RESUMEN
INTRODUCTION: Traditionally, galeal flap or cranialization was often used to reconstruct the skull base defect caused by trauma or tumor removal. However, in the case of huge skull base defect, galeal flap is not enough to block the communication between nasal cavity and intracranial space. In this study, authors suggest combination flap of galea and reverse temporalis muscle as a method for reconstruction of huge skull base defect. MATERIALS AND METHODS: From 2016 to 2019, retrospective review was conducted, assessing 7 patients with bone defect which is not just opening of frontal sinus but extends to frontal sinus and cribriform plate. Reconstructions were done by combination of galeal flap and reverse temporalis muscle flap transposition. RESULTS: Defects were caused by nasal cavity tumor with intracranial extension or brain tumor with nasal cavity extension. There was no major complication in every case. During the follow up period, no patient had signs of complication such as ascending infection, herniation and CSF rhinorrhea. Postoperative radiologic images of all patients that were taken at least 6 months after the surgery showed that flaps maintained the lining and the volume well. DISCUSSION: Conventional reconstruction of skull base defect with galeal flap is not effective enough to cover the large sized defect. In conclusion, galeal flap in combination with reverse temporalis muscle flap can effectively block the communication of nasal cavity and intracranium.
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Cavidad Nasal/cirugía , Procedimientos de Cirugía Plástica , Base del Cráneo/cirugía , Adulto , Anciano , Femenino , Seno Frontal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Colgajos Quirúrgicos/cirugíaRESUMEN
BACKGROUND: The latissimus dorsi (LD) myocutaneous flap is a widely used local option in oncoplastic surgery for avoiding breast deformities; however, concerns exist regarding its influence in monitoring recurrence. In this study, we evaluated the impact of this flap on postoperative cancer surveillance. METHODS: Each patient receiving oncoplastic surgery with LD flap after partial mastectomy were matched in age, cancer stage, and body mass index with patients receiving partial mastectomy alone. Twenty-nine patients with the oncoplastic LD flap received 99 mammograms and 139 ultrasonograms, while 29 patients with partial mastectomy alone underwent 92 mammograms and 129 ultrasonograms. Mammographic and ultrasonographic findings were classified by Breast Imaging Reporting and Data System (BI-RADS) category and reviewed. Any recommendations for additional evaluation and recurrence were documented. RESULTS: During an average follow-up period of 44 months, although the oncoplastic group demonstrated more newly developed benign calcifications (control 14% vs. oncoplastic 41%; p = 0.019) on mammography, the percentage of recall for additional imaging in category 0, and the short-interval follow-up in category 3, was not different between the control and oncoplastic group. Regarding ultrasonography, BI-RADS category was also not different between the two groups; however, the control group showed more fluid collections than the oncoplastic group (control 21% vs. oncoplastic 0%; p = 0.023). One case of local recurrence was observed in the control group. CONCLUSION: Although there was an increase in benign calcifications in the oncoplastic group, there were no additional abnormal findings requiring further intervention. We concluded that the LD flap for oncoplastic surgery does not interfere with cancer surveillance, and even decreases the rate of fluid collection.
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Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/cirugía , Mamoplastia/métodos , Recurrencia Local de Neoplasia/diagnóstico , Colgajos Quirúrgicos , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Mamografía , Mastectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Vigilancia de la Población , Periodo Posoperatorio , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Músculos Superficiales de la EspaldaRESUMEN
BACKGROUND: The internal mammary artery (IMA) perforator has assumed recent prominence as recipient vessels in free autologous breast reconstruction. However, anatomical understanding is unclear, due to limited cadaver and clinical studies. We evaluated the usability of these vessels by evaluating perforator size, dominance, laterality, interspace location, and relationship with breast volume. METHODS: A retrospective review assessed 197 female patients with breast cancer who had undergone computed tomography angiography (CTA) of the chest wall. The average age and body mass index (BMI) of patients was 49.0 ± 6.5 years and 24.2 ± 5 .8 kg/m2 , respectively. The average volume of breasts was 437 ± 190 mL. Our analysis focused on the anatomy of IMA perforator and its relationship to volume and BMI. RESULTS: A total of 377 hemi-chest evaluations were performed. Most patients (95.5%) had sizeable perforating artery identified on CTA. Among all sizeable perforators identified, the mean diameter of the most dominant arterial perforator was 1.8 ± 0 .8 mm. The right hemi-chest had significantly larger perforators than the left (1.9 ± 0 .9 mm vs. 1.7 ± 0 .7 mm, p = 0.002). The first intercostal space (ICS) had a slightly greater of perforators than second ICS (34.6% vs. 29.8%, p = 0.172). However, second ICS had a greater number of most dominant perforators compared to first ICS (38.9% vs. 34.7%, p = 0.357). Perforators from first ICS emerge medial to the sternal edge and breast footprint. When dividing groups with 0-1 versus 2-3 reliable perforators, breast volume was significantly higher in the later (422.0 mL vs. 461.2 mL, p = 0.019). CONCLUSION: These results are expected to encourage microsurgeons to use the IMA perforator by providing a clear anatomical roadmap.
