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Plast Reconstr Surg ; 149(1): 197-201, 2022 Jan 01.
Article En | MEDLINE | ID: mdl-34936623

SUMMARY: Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Cheek/surgery , Cleft Palate/surgery , Postoperative Complications/epidemiology , Reconstructive Surgical Procedures/methods , Surgical Flaps/transplantation , Child, Preschool , Female , Humans , Infant , Male , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Reconstructive Surgical Procedures/adverse effects , Retrospective Studies , Surgical Flaps/adverse effects , Treatment Outcome
Plast Reconstr Surg ; 149(1): 70e-73e, 2022 Jan 01.
Article En | MEDLINE | ID: mdl-34936624

SUMMARY: Surgical management of unilateral cleft lip is challenging. Correction requires a comprehensive approach to ensure optimal aesthetic outcomes. Various techniques have been proposed for the repair of cleft lip. This article and video vignette highlight the senior author's (D.S.) preferred method for repair of a unilateral cleft lip using a modified inferior triangle technique, a Noordhoff triangular flap for vermillion augmentation, orbicularis oris chemodenervation to reduce tension at the repair site, and autologous fat grafting for lip sculpting.

Adipose Tissue/transplantation , Cleft Lip/surgery , Reconstructive Surgical Procedures/methods , Surgical Flaps/transplantation , Esthetics , Facial Muscles/innervation , Humans , Lip/surgery , Male , Nerve Block/methods , Transplantation, Autologous/methods , Treatment Outcome
Plast Reconstr Surg ; 149(1): 104e-107e, 2022 Jan 01.
Article En | MEDLINE | ID: mdl-34936630

SUMMARY: Technology is advancing in benefit to solving complex problems. Preoperative planning is essential in any reconstructive process given the importance of achieving good results. New technologies facilitate the process to anticipate intraoperative findings. Virtual surgical planning has contributed in the evolution of craniomaxillofacial surgery. However, limited reports have been published regarding its usefulness in extremity reconstruction. The aim of this study was to push the limits and evaluate the use of virtual surgical planning with three-dimensional images for reconstruction of complex extremity defects using a free, open-source software. Patient candidates for upper or lower extremity microsurgical reconstruction with multiple defects or defects requiring reconstruction of various tissue components were included. Computed tomography angiography images were analyzed for virtual surgical planning using Horos software (Horos, Annapolis, Md.). Two upper and eight lower extremities were reconstructed with free flaps using virtual surgical planning; six cases had multiple defects, and four cases underwent different tissue components reconstruction. The postoperative period was uneventful, and there was no flap failure. A didactic video of the process and examples of some cases are presented. Virtual surgical planning is a powerful planning method, and the authors propose its use in complex extremity defects reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Extremities/surgery , Microsurgery/methods , Patient Care Planning , Reconstructive Surgical Procedures/methods , Surgery, Computer-Assisted/methods , Computed Tomography Angiography , Extremities/blood supply , Extremities/diagnostic imaging , Free Tissue Flaps/transplantation , Humans , Imaging, Three-Dimensional , Prospective Studies , Retrospective Studies , Software
Plast Reconstr Surg ; 149(1): 108e-120e, 2022 Jan 01.
Article En | MEDLINE | ID: mdl-34936631

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the indications and management options for secondary flexor tendon reconstruction, including tenolysis, tendon grafting, and tendon transfers. 2. Understand the reconstructive options for pulley reconstruction. 3. Understand the options for management of isolated flexor digitorum profundus injuries. SUMMARY: Despite current advances in flexor tendon repair, complications can still occur following surgery. This article presents the spectrum of treatment options for secondary flexor tendon reconstruction ranging from tenolysis to one- and two-stage tendon grafting, and tendon transfers. In addition, an overview of pulley reconstruction and the treatment of isolated flexor digitorum profundus injuries are discussed. A management algorithm for secondary flexor tendon reconstruction is provided.

