Enhanced technique of dural closure using autologous fat graft and Gelfoam for effective management of dural tear following interlaminar endoscopic lumbar spine surgery.

BACKGROUND: Incidental dural tears are common complications in lumbar spine surgery, particularly in endoscopic procedures where primary closure via suturing is challenging. The absence of a standardized approach for dural closure in endoscopic spine surgery necessitates exploring alternative techniques. OBJECTIVE: This study introduces a surgical technique for dural closure utilizing fat graft and Gelfoam, offering an effective alternative to standard approaches in endoscopic spine surgery. METHODS: Surgical data from patients who underwent interlaminar endoscopic discectomy or stenosis decompression at Lerdsin Hospital from October 2014 to October 2021 were analyzed. RESULTS: Among 393 cases, dural tears occurred in 2% (8 patients). Our technique achieved successful closure in all these cases, with no incidents of cerebrospinal fluid leakage or wound complications. The majority of patients showed favorable clinical outcomes, except for one case involving concomitant nerve root injury. CONCLUSION: This study demonstrates that using fat graft and Gelfoam for dural closure is a simple, reliable, and safe technique, particularly effective for challenging-to-repair areas in interlaminar endoscopic lumbar spine surgery.

Endoscopic lipofilling for velopharyngeal insufficiency after transoral surgery: a technical note.

BACKGROUND: Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as "syndrome of the nasopharyngeal dead space." Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis. METHODS: We proposed an effortless and minimally invasive procedure to treat this condition based on lipofilling the nasopharynx posterior wall endoscopically. To test the procedure's functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up. RESULTS: The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux. CONCLUSIONS: The "syndrome of the nasopharyngeal dead space" should be correctly identified after transoral surgery. It can be effectively treated with lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.

Upper Blepharoplasty through Infrabrow Skin Excision to Treat Dermatochalasis with Lateral Hooding and Medial Orbital Fat Loss in Selected Patients.

PURPOSE: Dermatochalasis with lateral hooding and medial orbital fat loss are common signs of aging in the upper eyelid. Removing the excess skin in this area through infrabrow skin excision can effectively lift the loose skin of the upper eyelid and minimizes visible scarring. Additionally, we have identified three compartments of orbital fat prolapse based on orbital anatomy. Transferring volume from the lateral compartment to the intermediate region can flatten the lateral upper eyelid and create medial fullness, which ultimately rejuvenates the upper eyelid. This study presents an operative method for correcting age-related changes in the upper eyelid using this technique. METHODS: A total of 34 eyelids from 17 patients underwent a surgical procedure involving infrabrow skin excision, along with repositioning and lifting of lateral orbital fat. The inclusion criteria consisted of patients with moderate to severe upper eyelid dermatochalasis, coupled with middle fat loss and lateral hooding. To correct lateral hooding and restore midfacial fullness, lateral orbital fat was repositioned to an intermediate position, and the orbicularis oculi muscle was fold-sutured to the corrugator supercilii muscle. RESULTS: The mean age of the patients was 55.59 ± 3.20 years, with a range of 48 to 61 years. The mean follow-up period was 9.94 ± 1.35 months, ranging from 8 to 12 months. Patients were evaluated at 1-month, 3-month, and 6-month intervals. The Strasser system was used to evaluate the surgical outcomes at 3 months. All patients achieved good surgical outcomes, expressed through satisfactory cosmetic improvements, and improved visual field. The procedure effectively corrected lateral hooding and loss of middle orbital fat through infrabrow skin excision. No complications, such as wound dehiscence, lagophthalmos, noticeable scarring, ocular dyskinesia, or sensory changes, were observed. CONCLUSIONS: The combination of infrabrow skin excision, repositioning of lateral orbital fat, and lifting of the orbicularis oculi muscle effectively addresses moderate to severe dermatochalasis, lateral hooding, medial fat loss, and improves elasticity of the anterior wall of the upper lid in our patients. This procedure can produce satisfactory and long-lasting aesthetic results with an inconspicuous scar beneath the brow.

Microwave ablation on ex vivo porcine pancreas: The influence of ablation parameters on ablation results and fat liquefaction.

