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1.
Mater Sci Eng C Mater Biol Appl ; 105: 110085, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546386

RESUMO

Bone and cartilage craniofacial defects due to trauma or congenital deformities pose a difficult problem for reconstructive surgeons. Human adipose stem cells (ADSCs) can differentiate into bone and cartilage and together with suitable scaffolds could provide a promising system for skeletal tissue engineering. It has been suggested that nanomaterials can direct cell behavior depending on their surface nanotopographies. Thus, this study examined whether by altering a nanoscaffold surface using radiofrequency to excite gases, argon (Ar), nitrogen (N2) and oxygen (O2) with a single step technique, we could enhance the osteogenic and chondrogenic potential of ADSCs. At 24 h, Ar modification promoted the highest increase in ADSCs adhesion as indicated by upregulation of vinculin and focal adhesion kinase (FAK) expression compared to O2 and N2 scaffolds. Furthermore, ADSCs on Ar-modified nanocomposite polymer POSS-PCU scaffolds upregulated expression of bone markers, alkaline phosphatase, collagen I and osteocalcin after 3 weeks. Cartilage markers, aggrecan and collagen II, were also upregulated on Ar-modified scaffolds at the mRNA and protein level. Finally, all plasma treated scaffolds supported tissue ingrowth and angiogenesis after grafting onto the chick chorioallantoic membrane. Ar promoted greater expression of vascular endothelial growth factor and laminin in ovo compared to O2 and N2 scaffolds as shown by immunohistochemistry. This study provides an important understanding into which surface chemistries best support the osteogenic and chondrogenic differentiation of ADSCs that could be harnessed for regenerative skeletal applications. Argon surface modification is a simple tool that can promote ADSC skeletal differentiation that is easily amenable to translation into clinical practice.

2.
Clin Rheumatol ; 38(12): 3669-3676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31482318

RESUMO

INTRODUCTION: Raynaud's phenomenon (RP) is a common condition and causes pain, paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective when injected via a digital palmar approach, in the treatment of severe RP. However, hand weakness resulting from lumbrical malfunction is a recognized complication. This study aimed to determine the effect of Btx-A injected via a dorsal approach. METHOD: Forty patients received 100 units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study. RESULTS: Eighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6 weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud's attacks. There was a significant improvement in both the DASH score (p = 0.001), Kapandji score (p = 0.001) and hand strength (p < 0.05). No patients reported weakness. Improvements in hand function and symptoms of RP were still evident at 12 weeks. CONCLUSIONS: Btx-A injected via a dorsal approach improves symptoms and reduces the number of RP. We have shown an effective non-surgical approach technique to treat RP.Key Points• Raynaud's phenomenon is a common vasospastic disorder of the digital vessels, which can cause severe pain, restrictions to hand function and ulceration.• Dorsal botulinum toxin type A injections can improve the symptoms of secondary Raynaud's phenomenon and hand function for approximately 3 months.

