The influence of three different primary treatment protocols on 5-year-old maxillary growth in patients with complete unilateral cleft lip and palate.

The study evaluated the effects of three different primary treatment protocols on maxillary growth in patients aged 5 years with complete unilateral cleft lip and palate (UCLP). The secondary objective was to assess the influence of initial cleft severity, family history of class III, and status of permanent lateral incisor on maxillary growth. In total, 54 patients with non-syndromic complete UCLP were included and grouped as follows: group An underwent lip adhesion, cheilorhinoplasty associated with tibial periosteal graft for hard palate repair, and finally veloplasty; group B underwent lip adhesion, then cheilorhinoplasty with intravelar veloplasty, and finally a hard-palate repair; group C underwent cheilorhinoplasty with intravelar veloplasty and then a hard-palate repair. Five-year maxillary growth was assessed on dental models, both clinically and digitally. No difference was found with GOSLON-Yardstick scoring. Five-year measurements showed that group C tended to have the best maxillary arch morphology (p = 0.012). Initial cleft severity did not impact maxillary growth, but status of permanent lateral incisor and family history of class III did (p = 0.019 and p = 0.004, respectively). In patients aged 5 years, the two-stage approach appeared to be the least detrimental to growth development. Predictive factors for growth retardation included the absence of lateral incisor and a family history of class III.

Silicone Particles in Capsules Around Breast Implants: An Investigation Into Currently Available Implants in North America.

BACKGROUND: Breast implants have always been composed of a silicone elastomer envelope filled with either silicone gel or saline. Breast implant illness (BII) is a set of symptoms that has previously been linked to the leakage of silicone particles from the implants into the body. OBJECTIVES: Our research aimed to quantify the number of silicone particles present in the capsules of breast implants available in North America. METHODS: Thirty-five periprosthetic capsules were sampled and analyzed, and silicone particles were counted and measured. The capsule surface area was then measured and utilized to calculate particle density and total number of silicone particles. RESULTS: Eighty-five percent of capsules analyzed from silicone gel implants contained silicone, with an average of 62 particles per mm3 of capsular tissue. These implants had approximately 1 million silicone particles per capsule. In contrast, none of the saline implant capsules contained silicone. Capsules from macrotextured tissue expanders contained fewer and larger silicone particles. CONCLUSIONS: Silicone gel implants presented silicone particle bleeding into the periprosthetic capsule, totaling on average 1 million silicone particles per capsule. On the other hand, no silicone particle bleeding was observed from saline breast implants. These data suggest that particle bleeding comes from the inner silicone gel, and not from the smooth outer silicone shell. Previous studies have reported the presence of breast implant illness in patients with both silicone- and saline-filled implants. Therefore, our data suggest that silicone migration is not the sole cause of BII.

Enhanced Avulsion Technique for Brachioplasty and Cruroplasty: Minimizing Complications and Ensuring Patient Safety.

Background Brachioplasty and cruroplasty are commonly performed aesthetic procedures, but they are not without their risks. Among the potential complications, the development of seroma or hematoma is particularly concerning. In this article, we present a modified avulsion technique designed to reduce complications and improve patient outcomes. Methods Our study included all consecutive patients (n=28) who underwent brachioplasty and/or cruroplasty using the modified avulsion technique at the Plastic Surgery Department of the University Hospital of Grenoble between September 2019 and November 2022. Data collection was conducted retrospectively to evaluate the complications of the procedure. Histological analysis was performed on samples of excised tissues from five patients operated on with the avulsion technique and five patients operated on with electrocautery resection. Results A total of 28 patients were reviewed, with a mean follow-up of 22 months. Among the 28 patients, regarding the Common Terminology Criteria for Adverse Events (CTCAE), there were no major complications, with minor complications occurring in 55% of the cases. Conclusion Dermolipectomies of the extremities are associated with a high level of patient satisfaction with a low risk of major complications. The avulsion technique practiced by the authors proved to be a safe and efficient procedure.

Bilateral Candidal abscess of the parotid gland: A case report and literature review.