The pancreas is adjacent to critical organs; excessive microwave ablation (MWA) can result in serious complications. The purpose of this paper is to provide the reference data of pancreas MWA for clinicians, analyze the ablation outcomes under different ablation parameters, and determine the critical temperature of pancreatic surface fat liquefaction outflow. Combinations of two power levels (30 W and 55 W), three antenna diameters (1.3 mm, 1.6 mm, and 1.9 mm), and three ablation times (1 min, 1.5 min, and 2 min) were applied to an ex vivo pig pancreas. Temperature measurements were taken at four thermocouple points. The center point is located 5 mm horizontally from the antenna slot, with a temperature measurement point located 5 mm above, below, and to the right of the center point. Main effect analysis and variance analysis were used to quantify the influences of each factor on the ablation outcomes. At 30 W, the antenna diameter contributing the most at 48.5%. At 30 W-1.3 mm-1 min, the spherical index (1.41) is closest to 1. At 55 W, the coagulation zone size was almost only affected by the ablation time, with a contribution rate of 28.7%, the temperature at point C exceeds point B. On the surface of the ex vivo porcine pancreas, the fat outflow temperature was 54ã. Ablation combinations with low power, short duration, and small antenna diameter results in a more nearly spherical coagulation zone. When performing MWA on the pancreas, it is advisable to avoid areas with higher fat content, while keeping the pancreatic surface temperature below 54°C.

Complicaciones Asociadas a la Remoción Estética del Cuerpo Adiposo de la Boca (de Bichat) - Revisión Narrativa / Complications Associated with Aesthetic Removal of the Buccal Adipose Body (Bichat's fat-pad) - Narrative Review

El cuerpo adiposo de la boca (CAB) es un componente adiposo multilobulado bien delimitado, localizado de manera bilateral en la región facial íntimamente relacionado a estructuras nerviosas y vasculares. La remoción de CAB es un procedimiento ampliamente estudiado en el campo de la cirugía maxilofacial, utilizado principalmente para cubrir defectos. Su influencia en la estética facial ha iniciado una popularización de la remoción de la extensión bucal de CAB para obtener un rostro más estilizado, intervención difundida como poco invasiva y sin complicaciones. El objetivo de este estudio fue recopilar y evaluar estudios que reporten y evalúen complicaciones asociadas a la remoción por razones estéticas de CAB. Se revisó la evidencia en las bases de datos Medline vía PubMed, Epistemonikos, Scopus y Google Scholar, utilizando términos predefinidos, seleccionando estudios primarios de reportes de casos. Se incluyeron 7 artículos con un total de 10 pacientes; de estos, ocho pacientes se realizaron este procedimiento en Brasil, uno en Estados Unidos y uno en Chile. La distribución de la población fue de 3:7 entre hombres y mujeres con edad promedio de 35 años y un rango entre los 23 a los 49 años. En relación a las complicaciones reportadas, 100 % de los pacientes presentaron asimetría facial, un 80 % presentó edema facial, 30 % manifestaron sialocele, Trismus 20 %, 40 % presentó hematoma, 20 % compromiso del estado general, 20 % presentaron disfagia, en los casos de hipoestesia, parestesia, absceso, seroma, parálisis facial, odinofagia, fiebre se expresaron en 10 % de la población estudiada. En todos los estudios se describió una reintervención quirúrgica posterior a la remoción estética del cuerpo adiposo de bichat. La escasa literatura y la baja calidad de esta, no permite estimar el porcentaje real de posibles complicaciones, tampoco es posible determinar sus resultados a largo plazo ya que no existe en la evidencia un seguimiento apropiado para estos pacientes.

The buccal adipose body (BAB) is a well- defined multilobulated adipose component, located bilaterally in the facial region, closely related to nervous and vascular structures. BAB removal is a widely studied procedure in the field of maxillofacial surgery, used mainly to cover defects. Its influence on facial aesthetics has started to popularize the removal of the BAB buccal extension to obtain a more stylized face, an intervention widely known as minimally invasive and without complications. The objective of this study was to collect and evaluate studies that report and evaluate complications associated with the removal of BAB for cosmetic reasons. The evidence was reviewed in the Medline databases via PubMed, Epistemonikos, Scopus, and Google Scholar, using predefined terms, selecting primary studies from case reports. 7 articles with a total of 10 patients were included; Of these, eight patients underwent this procedure in Brazil, one in the United States, and one in Chile. The distribution of the population was 3:7 between men and women with an average age of 35 years and a range between 23 to 49 years. In relation to the reported complications, 100 % of the patients presented facial asymmetry, 80 % presented facial edema, 30 % manifested sialocele, trismus 20 %, 40 % presented hematoma, 20 % compromised general state, 20 % presented dysphagia, in the cases of hypoesthesia, paresthesia, abscess, seroma, facial paralysis, odynophagia, fever were expressed in 10 % of the studied population. All the studies described a surgical reintervention after cosmetic removal of the bichat adipose body. The scarce literature and its low quality do not allow estimating the real percentage of possible complications, nor is it possible to determine their long-term results since there is no evidence of appropriate follow-up for these patients.