3.
PLoS One ; 14(7): e0218068, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314805

RESUMO

Oro-facial fibrosis in systemic sclerosis (Scleroderma;SSc) has a major impact on mouth function, facial appearance, and patient quality of life. Lipotransfer is a method of reconstruction that can be used in the treatment of oro-facial fibrosis. The effect of this treatment not only restores oro-facial volume but has also been found to reverse the effects of oro-facial fibrosis. Adipose derived stem cells (ADSCs) within the engrafted adipose tissue have been shown to be anti-fibrotic in SSc and are proposed as the mechanism of the anti-fibrotic effect of lipotransfer. A cohort of 62 SSc patients with oro-facial fibrosis were assessed before and after stem cell enriched lipotransfer treatment. Clinical evaluation included assessment of mouth function using a validated assessment tool (Mouth Handicap in Systemic Sclerosis Scale-MHISS), validated psychological measurements and pre and post-operative volumetric assessment. In addition, to understand the mechanism by which the anti-fibrotic effect of ADSCs occur, SSc derived fibroblasts and ADSCs from this cohort of patients were co-cultured in direct and indirect culture systems and compared to monoculture controls. Cell viability, DNA content, protein secretion of known fibrotic mediators including growth factor- ß1 (TGF ß-1) and connective tissue growth factor (CTGF) using ELISA analysis and fibrosis gene expression using a fibrosis pathway specific qPCR array were evaluated. Mouth function (MHISS) was significantly improved (6.85±5.07) (p<0.0001) after treatment. All psychological measures were significantly improved: DAS 24 (12.1±9.5) (p<0.0001); HADS-anxiety (2.8±3.2) (p<0.0001), HADS-depression (2.0±3.1) (p<0.0001); BFNE (2.9 ± 4.3) (p<0.0001); VAS (3.56±4.1) (p<0.0001). Multiple treatments further improved mouth function (p<0.05), DAS (p<0.0001) and VAS (p = 0.01) scores. SSc fibroblast viability and proliferation was significantly reduced in co-culture compared to monoculture via a paracrine effect over 14 days (p < 0.0001). Protein secretion of transforming growth factor (TGF-ß1) and connective tissue growth factor (CTGF) was significantly reduced in co-culture compared to monoculture (p < 0.0001). Multiple fibrosis associated genes were down regulated in SSc co-culture compared to monoculture after 14 days including Matrix metalloproteinase-8 (MMMP-8), Platelet derived growth factor-ß (PDGF-ß) and Integrin Subunit Beta 6 (ITG-ß6). Autologous stem cell enriched lipotransfer significantly improved the effects of oro-facial fibrosis in SSc in this open cohort study. Lipotransfer may reduce dermal fibrosis through the suppression of fibroblast proliferation and key regulators of fibrogenesis including TG-ß1 and CTGF. Our findings warrant further investigation in a randomised controlled trial.

4.
Int J Biomater ; 2018: 6565783, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30405715

RESUMO

An effective sterilisation technique that maintains structure integrity, mechanical properties, and biocompatibility is essential for the translation of new biomaterials to the clinical setting. We aimed to establish an effective sterilisation technique for a biodegradable (POSS-PCL) and nonbiodegradable (POSS-PCU) nanocomposite scaffold that maintains stem cell biocompatibility. Scaffolds were sterilised using 70% ethanol, ultraviolet radiation, bleach, antibiotic/antimycotic, ethylene oxide, gamma irradiation, argon plasma, or autoclaving. Samples were immersed in tryptone soya broth and thioglycollate medium and inspected for signs of microbial growth. Scaffold surface and mechanical and molecular weight properties were investigated. AlamarBlue viability assay of adipose derived stem cells (ADSC) seeded on scaffolds was performed to investigate metabolic activity. Confocal imaging of rhodamine phalloidin and DAPI stained ADSCs was performed to evaluate morphology. Ethylene oxide, gamma irradiation, argon plasma, autoclaving, 70% ethanol, and bleach were effective in sterilising the scaffolds. Autoclaving, gamma irradiation, and ethylene oxide led to a significant change in the molecular weight distribution of POSS-PCL and gamma irradiation and ethylene oxide to that of POSS-PCU (p<0.05). UV, ethanol, gamma irradiation, and ethylene oxide caused significant changes in the mechanical properties of POSS-PCL (p<0.05). Argon was associated with significantly higher surface wettability and ADSC metabolic activity (p<0.05). In this study, argon plasma was an effective sterilisation technique for both nonbiodegradable and biodegradable nanocomposite scaffolds. Argon plasma should be further investigated as a potential sterilisation technique for medical devices.