We report the case of a 75-year-old diabetic man who developed a bilateral abscess of the parotid gland. Although a bacterial parotitis was first suspected, cultures of fine-needle aspiration identified Candida albicans as the causal agent. Failure of medical treatment led us to perform a surgical drainage of the right abscess. The patient was then treated with oral fluconazole for 6 weeks, with complete recovery during follow-up. Of interest, the patient had a history of right superficial parotidectomy for a benign tumor 30 years ago. Despite the high prevalence of oral carriage, fungal abscesses of the parotid gland are extremely rare and have only been reported in a few cases. This might be due to the fungal toxicity of the salivary proteins, like histatins. To our knowledge, this is the first report of a Candida albicans abscess of the parotid gland developed bilaterally.

Epidemiology of Maxillofacial Traumatisms in French Alps Metropole (Grenoble) Specificity for the mountain sports and evolution in the last 40 years.

INTRODUCTION: Over the years, several studies have been carried in the Teaching Hospital of Grenoble, analysing the epidemiology of facial injuries. The aim of this study was to gather and compare the previous works, focusing on the injuries caused by mountains sports. The evolution of mountain sports trauma in the last 40 years was studied, and observations on the protective action on the face and facial bones of the helmet were made. MATERIALS AND METHODS: The data from all facial injuries treated in the years 2016 and 2017 were collected, and a retrospective study was performed. It was supplemented by the data of 3 articles (1981, 1992, 2006) and a thesis (1985). RESULTS: Localizations of the fractures, when not discriminated according to causes, were consistently the same in our study than in previous works, with 66% of upper 2/3 of the face fractures, and 22% of lower 1/3 fractures. When filtering only mountain sports traumatisms, a significant decrease of upper 2/3 facial injuries was observed in the current study compared to the 1981, 1985 and 2006 data. This drop tallies with the period where the use of the helmet generalized. The evolution of mountain sports practices, the improvement of protective personal equipment and of the security on sport sites triggered a real diminution of mid and upper face traumatisms.

Metabolism and genotoxicity of polycyclic aromatic hydrocarbons in human skin explants: mixture effects and modulation by sunlight.

Cutaneous exposure to carcinogenic polycyclic aromatic hydrocarbons (PAH) occurs frequently in the industrialized workplace. In the present study, we addressed this topic in a series of experiments using human skin explants and organic extracts of relevant industrial products. PAH mixtures were applied topically in volumes containing either 10 or 1 nmol B[a]P. We first observed that although mixtures were very efficient at inducing expression of CYP450 1A1, 1A2, and 1B1, formation of adducts of PAH metabolites to DNA, like those of benzo[a]pyrene diol epoxide (BPDE), was drastically reduced as the complexity of the surrounding matrix increased. Interestingly, observation of a nonlinear, dose-dependent response with the least complex mixture suggested the existence of a threshold for this inhibitory effect. We then investigated the impact of simulated sunlight (SSL) on the effects of PAH in skin. SSL was found to decrease the expression of CYP450 genes when applied either after or more efficiently before PAH treatment. Accordingly, the level of DNA-BPDE adducts was reduced in skin samples exposed to both PAH and SSL. The main conclusion of our work is that both increasing chemical complexity of the mixtures and co-exposure to UV radiation decreased the production of adducts between DNA and PAH metabolites. Such results must be taken into account in risk management.

Toxicity and DNA repair in normal human keratinocytes co-exposed to benzo[a]pyrene and sunlight.