Urgencia odontopediátrica asociada a Bola Adiposa de Bichat: informe de un caso / Pediatric dental emergency associated with Bichat ́s fat pad: a case report

Objetivo: Presentar la resolución quirúrgica de un caso clínico poco frecuente en un paciente pediátrico luego de ha- ber sufrido la herniación traumática de la Bola Adiposa de Bichat. Caso clínico: Un paciente de 3 años concurre a la guar- dia del Hospital Interzonal Especializado Materno Infantil "Don Victorio Tetamanti" de Mar del Plata, luego de haber sufrido un traumatismo que le provocó el desplazamiento par- cial de la Bola Adiposa de Bichat. Si bien este tipo de urgencias es poco frecuente, es impor- tante tener los conocimientos para un correcto diagnóstico y tratamiento (AU))

Aim: To present the surgical resolution of an infrequent clinical case in a pediatric patient who suffered traumatic herniation of Bichat's fat pad. Clinical case: A 3-year-old patient who visited the Emergency Service at the "Don Victorio Tetamanti" Hospital in Mar del Plata after suffering a trauma which caused the partial displacement of Bichat's fat pad. Although this type of emergency is quite rare, it is important to know how to per- form proper diagnosis and treatment (AU)

Comentario al artículo "Pérdida permisible de grasa en liposucción: fórmula y aplicación informática para cuantificar un nuevo concepto" / No disponible

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Respuesta al comentario del Dr. E. A. Moretti / No disponible

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Pérdida permisible de grasa en liposucción: fórmula y aplicación informática para cuantificar un nuevo concepto / Permissible loss of fat in liposuction: formula and computer application to quantify a new concept

INTRODUCCIÓN Y OBJETIVO: Existe poca evidencia científica de cuánta grasa se debería retirar en una lipoescultura, sólo parámetros rígidos recomendados. El concepto actual del volumen de grasa a retirar no puede ser generalizado, pues cada paciente tiene características intrínsecas distintas, por lo cual, el cálculo del volumen aspirado de grasa debería individualizarse para cada paciente. El objetivo de este trabajo es crear una fórmula matemática predictiva para conocer la máxima cantidad de grasa a aspirar en una liposucción (pérdida permisible de grasa) en función de un volumen permisible sanguíneo seguro y de la edad (sin necesidad de transfusiones y previniendo complicaciones hemodinámicas). MATERIAL Y MÉTODO: Estudio cuantitativo, analítico, retrospectivo y de diseño no experimental. La población de estudio estuvo formada por pacientes operados de liposucción por un mismo cirujano en 3 clínicas privadas de Lima (Perú). Determinamos el tamaño mínimo de muestra con un nivel de confianza del 95% y margen de error del 5%; la muestra final fue de 102 pacientes. Empleamos una base de datos en Microsoft Excel v19.00 para recolección de datos y técnicas descriptivas para homogeneizarlos. Luego, análisis multivariado teniendo en cuenta además edad del paciente y riesgo quirúrgico. Realizamos el análisis estadístico con el programa SPSS versión 25. RESULTADOS: Contamos con 97 mujeres entre 18 a 54 años y 5 hombres entre 23 a 48 años (media de 32.5 años); el índice de masa corporal promedio (IMC) fue 22.06. El estudio de regresión lineal para las variables aspirado total de grasa y volumen permisible sanguíneo obtuvo un coeficiente de determinación muy importante (R2=47%) (fuerte asociación de predecibilidad). Dado este resultado, ampliamos el estudio a uno multivariable con las variables edad y riesgo quirúrgico, donde no determinamos asociación con respecto a riesgo quirúrgico, sin embargo, para edad la asociación se volvió más fuerte (R2=49%), permitiendo construir una fórmula predictiva para la asociación de estas 3 variables y una aplicación informática para celulares y tabletas capaz de mejorar la aplicación de esta relación en la práctica clínica. CONCLUSIONES: El presente estudio determinó que las variables aspirado total de grasa y pérdida permisible de sangre son predictoras de la pérdida permisible de grasa. Así mismo, el análisis multivariable permitió aumentar el poder predictivo de esta relación al incluir la variable edad. De esta forma desarrollamos un método estadístico que permite determinar estas predicciones (fórmula) a fin de ayudar a los cirujanos a una mejor planificación quirúrgica de la lipoescultura. Para facilitar su uso, desarrollamos además una aplicación móvil gratuita que permite este cálculo de manera rápida y sencilla