5.
BMJ Case Rep ; 20182018 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-29525756

RESUMO

Raynaud's phenomenon is a vasospastic disorder of the digital vessels triggered by exposure to cold or stress. It is most commonly observed in the hands, but also frequently affects the toes. We present three cases of patients with severe Raynaud's phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud's syndrome and scleroderma was established according to the 2010 American College of Rheumatology and European League Against Rheumatism criteria. Patients were treated with 10 units of botulinum toxin injected into each foot. Two millilitres was injected into the base of each toe in both the left and right feet. Six weeks postinjection into the toes, patients reported an improvement of cold intolerance, colour change and frequency and severity of Raynaud's attacks. The effects were reported to last up to 5 months. To our knowledge, these are the first reported cases of the treatment of Raynaud's phenomenon in the toes with botulinum toxin A.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Doença de Raynaud/tratamento farmacológico , Escleroderma Sistêmico/diagnóstico , Dedos do Pé/irrigação sanguínea , Inibidores da Liberação da Acetilcolina/administração & dosagem , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Injeções/métodos , Pessoa de Meia-Idade , Doença de Raynaud/diagnóstico , Doença de Raynaud/etiologia , Escleroderma Sistêmico/complicações , Índice de Gravidade de Doença , Dedos do Pé/patologia , Resultado do Tratamento
6.
Sci Rep ; 8(1): 3097, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29449572

RESUMO

Decellularized scaffolds can induce chondrogenic differentiation of stem cells. This study compares different methods to optimise the decellularization of auricular cartilage. The process consisted of an initial 12 hour dry freeze thaw which froze the cartilage specimens in an empty tube at -20 °C. Samples were allowed to thaw at room temperature followed by submersion in phosphate buffer solution in which they were frozen at -20 °C for a 12 hour period. They were then allowed to thaw at room temperature as before. Protocol A subsequently involved subjecting specimens to both deoxyribonuclease and sodium deoxycholate. Protocol B and C were adaptations of this using 0.25% trypsin (7 cycles) and a 0.5 molar solution of ethylenediaminetetraacetic acid (3 hours for each cycle) respectively as additional steps. Trypsin accelerated the decellularization process with a reduction in DNA content from 55.4 ng/µL (native) to 17.3 ng/µL (P-value < 0.05) after 14 days. Protocol B showed a faster reduction in DNA content when compared with protocol A. In comparison to protocol C after 14 days, trypsin also showed greater decellularization with a mean difference of 11.7 ng/µL (P-value < 0.05). Histological analysis with H&E and DAPI confirmed depletion of cells at 14 days with trypsin.


Assuntos
Cartilagem Elástica/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Engenharia Tecidual/métodos , Cadáver , Cartilagem/fisiologia , Diferenciação Celular , Condrogênese , Orelha/cirurgia , Orelha Externa , Matriz Extracelular , Humanos , Células-Tronco Mesenquimais , Células-Tronco , Tecidos Suporte , Tripsina/metabolismo , Tripsina/fisiologia
7.
Stem Cell Res Ther ; 8(1): 23, 2017 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-28173869

RESUMO

BACKGROUND: Adipose-derived stem cells (ADSCs) are emerging as an alternative stem cell source for cell-based therapies. Recent data suggest that autologous ADSC-enriched micrografting improves the effects of facial involvement in systemic sclerosis (SSc). We have extensively characterised ADSCs from SSc patients and compared their phenotype and function to healthy age- and sex-matched control ADSCs. METHODS: ADSCs were isolated and characterised from a cohort of six SSc patients (ADSC-SSc) and were compared to six healthy age- and sex-matched controls (ADSC-N). Cell surface phenotype lineage commitment was explored by flow cytometric analysis of mesenchymal and hematopoietic markers and by the capacity to differentiate to chondrogenic, osteogenic, and adipogenic lineages. Functional activities of ADSCs were assessed by biochemical and cellular assays for proliferation, metabolism, adhesion, morphology, migration, and invasion. RESULTS: Upon characterization of ADSC-SSc, we found that there was no alteration in the phenotype or surface antigen expression compared to healthy matched control ADSCs. We found that the differentiation capacity of ADSC-SSc was equivalent to that of ADSC-N, and that ADSC-SSc did not display any morphological or adhesive abnormalities. We found that the proliferation rate and metabolic activity of ADSC-SSc was reduced (p < 0.01). We found that the migration and invasion capacity of ADSC-SSc was reduced (p < 0.01) compared to healthy matched control ADSCs. CONCLUSIONS: This study provides important findings that can differentially characterise ADSCs from SSc patients. Results indicate that the surface phenotype and differentiation capacity of ADSCs from SSc patients are identical to healthy matched ADSCs. While the findings indicate that the proliferation and migration capacity of ADSC-SSc is reduced, ADSC-SSc are capable of ex-vivo culture and expansion. These findings encourage further investigation into the understanding by which ADSCs can impact upon tissue fibrosis.