Finger Injuries/surgery , Reconstructive Surgical Procedures/methods , Reoperation/methods , Tendon Injuries/surgery , Tendon Transfer/methods , Humans , Male , Middle Aged , Tendons/surgery
Bone Joint J ; 104-B(1): 68-75, 2022 Jan.
Article En | MEDLINE | ID: mdl-34969286

AIMS: The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. METHODS: Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)). RESULTS: All patients returned to their pre-injury level of sports activities. One patient developed a delayed union of the medial malleolus. The mean return to play was 62 days (49 to 84) for isolated injuries, while the patients with concomitant injuries returned to play in a mean of 104 days (56 to 196). The AOFAS score returned to 100 postoperatively in all patients. Knee-to-wall measurements were the same as the contralateral side in 18 patients, while one patient lacked 2 cm compared to the contralateral side. CONCLUSION: This study suggests the use of the InternalBrace in the management of unstable syndesmotic injuries offers an alternative method of stabilization, with good short-term results, including early return to sports in elite athletes. Cite this article: Bone Joint J 2022;104-B(1):68-75.

Ankle Injuries/surgery , Athletic Injuries/surgery , Ligaments, Articular/injuries , Ligaments, Articular/surgery , Reconstructive Surgical Procedures/methods , Sutures , Adolescent , Adult , Humans , Male , Middle Aged , Prospective Studies , Return to Sport
Orthop Clin North Am ; 53(1): 105-112, 2022 Jan.
Article En | MEDLINE | ID: mdl-34799016

Patients with advanced pyogenic spondylodiscitis can present with neurologic deficits. However, the prevalence, severity, and outcome of the neurologic deficits are not well known. A systematic review was performed to improve the knowledge of this commonly encountered clinical scenario. The considerable number of severe neurologic deficits in addition to their poor recovery, even after surgical intervention, demonstrates that the early diagnosis of pyogenic spondylodiscitis is crucial. Prompt surgical intervention is likely associated with a greater chance of improvement of neurologic status than nonsurgical treatment.

Discitis/complications , Discitis/surgery , Nervous System Diseases/etiology , Nervous System Diseases/surgery , Humans , Osteomyelitis/complications , Osteomyelitis/surgery , Reconstructive Surgical Procedures/methods , Recovery of Function
Orthop Clin North Am ; 53(1): 51-56, 2022 Jan.
Article En | MEDLINE | ID: mdl-34799022

Slipped capital femoral epiphysis (SCFE) involves anterior-superior displacement of the proximal metaphysis relative to the epiphysis of the proximal femur. It is the most common hip disorder affecting the pediatric population. SCFE has a higher incidence in adolescent males in addition to racial and regional predilections. Despite being described over 500 years ago, there remains controversy surrounding the topic. This article examines current concepts in SCFE, with a spotlight on treatment. An evidence-based discussion of treatment controversies regarding reduction method, fixation construct, supplemental procedures and surgical timing is included.

Postoperative Complications/etiology , Reconstructive Surgical Procedures/methods , Slipped Capital Femoral Epiphyses/surgery , Humans
Orthop Clin North Am ; 53(1): 69-76, 2022 Jan.
Article En | MEDLINE | ID: mdl-34799024

Acute, traumatic rotator cuff tears typically occur in younger patients with a fall on an outstretched hand, grabbing an object to catch oneself when falling, or a glenohumeral dislocation. These tears are best evaluated with MRI. Partial-thickness tears may be managed nonoperatively with physical therapy, NSAIDs, and injections. Full-thickness tears in most patients should be managed with surgical repair as soon as possible, with better outcomes shown when repaired within 4 months of injury.

Rotator Cuff Injuries/diagnostic imaging , Rotator Cuff Injuries/therapy , Humans , Magnetic Resonance Imaging , Reconstructive Surgical Procedures/methods
Orthop Clin North Am ; 53(1): 77-81, 2022 Jan.
Article En | MEDLINE | ID: mdl-34799025

Scapulothoracic dissociation is a rare and devastating injury that is considered an orthopedic emergency. It is critical to recognize this injury early based on mechanism, physical examination, and radiographic parameters. Initial management should be focused on resuscitation and evaluation for potential limb-threatening ischemia.