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Neoplasias de la Mama/cirugía , Angiografía por Tomografía Computarizada , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/cirugía , Mamoplastia/métodos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Adulto , Mama/irrigación sanguínea , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional , Persona de Mediana Edad , Tamaño de los Órganos/fisiologíaRESUMEN
BACKGROUND: For implant-based breast reconstruction, inadequate tissue perfusion may cause devastating complications. Tissue tension by inadequate implant volume may reduce tissue perfusion by stretching and collapsing the capillaries. The SPY system is used to perform intraoperative fluorescence angiography with indocyanine green to assess visually the blood flow and evaluate tissue perfusion. However, there is no report yet about how mastectomy flap perfusion changes with the expander-filling volume. Therefore, to analyse the changes of tissue perfusion of the mastectomy flap according to the tension level, we used the SPY system and adjusted the filling volume of the tissue expander to change the tension on the skin flap. METHODS: Ten breasts of ten patients who underwent immediate two-stage, implant-based breast reconstructions were included. The expander-filling volume just before mastectomy flap blanching was set as 100%. Based on this, the expander-filling volume was reduced to 50% and increased to 150%. Ingress and egress rates were evaluated using the SPY system at each condition and analysed by a linear mixed model using least square means. RESULTS: The mean ingression rates were 138, 100, and 65%, and the mean egression rates were 145, 100, and 66% at 50, 100, and 150% inflation, respectively. CONCLUSIONS: It was objectively proven that tissue perfusion deteriorates as the tension applied on the flap increases. On the basis of this finding, we can control the amount of inflation volume of the expander or remove the skin in the pre-ischaemic condition to reduce complications of implant-based breast reconstruction.
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Angiografía/métodos , Implantación de Mama , Neoplasias de la Mama/patología , Verde de Indocianina , Rayos Láser , Mamoplastia/métodos , Colgajos Quirúrgicos/patología , Adulto , Anciano , Neoplasias de la Mama/irrigación sanguínea , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Colorantes , Femenino , Estudios de Seguimiento , Humanos , Mastectomía , Persona de Mediana Edad , Necrosis , Perfusión , Complicaciones Posoperatorias , Pronóstico , Colgajos Quirúrgicos/irrigación sanguínea , Dispositivos de Expansión TisularRESUMEN
Although there is ample evidence showing that radiation therapy increases the risk of complications of breast reconstruction, the efficacy of human acellular dermal matrix (CGCryoDerm®) in immediate tissue expander breast reconstruction in the setting of postmastectomy radiation therapy has not been fully elucidated. In this study, we report our institutional experience with pertinent refined surgical technique, and determine whether acellular dermal matrices have a protective effect in this increasingly prevalent clinical setting. Twenty-six patients who underwent immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy with at least 2 years of follow-up were retrieved. Fifteen patents were reconstructed with ADM, whereas 11 patients were reconstructed without ADM. The occurrence of complications was assessed according to the reconstruction type (with ADM vs without ADM). Furthermore, in patients reconstructed with ADM (n = 15), immunohistochemistry was performed to analyze the breast capsule with ADM compared with that without ADM in the same patient, according to the expression of alpha-smooth muscle actin (α-SMA). The occurrence of complications was significantly associated with the reconstruction type (with ADM vs. without ADM, p = 0.015). On the basis of the results of α-SMA staining, α-SMA+ myofibroblasts were relatively highly expressed throughout the breast capsule without ADM. On the contrary, α-SMA+ myofibroblasts present at the breast capsule adjacent to the ADM were scarce and irregularly scattered. Use of an acellular dermal matrix may be recommended to patients who are concerned about complications after immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy.
