Cryopreservation of autologous fat grafts harvested with the Coleman technique.

The viability of fat grafts harvested with an established technique after cryopreservation remains unknown. This study was conducted in vitro to evaluate the viability of autologous fat grafts harvested with the Coleman technique and subsequently preserved with our preferred cryopreservation method. Eight adult females were enrolled in this study. In each patient, 10 mL of fat grafts were harvested with the Coleman technique by a single surgeon from the lower abdomen. In group 1, 5 mL of fresh fat grafts were mixed with cryoprotective agents and underwent cryopreservation with controlled slow cooling and fast rewarming. In group 2, 5 mL of fresh fat grafts without cryopreservation from the same patient served as a control. The fat graft samples from both groups were evaluated with trypan blue vital staining, glycerol-3-phophatase dehydrogenase assay, and routine histology. Viable adipocyte counts were found similar in both group 1 and group 2 (3.46 +/- 0.91 vs. 4.12 +/- 1.11 x 10/mL, P = 0.22). However, glycerol-3-phophatase dehydrogenase activity was significantly lower in group 1 compared with group 2 (0.47 +/- 0.09 vs. 0.66 +/- 0.09 u/mL, P < 0.001). Histologically, the normal structure of fragmented fatty tissues was found primarily in both groups. Our results indicate that autologous fat grafts harvested with the Coleman technique and preserved with our preferred cryopreservation method have a normal histology with near the same number of viable adipocytes as compared with the fresh fat grafts. However, those cryopreserved fat grafts appear to have a less optimal level of adipocyte specific enzyme activity compared with the fresh ones and thus may not survive well after they are transplanted without being optimized.

Techniques of monitoring buried fasciocutaneous free flaps.

BACKGROUND: Although postoperative monitoring of microsurgical reconstruction is key to discovering early vascular compromise, monitoring a buried flap can be problematic. METHODS: A single surgeon's tracheal and pharyngoesophageal reconstructions with fasciocutaneous free flaps performed between 2002 and 2007 are reviewed, and different monitoring techniques are described. RESULTS: Eighty-six cases of pharyngoesophageal and eight tracheal reconstructions were identified. The anterolateral thigh flap was used in 78 patients and the radial forearm flap was used in 16 patients. Three different monitoring techniques were used. In group I, a component of the flap used for neck resurfacing simultaneously served as a monitoring segment in 59 patients. No flap compromise or failure occurred. In group II, either an implantable or handheld Doppler device was used to monitor a completely buried flap in 29 patients. The implantable Doppler had a false-positive rate of 31 percent, leading to unnecessary surgical exploration. One case each of unrecognized flap loss occurred with the implantable and handheld Doppler methods. In group III, a segment of tissue separate from the main flap but sharing the same source vessels was temporarily externalized for monitoring and removed before patient discharge in six patients. This technique was also used in a patient with an anterolateral thigh flap for temporal reconstruction. There was no thrombosis or flap loss in these patients. CONCLUSIONS: Temporarily externalizing a segment of tissue is an easy and reliable method for monitoring a buried fasciocutaneous free flap. It is important, however, to avoid obstruction at the perforator level beyond the common source vessels.

Autologous fat grafts harvested and refined by the Coleman technique: a comparative study.

BACKGROUND: The viability of fat grafts obtained by even a well-established technique remains poorly studied and unknown. This study was designed to determine the viability of fat grafts harvested and refined by the Coleman technique. METHODS: Sixteen adult white women were enrolled in this study. In group 1 (n = 8), fat grafts were harvested and processed with the Coleman technique by a single surgeon from the abdomen of each patient according to his standardized method. In group 2 (n = 8), fat grafts were harvested with the conventional liposuction by another surgeon. After centrifugation, the resulting middle layer of tissue was collected. All fat graft samples were analyzed for the following studies: trypan blue vital staining for viable adipocyte counts, glycerol-3-phophatase dehydrogenase assay, and routine histologic examination. RESULTS: The higher viable adipocyte counts were found in group 1 compared with group 2 (4.11 +/- 1.11 versus 2.57 +/- 0.56 x 10 cells/ml; p < 0.004). The level of glycerol-3-phophatase dehydrogenase activity was significantly higher in group 1 compared with group 2 (0.66 +/- 0.09 versus 0.34 +/- 0.13 U/ml; p < 0.0001). Histologic examination showed normal structure of fragmented fatty tissues in both groups. CONCLUSIONS: Although fat grafts obtained by both methods maintain normal histologic structure, the Coleman technique yields a greater number of viable adipocytes and sustains a more optimal level of cellular function within fat grafts and should be considered superior to conventional liposuction as a preferred method of choice for fat graft harvesting.

The viability of autologous fat grafts harvested with the LipiVage system: a comparative study.