BACKGROUND AND OBJECTIVE: There is little scientific evidence of how much fat should be removed in a liposculpture, only rigid recommended parameters. The current concept of the volume of fat that should be removed cannot be generalized, since each patient has different intrinsic characteristics, therefore, the calculation of the aspirated volume of fat should be individualized for each patient. The objective of this work is to create a predictive mathematical formula that allows us to know what is the maximum amount of fat that can be aspirated in liposuction (allowable fat loss) based on a safe allowable blood volume and age (without the need for blood transfusions and preventing hemodynamic complications). METHODS: A quantitative, analytical, retrospective study that responds to a non-experimental design was conducted. The study population was made up of patients undergoing liposuction by the same surgeon in 3 private clinics in Lima (Peru). The minimum sample size was determined with a confidence level of 95% and a margin of error of 5%, where the final sample consisted of 102 patients. A database in Microsoft Excel v19.00 was used for data collection, likewise descriptive techniques were used to homogenize them. Then, the multivariate analysis was carried out, taking into account the patient's age and surgical risk. Statistical analysis was performed with the SPSS version 25 statistical program. RESULTS: We collected 97 women between 18 to 54 years old and 5 men between 23 to 48 years old (average age 32.5 years); the average body mass index (BMI) was 22.06. A linear regression study was carried out for the variables total fat aspirate and permissible blood volume, obtaining a very important coefficient of determination (R2=47%) (strong association of predictability). Given this result, it was decided to extend the study to a multivariate one, with the variables age and surgical risk, where no association was determined with respect to surgical risk, however for age the association became stronger (R2=49%), allowing the construction of a predictive formula for the association of these 3 variables, creating a computer application for cell phones and tablets to improve the application of this relationship in clinical practice. CONCLUSION: The present study determined that the variables total fat aspiration and permissible blood loss are predictive variables of permissible fat loss. Likewise, the multivariate analysis allowed us to increase the predictive power of this relationship, as the age variable was included. In this way, it is possible to develop a statistical method that allows us to determine these predictions (formula), which will help surgeons to have a better surgical planning of liposculpture. To make this easier, a free mobile application was developed that allows this calculation quickly and easily

Relaciones anatómicas del cuerpo adiposo de la mejilla asociadas a complicaciones de bichectomía: a propósito de un caso / Anatomical relationships of the adipose buccal fat pad associated with bichectomy complications: about a case

RESUMEN: El presente estudio busca entregar conocimientos y aspectos importantes de las estructuras anatómicas asociadas al cuerpo adiposo de la mejilla (CAM), a consecuencia del reporte de un caso de complicación posterior a una bichectomía. Conocer los elementos anatómicos y sus relaciones con el CAM es de vital importancia, ya que en la actualidad son muchos los cursos y pasadas que se realizan para odontólogos generales y especialistas para el retiro del CAM, esto producto de la creciente demanda estética de las personas por presentar un perfil más fino y estilizado. El caso presentado corresponde a una mujer que consultó al servicio de urgencia por aumento de volumen facial posterior a la extracción del CAM, el cual se diagnosticó como sialocele, consecutivo a daño del conduc- to parotídeo. Al revisar la literatura y observar en nuestros preparados anatómicos se aprecia la cercanía de elementos de importancia, como son el conducto parotídeo, los ramos cigomático y bucal del nervio facial, vasos faciales como la arteria facial, vena facial y arteria transversa facial, es por esto que es necesario conocer en detalle la zona a intervenir y considerar las posibles variaciones anatómicas de estos elementos, para así evitar dañarlos durante el procedimiento, tomando una actitud preventiva. Apuntado entonces al objetivo de este estudio, fue lograr entregar información anatómica precisa y concisa de los elementos de importancia próximos o inmersos en el CAM, para prevenir la iatrogenia de estos.

SUMMARY: The present study seeks to provide knowledge and important aspects of the anatomical structures associated with the buccal fat pad (BFP), as consequence of the report of a case of complication after bichectomy. Knowing the anatomical elements and their relationships with BFP is of vital importance, because nowadays there are too many BFP removal courses and internships, for general dentists and specialists, due to the increasing aesthetic demands of individuals seeking a finer and more stylized profile. The case presented is a female patient who consults the emergency department for an increase in facial volume after BFP extraction, which was diagnosed as sialocele, following damage to the parotid duct. When reviewing the literature and observing our anatomical preparations, the proximity of important elements is appreciated, such as the parotid duct, the zygomatic and buccal branches of the facial nerve, facial vessels such as the facial artery, facial vein and facial transverse artery. It is essential to know in detail the area in order to intervene and consider the possible anatomical variations of these elements to avoid injury during the procedure. The aimed objective of this study, is to provide accurate and concise anatomical information of important elements near or immersed in BFP, to prevent iatrogenesis.