Brachial Plexus/injuries , Brachial Plexus/surgery , Scapula/injuries , Scapula/surgery , Shoulder Injuries , Shoulder Joint/surgery , Vascular System Injuries/surgery , Brachial Plexus/diagnostic imaging , Diagnostic Imaging , Humans , Reconstructive Surgical Procedures/methods , Scapula/diagnostic imaging , Shoulder Joint/diagnostic imaging , Vascular System Injuries/diagnostic imaging
Orthop Clin North Am ; 53(1): 95-103, 2022 Jan.
Article En | MEDLINE | ID: mdl-34799027

Temporizing care has become a critical part of the treatment armamentarium for select foot and ankle injuries. Indications for performing temporizing care are based on the specific injury pattern, the host, associated injuries, as well as surgeon resources. Foot and ankle injuries are often associated with severe adjacent injury to the soft tissue sleeve. An acute procedure performed through a traumatized soft tissue envelope will often lead to the failure of wound healing and/or infectious complications. Thus, delayed reconstruction of acute foot and ankle injuries is often advisable in these cases.

Ankle Injuries/surgery , Foot Injuries/surgery , Reconstructive Surgical Procedures/methods , Soft Tissue Injuries/surgery , Clinical Decision-Making , Humans , Postoperative Complications
Ann Otol Rhinol Laryngol ; 131(1): 94-100, 2022 Jan.
Article En | MEDLINE | ID: mdl-33880969

OBJECTIVE: Complications associated with intracranial vault compromise can be neurologically and systemically devastating. Primary and secondary repair of these deficits require an air and watertight barrier between the intracranial and extracranial environments. This study evaluated the outcomes and utility of using intracranial free tissue transfer as both primary and salvage surgical repair of reconstruction. METHODS: A retrospective review was performed of all subjects who underwent intracranial free tissue transfer as primary or salvage repair. RESULTS: A total of 13 intracranial free tissue transfers were performed on 11 subjects: osteocutaneous radial forearm free flaps (n = 6), partial myofascial rectus abdominis flaps (n = 5), temporoparietal fascia flap (n = 1), and serratus anterior myofascial flap (n = 1). Primary reconstruction was performed on 4 subjects with the remaining being salvage repair. Indications for surgery included neoplasm (n = 6 of 11), ballistic trauma (n = 3 of 11), motor vehicle accident (n = 1 of 11), and infection (n = 1 of 11). Three subjects required additional surgical repair for CSF leak and pneumocephalus, with 2 subjects requiring an additional free tissue transfer at a different site. CONCLUSION: In our experience, free tissue transfer is an effective primary and salvage surgical technique in the reconstruction of complex intracranial problems.

Free Tissue Flaps , Reconstructive Surgical Procedures/methods , Skull Base/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
Medicine (Baltimore) ; 100(51): e28410, 2021 Dec 23.
Article En | MEDLINE | ID: mdl-34941186

ABSTRACT: Posterior instrumentation is an established treatment for a range of spinal disorders. Material failure is not uncommon, and the indications for a revision are very heterogeneous. This study aimed to evaluate the indications and timing for early revision spinal surgery due to material failure.In this retrospective, single-center cohort study, patients underwent spinal posterior instrumentation between January 2017 and July 2019. They were followed up at 3, 12, and 18 months postoperatively. The time of onset of material failure which led to revision surgery was analyzed. In addition, the relationship between the indications for revision surgery and independent variables was examined using a multivariate logistic regression model.A total of one hundred thirty-five patients were enrolled. Radiolucent zones were found in 30 patients (20%) after 3 months, whereas 48 patients (31%) had radiolucent zones after 12 months. Revision surgery was performed in 13 patients (8.5%). The peak time for revision due to instability was within the first four months of the primary surgery. Multivariate analysis revealed that location, pathology, ASA score, and smoking had no significant impact on the indication for revision surgery, and neither did BMI (P = .042). Non-fusion (P = .007) and radiolucent zones (P = .004), in combination with increased pain (P = .006), were predictors for revision.Our data show that the peak time for early revision of material failure after posterior instrumentation was within the first 4 months of primary surgery. The abnormalities (e.g., radiolucent zones) surrounding the screws without fusion, including persistence of pain, were predictors for revision surgery.

