Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations.

BACKGROUND: Currently, the Wallace Rule of Nines is the most widely used method to measure total body surface area (TBSA) in burned patients due to its practicality and speed in its application; however, it often provides inaccurate estimations in obese patients, affecting the fluid resuscitation process. OBJECTIVE: In this study, we aimed to modify and optimize the Rule of Nines' values for its application in these patients. METHODS: We compared the estimations of the TBSA established by the Wallace Rule of Nines against the measurements of the three-dimensional (3D) software Skanect - Meshmixer 3.5Ⓡ in participants without different obesity grades. Based on our results, we generate an optimized guideline for the evaluation of TBSA in normal body mass index (BMI) and obese patients. RESULTS: In our study, 32 participants were recruited with a mean age of 28.5 ± 3.3 years. In the general population, we observed a poor correlation between the Wallace Rule of Nines and the 3D method measures in all body regions (e.g., Anterior Trunk: 18.0 vs. 16.61 ± 2.11, p = 0.0008) except the anterior arm. Interestingly, these differences narrowed in the Trunk and Leg regions as the participants' BMI increased (e.g., Anterior Trunk in Obesity Grade II patients: 18.0 vs. 18.66 ± 1.69, p = 0.3089). CONCLUSIONS: We found important differences in TBSA determination using the 3D Skanect-MeshmixerⓇ software compared with the Wallace Rule of Nines. Therefore, we generated a modified and optimized Wallace Rule of Nines estimations based on BMI. Future studies are needed to assess the safety and efficacy of this optimized table.

Lipoinjection with Adipose Stem Cells for Nasal Modeling: Rhino Cell, a Highly Versatile Alternative.

It is undeniable that a significant number of patients who want to improve their facial appearance is increasingly interested in nonsurgical procedures. Without a doubt, the use of autologous fat could not be left out as a magnificent alternative for nasal modeling simply because of four influential factors: ease of collection, compatibility, the temporality of the results, and safety. This work describes an innovative alternative technique for nasal modeling using micrografts enriched with adipose-derived mesenchymal stem cells (ASCs). With this technique, fat was collected and divided into two samples, nanofat and microfat. Nanofat was used to isolate the ASCs; microfat was enriched with ASCs and used for nasal modeling. Lipoinjection was performed in a supraperiosteal plane on the nasal dorsum. Through a retrolabial access, the nasal tip and base of the columella were lipoinjected. We consider that nonsurgical nasal modeling using micrografts enriched with ASCs can be an attractive and innovative alternative. This technique will never be a substitute for surgical rhinoplasty. It can be performed in a minor procedure area with rapid recovery and return to the patient's daily activities the next day. If necessary, the procedure can be repeated.

Unusual presentation of orbital compartment syndrome due to complicated herpes zoster ophthalmicus: A case report.

Herpesvirus reactivates from a latent infection in older adults and critically ill and immunocompromised individuals. Herpes zoster ophthalmicus (HZO) is a latent infection that affects the fifth cranial nerve. It is an infrequent cause of increased intraocular pressure. We present the case of a 50-year-old man with a reactivation of latent varicella-zoster virus infection involving the ophthalmic branch of the fifth cranial nerve. The patient was initially managed as an outpatient with an antiviral, but his clinical evolution worsened and required urgent surgical decompression. Lateral canthotomy was performed with cantholysis of the inferior crus of the lateral canthal tendon. Only partial decompression was achieved, so cantholysis of the upper crus was performed with significant tissue tension release. The patient evolved well and was discharged after 6 days without symptoms for outpatient management.

False-Positive Nodes With Axillary Silicone Lymphadenopathy in an Oncologic Patient With a Rare Breast Cancer and Implant Rupture.

In this case, a 43-year-old woman with a rare breast tumor and a history of augmentation mammoplasty is presented. The patient arrived at the clinic reporting a palpable lump in the right mammary gland and two ipsilateral axillary nodes with pain on palpation. Mammography and ultrasound confirmed the presence of a 4 cm tumor and 2 metastatic lymph nodes of 2 cm each, histopathological diagnosis was an encapsulated papillary cancer and two siliconomas, respectively. Interestingly, these nodes were able to take up technetium 99 and methylene blue contrast media. Due to these findings, adequate patient management was carried out with a skin-sparing mastectomy and hormonal treatment with tamoxifen. This report is relevant as it shows that axillary lymphadenopathy caused by silicone must be considered in the evaluation of a patient with a cancer diagnosis and history of augmentation mammoplasty, especially breast cancer as the node siliconomas present a high risk of being considered a false positive metastasis.