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Dermis Acelular , Implantes de Mama , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Traumatismos por Radiación/prevención & control , Radioterapia Adyuvante/efectos adversos , Adulto , Neoplasias de la Mama/patología , Terapia Combinada , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Dispositivos de Expansión TisularRESUMEN
Blood supply is the most important factor determining the survival of a skin flap. Botulinum toxin-A (Botox-A) is used as pharmacologic agent not only for aesthetic purposes, but also for its vasomotor actions. This study was conducted to establish whether local application of Botox-A increased survival of random pattern skin flaps in rats by changing the expression of neurotransmitters. Forty adult Sprague-Dawley rats with a caudally-based random pattern skin flap were divided into two groups: Botox-A group and saline group. Surviving flap area and cutaneous blood flow in the flap were evaluated on postoperative days 3 and 7. After injection of Botox-A, changes in vessels were analyzed using immunohistochemical staining. Levels of norepinephrine, neuropeptide-Y, nitric oxide, and endothelial nitric oxide synthase were analyzed quantitatively by high performance liquid chromatography, Western blot, and colorimetric assay. The survived area in the Botox-A group was significantly higher than that in the control group on postoperative days 3 and 7. Blood flow in the Botox-A group was significantly high in the proximal and middle areas immediately after the operation. The number of CD31-positive vessels in the Botox-A group was significant greater than that in the control group. Norepinephrine level in the Botox-A group decreased significantly immediately after flap elevation and at postoperative day 3. There were no significant differences in neuropeptide-Y level between the two groups. Nitric oxide level did not change significantly in either group despite the increase in endothelial nitric oxide synthase immediately after flap elevation and at 3 days postoperatively. In conclusion, Botox-A increased vascular blood flow and viable flap area in rats by reducing norepinephrine level. In contrast, neuropeptide-Y, another vasoconstrictor, was not affected by Botox-A. Nitric oxide, a vasodilator, was also not affected by Botox-A, despite the significant increase in endothelial nitric oxide synthase expression in the flaps.
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Toxinas Botulínicas Tipo A/administración & dosificación , Fármacos Cardiovasculares/administración & dosificación , Neurotransmisores/biosíntesis , Piel/efectos de los fármacos , Colgajos Quirúrgicos/irrigación sanguínea , Cicatrización de Heridas/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Inmunohistoquímica , Inyecciones , Neuropéptido Y/análisis , Neuropéptido Y/metabolismo , Óxido Nítrico/análisis , Óxido Nítrico/metabolismo , Óxido Nítrico Sintasa de Tipo III/análisis , Óxido Nítrico Sintasa de Tipo III/metabolismo , Norepinefrina/análisis , Norepinefrina/metabolismo , Ratas , Ratas Sprague-Dawley , Piel/irrigación sanguínea , Piel/fisiopatología , Simpatomiméticos/metabolismo , Vasoconstricción/efectos de los fármacos , Vasoconstricción/fisiología , Cicatrización de Heridas/fisiologíaRESUMEN
Skull base reconstruction is a challenging task. The method depends on the anatomical complexity and size of the defect. We obtained tissue by harvesting fat-containing perifascial areolar tissue (PAT) for reconstruction of limited skull base defects and volume augmentation. We demonstrated the effective option for reconstruction of limited skull base defects and volume augmentation. From October 2013 to November 2015, 5 patients underwent operations using fat-containing PAT to fill the defect in skull base and/or perform volume replacement in the forehead. Perifascial areolar tissue with 5- to 10-mm fat thickness was harvested from the inguinal region. The fat-containing PAT was grafted to the defect contacting the vascularized wound bed. Patients were followed up in terms of their clinical symptoms and postoperative magnetic resonance imaging findings. Four patients were treated using fat-containing PAT after tumor resection. One patient was treated for a posttraumatic forehead depression deformity. The fat-containing PAT included 5- to 9-mm fat thickness in all cases. The mean size of grafted PAT was 65.6 cm (28-140 cm). The mean follow-up period was 18.6 months (12-31 months). There was no notable complication. There was no donor site morbidity. We can harvest PAT with fat easily and obtain the sufficient volume to treat the defect. It also could be used with other reconstructive method, such as a free flap or a regional flap to fill the left dead space. Therefore, fat-containing PAT could be additional options to reconstruction of skull base defect.