Skin has the potential to be exposed to both solar UV radiation and polycyclic aromatic hydrocarbons, especially in occupational environments. In the present work, we investigated how benzo[a]pyrene (B[a]P) modulates cellular phototoxicity and impacts formation and repair of pyrimidine dimers induced by simulated sunlight (SSL) in normal human keratinocytes (NHK). We were especially interested in determining whether the aryl hydrocarbon receptor (AhR) was involved since it was recently shown to negatively impact repair. Addition of 1 µM B[a]P after exposure to 2 minimal erythemal doses of SSL had little impact on NHK. The inverse protocol involving incubation with B[a]P followed by irradiation led to a strong increase in phototoxicity. Repair of DNA photoproducts was drastically impaired. Using agonists and antagonists of AhR allowed us to conclude that this factor was not involved in these results. Observation of a strong increase in the level of the oxidative marker 8-oxo-7,8-dihydroguanine in the protocol involving B[a]P treatment followed by exposure to SSL strongly suggested that a photosensitized oxidative stress was responsible for cell death and inhibition of DNA repair. Accordingly, both adverse effects were diminished with a lower concentration of B[a]P and a lower SSL dose, leading to less oxidative stress.

Oncostatin M exerts a protective effect against excessive scarring by counteracting the inductive effect of TGFß1 on fibrosis markers.

Wound healing is a complex physiological process that repairs a skin lesion and produces fibrous tissue. In some cases, this process can lead to hypertrophic scars (HS) or keloid scars (KS), for which the pathophysiology remains poorly understood. Previous studies have reported the presence of oncostatin M (OSM) during the wound healing process; however, the role of OSM in pathological scarring remains to be precisely elucidated. This study aims to analyse the presence and involvement of OSM in the pathological scarring process. It was conducted with 18 patients, including 9 patients with hypertrophic scarring and 9 patients with keloid scarring. Histological tissue analysis of HS and KS showed minor differences in the organization of the extracellular matrix, the inflammatory infiltrate and the keratinocyte phenotype. Transcriptomic analysis showed increased expression levels of fibronectin, collagen I, TGFß1, ß-defensin-2 and S100A7 in both pathological samples. OSM expression levels were greater in HS than in KS and control skin. In vitro, OSM inhibited TGFß1-induced secretion of components of the extracellular matrix by normal and pathological fibroblasts. Overall, we suggest that OSM is involved in pathological wound healing processes by inhibiting the evolution of HS towards KS by controlling the fibrotic effect of TGFß1.

Solar simulated light exposure alters metabolization and genotoxicity induced by benzo[a]pyrene in human skin.

Skin is a major barrier against external insults and is exposed to combinations of chemical and/or physical toxic agents. Co-exposure to the carcinogenic benzo[a]pyrene (B[a]P) and solar UV radiation is highly relevant in human health, especially in occupational safety. In vitro studies have suggested that UVB enhances B[a]P genotoxicity by activating the AhR pathway and overexpressing the cytochrome P450 enzymes responsible for the conversion of B[a]P into DNA damaging metabolites. Our present work involved more realistic conditions, namely ex vivo human skin explants and simulated sunlight (SSL) as a UV source. We found that topically applied B[a]P strongly induced expression of cutaneous cytochrome P450 genes and formation of DNA adducts. However, gene induction was significantly reduced when B[a]P was combined with SSL. Consequently, formation of BPDE-adducts was also reduced when B[a]P was associated with SSL. Similar results were obtained with primary cultures of human keratinocytes. These results indicate that UV significantly impairs B[a]P metabolism, and decreases rather than increases immediate toxicity. However, it cannot be ruled out that decreased metabolism leads to accumulation of B[a]P and delayed genotoxicity.

Capsular Biofilm Formation at the Interface of Textured Expanders and Human Acellular Dermal Matrix: A Comparative Scanning Electron Microscopy Study.