Lumbar Vertebrae/surgery , Reconstructive Surgical Procedures/methods , Reoperation , Spinal Fusion , Cohort Studies , Humans , Pain , Retrospective Studies , Time Factors , Treatment Outcome
Surg Clin North Am ; 101(6): 1007-1022, 2021 Dec.
Article En | MEDLINE | ID: mdl-34774264

This article discuses current controversies in abdominal wall reconstruction, including the standardization of outcome reporting, mesh selection, the utility of robotic surgery in ventral hernia repair, and role for prophylactic stoma mesh at the time of permanent end colostomy formation. The current state of the literature pertaining to these topics is reviewed in detail.

Abdominal Wall/surgery , Hernia, Ventral/surgery , Herniorrhaphy , Robotic Surgical Procedures , Herniorrhaphy/methods , Herniorrhaphy/standards , Humans , Incisional Hernia/surgery , Patient Reported Outcome Measures , Prosthesis Implantation , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/standards , Recurrence , Reoperation , Robotic Surgical Procedures/standards , Surgical Mesh , Treatment Outcome
Am Fam Physician ; 104(5): 500-508, 2021 Nov 01.
Article En | MEDLINE | ID: mdl-34783490

Breast implants are used for a wide range of cosmetic and reconstructive purposes. In addition to breast augmentation, implants can be used for postmastectomy breast reconstruction, correction of congenital breast anomalies, breast or chest wall deformities, and male-to-female top surgery. Breast implants may confer significant benefits to patients, but several factors are important to consider preoperatively, including the impact on mammography, future lactation, and potential long-term implant complications (e.g., infection, capsular contracture, rupture, and the need for revision, replacement, or removal). A fundamental understanding of implant monitoring is also paramount to implant use. Patients with silicone breast implants should undergo routine screening for implant rupture with magnetic resonance imaging or ultrasonography completed five to six years postoperatively and then every two to three years thereafter. With the exception of complications, there are no formal recommendations regarding the timing of breast implant removal or exchange. Women with unilateral breast swelling should be evaluated with ultrasonography for an effusion that might indicate breast implant-associated anaplastic large cell lymphoma. There are no specific breast cancer screening recommendations for patients with breast implants, but special mammographic views are indicated to enhance accuracy. Although these discussions are a routine component of consultation and postoperative follow-up for plastic surgeons performing these procedures, family physicians should have a working knowledge of implant indications, characteristics, and complications to better counsel their patients, to ensure appropriate screening, and to coordinate care after surgery.

Breast Implantation , Breast Implants , Breast , Long Term Adverse Effects , Mastectomy/adverse effects , Postoperative Complications/diagnosis , Aftercare/methods , Breast/diagnostic imaging , Breast/surgery , Breast Implantation/adverse effects , Breast Implantation/instrumentation , Breast Implantation/methods , Breast Implants/adverse effects , Breast Implants/classification , Female , Humans , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/etiology , Long Term Adverse Effects/prevention & control , Male , Mammography/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Reconstructive Surgical Procedures/methods , Sex Reassignment Surgery/methods , Surgery, Plastic/methods
Ann R Coll Surg Engl ; 103(10): 730-733, 2021 Nov.
Article En | MEDLINE | ID: mdl-34719961

AIM: Forklift trucks can cause serious lower limb trauma with long-lasting sequelae to patients. The aim of this study was to analyse a case series of patients with forklift-related injuries over 7 years at a level 1 major trauma centre in the UK and present their patient-reported outcome measures (PROMs) with long-term follow-up. To the best of the authors' knowledge, this is the largest case series study in the UK describing forklift injuries. METHODS: Retrospective case note analysis of 19 patients over 7 years. Data including demographics, injury mechanism, pattern of injury, management, length of hospital stay, number of operations and complications were extracted from the notes. We used 'Enneking score' as a validated tool for PROMs. RESULTS: Seventeen men and two women with mean age of 47 years; 20% had bilateral injuries and 34% had multi-level fractures. The mean number of theatre sessions was 5.21, while the mean length of hospital stay was 30.10 days. There was one mortality. Twelve patients (63%) required reconstruction with free tissue transfer, with one flap failure. The mean long-term Enneking percentage score was 57.33%. The mean Enneking score for patients in this study is lower than our institute's score for Gustilo 3B, highlighting the gravity of these injuries. CONCLUSION: Forklifts can cause grave injuries with massive energy transfer. This study highlights the seriousness of those injuries, thus guiding patient counselling and optimising planning of management.