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Tejido Adiposo/trasplante , Cordoma/cirugía , Fascia/trasplante , Meningioma/cirugía , Neuroma Acústico/cirugía , Procedimientos de Cirugía Plástica/métodos , Neoplasias de la Base del Cráneo/cirugía , Base del Cráneo/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Base del Cráneo/lesiones , Resultado del TratamientoRESUMEN
BACKGROUND: Mild to moderate blepharoptosis, or ptosis, is relatively common among Asians, and it is not uncommon to offer ptosis correction at the time of double-eyelid surgery in this patient population. The traditional open approaches to ptosis correction are subject to scarring and prolonged recovery time, whereas the newer nonincisional approaches are marred by issues of incomplete correction or recurrence. This study describes a new nonincisional technique that overcomes the limitations of current methods by using conjoint fascial sheath (CFS) for suspension. METHODS: From January 2014 to April 2015, a retrospective review was conducted on 21 patients (41 eyelids) who underwent simultaneous nonincisional ptosis correction and double-eyelid surgery. All patients had either mild or moderate ptosis without excess skin hooding and excellent or good levator palpebrae function. RESULTS: Mild ptosis correction (1-loop CFS suspension) was performed in 25 eyelids, and moderate ptosis correction (2-loop CFS suspension) was performed in 16 eyelids. At 6 months of follow-up, 23 eyelids (56.1 %) improved to "normal" with overall improvement seen in 33 eyelids (80.0%). The mean marginal reflex distance 1 increased from 3.16 ± 0.61 mm preoperatively to 4.11 ± 0.61 mm postoperatively, which was statistically significant (P < 0.001). CONCLUSIONS: Mild to moderate ptosis correction with nonincisional CFS suspension technique is a safe and effective method that combines the benefits of nonincisional procedure with longevity and precision seen in the traditional open approaches. The procedure is easy to perform with minimal recovery time and high patient satisfaction and can be combined with nonincisional double-eyelid surgery.
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Blefaroplastia/métodos , Blefaroptosis/cirugía , Fasciotomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adolescente , Adulto , Blefaroptosis/diagnóstico , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The combination of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) has been widely adopted to overcome functional and cosmetic limitations of conventional STSG. In this study, we evaluated the efficacy of this combination using 2 types of ADM: cadaveric acellular dermal matrix (CDM) and bovine acellular dermal matrix (BDM). METHODS: We recruited 72 patients undergoing autologous STSG to cover radial forearm free flap donor sites. They were included in 1 of 3 therapeutic groups: group 1, STSG using CDM (n = 29); group 2, STSG using BDM (n = 20); and group 3, STSG only (n = 23). Functional skin values for skin elasticity, humidification, transepidermal water loss, and color were determined. Values were compared between graft sites and adjacent normal (control) skin, and between grafted areas of each group. RESULTS: All skin defects were successfully reconstructed without graft loss. Groups 1 and 2 demonstrated better elasticity than did group 3, based on the analysis using the ratio of grafted area to control. Grafted areas in all 3 groups exhibited less moisture than did control normal skin. There was less transepidermal water loss in group 1 than in group 3, which implied that CDM application had better barrier capacity against water evaporation. Graft sites of groups 1 and 3 exhibited darker and redder color compared with control areas. CONCLUSIONS: Composite forearm defects were successfully restored and exhibited acceptable quality after treatment with an ADM plus STSG. Applying either CDM or BDM under a STSG was a suitable procedure, as verified by objective measurements. Elasticity was well preserved in CDM and BDM groups. However, both ADMs revealed functional impairment of humidification. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Dermis Acelular , Traumatismos del Antebrazo/cirugía , Antebrazo/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Trasplante de Piel/métodos , Heridas y Lesiones/cirugía , Adulto , Anciano , Animales , Cadáver , Bovinos , Procedimientos Quirúrgicos Dermatologicos , Femenino , Traumatismos del Antebrazo/etiología , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Piel , Piel Artificial , Colgajos Quirúrgicos , Trasplante Autólogo , Cicatrización de Heridas , Heridas y Lesiones/etiologíaRESUMEN