BACKGROUND: Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls, such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix on textured implants produces similar findings. This study aims to characterize biofilm formation at the capsular-acellular dermal matrix interface with scanning electron microscopy. METHODS: The authors performed a prospective observational pilot study in patients undergoing two-stage expander-to-permanent implant exchange. Patients were inflated with Biocell or Siltex expanders, and specimens from the capsular-pectoralis interface and capsular-acellular dermal matrix interface were obtained and examined under scanning electron microscopy for capsular ingrowth and biofilm formation using the Van Herdeen Biofilm Grading System and the Biofilm Thickness Grading Scale. RESULTS: Nine patients including 14 breasts (28 capsular samples in total) were examined. Thick biofilm formation was observed in all specimens from the capsular-acellular dermal matrix interface with Biocell and 25 percent of capsule-pectoralis interface, whereas no biofilm formation was found in Siltex implants. For Biocell implants, a significant difference in biofilm coverage between the upper and lower poles was observed using the Van Herdeen Biofilm Grading System (p = 0.0028) and the Biofilm Thickness Grading Scale (p = 0.0161). CONCLUSIONS: Biocell implants produce a significant rate of biofilm formation over acellular dermal matrix-covered capsules, which is not present in the muscular region or in Siltex implants. Further randomized controlled trials will further elucidate the clinical impact of using acellular dermal matrices with macrotextured implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Delaying implant-based mammary reconstruction after radiotherapy does not decrease capsular contracture: An in vitro study.

The most common complications of irradiated implant-based mammary reconstruction are fibrosis and capsular contracture. The indications for postmastectomy adjuvant radiotherapy have considerably broadened. Facing an increased number of patients who will require radiotherapy, most guidelines recommend delaying reconstruction after radiotherapy to prevent long-term fibrotic complications. Does radiotherapy permanently alter cellular properties which will adversely affect implant-based reconstruction? If so, is there a benefit in delaying reconstruction after radiotherapy? Our in vitro model simulates two implant-based mammary reconstruction approaches: the irradiated implant and the delayed implant reconstructions by using an implant inset beneath healthy non-irradiated tissue post radiotherapy. We performed cell culture of fibroblasts and endothelial cells to simulate these two surgical conditions. Irradiated fibroblasts simulate the capsular tissue seen around the breast implant. The delayed reconstruction approach is simulated by non-irradiated fibroblasts conditioned with supernatant culture media obtained from irradiated endothelial cells. Irradiation induced fibrosis through fibroblast differentiation into myofibroblasts, as demonstrated by increased α-smooth-muscle actin levels in fibroblasts. This constitutes the basis for scar tissue contraction observed in irradiated implant-based breast reconstruction. Irradiation of endothelial cells induced irreversible cell cycle arrest known as senescence and secretion of the profibrotic connective tissue growth factor. Non-irradiated fibroblasts conditioned with culture media obtained from irradiated endothelial cells exhibited myofibroblast differentiation and the expression of fibrotic phenotype akin to capsular contracture. Our results demonstrate that radiotherapy causes irreversible cellular changes, which permanently alter the microenvironment in favor of fibrosis. Given that these changes are permanent, delaying reconstruction does not present an advantage in preventing capsular contracture.

Free Transfer of a Paralyzed Contralateral Little Finger for Total Thumb Reconstruction in an Electrical Burn Patient: A Case Report and Literature Review.

The authors report the case of a 30-year-old male with 52% TBSA high-voltage electrical injury of the upper half of the body. Injuries included a cervical burn with associated alteration of the left brachial plexus as well as extensive soft tissue burn of the right hand. Three months later, he developed osteomyelitis of the right thumb metacarpal bone requiring amputation proximal to the metacarpophalangeal joint. Following initial management, the patient had a permanent distal left upper extremity paralysis with nonfunctional but relatively undamaged ipsilateral hand digits. The right hand remained functional with four intact digits and a thumb stump. Usually, late reconstruction of proximal thumb amputation is performed by pollicization or free toe transfer procedures. In this particular case, right thumb reconstruction was done by free transfer of the left little finger. Four months postoperatively, the patient demonstrated a functional pinch between the reconstructed thumb and the ipsilateral digits along with improving sensation. This uncommon surgical procedure restored a functional thumb with minimal donor site morbidity. The decision-making process and operative technique are presented in detail along with a review of the thumb reconstruction literature.

Arteriovenous fistulas for microvascular head and neck reconstruction.