Leg Injuries/etiology , Occupational Injuries/etiology , Adult , Aged , Female , Humans , Leg Injuries/epidemiology , Leg Injuries/surgery , Length of Stay/statistics & numerical data , Male , Middle Aged , Motor Vehicles , Occupational Injuries/epidemiology , Occupational Injuries/surgery , Patient Reported Outcome Measures , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/statistics & numerical data , Retrospective Studies , United Kingdom/epidemiology
Medicine (Baltimore) ; 100(40): e27452, 2021 Oct 08.
Article En | MEDLINE | ID: mdl-34622866

RATIONAL: Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital defects of different etiologies in one-stage surgical reconstruction with polyetheretherketone (PEEK) prosthesis using computer-assisted design and computer-assisted manufactured (CAD-CAM) techniques. PATIENT CONCERNS: One patient was a 49-year-old man, who admitted with a depressed and comminuted fracture in the left fronto-orbital region as a result of a motor vehicle collision. The other patient was a 45-year-old woman who was hospitalized with an unexpected diagnosis of a fronto-orbital bone tumor during a head CT examination in a minor traumatic brain injury. None of them had a significant past medical history. DIAGNOSES: The first patient's head computed tomography (CT) showed multiple depressed comminuted fractures in the right fronto-orbital region with localized frontal lobe contusion, and the diagnosis was clear when combined with the mechanism of traumatic head injuries. The second patient's head CT and magnetic resonance image suggested a right lateral orbital neoplastic lesion that distorted peripheral bone, the postoperative pathological examination demonstrated an osteoma with fibromatous hyperplasia, and thus the women's diagnosis was confirmed. INTERVENTIONS: A three-dimensional image of both patients' skull bone were collected from a high-resolution CT. A virtual surgical planning for lesion excision and defect remodeling based on CAD-CAM techniques was undertaken, and than the reconstruction surgery was performed in a single procedure using PEEK prosthesis. Antibacterial treatment was prescribed routinely. OUTCOMES: Postoperatively, both patients achieved excellent aesthetic restoration as well as functional recovery of the orbital cavity without neurological or infectious complications during an average 22 months follow-up. LESSONS: The CAD-CAM PEEK implants could be a preferred option for reconstruction of patients with various complex fronto-orbital defects.

Orbital Fractures/surgery , Orbital Neoplasms/surgery , Osteoma/surgery , Reconstructive Surgical Procedures/methods , Adult , Computer-Aided Design , Female , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Middle Aged , Orbital Fractures/diagnostic imaging , Orbital Implants , Orbital Neoplasms/diagnostic imaging , Osteoma/diagnostic imaging , Tomography, X-Ray Computed
Anticancer Res ; 41(10): 5015-5023, 2021 Oct.
Article En | MEDLINE | ID: mdl-34593450

BACKGROUND/AIM: Limb-sparing procedures are frequently applied to improve patient outcomes. The use of vascularized bone grafts is associated with significant improvements in oncologic safety and functional satisfaction. This study highlights the clinical outcomes following tumor resection combined with vascularized bone graft reconstructions. PATIENTS AND METHODS: Twenty-five free vascularized bone grafts (17 fibulas, 5 iliac crests, 3 medial femoral condyles) were assessed with respect to consolidation and hypertrophy, functional and oncologic outcomes, and local complications. RESULTS: The rate of healing of fibular grafts after a median of 5 months was 86%. The rate of achieved unions of iliac crest grafts after a median of 5 months was 80%. In medial femoral condyle bone grafts, union occurred after a median of 4 months. Significant hypertrophy was observed in 13 patients. We identified six complications with highest rates in the fibula-group. Despite the high complications, functional results were highly satisfactory. CONCLUSION: Vascularized bone grafts represent a reconstructive approach, maintaining long-term functionality and cosmetic satisfaction without compromising tumor recurrence outcomes.