OBJECTIVE: The purpose of this study is to evaluate the long-term results of flap volume change, swallowing capacity, speech intelligibility, and differences between vertical rectus musculocutaneous (VRAM) and anterolateral musculocutaneous (ALT) free flaps in total tongue reconstruction. PATIENTS AND METHODS: We retrospectively analyzed the medical records of 31 patients who underwent total tongue reconstruction with VRAM (24 cases) and ALT flap (7 cases). The mean age of patients was 52.09 ± 2.25 years. The tumor types were as follows: squamous cell carcinoma (28 cases), adenoid cystic carcinoma (2 cases), and metastatic cancer (1 case). The flap volume was determined based on clinical and imaging examinations. Swallowing and speech function were analyzed using seven-point rating scales. RESULTS: All flaps survived eventually after surgery; however, 1 patient underwent VRAM flap experienced partial flap necrosis, wound dehiscence in 4 patients underwent VRAM flap, and infection in 3 patients (VRAM; 2 patients, ALT; 1 patient). The mean follow-up period was 3.97 ± 0.54 years. The volume of the flaps remained relatively constant over time. The swallowing capacity positively correlated with the flap volume (P < 0.0001); however, the speech intelligibility did not correlate with the flap volume in analysis of total cohort. There were no statistical differences in functional outcomes between the two types of reconstructed flaps (P > 0.05). CONCLUSION: The preservation of flap volume was important to achieve superior swallowing capacity; however, it was insufficient to promote the speech outcome. The functional outcomes did not differ depending on the type of flap. © 2015 Wiley Periodicals, Inc. Microsurgery 37:190-196, 2017.
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Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función/fisiología , Colgajos Quirúrgicos/trasplante , Neoplasias de la Lengua/cirugía , Adulto , Anciano , China , Estudios de Cohortes , Deglución/fisiología , Femenino , Estudios de Seguimiento , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Glosectomía/métodos , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Colgajo Miocutáneo/irrigación sanguínea , Colgajo Miocutáneo/trasplante , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Inteligibilidad del Habla , Estadísticas no Paramétricas , Colgajos Quirúrgicos/irrigación sanguínea , Factores de Tiempo , Neoplasias de la Lengua/patología , Resultado del TratamientoRESUMEN
The selection of materials for orbital wall reconstruction has been a matter of debate. This study aimed to evaluate the effectiveness of an acellular allogenic dermal matrix (ADM) as an orbital wall reconstruction material and to compare the results of orbital wall reconstruction with the ADM to those of reconstruction with the more widely used absorbable mesh plate and porous polyethylene. We retrospectively reviewed the clinical charts and computed tomography images of 73 patients who underwent orbital reconstruction at 1 institution between March 2013 and February 2014. In the ADM group, the mean defect size of 29 patients was 2.89âcm. After orbital wall reconstruction with ADM, patients with preoperative enophthalmos (7 patients), limited range of eyeball movement (6 patients), and diplopia (12 patients) showed improvements. In the comparative study, the 3 groups showed no significant differences with respect to age distribution (Pâ=â0.522), defect size (Pâ=â0.455), and preoperative findings such as enophthalmos (Pâ=â0.811), diplopia (Pâ=â0.357), and limited range of eyeball movement (Pâ=â0.795). All the preoperative symptoms improved in every group, and in the ADM group, no complication was observed during the postoperative follow-up. ADM is a biocompatible material that combines the flexibility and rigidity required to support the orbital soft tissue. Therefore, it could be an excellent alternative material for orbital wall reconstruction.