Assuntos
Adipócitos/patologia , Tecido Adiposo/patologia , Medicina Regenerativa/métodos , Escleroderma Sistêmico/patologia , Células-Tronco/patologia , Adipócitos/metabolismo , Tecido Adiposo/metabolismo , Adulto , Fatores Etários , Antígenos CD/genética , Antígenos CD/metabolismo , Biomarcadores/metabolismo , Estudos de Casos e Controles , Adesão Celular , Diferenciação Celular , Movimento Celular , Proliferação de Células , Condrócitos/citologia , Condrócitos/metabolismo , Feminino , Expressão Gênica , Humanos , Imunofenotipagem , Osteoblastos/citologia , Osteoblastos/metabolismo , Fenótipo , Cultura Primária de Células , Escleroderma Sistêmico/genética , Escleroderma Sistêmico/metabolismo , Fatores Sexuais , Células-Tronco/metabolismo
8.
Tissue Eng Part B Rev ; 23(2): 183-198, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27824295

RESUMO

Traumatic soft tissue wounds present a significant reconstructive challenge. The adoption of closed-circuit negative pressure wound therapy (NPWT) has enabled surgeons to temporize these wounds before reconstruction. Such systems use porous synthetic foam scaffolds as wound fillers at the interface between the negative pressure system and the wound bed. The idea of using a bespoke porous biomaterial that enhances wound healing, as filler for an NPWT system, is attractive as it circumvents concerns regarding reconstructive delay and the need for dressing changes that are features of the current systems. Porous foam biomaterials are mechanically robust and able to synthesize in situ. Hence, they exhibit potential to fulfill the niche for such a functionalized injectable material. Injectable scaffolds are currently in use for minimally invasive surgery, but the design parameters for large-volume expansive foams remain unclear. Potential platforms include hydrogel systems, (particularly superabsorbent, superporous, and nanocomposite systems), polyurethane-based moisture-cured foams, and high internal phase emulsion polymer systems. The aim of this review is to discuss the design parameters for such future biomaterials and review potential candidate materials for further research into this up and coming field.


Assuntos
Hidrogéis/farmacologia , Injeções , Engenharia Tecidual/métodos , Tecidos Suporte/química , Cicatrização/efeitos dos fármacos , Animais , Fenômenos Biomecânicos/efeitos dos fármacos , Humanos , Porosidade
9.
Transpl Int ; 27(10): 1086-96, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24963743

RESUMO

This study tested the hypothesis that vascularized composite allografts (VCA) could be accepted in a robust model of hematopoietic chimerism by injecting allogeneic bone marrow cells (BMC) into swine fetuses. Outbred Yorkshire sows and boars were screened to ensure the absence of the major histocompatibility (MHC) allele SLA(cc) of inbred MGH miniature swine and then mated. Bone marrow harvested from an SLA(cc) swine donor was T-cell depleted and injected intravenously into the fetuses between days 50-55 of gestation. After birth, the piglets were studied with flow cytometry to detect donor cells and mixed lymphocyte reactions (MLR) and cell-mediated lympholysis (CML) assays to assess their response to donor. Donor-matched VCAs from SLA(cc) donors were performed on four chimeric and two nonchimeric swine. The results showed donor cell engraftment and multilineage macrochimerism after the in utero transplantation of adult BMC, and chimeric animals were unresponsive to donor antigens in vitro. Both control VCAs were rejected by 21 days and were alloreactive. Chimeric animals accepted the VCAs and never developed antidonor antibodies or alloreactivity to donor. These results confirm that the intravascular, in utero transplantation of adult BMC leads to donor cell chimerism and donor-specific tolerance of VCAs across a full MHC barrier in this animal model.


