage volume and weight, histologic changes, and peroxisome proliferator-activated receptor gamma expression, a key regulator of adipogenesis, were measured by the water displacement method, light microscopy, and quantitative real-time polymerase chain reaction, respectively. RESULTS: The harvested percentage volumes were 74.0% ± 3.4%, 82.5% ± 5.0%, and 67.5% ± 9.6% for the control, 44°C-pretreatment, and 48°C-pretreatment groups, respectively. The percentage volume and weight of the 44°C-pretreatment group was higher than the other groups ( P < 0.05). The 44°C-pretreatment group exhibited significantly higher integrity with fewer cysts and vacuoles than the other groups. Both heating pretreatment groups showed markedly higher rates of vascularity than the control group ( P < 0.017), and also increased the expression of peroxisome proliferator-activated receptor gamma over two-fold. CONCLUSION: Heating preconditioning of the recipient site during fat grafting can increase the retention volume and improve the integrity, which is partly explained by increased adipogenesis in a short-term mouse model. CLINICAL RELEVANCE STATEMENT: Tanning could be an alternative pretreatment for fat grafting.

Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study.

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.

Better survival of random pattern skin flaps through the use of epigallocatechin gallate.

BACKGROUND: Surgical skin flaps are useful, but flap necrosis is a common problem. Epigallocatechin gallate (EGCG), the major polyphenol of green tea, has been investigated as a neovascularization agent to counteract necrosis. OBJECTIVES: To evaluate the effect of EGCG on random pattern skin flap survival. MATERIALS AND METHODS: The rat dorsal skin flap model was employed. One hundred rats were divided into five groups of equal size. Experimental Group A received local injection of EGCG to the flap, experimental Group B received topical application of EGCG, control Group C received local injection of saline, control Group D received topical application of an acetone-olive oil mixture, and control Group E received no treatment. The surviving area of the flap, regional blood perfusion, capillary density, and vascular endothelial growth factor (VEGF) expression were evaluated. RESULTS: We observed a larger area of skin flap survival in Groups A and B than in the control groups. Doppler measurement showed greater perfusion in Groups A and B, and the capillary density and VEGF expression were significantly higher in the experimental animals. CONCLUSION: The EGCG treatment enhanced neovascularization and regional perfusion and, as a result, improved skin flap survival.

Activated platelet-rich plasma improves fat graft survival in nude mice: a pilot study.

BACKGROUND: Numerous processing methods have been proposed to enhance the survival of fat grafts, but no definitive treatment protocol is available. Platelet-rich plasma (PRP) contains a high concentration of platelets with neovascularization properties and has the potential to promote fat graft survival. OBJECTIVE: To evaluate the effect of activated PRP on human graft quality and survival. MATERIALS AND METHODS: Using the scalp model, nude mice received fat mixed with PRP followed by injection of thrombin and calcium chloride to activate the PRP (PRP group) or fat mixed with saline (control group). After 10 weeks, mice were killed, the volume and weight of the fat graft were determined, and graft sections were examined using light microscopy. RESULTS: Fat graft volume and weight were significantly higher in the PRP group than in the control group, and histologic evaluation revealed greater vascularity, fewer cysts and vacuoles, and less fibrosis in the PRP group than in the control group. The cellular integrity and inflammation were not statistically different between the two groups. CONCLUSION: PRP treatment improved the survival and quality of fat grafts. Safer methods of PRP activation and preparation should be further investigated for potential application in humans.

Charge-Modulated Synthesis of Highly Stable Iron Oxide Nanoparticles for In Vitro and In Vivo Toxicity Evaluation.

The surface charge of iron oxide nanoparticles (IONPs) plays a critical role in the interactions between nanoparticles and biological components, which significantly affects their toxicity in vitro and in vivo. In this study, we synthesized three differently charged IONPs (negative, neutral, and positive) based on catechol-derived dopamine, polyethylene glycol, carboxylic acid, and amine groups, via reversible addition-fragmentation chain transfer-mediated polymerization (RAFT polymerization) and ligand exchange. The zeta potentials of the negative, neutral, and positive IONPs were -39, -0.6, and +32 mV, respectively, and all three IONPs showed long-term colloidal stability for three months in an aqueous solution without agglomeration. The cytotoxicity of the IONPs was studied by analyzing cell viability and morphological alteration in three human cell lines, A549, Huh-7, and SH-SY5Y. Neither IONP caused significant cellular damage in any of the three cell lines. Furthermore, the IONPs showed no acute toxicity in BALB/c mice, in hematological and histological analyses. These results indicate that our charged IONPs, having high colloidal stability and biocompatibility, are viable for bio-applications.