Resección parcial laparoscópica de plasmocitoma extramedular retroperitoneal / Laparoscopic partial resection of retroperitoneal extramedullary plasmacytoma

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Avaliação da segurança no emprego do VASER® em cirurgia de lipoaspiração para melhora de contorno corporal / Evaluation of the safety of VASERTM in liposuction surgery to improve body contour

Introdução: A lipoaspiração tem sido submetida à evolução constante desde a sua consolidação e emprego sistemático. O auxílio de tecnologia ultrassônica de terceira geração, VASER® (Vibration Amplification of Sound Energy at Resonance), se destina a facilitar a execução da lipoaspiração e trazer maior segurança e resultados satisfatórios, especialmente na busca por maior definição e lipoaspiração superficial. Métodos: No período de 2015 a 2017, 76 pacientes foram submetidas à lipoaspiração para melhora de contorno corporal no Centro Hospitalar Santa Mônica em Erechim. Foram avaliados os resultados obtidos, as possíveis complicações e a segurança do emprego do VASER®. Resultados: A utilização rotineira do VASER® gera aperfeiçoamento de resultados em contorno corporal. A emulsificação gerada pelo dispositivo associada à lipoaspiração em diversos níveis permite uma maior definição e evidenciação dos marcos anatômicos. Conclusão: Lipoaspiração associada ao VASER® permite ao cirurgião plástico o refinamento de seus resultados com a preservação da segurança do paciente.

Introduction: Liposuction has been improved continuously since it was first introduced. The third-generation ultrasound technology VASERTM (Vibration Amplification of Sound Energy at Resonance) facilitates liposuction, providing improved safety and satisfactory results, especially in the search for greater definition and superficial liposuction. Methods: From 2015 to 2017, 76 patients underwent liposuction to improve their body contour at the Santa Monica Hospital Center in Erechim, Rio Grande do Sul, Brazil. The results, complications, and the safety of VASERTM were evaluated. Results: The routine use of VASERTM improves body contour. The emulsification generated by the device, along with liposuction, resulted in greater definition and revelation of the anatomical landmarks. Conclusion: Liposuction associated with VASERTM allows plastic surgeons to refine the results better while ensuring patient safety is maintained.

Buccal fat pad removal to improve facial aesthetics: an established technique?

BACKGROUND: Buccal fat pad (BFP) is a singular structure between the facial muscles. Its removal may enhance the zygomatic prominences resulting in an inverted triangle of beauty. OBJECTIVE: The aim of this study was to perform a systematic review of literature about BFP removal for facial aesthetic improvement. In order to answer the following research question: What are the indications, complication types and rates, surgical techniques and outcomes of the technique?. MATERIAL AND METHODS: The initial search in Pubmed, Scopus, and Cochrane databases recognized 220 articles. The final review included eight of them. None of the included studies were clinical trials. RESULTS: BPF removal was performed by intraoral incision or associated with the face lift procedure. In 71 patients submitted to the procedure and evaluated about complications, only 8.45% presented minor complications. Parotid duct and facial nerve injuries were not found. No study evaluated facial aging and long-term effects, therefore the harmless effect of the procedure to those features is not clear. CONCLUSIONS: Although it is not a novel procedure, there is a lack of information about long-term outcomes. Thus, controlled clinical studies should be performed to achieve adequate clinical evidence of those aspects

Descripción de las Diferentes Indicaciones del Cuerpo Adiposo de la Mejilla como Colgajo e Injerto Autólogo en Cirugía Maxilofacial. Revisión Narrativa / Buccal Fat Pad Indications as a Flap and Autologous Graft in Maxillofacial Surgery. Narrative Review

RESUMEN: Uno de los objetivos de la cirugía maxilofacial es devolver anatomía, función y estética a través de distintas técnicas quirúrgicas. Dentro de los tejidos utilizados para esto se encuentra el cuerpo adiposo de la mejilla (CAM). La gran evidencia clínica existente y el conocimiento que se tiene acerca de este tejido ha permitido poder utilizarlo como injerto o colgajo para el tratamiento de una serie de condiciones que afectan al territorio maxilofacial con buenos resultados tanto estéticos como funcionales. Describir las diferentes indicaciones que tiene el CAM como colgajo e injerto autólogo para el tratamiento de las distintas anomalías que afectan al territorio maxilofacial. Se realizó una búsqueda entre abril y junio de 2018 utilizando 3 bases de datos electrónicas: PubMed, EBSCO y Cochrane. Las palabras clave utilizadas fueron buccal fat pad, bichat's fat pad y oral surgery con la selección del término booleano AND y OR. Se seleccionaron aquellos estudios publicados entre los 2014 y 2018, de texto completo. Se seleccionaron 17 artículos de que cumplieron con los criterios de inclusión; 2 revisiones sistemáticas, 8 ensayos clínicos, 6 estudios observacionales y una serie de casos. El uso del CAM como injerto y colgajo para la corrección de anomalías en el territorio maxilofacial es una técnica versátil y predecible. La totalidad de los estudios analizados avalan su uso en dicho campo. Se necesitan más estudios clínicos aleatorizados, con un mayor número de casos, seguimiento a largo plazo y parámetros a evaluar para establecer una conclusión final sobre el uso del CAM en las diversas aplicaciones de la cirugía maxilofacial.