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Dermis Acelular , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Placas Óseas , Diplopía/cirugía , Enoftalmia/cirugía , Femenino , Humanos , Masculino , Polietileno , Procedimientos de Cirugía Plástica/efectos adversos , Estudios RetrospectivosRESUMEN
Reduced horizontal length of the palpebral fissure is a distinctive characteristic of Asian eyelids, and aesthetic lateral canthal lengthening techniques have been performed for a refinement. The aim of this study is to describe a novel lateral canthoplasty using tarso-conjunctival advancement with a lid margin splitting procedure on the upper eyelids and to report the postoperative results. From December 2011 to June 2014, patients who underwent lateral canthoplasty using the tarso-conjunctival advancement procedure for aesthetic purposes were reviewed retrospectively. The predictor variables were grouped into demographic and operative categories. The primary outcome variables were the distances from the mid-pupillary line to the lateral canthus and the horizontal length of the palpebral aperture (distance from the medial to lateral canthus). Data analyses were performed using descriptive and univariate statistics. Patients who showed increment in objective measurements were considered significant. Aesthetic appearance was also evaluated based on pre- and postoperative clinical photographs. A total of 45 patients were enrolled in this study. Both the distance from the mid-pupil to the lateral canthus (ΔDpupil-lateral; 2.78â±â0.54âmm, Pâ<0.05) and the palpebral aperture horizontal length (ΔDmedial-lateral 2.93â±â0.81âmm, Pâ<0.05) increased significantly from pre- to postoperative state. All the patients demonstrated satisfactory results aesthetically during the follow-up. The tarso-conjunctival advancement technique for lateral canthoplasty produced satisfactory aesthetic results with an enlarged palpebral aperture. Future research is required to fully delineate the risk of possible complications, including injury to the eyelashes and meibomian glands.
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Pueblo Asiatico , Blefaroplastia/métodos , Conjuntiva/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , República de Corea , Estudios RetrospectivosRESUMEN
PURPOSE: The effects of platelet-rich plasma (PRP) on improvement of bone regeneration have been widely investigated. However, use of a proper scaffold is also important to the delivery of bioactive materials. The aim of this study was to analyze the effects of PRP with acellular dermal matrix (ADM) as a bone substitute in a cranial defect model. METHODS: Twenty-nine New Zealand white rabbits were randomly divided into four groups including control, PRP, ADM, and PRP with ADM. A 15 × 15-mm(2) bony defect was carefully created in the cranium. The experimental materials were applied in each group. After 16 weeks, the volume and surface area of new bone were measured using three-dimensional computed tomography and digital photography, and the new bone was analyzed histologically. RESULTS: The PRP with ADM group exhibited a statistically significant increase in volume and surface area of newly formed bone compared with the other groups (p < 0.05). Histological findings revealed compact lamellar bone in the PRP with ADM group. In contrast, scattered bone islands were detected within the fibrous connective tissue in the other groups. CONCLUSIONS: The regeneration of mature and augmented bone was achieved following the application of PRP mixed with ADM. The results indicated that the PRP combined with ADM could be a potentially useful substitute for bone and may aid in the elimination of additional donor-site harvest procedures.
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Dermis Acelular , Modelos Animales de Enfermedad , Osteogénesis/fisiología , Plasma Rico en Plaquetas/fisiología , Cráneo/diagnóstico por imagen , Cráneo/fisiología , Animales , Humanos , Proyectos Piloto , Conejos , Distribución Aleatoria , Cráneo/cirugíaRESUMEN
BACKGROUND: Although various techniques of mandibular angle ostectomy have been devised to correct overly prominent bony contours, none have incorporated methods to delineate the surgical line with precision. Herein, the authors describe one means of marking an ostectomy line more easily, using a specially designed oscillating-blade saw. METHODS: Between July 2013 and June 2014, a total of 75 patients underwent quantitative mandibular angle ostectomy using a custom oscillating-blade saw equipped with a scalable guide. Corticectomy, also done routinely to improve frontal appearance, called for a reciprocating saw only. Aesthetic outcomes gauged subjectively by the questionnaire about satisfaction and symmetry after postoperative 6 months. RESULTS: Satisfaction score was 4.9 and symmetric score was 4.7. No major complications, such as persistent nerve injury or fracture, were encountered. CONCLUSIONS: Use of an oscillating-blade saw equipped with a scalable guide facilitated quantitative mandibular angle ostectomy, enabling precise, and reproducible surgery with satisfactory outcomes with less complications.