Assuntos
Aloenxertos Compostos/irrigação sanguínea , Prenhez , Quimeras de Transplante/imunologia , Tolerância ao Transplante/fisiologia , Aloenxertos , Animais , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/métodos , Aloenxertos Compostos/transplante , Modelos Animais de Doenças , Feminino , Citometria de Fluxo , Rejeição de Enxerto , Sobrevivência de Enxerto , Histocompatibilidade , Tolerância Imunológica/fisiologia , Teste de Cultura Mista de Linfócitos , Gravidez , Distribuição Aleatória , Medição de Risco , Sensibilidade e Especificidade , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Suínos , Porco Miniatura
10.
J Plast Reconstr Aesthet Surg ; 66(3): 345-51, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23200740

RESUMO

BACKGROUND: The inability to smile stands out as a notable difficulty for individuals with facial nerve palsies; a problem that facial reanimation surgery aims to rectify. However, smile reconstruction currently lacks quantitative data by which to objectively measure outcomes. This study aims to identify the relative importance of different oral muscles in terms of smiling, and explore the percentage function that needs to be restored for a smile to be perceived by an observer. METHODS: A computer animation tool was developed to model the oral facial muscles and demonstrate the facial expressions produced by contraction of different muscle groups. By programming a variable unilateral paralysis of the zygomaticus major, the effects of 0-100% function of this muscle can also be seen in a further set of animations using the basic muscular structure of a smile to produce a computerized proxy smile. These animations were shown to 75 adults from the general population who reported those expressions they perceived as a smile. RESULTS: The only facial expression consistently associated with a perceived smile was caused by the combined contraction of the zygomaticus major and the levator anguli oris (P < 0.001). This concurs with previously reported observations of the human smile. Over 70% of the subjects were able to perceive a smile with just 40% function of the unilateral paralyzed zygomaticus major. CONCLUSIONS: These results present an objective target for facial reanimation surgery by which outcomes may be measured. This computerized model also provides a valuable tool for patient education during pre-operative consent.


Assuntos
Simulação por Computador , Paralisia Facial/diagnóstico , Sorriso/fisiologia , Adolescente , Adulto , Músculos Faciais/inervação , Músculos Faciais/fisiologia , Paralisia Facial/cirurgia , Humanos , Pessoa de Meia-Idade , Modelos Anatômicos , Contração Muscular/fisiologia , Percepção , Amostragem , Sensibilidade e Especificidade , Software , Adulto Jovem
11.
Curr Opin Otolaryngol Head Neck Surg ; 20(4): 291-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22894997

RESUMO

PURPOSE OF REVIEW: Twenty-one face transplants have been performed to date. This review provides an overview of the clinical outcomes and the lessons learned from these initial cases. RECENT FINDINGS: Facial transplantation has progressed over the past 10 years from an experimental possibility to a clinical reality. The most recent transplants performed in the USA, Spain and Turkey involve the full face. Good sensory recovery of the allograft has been consistently reported, even in the absence of nerve repair. As predicted, motor recovery has been slower than re-innervation of sensation. Dramatic improvements to functional status have been seen, with recipients regaining the ability to smile, smell, eat, drink and speak. Episodes of acute rejection have been common and controlled with increases in systemic immunosuppression. The first face transplant recipient is now over 5 years after surgery. Chronic rejection has not been seen in her or any other case. Despite the encouraging outcomes, complications because of immunosuppression, including malignancy, have occurred. SUMMARY: The outcomes of facial transplantation thus far have been very encouraging. The development of standardized tools to measure functional and psychological outcomes is required as more cases are performed. We recommend that facial transplantation is still only to be performed by experienced multidisciplinary teams.