ABSTRACT: One of the main objectives of maxillofacial surgery is to restore patient normal anatomy, function and esthetic. Among the various tissues used to achieve the above, is the buccal fat pad. Currently, there is sufficient clinical evidence and knowledge regarding this tissue type, to approve its use as graft or flap, in order to treat a number of conditions that affect the maxillofacial area. Furthermore, it has shown various esthetical as well as functional results. The purpose of this narrative review is to describe different indications of the buccal fat pad, as a flap and autologous graft in treating various maxillofacial abnormalities. A search was conducted between april and june 2018 using 3 electronic data bases: PubMed, EBSCO and Cochrane library. Key words used were buccal fat pad, Bichat's fat pad y oral surgery using Boolean terms AND/ OR. Studies published between 2014 and 2018 were selected. For the study, 17 complete text studies that met the inclusion criteria were selected; two systematic reviews, eight randomized clinical trials, six observational studies and one case series. The use of the buccal fat pad as flap and graft for correcting maxillofacial abnormalities, is a predictable and versatile technique. The total number of studies analyzed, support its use in this surgical field. In conclusion and despite these results however, there is a need for further randomized clinical trials with a greater number of cases, long term follow up, and greater parameter assessment to support the use of the buccal fat pad in maxillofacial surgery.

Bichectomia e sua contribuição para harmonia facial / Bichectomy and its contribution to facial harmony

Introdução: O tecido gorduroso bucal foi descrito pela primeira vez em 1732, por Heister. Em 1802, Bichat diagnosticou sua natureza adiposa. Há uma estreita relação entre a gordura bucal e músculos da mastigação, auxiliando os lactentes na sucção do leite por atuar com um tecido de deslizamento. Sua projeção diminui com o aumento da idade, tanto pela redução discreta de seu volume quanto pelo crescimento facial. A bichectomia ou bichatectomia é o procedimento cirúrgico que visa remover a "bola gordurosa de Bichat", com fins estéticos e/ ou funcionais. O objetivo é demonstrar que a bichectomia é um procedimento de baixo risco cirúrgico e com bons resultados, desde que seja bem indicada e siga os padrões técnicos, respeitando a anatomia das estruturas faciais. Métodos: Estudo prospectivo de coorte, realizado entre janeiro de 2016 e abril de 2018, totalizando 59 pacientes, com média de idade de 31 anos. O tempo de seguimento foi de 12 a 26 meses. Resultados: Foram avaliados 59 pacientes, com média de idade de 31 anos, sendo 46 do sexo feminino e 13 do sexo masculino. Todos os pacientes receberam alta no mesmo dia. Em média, foram retirados 3,2ml de volume da gordura de Bichat. Conclusão: A retirada de porções das gorduras de Bichat é segura, desde que sejam observados os detalhes anatômicos. Pode oferecer maior harmonia entre os três terços da face. O sucesso dos resultados depende de uma indicação precisa para o procedimento.

Introduction: Buccal fat removal was described for the first time by Heister in 1732. In 1802, Bichat identified the adipose nature of this tissue. There is a close association between buccal fat and masticatory muscles, which helps infants suck owing to the sliding motion of the tissues. Its prominence diminishes with age, both through modest reduction in volume and facial growth. Bichectomy or bichatectomy is a surgical procedure that involves extraction of Bichat's fat pad for aesthetic and/or functional purposes. This study aimed to show that bichectomy is a low-risk surgical procedure with good results, provided it is appropriately indicated and is performed following technical standards according to the anatomy of the facial structures. Methods: This prospective cohort study was conducted between January 2016 and April 2018 and included 59 patients with a mean age of 31 years. The follow-up time was 12-26 months. Results: Of 59 patients, 46 were female, and 13 were male. All patients underwent same-day surgery. On average, 3.2 mL of fat was removed. Conclusion: Removal of Bichat's fat according to anatomical principles is safe. This technique can improve facial harmony. Success depends on application of appropriate techniques.