Reducción mamaria con implantes: serie de casos, técnica operatoria y resultados a largo plazo.

BACKGROUND: Breast reduction techniques have been considered functional procedures proposed to reduce the volume and elevate the position of the nipple-areola complex. Traditionally these techniques were performed as mostly functional procedures. The main reasons for dissatisfaction after a reduction technique are breasts with a deflated appearance due to alteration of the shape, particularly of the upper pole, and simultaneously, the high frequency in the appearance of pseudoptosis in the medium and long term. All this contributes to the patients' desire for secondary surgeries or refinements. OBJECTIVE: We know that currently the demands and expectations of our patients are increasing, and they specifically request a better aesthetic outcome. METHOD: We present our experience and surgical approach to breast reduction, using a superior base flap in combination with implants. RESULTS: We believe that the results are more stable in the long term and with low complication rates. CONCLUSIONS: According to what has been reported in the literature, our casuistry represents the most extensive to date.

ANTECEDENTES: Las técnicas de reducción mamaria se han considerado procedimientos funcionales propuestos para reducir el volumen y elevar la posición del complejo areola-pezón. Tradicionalmente fueron realizadas como procedimientos mayormente funcionales. Las principales razones de insatisfacción posterior a una técnica de reducción son senos con aspecto desinflado por alteración de la forma, en particular del polo superior, y simultáneamente la elevada frecuencia en la aparición de pseudoptosis a mediano y largo plazo. Todo ello contribuye al deseo por parte de las pacientes de cirugías secundarias o refinamientos. OBJETIVO: Tenemos claro que actualmente las exigencias y las expectativas de nuestras pacientes son cada vez mayores, y por supuesto específicamente radica en un mejor refinamiento estético. MÉTODO: Presentamos nuestra experiencia y enfoque quirúrgico de reducción mamaria utilizando un colgajo de base superior en combinación con implantes. RESULTADOS: Creemos que los resultados son más estables a largo plazo y con bajas tasas de complicaciones. CONCLUSIONES: De acuerdo con lo reportado en la literatura, nuestra casuística representa la más extensa hasta el momento.

Effect of exogenous lipase on subcutaneous adipose tissue in a porcine animal model.

BACKGROUND: Topical exogenous lipase has been approved for cosmetic use and has been used to mobilize fat from adipocytes. The objective of this study was to determine the effects of exogenous lipase in the subcutaneous adipose tissue. METHODS: Three different concentrations of exogenous lipase 1× (2 Units per ml), 5× (10 units per ml), and 10× (20 units per ml) were applied in a porcine model. Normal saline (NS) solution (as negative control) and phosphatidylcholine (as positive control) were also injected. Skin and subcutaneous tissue biopsies, up to the fascia, were obtained from each injection site on the 3rd day after injection. The number of cells per 20× field was counted as an indirect measurement of the size of the adipocytes. RESULTS: For 1× lipase, the number of cells per field was 47.80 (±7.63) versus 27.26 (±4.93), and 34.66 (±6.84) for NS, and phosphatidylcholine, respectively. For 5× lipase, the count was 36.06 (±4.74) versus 24.13 (±5.18), and 33.2 (±9.34). For 10× lipase, it was 40.06 (±4.35) versus 29.26 (±2.34) and 32.66 (±6.30) (p < .05 for all groups). CONCLUSIONS: A higher number of cells per field were observed in the lipase samples, inferring a decreased volume of adipocytes. No inflammation and/or loss of cell architecture were evidenced in the exogenous lipase groups.

Effect of Diameter and Fenestration Area of the Liposuction Cannula on the Viability of the Adipocytes.

