In situ-formable, dynamic crosslinked poly(ethylene glycol) carrier for localized adeno-associated virus infection and reduced off-target effects.

The adeno-associated virus (AAV) is a potent vector for in vivo gene transduction and local therapeutic applications of AAVs, such as for skin ulcers, are expected. Localization of gene expression is important for the safety and efficiency of genetic therapies. We hypothesized that gene expression could be localized by designing biomaterials using poly(ethylene glycol) (PEG) as a carrier. Here we show one of the designed PEG carriers effectively localized gene expression on the ulcer surface and reduced off-target effects in the deep skin layer and the liver, as a representative organ to assess distant off-target effects, using a mouse skin ulcer model. The dissolution dynamics resulted in localization of the AAV gene transduction. The designed PEG carrier may be useful for in vivo gene therapies using AAVs, especially for localized expression.

Successful Repair of a Forehead Depression Deformation due to En Coup de Sabre Using Costal Cartilage Transplantation.

ABSTRACT: The authors report a successful repair of a case of en coup de sabre using costal cartilage for depression deformation of the forehead. A 23-year-old woman was diagnosed with linear scleroderma at age 10 and underwent a dermal fat transplant at another hospital when she was 18. However, after surgery, the graft began to atrophy. In about 2 years, the deformation was almost the same as before surgery. Therefore, she visited our hospital for surgical intervention. The authors treated the deformity with costal cartilage transplantation. There were no postoperative complications, and the deformation did not recur during a one-year follow-up period after surgery. As far as the authors know, this is the first report of repairing a forehead deformity due to en coup de sabre using costal cartilage. The authors suggest that costal cartilage grafting is a good surgical option because costal cartilage can be easily carved and maintain its shape without absorption.

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases.

The superior gluteal artery perforator (SGAP) flap is a widely used flap for sacral reconstruction. However, it is non-sensate flap and sensory loss is one of the most important risk factors for pressure ulcer development and recurrence; therefore, a sensate SGAP flap would be ideal for the reconstruction. Because the upper buttock is innervated by the superior cluneal nerves (SCNs) which originate from Th11 to L4, a sensate SGAP flap based on SCNs is anatomically possible. Herein, we present a novel sensate SGAP flap based on SCNs for reconstruction of sacral defects. Two patients with a sacral defect underwent reconstruction using a sensate SGAP flap (53 and 56 years old, both men). Diagnoses were sacral spindle cell sarcoma and sacral pressure ulcer. The defect sizes were 16 × 13 and 12 × 11 cm. The flap was designed based on the locations of SCNs which are commonly located at 6-8 cm lateral from the midline at the iliac crest. Flap sizes were 16 × 9 and 15 × 13 cm, respectively. The flaps survived completely in both cases. Flap sensation was observed immediately after surgery except in flap margins. However, sensory recovery occurred in these areas as well several months postoperatively. None of the patients developed postoperative pressure ulcers during the follow-up period of 37 and 13 months. This method may preserve flap sensation and therefore can contribute to reducing the risk of postoperative pressure ulcers and could be a useful option for sacral reconstruction.

Replantation and simultaneous free-flap reconstruction of severely traumatic forefoot amputation: a case report.

We report a successful replantation of a severely damaged and partially amputated foot covered by a simultaneous free flap. Arterial thrombosis occurred at the flap anastomosis, causing partial flap loss, which were resolved through re-anastomosis and skin-grafting. The patient resumed full, unassisted ambulation 10 months after replantation.

Endoscopic open rhinoplasty enables a cosmetic approach for a rare case of intraosseous cavernous hemangioma in the nasal bone.

A rare case of intraosseous cavernous hemangioma was identified in the nasal root. Using a combination of endoscopic surgery and open rhinoplasty, an osteotomy was performed and resection of the hemangioma was successfully achieved with transcolumellar and infracartilaginous incisions and 2 stab incisions. No adverse side effects were observed after the procedure, no tumor recurrence was observed at the 16-month-postoperative follow-up. The preserved periosteum contributed to the osteogenesis and thus, a need for a reconstructive surgery was indicated. The favorable outcomes associated with this approach justify and authenticate the use of endoscopy-assisted open rhinoplasty in the treatment of intraosseous cavernous hemangiomas without leaving ventral surgical scarring.

Multisite Lymphaticovenular Anastomosis Using Vein Graft for Uterine Cancer-Related Lymphedema After Pelvic Lymphadenectomy.

BACKGROUND: Lymphaticovenular anastomosis (LVA) is becoming a treatment option for lymphedema. It is challenging to perform LVA when a lymphatic vessel is too far from a vein to anastomose directly. METHODS: We applied vein grafting for simultaneous multisite LVA (SM-LVA), when there was a considerable distance between a lymphatic vessel and a vein. Five patients with lower extremity lymphedema (LEL) who underwent SM-LVA were included in this study. Feasibility and treatment effect of the method were evaluated. RESULTS: Simultaneous multisite LVA resulted in 35 anastomoses. Vein grafting was performed in 5 of 35 anastomoses with 100% technical success. All LVAs showed good intraoperative anastomosis patency. At 6 months postoperatively, LEL index was significantly lower than preoperative LEL index (251.0 ± 33.0 vs 271.0 ± 38.5, P < .001). CONCLUSION: In SM-LVA surgery, a vein can be harvested from another surgical field without additional invasiveness and is useful for bridging a lymphatic vessel and a distant vein.

Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema.

BACKGROUND: Lymphatic supermicrosurgery is becoming the treatment of choice for refractory lymphedema. Detection and anastomosis of functional lymphatic vessels are important for lymphatic supermicrosurgery. METHODS: Navigation lymphatic supermicrosurgery was performed using an operating microscope equipped with an integrated near-infrared illumination system (OPMI Pentero Infrared 800; Carl Zeiss, Oberkochen, Germany). Eight patients with extremity lymphedema who underwent navigation lymphatic supermicrosurgery were evaluated. RESULTS: A total of 21 lymphaticovenular anastomoses were performed on 8 limbs through 14 skin incisions. Lymphatic vessels were enhanced by intraoperative microscopic indocyanine green (ICG) lymphography in 12 of the 14 skin incisions, which resulted in early dissection of lymphatic vessels. All anastomoses showed good anastomosis patency after completion of anastomoses. Postoperative extremity lymphedema index decreased in all limbs. CONCLUSIONS: Navigation lymphatic supermicrosurgery, in which lymphatic vessels are visualized with intraoperative microscopic ICG lymphography, allows a lymphatic supermicrosurgeon to find and dissect lymphatic vessels earlier and facilitates successful performance of lymphaticovenular anastomosis.