Respuesta al comentario del Dr J Fontdevilla / No disponible

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Criopreservación de células estromales derivadas del tejido adiposo: viabilidad utilizando un medio definido libre de proteína animal / Cryopreservation of adipose derived stromal cells: viability using a defined free of animal protein médium

Introducción y Objetivo. El tejido adiposo es una fuente de células estromales de fácil acceso. Para su almacenamiento y posterior aplicación en clínica es importante que el método de criopreservación a utilizar mantenga adecuadas tasas de viabilidad tras un ciclo de congelación. El objetivo del presente trabajo es obtener células estromales humanas derivadas del tejido adiposo, implementar un protocolo de criopreservación libre de proteína animal y medir las tasas de viabilidad posterior a un ciclo de criopreservación para su eventual aplicación clínica. Material y Método. Utilizamos grasa fresca de 5 pacientes sometidas a lipoaspiración y aislamos las células estromales mediante técnicas de digestión enzimática y expansión celular. Realizamos la caracterización de las células mediante inmunofenotipificación. Criopreservamos las células utilizando dimetil-sulfóxido 10% y las almacenamos durante 1 mes en nitrógeno líquido. Evaluamos la tasa de viabilidad mediante ioduro de propidio y citometría de flujo, antes y después de un ciclo de criopreservación. Resultados. Obtuvimos células estromales derivadas del tejido adiposo, confirmado con el panel de inmunofenotipificación. Las tasas de viabilidad promedio obtenidas con ioduro de propidio fue 61.89% mientras que la tasa de mortalidad fue 32.68% tras un ciclo de criopreservación. Conclusiones. Mediante un protocolo de criopreservación utilizando un medio definido con dimetil-sulfóxido 10% en ausencia de proteína animal, es posible obtener tasas aceptables de viabilidad de las células estromales derivadas del tejido adiposo tras un ciclo de criopreservación (AU)

Background and Objective. Adipose tissue is an easy access source of stromal cells. For storage and subsequent clinical application, it is important that the method of cryopreservation used maintain adequate viability rates after a cycle of freezing. Our aim is to get stromal cells derived from human adipose tissue, implement a protocol of cryopreservation free of animal protein and subsequent measure viability rates after a cryopreservation cycle for its posterior clinical use. Methods. Fresh adipose tissue of 5 patients undergoing liposuction was used and stromal cells were isolated by enzymatic digestion techniques and cell expansion. Characterization of the cells was performed by immunophenotyping. Cells using 10% dimethylsulfoxide and stored for 1 month were cryopreserved in liquid nitrogen. Viability rates were assessed by propidium iodide and flow cytometry before and after a cryopreservation cycle. Results. Stromal cells derived from adipose tissue, confirmed immunophenotyping panel, were obtained. The average viability rates obtained with propidium iodide was 61.89% while the mortality rate was 32.68% after a cryopreservation cycle. Conclusions. Using a cryopreservation protocol with a defined medium with 10% dimethylsulfoxide and animal protein free, it is possible to obtain acceptable viability rates of stromal cells derived from adipose tissue after a cryopreservation cycle (AU)

El factor de crecimiento endotelial vascular (VEGF) y el fragmento N-terminal de la proteína relacionada con la parathormona (PTHrP) regulan la proliferación de células madre mesenquimales humanas / Vascular endothelial growth factor (VEGF) and the N-terminal portion of parathyroid hormone-related protein (PTHrP) regulate the proliferation of human mesenchymal stem cells

El tejido adiposo contiene un gran número de células madre mesenquimales (Adipose Stem Cells, ASCs) que residen en su estroma vascular. Aunque existe controversia acerca de la capacidad de generar tejido óseo de estas células in vivo, in vitro constituyen un buen modelo de diferenciación osteogénica debido a su semejanza fenotípica con las células estromales de la médula ósea (Bone Marrow Stromal Cells, BMSCs) en cultivo. La diferenciación de las poblaciones osteoprogenitoras de la médula ósea está intensamente regulada por factores locales, como el factor de crecimiento endotelial vascular (VEGF) y la proteína relacionada con la parathormona (PTHrP), que modulan la proliferación de estas poblaciones en distintos estadios de diferenciación. Tanto el VEGF como el fragmento N-terminal de la PTHrP ejercen efectos osteogénicos. En este estudio hipotetizamos que sus efectos sobre la proliferación celular de los osteoprogenitores son dependientes del estadio de diferenciación osteoblástica. Tras confirmar su capacidad de diferenciación in vitro por expresión génica de Runx2 y acumulación de calcio, se analizó la respuesta proliferativa a estímulos con VEGF o PTHrP(1-36) de ASCs sometidas o no a inducción osteogénica. VEGF pero no PTHrP(1-36) estimuló la capacidad proliferativa de las ASCs no inducidas mientras que PTHrP(1-36), pero no VEGF, estimuló la proliferación de las ASCs inducidas, corroborando el papel diferencial de estos factores de crecimiento en distintos estadios de diferenciación (AU)