BACKGROUND: Loss of volume is perhaps the most frustrating problem of fat grafting. The process of fat grafting depends on different variables such as harvesting, processing, and injection techniques. Results between studies that evaluate the effect of the cannula size on fat graft survival have been controversial. However, the role of the fenestration area of the cannula has not been described. METHODS: Four custom-made cannulas with a single fenestration were used for this study. Cannulas vary in diameter and area of the fenestration. Healthy patients seeking primary liposuction of the abdomen for aesthetic reasons were included. Lipoaspiration was performed in a clockwise pattern, and the order of the cannulas was rotated. Negative pressure was maintained at 0.8 atm at all times. Ten ml of fat, obtained from the suction tube, was poured into 20-ml conical centrifugal tubes for further processing. One gram of lipoaspirate was extracted from each sample, and acridine orange stain was added. Adipocytes were extracted, extended in a frotis, and observed by a histologist (masked fashion) under fluorescence microscopy. Viability was reported in percentages per sample. RESULTS: The overall viability was 64.75% ± 18.58. The viability of the obtained samples ranged from 66.51± 20.66 % to 62.83 ± 18.1. In further analysis, comparing the viability according to the shaft diameter and fenestration area, there was no significant difference among groups. CONCLUSIONS: Neither the diameter of the cannula nor the size of the fenestrations are determining factors to affect the viability of the adipocytes. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sequential growth factor exposure of human Ad-MSCs improves chondrogenic differentiation in an osteochondral biphasic implant.

Joint cartilage damage affects 10-12% of the world's population. Medical treatments improve the short-term quality of life of affected individuals but lack a long-term effect due to injury progression into fibrocartilage. The use of mesenchymal stem cells (MSCs) is one of the most promising strategies for tissue regeneration due to their ability to be isolated, expanded and differentiated into metabolically active chondrocytes to achieve long-term restoration. For this purpose, human adipose-derived MSCs (Ad-MSCs) were isolated from lipectomy and grown in xeno-free conditions. To establish the best differentiation potential towards a stable chondrocyte phenotype, isolated Ad-MSCs were sequentially exposed to five differentiation schemes of growth factors in previously designed three-dimensional biphasic scaffolds with incorporation of a decellularized cartilage matrix as a bioactive ingredient, silk fibroin and bone matrix, to generate a system capable of being loaded with pre-differentiated Ad-MSCs, to be used as a clinical implant in cartilage lesions for tissue regeneration. Chondrogenic and osteogenic markers were analyzed by reverse transcription-quantitative PCR and cartilage matrix generation by histology techniques at different time points over 40 days. All groups had an increased expression of chondrogenic markers; however, the use of fibroblast growth factor 2 (10 ng/ml) followed by a combination of insulin-like growth factor 1 (100 ng/ml)/TGFß1 (10 ng/ml) and a final step of exposure to TGFß1 alone (10 ng/ml) resulted in the most optimal chondrogenic signature towards chondrocyte differentiation and the lowest levels of osteogenic expression, while maintaining stable collagen matrix deposition until day 33. This encourages their possible use in osteochondral lesions, with appropriate properties for use in clinical patients.

Surgical management of palatal teratoma (epignathus) with the use of virtual reconstruction and 3D models: a case report and literature review.

Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.

Effectiveness of surgical treatment in chronic migraine.

OBJECTIVE: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. METHODS: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. RESULTS: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. CONCLUSION: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

OBJETIVOS: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. MÉTODO: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. RESULTADOS: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. CONCLUSIONES: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

Effect of Decantation Time on Viability and Apoptosis in Adipocytes After Liposuction.

BACKGROUND: The effect of decantation time on viability and apoptosis in adipocytes has not been described. The objective of the study was to describe viability and apoptosis in adipocytes up to 2 h after harvesting. METHODS: Twenty patients who underwent esthetic liposuction from the abdomen were included. The lipoaspirate was obtained from the infra-umbilical area with the tumescent technique. Liposuction was performed with a 60-ml syringe and a 3-ml cannula. Lipoaspirates were centrifuged at 50 g for 5 min at 0, 60 and 120 min after harvesting. One gram of fat was digested with 0.1% type 1 collagenase and incubated at 37 degrees for 30 min. Adipocytes were counted on 10 random microscopic fields. Apoptosis was determined by TUNEL assay. A fluorescence microscope was used to visualize the staining nuclei and cells. RESULTS: Regarding viability, immediately after harvesting, 57.6 ± 18.9% of the cells were viable, whereas 60 min after liposuction the viability decreased to 51.62 ± 8.8% and 120 min after liposuction the percentage of viable cells was 46.8 ± 16.9%. The percentage of apoptotic cells at time 0 was 38.2 ± 8.0%, whereas it was 51.24 ± 8.1% at 60 min and 62.9 ± 16.1% at 120 min after collection. CONCLUSIONS: Apoptosis and mortality of adipocytes after liposuction increase directly proportional to the time of decantation. Lipoinjection should be performed as soon as possible after harvesting. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Test for the Clinical Evaluation of the Flexor Digitorum Superficialis of the Fifth Finger.