BACKGROUND: In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks. METHODS: The authors performed a case series of major head and neck reconstructions using temporary arteriovenous fistulas with a saphenous vein graft. A subclavian surgical approach was used. All reconstructions were performed at least two weeks after the creation of the initial fistula. RESULTS: The authors have performed nine reconstructive cases for malignancy using five different free flaps. The subclavian and transerve cervical arteries were used, and the subclavian, internal jugular and cephalic veins were used for microanastomosis. Two cases of flap hematoma and one case of venous pedicle compression were recorded. No cases of flap failure were reported. CONCLUSIONS: Reconstruction using temporary arteriovenous fistulas is a reliable technique that can be used in the vessel-depleted neck, with excellent outcomes in experienced hands.

HISTORIQUE: Chez les patients atteints d'un cancer de la tête et du cou, les multiples opérations et la radiothérapie peuvent expurger le cou des vaisseaux receveurs convenant à la reconstruction microvasculaire. La création de fistules artérioveineuses temporaires par interposition veineuse en vue d'une reconstruction microvasculaire a rarement été signalée sur la tête et le cou. Les auteurs rendent compte de la plus vaste série de cas de boucles artérioveineuses temporaires sur des cous expurgés de vaisseaux receveurs lors de la reconstruction de la tête et du cou. MÉTHODOLOGIE: Les auteurs ont procédé à une série de cas de reconstructions majeures de la tête et du cou au moyen de fistules artérioveineuses temporaires par greffe de la veine saphène, en privilégiant un abord par la sous-clavière. Ils ont effectué toutes les reconstructions au moins deux semaines après la création de la fistule initiale. RÉSULTATS: Les auteurs ont effectué neuf reconstructions au moyen de cinq lambeaux libres différents après un cancer. Ils ont utilisé les artères sous-clavière et cervicale transverse ainsi que les veines sous-clavière, jugulaire interne et céphalique pour la micro-anastomose. Ils ont enregistré deux cas d'hématome du lambeau et un cas de compression du pédicule, mais aucun cas d'échec du lambeau. CONCLUSIONS: Entre des mains expérimentées, la reconstruction au moyen de fistules artérioveneuses temporaires est une technique fiable qui peut être utilisée dans le cou expurgé de vaisseaux receveurs et donner d'excellents résultats.

Pulmonary Artery Sealing Using the HARMONIC ACE+ Shears for Video-Assisted Thoracoscopic Surgery Lobectomy.

BACKGROUND: The standard technique for pulmonary arterial (PA) branch sealing in video-assisted thoracoscopic surgery lobectomy consists of vascular endostaplers. We evaluated the immediate efficacy of an ultrasonic energy vessel-sealing device for sealing PA branches and compared it with the gold standard (endostapler) in an ex vivo model. METHODS: This was a prospective cohort study. Immediately after anatomical lung resection, PA vessel sealing was achieved using the HARMONIC ACE+ Shears (ACE; Ethicon, Cincinnati, OH) sealing device or a vascular endostapler (VES) in a 3:1 ratio based on vessel diameter. The vessel was slowly pressurized, and the bursting pressure was recorded. RESULTS: A total of 137 PA branches were sealed in specimens from 43 patients, of which 90 vessels were sealed with ACE and 47 were sealed with VES. The mean PA branch diameter was 6.0 mm (range, 1.7 mm to 24.0 mm; standard deviation, 3.1 mm Hg). The mean bursting pressure was 333.0 mm Hg (range, 84.0 mm Hg to 1415.1 mm Hg; standard deviation, 231.4 mm Hg) in the ACE group and 114.2 mm Hg (range, 0 mm Hg to 840.0 mm Hg; standard deviation, 124.7) in the VES group (p < 0.001). There were no complete sealing failures in the ACE group. Electron microscopy of ACE-sealed PA vessels demonstrated adventitial sealing with partial preservation of the collagen bundles and media with a sealed matrix of melted collagen. CONCLUSIONS: PA branches sealed using the HARMONIC ACE+ in a simulated ex vivo model were able to sustain high intraluminal pressures. ACE-sealed vessels burst at mean bursting pressures equal to or greater than the VES-stapled vessels.