Prolongation of the rat composite tissue allograft survival by the combination of tolerogenic immature dendritic cells and short-term treatment with FK506.

OBJECTIVE: Prevention of rejection in composite tissue allotransplantation without continuous immunosuppression is of paramount importance in the field of transplantation. Recently dendritic cells (DCs) have gained considerable attention as antigen-presenting cells that are also capable of tolerance induction. This study assessed the effect of interleukin (IL)-10-supplemented, alloantigen-pulsed immature tolerogenic DC to increase survival of orthotopic hind limb transplantations in rats. MATERIALS AND METHODS: Hind limbs from Sprague-Dawley (SD) hosts were transplanted to Fischer 344 (F344) rats. Peripheral blood mononuclear cells (PBMC) isolated from F344 were cultured to generate immature DCs (imDCs); IL-10 was added for tolerogenic DC induction. Flow cytometric analysis were performed to characterize the DC phenotype. IL-10-imDCs cocultured with donor mononuclear cells for 24 hours were reinjected into recipients subcutaneously 1 day before transplantation. Recipient animals were divided into 4 groups, each comprising 6 rats (n = 6): group I (untreated controls), group II (IL-10-imDCs alone), group III (FK-506 [Tacrolimus, 2 mg/kg] for 2 weeks postoperative), and group IV (recipient origin IL-10-imDCs combined with FK-506 for 2 weeks postoperative). Observation of graft appearance, cytokine production assays, and confocal immunofluorescence were performed at postoperative 1 week. RESULTS: The combination of IL-10-treated imDCs and FK-506 produced a significantly prolonged median allograft survival (46.7 days) compared with groups I (4.7), II (5.3), or III (26.3). Splenocytes isolated from rats treated with IL-10-imDCs plus and FK-506 produced significant amounts of IL-10 and IL-4 cytokines upon alloantigen stimulation, as confirmed using ELISPOT and ELISA. CONCLUSIONS: We demonstrated that IL-10-treated imDCs induced T-cell hyporesponsiveness, skewing the immune response to Th2 elements, resulting in long-term survival of composite tissue allografts.

A new surgical treatment of keloid: keloid core excision.

Keloids and hypertrophic scars result from excessive collagen deposition, the cause of which is not yet known. Unlike hypertrophic scars, keloids frequently persist at the site of injury, often recur after excision and always overgrow the boundaries of the original wound. There have been many trials to control keloids, but most of them have been unsuccessful. The authors propose a new surgical technique to treat keloids and name it keloid core extirpation. They excise the inner fibrous core from the keloid and cover the defect with a keloid rind flap, which is arterialized by the subcapsular vascular plexus. The authors treated 24 keloids of the ear, trunk, face, and genitalia with keloid core excision. Four cases of partial rind flap congestion or necrosis occurred. Those patients who healed primarily after surgery showed no evidence of keloid recurrence as long as they were followed. The authors have found the keloid core extirpation technique to be excellent in preventing keloid recurrence, with no adjuvant therapy after surgery.

Refinement in aesthetic contouring of the prominent mandibular angle.

Oriental women, in general, greatly desire a more delicate and feminine facial shape. This can be obtained by contouring the prominent mandibular angles that give a strong, masculine image. Western authors regarded masseteric muscular hypertrophy the main cause of a square facial appearance, so they usually corrected it by partially excising the masseter muscle. In the authors' view, a square facial appearance in the Oriental is not due to masseteric hypertrophy but to a posterior projection and lateral flaring of the mandibular angle. However, it is sometimes difficult to make the square face narrow and ovoid by using only the conventional curved-angle osteotomy. We divided patients, whose chief complaint was a square facial appearance, into three groups after clinical, photographic, and radiographic evaluation. We applied different contouring methods to each of the three groups and obtained cosmetically improved facial appearance in both lateral and frontal views.

Profiloplasty of the lower face by maxillary and mandibular anterior segmental osteotomies.

Maxillary and mandibular anterior segmental osteotomies (ASO) are ways to correct disharmony in the lip (contour, lip seal, and profile) and occasional dentoalveolar malocclusion. We performed 23 maxillary setback ASO, three maxillary advancement ASO, 21 mandibular setback ASO, and six mandibular advancement ASO in 28 patients to improve their lower facial profile. Other combined operative procedures include nine LeFort 1 osteotomies, four bilateral mandibular ramus osteotomies, two genioplasties, four mandibular angle contouring procedures, two reduction malar plasties, two piriform augmentations with bone graft, and a facelift for correcting of long faces, asymmetric faces, severe malocclusions, microgenias, prominent mandibular angles, prominent malar eminences, piriform recessions, and an aging face. Twenty five patients were satisfied with the results. Two patients complained of an over-recessed lip region, and one of septal deviation. There were no other significant complications or relapses throughout the followup period (9-30 months). Maxillary and mandibular ASO are effective, selective, relatively safe, and simple methods for correcting lower facial profile disharmony to attain a satisfactory aesthetic facial contour.