Physical examination is essential in diagnosing tendinous lesions. This is particularly true of the flexor digitorum superficialis of the little finger (FDS5), which is functionally absent in approximately 30% of the population. The objective of our study was to determine the diagnostic value of 3 clinical tests commonly used to assess the function of this tendon. METHODS: Patients with wounds of the FDS5 were included in this study. Under local or regional anesthesia, 3 described clinical tests were performed to assess the function of the FDS5: (i) the classic test; (ii) Stein's modified test, and (iii) Mecott's modified test. We determined sensitivity, specificity, and predictive values of all such tests. The integrity of the tendon was assessed surgically. Correlation among blinded observers was also established. RESULTS: A total of 28 subjects with a mean age of 28 years (ranging from 5 to 56) participated in this study. The classic test obtained a sensitivity of 100% and a specificity of 72%; Stein's test resulted in a sensitivity of 83% and a specificity of 95%, whereas Mecott's test reached a sensitivity of 100% and a specificity of 95%. CONCLUSIONS: Among the 3 tests described and used in our study, Mecott's modified test proved to be more sensitive and specific than the other two; therefore, we consider this to be the test that should be used in determining the integrity of the FDS5.

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Pirfenidone increases the epithelialization rate of skin graft donor sites.

BACKGROUND: Improving epithelialization of donor sites of split-thickness skin grafts (STSG) is extremely important in burned patients. We aimed to assess the efficacy of pirfenidone, a drug with anti-inflammatory, antifibrotic, and antioxidant effects, to accelerate wound healing. We hypothesized that pirfenidone accelerates the epithelialization rates in donor sites. METHODS: We included 28 patients requiring STSGs with donor sites of at least 7.5×10cm. After harvesting, the donor sites were randomly treated with either non-adherent gauze or topical pirfenidone and covered with non-adherent gauze. To assess epithelialization, biopsies were taken at day 7 and 10 on the pirfenidone group, and at day 10 on the control group. Percentage of epithelialization was assessed on the same days through clinical photographs. The pathologists and the clinical observer were blinded to the group and timepoint of the samples. RESULTS: 24 patients were included in the study, with a median age of 21(5-73) for control group and 28(9-61) for pirfenidone. The thickness of epithelium was 75.10±60µm at day 10 for the control group; and 98.21±6µm at day 7, and 108±22µm at day 10 for the pirfenidone group (p=<0.05). Epithelization rate was 83.58±14.09% at day 10 for the control group; and 98.7±1.8% at day 7, and 99.5±1.6% at day 10 for the pirfenidone group. CONCLUSIONS: Pirfenidone is efficient in reducing the healing times when applied in STSG donor sites, at both days 7 and 10.

Effectiveness of surgical treatment in chronic migraine.

Objective: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. Methods: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. Results: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. Conclusion: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

Objetivos: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. Método: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. Resultados: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. Conclusiones: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

Volumetric lipoinjection of the fronto-orbital and temporal complex with adipose stem cells for the aesthetic restoration of sequelae of craniosynostosis.

BACKGROUND: Non-syndromic craniosynostosis causes craniofacial asymmetry and may persist after cranioplasty. These postoperative asymmetries are primarily depressions. In some cases, patients may be subjected to pranks and harassment by their peers, affecting their psychosocial development. We propose lipoinjection enriched with adipose stem cells (ASCs) to treat the sequelae of craniosynostosis in the fronto-orbital and temporal complex in cranioplasty patients, with the goal of improving the appearance of the upper third of the face. METHODS: Twelve children (four boys and eight girls) between 4 and 8 years of age (mean age, 6 years) in the postoperative period after treatment for plagiocephaly, brachycephaly, and trigonocephaly were included, with a follow-up period of 1 to 18 months. Fat tissue was obtained from the lower abdomen, and ASCs were isolated using the Yoshimura technique. Lipoinjection was performed using several mini-approaches to ensure adequate distribution. RESULTS: Two different scales were used to evaluate the aesthetic outcomes. At 6 months, three plastic surgeons independent of the study classified the results using a Likert scale. The patients' parents categorized the results using a visual analog scale at 6, 9, and 18 months. R esults were favorable on both scales, as the patients' facial appearance improved and they reported increased happiness and self-esteem due to their remodeled facial appearance. CONCLUSIONS: We suggest that lipoinjection enriched with ASCs is a good alternative for correcting asymmetry of the fronto-orbital and temporal contour in patients with sequelae of craniosynostosis. This treatment will help boost patients' self-esteem starting at an early age.