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Mandíbula/cirugía , Osteotomía/métodos , Procedimientos de Cirugía Plástica/métodos , Adulto , Puntos Anatómicos de Referencia/diagnóstico por imagen , Calibración , Diseño de Equipo , Estética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Nervio Mandibular/diagnóstico por imagen , Tempo Operativo , Osteotomía/instrumentación , Satisfacción del Paciente , Radiografía Panorámica , Procedimientos de Cirugía Plástica/instrumentación , Resultado del Tratamiento , Adulto JovenRESUMEN
Although platelet-rich plasma (PRP) is widely used to enhance bone graft survival, the effect of PRP itself on bone regeneration is unclear. Because activated PRP releases many growth factors in a bolus, there are controversies regarding the effect of activation of the PRP on bone regeneration. Thus, we studied the effect of activated versus nonactivated PRP on bone regeneration and compared the effect with that of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a critical-sized cranial defect model. Forty New Zealand white rabbits were randomly divided into 4 groups. Defect sizing 15 × 15 mm(2) was created on the cranium of each rabbit, and then a collagen sponge soaked with normal saline, rhBMP-2, nonactivated PRP, or PRP activated with CaCl2 solution was immediately placed on the defect. After 16 weeks, using three-dimensional computed tomography and digital photography, the volume and new bone surface area were measured. The newly created bone was histologically analyzed. The experimental groups showed a significantly increased volume and surface area of new bone compared with the control group (P < 0.05), but no significant differences were found among the experimental groups. Histologic examination in the experimental groups showed newly created bone that had emerged in the center as well as the margin of the defect. Overall, these results indicate that PRP enhanced bony regeneration regardless of activation with an effect that was comparable to that of rhBMP-2. Thus, PRP has therapeutic effects on bone regeneration and may replace rhBMP-2, which is costly.
Asunto(s)
Proteína Morfogenética Ósea 2/administración & dosificación , Proteína Morfogenética Ósea 2/fisiología , Regeneración Ósea/fisiología , Trasplante Óseo/métodos , Activación Plaquetaria/fisiología , Plasma Rico en Plaquetas/fisiología , Cráneo/fisiopatología , Cráneo/cirugía , Factor de Crecimiento Transformador beta/administración & dosificación , Factor de Crecimiento Transformador beta/fisiología , Animales , Regeneración Ósea/efectos de los fármacos , Cloruro de Calcio/farmacología , Imagenología Tridimensional , Masculino , Activación Plaquetaria/efectos de los fármacos , Conejos , Proteínas Recombinantes/administración & dosificación , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Decorin is a natural transforming growth factor-ß1 (TGF-ß1) antagonist. Reduced decorin synthesis is associated with dermal scarring, and increased decorin expression appears to reduce scar tissue formation. To investigate the therapeutic potential of decorin for keloids, human dermal fibroblasts (HDFs) and keloid-derived fibroblasts (KFs) were transduced with decorin-expressing adenovirus (dE1-RGD/GFP/DCN), and we examined the therapeutic potential of decorin-expressing Ad for treating pathologic skin fibrosis. Decorin expression was examined by immunofluorescence assay on keloid tissues. HDFs and KFs were transduced with dE1-RGD/GFP/DCN or control virus, and protein levels of decorin, epidermal growth factor receptor (EGFR) and secreted TGF-ß1 were assessed by Western blotting and ELISA. And type I and III collagen, and matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-3 (MMP-3) mRNA levels were measured by real-time RT-PCR. Additionally, we immunohistochemically investigated the expression levels of the major extracellular matrix (ECM) proteins in keloid spheroids transduced with dE1-RGD/GFP/DCN. Lower decorin expression was observed in the keloid region compared to adjacent normal tissues. After treatment with dE1-RGD/GFP/DCN, secreted TGF-ß1 and EGFR protein expressions were decreased in TGF-ß1-treated HDFs and KFs. Also, type I and III collagen mRNA levels were decreased, and the expression of MMP-1 and MMP-3 mRNA was strongly upregulated. In addition, the expression of type I and III collagen, fibronectin and elastin was significantly reduced in dE1-RGD/GFP/DCN-transduced keloid spheroids. These results support the utility of decorin-expressing adenovirus to reduce collagen synthesis in KFs and keloid spheroid, which may be highly beneficial in treating keloids.