Bone Neoplasms/surgery , Bone Transplantation/methods , Reconstructive Surgical Procedures/methods , Sarcoma/surgery , Surgery, Computer-Assisted/methods , Adolescent , Adult , Bone Neoplasms/blood supply , Bone Neoplasms/pathology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Prognosis , Retrospective Studies , Sarcoma/blood supply , Sarcoma/pathology , Young Adult
PLoS One ; 16(10): e0258776, 2021.
Article En | MEDLINE | ID: mdl-34665840

BACKGROUND: After cranioplasty, in many cases a not negligible soft tissue defect remains in the temporozygomatical area, also referred to as a hollowing defect of the temple. OBJECTIVE: To assess the precise localization and volume of the hollowing defect, to optimize future cranioplasties. METHODS: CT data of patients who received craniectomy and conventional CAD cranioplasty in our institution between 2012 and 2018 were analyzed. CT datasets prior to craniectomy and after cranioplasty were subtracted to quantify the volume and localization of the defect. RESULTS: Out of 91 patients, 21 had suitable datasets. Five cases had good cosmetic results with no defect visible, 16 patients had an apparent hollowing defect. Their average defect volume was 5.0 cm3 ± 4.5 cm3. The defect localizations were in the area behind the zygomatic process and just below the superior temporal line, covering an area of app. 3x3 cm2. Surgical attempts of temporal muscle restoration were more often found in reports of good results (p<0.01), but also in 50% of reports, whose surgeries resulted in hollowing of the temple. Mean time between the two surgeries was 112 ± 43 days. No significant differences between patients with and without hollowing defect were detected regarding time between the two surgeries, age or performing surgeon. CONCLUSION: This work supplies evidence for the indication of a surgical corrective during cranioplasty in the small but cosmetically relevant area of the "frontozygomatic shadow". Based on our 3D data analysis, future focused surgical strategies may obtain better aesthetical results here.

Decompressive Craniectomy/adverse effects , Head/diagnostic imaging , Reconstructive Surgical Procedures/methods , Temporal Muscle/surgery , Adult , Aged , Female , Head/surgery , Humans , Male , Middle Aged , Retrospective Studies , Time-to-Treatment , Tomography, X-Ray Computed , Treatment Outcome
Int J Mol Sci ; 22(19)2021 Sep 25.
Article En | MEDLINE | ID: mdl-34638663

Decellularization has emerged as a potential solution for tracheal replacement. As a fully decellularized graft failed to achieve its purposes, the de-epithelialization partial decellularization protocol appeared to be a promising approach for fabricating scaffolds with preserved mechanical properties and few immune rejection responses after transplantation. Nevertheless, a lack of appropriate concurrent epithelialization treatment can lead to luminal stenosis of the transplant and impede its eventual success. To improve re-epithelialization, autologous nasal epithelial cell sheets generated by our cell sheet engineering platform were utilized in this study under an in vivo rabbit model. The newly created cell sheets have an intact and transplantable appearance, with their specific characteristics of airway epithelial origin being highly expressed upon histological and immunohistochemical analysis. Subsequently, those cell sheets were incorporated with a partially decellularized tracheal graft for autograft transplantation under tracheal partial resection models. The preliminary results two months post operation demonstrated that the transplanted patches appeared to be wholly integrated into the host trachea with adequate healing of the luminal surface, which was confirmed via endoscopic and histologic evaluations. The satisfactory result of this hybrid scaffold protocol could serve as a potential solution for tracheal reconstructions in the future.

Epithelial Cells/cytology , Nose/cytology , Trachea/cytology , Animals , Cross-Sectional Studies , Extracellular Matrix/physiology , Male , Rabbits , Reconstructive Surgical Procedures/methods , Tissue Engineering/methods , Tissue Scaffolds/chemistry , Transplantation, Autologous/methods