Assuntos
Traumatismos Faciais/cirurgia , Transplante de Face/métodos , Complicações Pós-Operatórias/etiologia , Estética , Expressão Facial , Traumatismos Faciais/fisiopatologia , Traumatismos Faciais/psicologia , Músculos Faciais/inervação , Traumatismos do Nervo Facial/fisiopatologia , Traumatismos do Nervo Facial/cirurgia , Transplante de Face/fisiologia , Transplante de Face/psicologia , Rejeição de Enxerto/fisiopatologia , Rejeição de Enxerto/prevenção & controle , Rejeição de Enxerto/cirurgia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Microcirurgia/métodos , Neurônios Motores/fisiologia , Regeneração Nervosa/fisiologia , Satisfação do Paciente , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Complicações Pós-Operatórias/cirurgia , Qualidade de Vida/psicologia , Células Receptoras Sensoriais/fisiologia , Resultado do Tratamento , Traumatismos do Nervo Trigêmeo/cirurgia
12.
Body Image ; 9(4): 455-61, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22766453

RESUMO

Social intrusions by observers are commonly reported by those with disfiguring conditions. This study examined the role of disgust emotions in the observer response. A group of students (N=48) completed quantitative questionnaires measuring extent of disfigurement, whilst viewing images of faces with varying disfigurements. Another group of students (N=84) completed quantitative questionnaires measuring level of disgust elicited by the same images. Disgust sensitivity was measured using the Disgust Scale Revised. Observers reported greater levels of disgust (p<.01) with increasing severity of facial disfigurement. Individuals with a higher disgust sensitivity reported increased levels of disgust in response to faces of mild (p=.03), moderate (p=.02) and severe (p<.01) disfigurement compared to those with a lower disgust sensitivity. This provides an explanatory framework for the avoidance reactions of observers and may be important in understanding variability in adjustment following disfigurement.


Assuntos
Imagem Corporal , Emoções , Dermatoses Faciais/psicologia , Expressão Facial , Traumatismos Faciais/psicologia , Neoplasias Faciais/psicologia , Relações Interpessoais , Reconhecimento Visual de Modelos , Neoplasias Cutâneas/psicologia , Estigma Social , Adolescente , Adulto , Cicatriz/psicologia , Estudos Transversais , Traumatismos Faciais/cirurgia , Neoplasias Faciais/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/psicologia , Fatores Sexuais , Neoplasias Cutâneas/cirurgia , Estudantes/psicologia , Retalhos Cirúrgicos , Inquéritos e Questionários , Adulto Jovem
13.
Int J Surg ; 9(8): 600-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21982908

RESUMO

A total of 18 composite tissue allotransplants of the face have currently been reported. Prior to the start of the face transplant programme, there had been intense debate over the risks and benefits of performing this experimental surgery. This review examines the surgical, functional and aesthetic, immunological and psychological outcomes of facial transplantation thus far, based on the predicted risks outlined in early publications from teams around the world. The initial experience has demonstrated that facial transplantation is surgically feasible. Functional and aesthetic outcomes have been very encouraging with good motor and sensory recovery and improvements to important facial functions observed. Episodes of acute rejection have been common, as predicted, but easily controlled with increases in systemic immunosuppression. Psychological improvements have been remarkable and have resulted in the reintegration of patients into the outside world, social networks and even the workplace. Complications of immunosuppression and patient mortality have been observed in the initial series. These have highlighted rigorous patient selection as the key predictor of success. The overall early outcomes of the face transplant programme have been generally more positive than many predicted. This initial success is testament to the robust approach of teams. Dissemination of outcomes and ongoing refinement of the process may allow facial transplantation to eventually become a first-line reconstructive option for those with extensive facial disfigurements.