Adipose tissue contains a large number of mesenchymal stem cells (ASCs) residing in their vascular stroma. Although there is controversy regarding the ability to generate bone tissue from these cells in vivo, the in vitro cells offer a good model of osteogenic differentiation due to its phenotypic similarity with the bone marrow stromal cells (BMSCs) in culture. The differentiation of osteo-progenitor populations of bone marrow is intensely regulated by local factors, such as vascular endothelial growth factor (VEGF) and parathyroid hormone-related protein (PTHrP), which modulate these populations' proliferation in different stages of differentiation. Both the VEGF and the N-terminal fragment of the PTHrP exert osteogenic effects. In this study, we posited that its effects on proliferation of osteo-progenitors are stage dependent of osteoblastic differentiation. After confirming its capacity to in vitro differentiation by Runx2 gene expression and accumulation of calcium, the proliferative response to stimuli was analyzed with VEGF or PTHrP (1-36) of ASCs submitted or not to osteogenic induction. VEGF, but not PTHrP (1- 36), stimulated the proliferative capacity of uninduced ASCs, whereas BMSCs, but not VEGF, stimulated the proliferation of induced ASCs, corroborating the differential role of this growth in different stages of differentiation (AU)

Paciente con xerostomía posradioterapia por cáncer de cabeza y cuello tratado con células madre mesenquimales autólogas expandidas de tejido adiposo: una nueva oportunidad terapéutica / Radiation-induced xerostomia in a patient with head and neck cancer treated with Injection of autologous expanded adipose tissue-derived mesenchymal stem cells: A new therapeutic opportunity

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Enxerto autólogo de células-tronco derivadas do tecido adiposo: uma nova visão de sua aplicação no tratamento de queimados e na cirurgia plástica reparadora / Adipose tissue-derived stem cell autologous grafts: a new approach to application in the treatment of burn victims and reconstructive plastic surgery

No Brasil, 1 milhão de acidentes com queimaduras acontecem por ano e as infecções são responsáveis por 75% dos óbitos nestes pacientes, além de deixar lesões que ocasionam deformidades nas áreas atingidas. Sendo assim, o objetivo deste trabalho é fornecer uma visão atual sobre células-tronco mesenquimais (MSCs), com ênfase nas células-tronco derivadas do tecido adiposo (ADSCs), associadas a gel de plasma, gel de fibrina e membranas (scaffold). O uso de géis e membranas tendem a auxiliar o crescimento celular visando sua possível aplicação na Cirurgia Plástica Reparadora para o tratamento pacientes queimados ou que necessitam de enxerto de pele. O presente trabalho abordou de forma exploratória e narrativa o tema células-tronco mesenquimais, células-tronco mesenquimais derivadas do tecido adiposo, gel de fibrina, gel de plasma e scaffold. O tipo de pesquisa empregada foi conduzido com coleta de informações utilizando-se a Biblioteca Virtual em Saúde (BVS) e PubMed. O número absoluto de artigos publicados relacionados ao tratamento de queimaduras é considerável. Até o momento, a quantidade de pesquisas relacionadas à terapia com células-tronco derivadas do tecido adiposo, gel de fibrina, gel de plasma e scaffold para o tratamento de queimaduras apresenta-se escassa. O autoenxerto de ADSCs associado a biocurativos torna-se uma perspectiva promissora na Cirurgia Plástica Reparadora para o tratamento e recuperação de pacientes que sofreram queimaduras ou outros acidentes que necessitam de enxerto de pele. Estes recursos podem reduzir a dor e prover a dessecação da lesão, promovendo neovascularização e a reepitelização da ferida.

In Brazil, 1 million burn accidents occur annually, and subsequent wound infections account for 75% cases of deaths among these patients, in addition to inducing deformities in the affected areas. Therefore, the aim of this study was to discuss the current status of mesenchymal stem cells, with an emphasis on adipose-derived stem cells (ADSCs), in combination with plasma gel, glue fibrin, and membranes (scaffold). The use of gels and membranes supports cell growth, and aims at potential application in reconstructive plastic surgery for the treatment of burn patients or individuals requiring skin grafts. This study explores and discusses the role of mesenchymal stem cells, adipose-derived mesenchymal stem cells, glue fibrin, plasma gel, and the scaffold. This research collected information from the Virtual Health Library (VHL) and PubMed. A considerable number of articles have been published on burn treatment. However, there is little research on burn treatment with ADSCs, glue fibrin, plasma gel, and scaffold. An ADSC autograft combined with a biological dressing is promising in reconstructive plastic surgery for the treatment and recovery of burn patients or individuals with other injuries that require skin grafts. These features can reduce pain and aid in drying of the lesion, thus promoting neovascularization and wound reepithelialization.