This study evaluates the viability of adipose aspirates harvested with the LipiVage system (Genesis Biosystems Inc, Lewisville, TX), a newly developed fat harvesting device, and determines a potentially preferred method for possible large-quantity fat graft harvesting. Adipose aspirates were harvested with the LipiVage system from the abdomen of 16 female patients (group 1, n = 8) according to the instruction by the manufacturer and with conventional liposuction (group 2, n = 8). Samples from conventional liposuction were spun at 50 g for 10 minutes and the resulting middle layer of fat was collected. All fat graft samples were evaluated with trypan blue vital staining for viable adipocyte count, glycerol-3-phosphatase dehydrogenase (G3PDH) assay for intracellular enzyme activity, and histology. In this study, group 1 had significantly higher viable adipocyte count than group 2 had (3.7 +/- 0.64 versus 2.37 +/- 0.56 x 10(6) /mL, P = 0.0021). G3PDH assay showed a marked increase of intracellular enzyme activity in group 1 compared with in group 2 (0.61 +/- 0.10 versus 0.34 +/- 0.13 U/mL, P = 0.00045). Histology revealed normal structures of fragmental fatty tissues in both groups. While adipose aspirates by both modalities maintain normal structure, the LipiVage system yields a greater number of viable adipocytes and sustains a higher level of intracellular enzyme activity within fat grafts and can potentially be a preferred method of choice for large-quantity fat graft harvesting.

The effect of saliva and oral intake on the tensile properties of sutures: an experimental study.

The plastic surgeon often operates in the oral cavity. Little or no information exists regarding the effect of saliva and oral intake upon the tensile properties of suture. Polyglactin 910 (Vicryl) and chromic gut were studied. Five sutures of each type were subjected to saline, saliva, milk, or soy milk over different durations of exposure. Suture breaking strength was tested. A 4-way interaction between suture type, size, liquid, and time was significant (P = 0.0046). Sutures soaked in saliva were significantly weaker. No significant difference was observed between sutures soaked in milk or soy. Saliva appears to enhance degradation rates in both sutures. Suture selection in the oral cavity should be predicated upon the demands of the repair and surgeon's preference. Postoperative feeding instructions should limit tension across mucosal repairs, but the selection of formula should be based upon nutritional requirements and preferences of the child rather than concern over suture degradation.

Repair of the abdominal donor-site fascial defect with small intestinal submucosa (Surgisis) after TRAM flap breast reconstruction.

We report the successful use of Surgisis in the repair of the abdominal donor site fascial defect following a free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. No abdominal wall weakness in the flap donor site was evidenced by a series of clinical examinations to at least 14 months after Surgisis placement. A well-formed and thickened fascial layer at the abdominal donor fascial repair site was revealed by computed tomography scan. This objective finding, along with our clinical observation, supports the use of Surgisis for repair of the abdominal donor site fascial defect following a TRAM flap harvesting.

The use of a hydrogel sealant on flexor tendon repairs to prevent adhesion formation.

The prevention of peritendinous adhesions after zone II flexor tendon repair poses a significant challenge to hand surgeons. This study evaluates a hydrogel sealant (FocalSeal-L) as a barrier to peritendinous adhesion formation. The deep flexors of toes 2 through 4 were divided and repaired in 30 chickens. Chickens were randomized to tendon repair with (n = 15) or without (n = 15) FocalSeal-L. Each group was further randomized to have their tendons studied postoperatively at 3 (n = 10), 6 (n = 10), or 12 (n = 10) weeks. Histologic evaluation revealed decreased peritendinous adhesion formation in the FocalSeal-L group. Biomechanical analysis demonstrated a decrease in work of flexion in the FocalSeal-L group that was most pronounced at 6 weeks (P = 0.0020). There was no significant difference in breaking strength. Apparently, an effective barrier to peritendinous adhesion formation, this sealant system is easy to use, biocompatible, and bioresorbable. In addition, it is not bulky or restrictive to tendon glide.

Current practice of thromboprophylaxis in the burn population: a survey study of 84 US burn centers.

While there is limited prospective data on the incidence of venous thromboembolism (VTE) in the burn population, there are no prospective studies on the efficacy and safety of VTE prophylaxis in these patients. Despite lack of such data, we hypothesized that most burn centers practice some form of prophylaxis. Eighty-four US burn centers were contacted regarding their modality of VTE prophylaxis, if any. Of the 84 US burn centers, 71 were enrolled in this survey. 76.1% centers reported routine VTE prophylaxis. Modalities included sequential compression device (SCD) (33), subcutaneous heparin (31), enoxaparin (13), dalteparin (3), and intravenous heparin infusion (1). Twenty-one reported combined modalities of SCD and subcutaneous heparin (19), SCD and enoxaparin (1), or SCD and dalteparin (1). Survey results underscore the need to definitively establish risk factors for VTE in the burn population and to prospectively define an evidence-based standard of care in prophylaxis for those patients.

Laser treatment of congenital nevi.

Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.