Remarkably higher efficacy and a wider safety window for nonfrontline over first-line drug combinations in the adenocarcinoma Colo 320DM cell line.

PURPOSE: To determine in vitro, the efficacy and safety window of not-front-line and first-line anti-colorectal (CRC) drug combinations. METHODS: The adenocarcinoma cell line Colo 320DM and normal human mesenchymal stem cells derived from adipose tissue were used respectively to determine the anti-CRC efficacy (% of Colo 320DM cell death [CD]) and safety window [SW] - % Colo 320DM percent cancer death (PCD)/% of mesenchymal stem cell's death) of drug combinations, using the adenosine triphosphate-based chemotherapy response assay (ATP-CRA). RESULTS: First-line anti-CRC drug combinations (5-fluorouracil [5FU]/oxaliplatin [oxa] and 5-FU/Oxa /leucovorin [Leuco]) produced 57.7% and 52.4% CD, and 1.38 and 2.44 SW, respectively. Combinations of 5-FU/Oxa and 1 to 3 non-front line drugs led to 56.3-99.8% CD and to 0.96-2.2 SW. The highest safety window corresponded to 5FU/Oxa/ carboplatin [Carbo] (93% CD and 1.4 SW) and to 5-FU/ Oxa/cisplatin [Cispl] (93.5% CD and 1.4 SW). In contrast, non-front line drugs led to 89.8-97.4% CD and to 1.1-78.2 SW. Outstandingly, those combinations containing Carbo/ Cispl/3,3'-diindolylmethane (DIM), aspirin (Asp), or 3,3'- DIM/ Asp showed a very high CD (91.9-96.9% [39.2-39.5 times higher than first-line-combined drugs]) and very wide SW (57.8-81.56 [66.6-40 times higher than the first-line drug combinations]). CONCLUSIONS: Human mesenchymal stem cells could be an excellent alternative to laboratory animals, when testing the safety profiles of drugs. The most promising combinations of non-frontline drugs to treat CRC are Carbo/Cispl/ Asp and Carbo/Cispl/DIM.

Lipoinjection and Multiple Internal Cuts for Congenital Constriction Bands: A New Treatment Approach.

BACKGROUND: Traditional treatment for a congenital constriction band of the limb involves multiple Z-plasties and W-plasties. We propose an alternative surgical procedure for the treatment of congenital constriction bands that obviates the need for Z-plasties and eliminates the constriction band. METHODS: We present the case of a 36-year-old woman with a congenital constriction band of the leg. Using a minimally invasive approach, the skin segment that included the band was dissected from the deep tissues. Afterwards, multiple slices were performed on the internal surface of the fibrous ring. This and lipoinjection were used to reverse the depression that characterizes the "hourglass sign" and homogenize the skin surface. RESULTS: Results have remained stable in a follow-up period of 18 months. CONCLUSIONS: This surgical alternative can be considered as an option for the treatment of congenital constriction bands. It is a safe, reproducible procedure that does not cause additional scars and has good functional and aesthetic results. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diced and crushed cartilage plus autologous fibrin matrix obtained by a simple process for dorsal augmentation of the Mestizo nose.

Several alternatives can be used for nasal dorsum augmentation. We report the use of crushed diced cartilage embedded in an autologous fibrin matrix. This construct is placed on the nasal dorsum and is gently molded according to the characteristics of each patient. Rhinoplasty and nasal dorsum augmentation were performed in 45 patients with Mestizo characteristics after a complete medical history and development of a surgical plan. A crushed diced cartilage autologous graft and an autologous fibrin matrix from peripheral blood processed using the Choukroun method was used. Pre- and postoperative photographs were taken at short- and long-term follow-up. Two separate variables were evaluated: reabsorption and irregularities. Three plastic surgeons evaluated the results, using a Likert scale: the first variable was considered very excellent in 88.9%, very good in 6.7%, good in 4.4% with no poor or very poor results. In the second variable, results were excellent in 88.9%, very good in 4.4%, good in 3.4%, and poor in 3.3% with no very poor results. Our patients carry a volume with an aesthetically pleasing contour and form with no changes over a mean follow-up period of 4 years. Long-term effectiveness continues to be the main topic of discussion; however, this method can be considered an alternative not only to augment but also to smoothen irregularities of the nasal dorsum. We used a simple method with good and stable long-term clinical results.