Optimal administration routes for adipose-derived stem cells therapy in ischaemic flaps.

Improvement of flap survival represents an ongoing challenge in reconstructive surgery. The angiogenic potential of adipose-derived stem cells (ASCs) offers a promising approach to improve the viability of random pattern flaps. Recently, to maximize the therapeutic effects of ASCs, increasing focus is being placed on how to deliver the stem cells to target lesions. The purpose of the present study was to compare the effectiveness of different administration routes of ASCs to improve the viability of the random pattern skin flap. ASCs labelled with PKH26 were applied via four methods to the cranially-based random pattern skin flaps of rats: (a) intravenous injection; (b) subcutaneous injection; (c) application with collagen sponge seeding; and (d) application with fibrin glue seeding. ASCs led to a significant increase in flap viability in the subcutaneous injection group and the collagen sponge group. Cutaneous blood flow was increased in the intravenous injection, subcutaneous injection and collagen sponge groups. Capillary density in the intravenous injection group and collagen sponge group was significantly greater than in the control group (no treatment). PKH26-positive cells via the collagen sponge were distributed more densely within the flap than in other groups. This study demonstrated that the collagen sponge method delivered ASCs most effectively within the flap and increased flap vascularity. The clinical therapeutic effects of ASCs can therefore be maximized when the optimal delivery route is chosen.

Correcting upper eyelid retraction by means of pretarsal levator lengthening for complications following ptosis surgery.

BACKGROUND: Eyelid retraction is a condition in which the upper eyelid ascends past its ideal position, 1 to 2 mm below the upper limbus of the cornea. This condition can be a result of overcorrecting ptosis, hyperthyroidism, and other causes. The authors present studies conducted on eyelid retraction caused by ptosis overcorrection. An innovative approach for levator lengthening using the pretarsal tissue as a spacer flap is introduced as a method to correct the retraction. METHODS: A series of 60 patients over a 6-year period underwent 71 eyelid procedures to correct upper lid retraction following upper blepharoplasty and ptosis repair. All eyelid retractions ranged from 1 to 3 mm above its ideal position. All eyelids were corrected with the authors' technique of lengthening the levator with pretarsal tissue. Twelve cases that required further lengthening were completed by creating a superiorly based rotation flap. RESULTS: Of the 71 cases, 61 (86 percent) observed favorable results, six (8 percent) attained mild ptosis after surgery, and four (6 percent) regained upper eyelid retraction. All of the unsuccessful cases were corrected through early revision surgery, more advancement for the ptosis, and further recess or rotation flap for the retraction. No other complications were observed, except formation of supratarsal fold asymmetry, which was corrected through minor revision surgery. CONCLUSIONS: It is very difficult to correct eyelid retraction caused by tissue fibrosis and muscle degeneration. Correction of the retraction by levator lengthening using the pretarsal tissue is simpler to execute, measurable during surgery, and easy to adjust, and offers high predictability in its result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Surgical correction of multiple upper eyelid folds in East Asians.

BACKGROUND: Unwanted multiple upper eyelid folds may occur after various blepharoplasty procedures used in Asian "double-eyelid" surgery. These multiple lines are caused by adhesions that may occur after inappropriate manipulation during blepharoplasty. Correction is difficult in cases of multiple reoperations because the adhesions in such cases are severe and an insufficient amount of tissue remains for reconstruction. METHODS: The authors divided 62 patients into three groups. Patients in group 1 developed lines for reasons unrelated to eyelid surgery, those in group 2 developed lines after blepharoplasty, and those in group 3 developed lines after secondary operations. After skin incision, the authors performed a complete dissection and release of the scar tissue. Then, the authors augmented the preorbital area using eyelid tissues such as the orbicularis oculi muscle and orbital fat to prevent readhesion of the orbicularis oculi and levator muscles. For severe cases, unwanted creases were prevented by rolling the orbicularis oculi muscle and attaching a thick piece of tape to the problem area after surgery. RESULTS: In 57 patients (92 percent), the unwanted lines disappeared completely. Five patients (8 percent) experienced recurrence of the lines, but these lines were successfully corrected by reoperation. All cases with recurrence were in groups 2 and 3, in which the adhesions were very severe. CONCLUSIONS: The most important factors for correction of unwanted multiple fold lines are accurate dissection, the maintenance of sufficient tissue, and prevention of readhesion between the skin and levator using other soft-tissue augmentation. This method can provide very satisfactory results, even in severe cases.