Asunto(s)
Adenoviridae/genética , Decorina/uso terapéutico , Proteínas de la Matriz Extracelular/biosíntesis , Fibroblastos/metabolismo , Regulación de la Expresión Génica , Terapia Genética , Vectores Genéticos/farmacología , Queloide/patología , Metaloproteinasa 1 de la Matriz/biosíntesis , Metaloproteinasa 3 de la Matriz/biosíntesis , Células Cultivadas , Colágeno Tipo I/biosíntesis , Colágeno Tipo I/genética , Colágeno Tipo III/biosíntesis , Colágeno Tipo III/genética , Decorina/genética , Proteínas de la Matriz Extracelular/genética , Fibroblastos/patología , Vectores Genéticos/genética , Humanos , Queloide/metabolismo , Metaloproteinasa 1 de la Matriz/genética , Metaloproteinasa 3 de la Matriz/genética , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Piel/patología , Esferoides CelularesRESUMEN
Endothelial-to-mesenchymal transition is a phenotypic conversion characterized by down-regulation of vascular endothelial markers and the acquisition of a mesenchymal phenotype. We hypothesized that keloid fibroblasts are of endothelial origin and that endothelial-to-mesenchymal transition substantially contributes to collagen accumulation during the development and progression of keloids. Wingless protein (Wnt-3a) protein expression was examined using immunohistochemistry in keloid tissues. Human dermal microvascular endothelial cells (HDMECs) were treated with Wnt-3a. mRNA and protein expression of endothelial (vascular endothelial cadherin) and mesenchymal (vimentin, snail family transcription factor [slug], and α-smooth muscle actin) cell markers were measured using real-time RT-PCR and immunocytochemistry, respectively. Additionally, coexpression of CD31 (cluster of differentiation 31), and endothelial cell marker, and vimentin in the vascular endothelium of keloid tissues was examined using immunofluorescence. Wnt-3a overexpression was observed in human keloid tissues. Wnt-3a treatment significantly reduced vascular endothelial cadherin mRNA expression and induced vimentin and slug mRNA expression in HDMECs. HDMECs became spindle-shaped and exhibited reduced expression of CD31 and increased expression of vimentin, slug, and α-smooth muscle actin. Moreover, coexpression of CD31 and vimentin was observed in the dermal vascular endothelium of keloid tissues from two patients with clinically active keloids. In conclusion, transient conversion of HDMECs to a mesenchymal phenotype may contribute to dermal fibrosis of keloid and hypertrophic scars.
Asunto(s)
Cicatriz Hipertrófica/patología , Células Endoteliales/metabolismo , Células Epiteliales/efectos de los fármacos , Fibroblastos/metabolismo , Queloide/patología , Vía de Señalización Wnt/efectos de los fármacos , Proteína Wnt3A/farmacología , Cicatrización de Heridas , Adolescente , Adulto , Anciano , Proliferación Celular , Células Cultivadas , Regulación hacia Abajo , Células Epiteliales/citología , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Factor A de Crecimiento Endotelial Vascular , Cicatrización de Heridas/efectos de los fármacosRESUMEN
PURPOSE: Helmet therapy is a non-surgical option for treating positional plagiocephaly, and its effectiveness has been validated by various researches. In addition to cranial flattening and asymmetry, ipsilateral prominence of the mid-face and relative anterior transposition of the ipsilateral ear is also common. Hence, we investigated the impact of helmet therapy on mid-facial asymmetry. METHODS: Ninety-nine patients diagnosed with positional plagiocephaly and treated by helmet therapy between September 2005 and July 2012 were enrolled. Therapy was initiated at various ages: group I, <6 months (n = 35); group II, 6 months to 1 year (n = 43); group III, >1 year (n = 21). A cranial vault asymmetry index was measured at the levels of the inferior orbital rim (CVAIIOR-MF) and superior orbital rim (CVAISOR-LC) and midway from the superior orbital rim to the vertex (CVAIMID-UC). Anterior transposition of the ipsilateral ear was verified by measuring the distance (D EAR) between the actual position of the ear and its expected position relative to the contralateral ear. All variables were compared before and after helmet therapy and were categorized by age at treatment initiation. RESULTS: CVAIIOR-MF and CVAISOR-LC were lower in all three age groups after helmet therapy, confirming therapeutic efficacy. CVAIMID-UC (upper level cranial asymmetry) and D EAR (mid-facial soft tissue asymmetry) also improved significantly in groups I and II which were younger than 1 year old. CONCLUSION: In positional plagiocephaly, helmet therapy is effective in correcting both cranial and mid-facial asymmetries. Outcomes were optimal in patients <1 year of age, but older patients also showed some improvement.
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Asimetría Facial/diagnóstico , Asimetría Facial/etiología , Dispositivos de Protección de la Cabeza/efectos adversos , Imagenología Tridimensional , Plagiocefalia no Sinostótica/terapia , Femenino , Lateralidad Funcional , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomógrafos Computarizados por Rayos XRESUMEN
The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.