Experiences and attitudes toward aesthetic procedures in East Asia: a cross-sectional survey of five geographical regions.

BACKGROUND: The demand for aesthetic procedures continues to grow globally, particularly in East Asian countries. The popularity of specific aesthetic procedures varies, however, depending on the particular East Asian geographical region being studied. This study aimed to evaluate the experiences of and attitudes toward aesthetic procedures in five East Asian countries/regions, including China, Japan, South Korea, Hong Kong, and Taiwan. METHODS: To recruit participants, an online questionnaire was designed and distributed on social media networks between May 2015 and March 2016. The statistical analysis was conducted using SPSS software, version 22.0. RESULTS: A total of 3,088 people responded (approximately 600 in each country/region). Of these, 940 participants (47.8%) responded that they had experienced at least one aesthetic procedure in the past. Taiwan had the highest number of participants who had experienced at least one procedure (264/940, 41%), with primarily non-surgical experiences. Only in South Korea did surgical cosmetic experiences exceed non-surgical cosmetic experiences (55.9% vs. 44.1%). The popularity of particular procedures and the motivation for undergoing aesthetic procedures varied by country. CONCLUSIONS: The popularity of aesthetic procedures continues to evolve. Similar trends were observed across the East Asian regions; however, each country had its unique demands and preferences. The information provided by this study can help aesthetic plastic surgeons further understand the patients in their corresponding region, customize their practice, and develop the requisite skills.

Enhanced chondrogenic responses of human articular chondrocytes onto silk fibroin/wool keratose scaffolds treated with microwave-induced argon plasma.

Silk fibroin (SF) is a natural, degradable, fibrous protein that is biocompatible, is easily processed, and possesses unique mechanical properties. Another natural material, wool keratose (WK), is a soluble derivative of wool keratin, containing amino acid sequences that induce cell adhesion. Here, we blended SF and WK to improve the poor electrospinability of WK and increase the adhesiveness of SF. We hypothesized that microwave-induced argon plasma treatment would improve chondrogenic cell growth and cartilage-specific extracellular matrix formation on a three-dimensional SF/WK scaffold. After argon plasma treatment, static water contact angle measurement revealed increased hydrophilicity of the SF/WK scaffold, and scanning electron microscopy showed that treated SF/WK scaffolds had deeper and more cylindrical pores than nontreated scaffolds. Attachment and proliferation of neonatal human knee articular chondrocytes on treated SF/WK scaffolds increased significantly, followed by increased glycosaminoglycan synthesis. Our results suggest that microwave-induced, plasma-treated SF/WK scaffolds have potential in cartilage tissue engineering.

Objective and quantitative evaluation of scar color using the L*a*b* color coordinates.

Scar color evaluation by clinical physicians has been based on subjective judgments. The purpose of this study was to investigate the application of a novel photographic analysis to produce an objective and quantitative measurement of scar color using the L*a*b* color coordinates. Three plastic surgeons evaluated photos of 207 scars using the clinical scar assessment scale developed by Beausang et al. Scar color was subjectively classified as group 1 (perfect match), 2 (slight mismatch), 3 (obvious mismatch), or 4 (gross mismatch). Three general physicians quantified color differences between the scar and the surrounding normal skin using the L*a*b* color coordinates. The total color difference (DeltaT*) and the color differences for each coordinate (DeltaL*, Deltaa*, and Deltab*) were calculated. The measurement was performed 3 times with a 4-week interval. Group 1 contained 51 scars, group 2 had 68, group 3 had 46, and group 4 had 42. The mean (SD) total color difference values (DeltaT*) for each group were 4.4 (1.83), 9.55 (2.18), 17.76 (2.96), and 29.06 (9.45), respectively (P < 0.001). The mean of each color coordinate (DeltaL* = light to dark, and Deltaa* = green to red) also differed between the groups, except in groups 1 and 2. The mean Deltab* (blue to yellow) did not differ between the groups. The correlation coefficients for interrater reliability and test-retest consistency were satisfactory. Objective scar evaluation using the L*a*b* color coordinates is found to be a reliable method to quantify scar color. With further study, this method could be simple and effective to assess the effects of scar management.

Effectiveness of the trapezius vein in the reconstruction of intraoral defects with bare neck.

In head and neck cancer reconstruction, the transverse cervical artery is a good alternative vessel when the appropriate recipient vessels cannot be identified because of preoperative radiation and radical neck dissection. Selecting the appropriate recipient vein is essential for a successful intraoral reconstruction. We attempted to determine which veins are candidate partners of the transverse cervical artery by anatomically examining 10 necks (2 sides of the neck in 5 cadavers) in a cadaver study. Three types of veins (suprascapular vein, transverse cervical vein, and descending vein from the trapezius muscle) were selected as recipient vein candidates, and the characteristics of each vein were analyzed. Clinically, we also examined which vessels were chosen as recipient veins in 13 patients in whom intraoral reconstruction with bare neck was performed using the transverse cervical artery as recipient. The descending vein from the trapezius muscles (trapezius vein) was used most frequently, followed by the transverse cervical vein. The transverse cervical vein could be considered an appropriate recipient vein, but it is prone to damage from neck dissection in some cases. Therefore, the use of the trapezius vein can aid in the successful reconstruction in such patients.

A rare case of abdominal adenoid basal cell carcinoma in a patient with a history of radiation therapy.

Basal cell carcinoma (BCC) is the most common skin cancer and its incidence is steadily increasing. Prior radiation therapy is one of the most important risk factors for BCC. Although the mechanism remains undefined, long-term studies have shown that people exposed to radiation have an increased risk of BCC. Despite the fact that BCC occurs most frequently in sun-exposed areas of the body, patients with a history of radiation therapy have an increased risk of BCC in areas previously exposed to radiation. Here, we report a case of adenoid BCC on the abdomen in a 67-year-old woman after radiation therapy post-hysterectomy.

Insulin Promotes Adipose-Derived Stem Cell Differentiation after Fat Grafting.

BACKGROUND: Adipose-derived stem cells are used to enhance fat graft survival. However, their mechanism of action when grafted is controversial. The grafted cells can be replaced by connective tissue or survive at the recipient site and differentiate. Insulin is a powerful agent used to induce their differentiation to adipocytes. The purpose of this study was to elucidate the fate of grafted adipose-derived stem cells in nonvascularized fat grafts with or without insulin. METHODS: Fat was harvested from a female human donor who had undergone reduction mammaplasty. The authors also isolated and cultured adipose-derived stem cells expressing green fluorescent protein from transgenic Sprague-Dawley rats. Injection of free fat graft, the adipose-derived stem cells, phosphate-buffered saline, and insulin was performed on the four paravertebral points of the back of each mouse (n = 30) as follows: group A (control group) received adipose tissue and phosphate-buffered saline; group B received adipose tissue and adipose-derived stem cells; group C received adipose tissue, adipose-derived stem cells, and phosphate-buffered saline; and group D received adipose tissue, adipose-derived stem cells, and insulin. Green fluorescent protein expression was evaluated using an in vivo imaging system. The volume of transplanted fat was evaluated at 8 weeks after graft with six histologic parameters. The fat graft was immunostained with green fluorescent protein, 4',6-diamidino-2-phenylindole, and perilipin. Statistical analysis was performed using a one-way analysis of variance test. RESULTS: The fat graft volume was significantly higher in group D (p < 0.05). Histologic examination revealed reduced fibrosis and increased cysts, vacuoles, integrity, and vascularity in group D. The green fluorescent protein and perilipin co-positive area was more apparent in group D compared with groups B and C. CONCLUSION: Insulin could enhance the survival and differentiation of adipose-derived stem cells in nonvascularized fat grafts.