Assuntos
Estética , Transplante de Face/métodos , Rejeição de Enxerto , Traumatismos Faciais/cirurgia , Transplante de Face/mortalidade , Transplante de Face/psicologia , Humanos , Imunossupressão/efeitos adversos , Neurofibromatoses/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Ann Plast Surg ; 67(2): 184-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21712695

RESUMO

The main arterial supply of the facial skin envelope is the facial artery which serves as the main pedicle for a number of facial flaps, including a facial transplant graft. This study explored the course of the facial artery and vein, branching patterns, terminations, and anomalous variants. Cadaveric dissections of 201 facial arteries and 198 facial veins were performed. All branches originated from a single facial arterial trunk in 86% of specimens and branching patterns were symmetrical in 53%. The facial artery predominantly terminated as a lateral nasal artery (49%). In 5 cases, the facial artery was undetectable with transverse facial arterial dominance (1 case bilateral). The facial vein was predictable in position except for 2 instances, being replaced by a transverse facial vein (unilateral). Facial arterial dominance in facial blood supply is common but unpredictable. Careful vascular workup prior to facial transplantation and unipedicled flap procedures is therefore essential.


Assuntos
Face/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Artérias/anatomia & histologia , Face/cirurgia , Transplante de Face , Humanos , Veias/anatomia & histologia
15.
Int J Surg ; 9(5): 433-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21545854

RESUMO

OBJECTIVES: Facial transplantation has emerged as a treatment option in facial reconstruction. In this pilot study, we investigate initial attitudes to this concept in relevant patient and health professional groups. METHOD: Attitudes towards facial transplantation as a procedure were examined among 200 participants, including 30 nurses, 30 doctors, 30 plastic surgeons, 30 renal transplant patients, 30 medical students, 30 members of the lay public and 20 patients with facial disfigurements through the use of a questionnaire. RESULTS: Identity was important for all participating groups with 83.5% positive about receiving a facial transplant provided no resemblance to donor. There was an inverse relationship between the side effects of the immunosuppressant regimen and organ rejection and the willingness to undergo facial transplantation when compared to other forms of organ transplantation. A relationship to the recipient and familiarity with a transplant programme were positively related to potential donation. CONCLUSION: This study identifies the key issues of altered identity and the understanding of immunosuppression and surgical risk as the focus for research and patient selection. The ethical aspects of facial transplantation are not addressed in this study, and have been addressed elsewhere.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Transplante de Face/psicologia , Imunossupressão , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Procedimentos Cirúrgicos Reconstrutivos/métodos , Risco , Autoimagem , Inquéritos e Questionários , Doadores de Tecidos/psicologia
16.
Ann Plast Surg ; 65(3): 349-53, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20733373

RESUMO

This study examines the utility of the aesthetic and reconstructive categorization for making treatment decisions in patients seeking facial surgery. A total of 360 patients with aesthetic or combined functional aesthetic deficits were included. Validated psychological scales were used as outcome measures. All subjects showed clinically significant levels of appearance-related distress, with highest levels in the aesthetic and lowest levels in the functionally impaired group. Significant gender differences were not found on any psychological measures. A small negative correlation was found between age and distress. These findings challenge the validity of restricting treatment on the basis of an aesthetic distinction, since this is the group demonstrating the highest level of need. Neither age nor gender is a reliable discriminator. Subjective assessment of noticeability of disfigurement and associated psychological distress may be more useful in prioritizing treatment in systems with limited resources.


Assuntos
Estética/psicologia , Síndrome de Lipodistrofia Associada ao HIV/psicologia , Procedimentos Cirúrgicos Reconstrutivos/psicologia , Esclerodermia Localizada/psicologia , Autoimagem , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Ansiedade/epidemiologia , Imagem Corporal , Comorbidade , Depressão/epidemiologia , Face/cirurgia , Feminino , Síndrome de Lipodistrofia Associada ao HIV/induzido quimicamente , Síndrome de Lipodistrofia Associada ao HIV/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Ritidoplastia/estatística & dados numéricos , Esclerodermia Localizada/epidemiologia , Esclerodermia Localizada/cirurgia , Inquéritos e Questionários , Adulto Jovem
17.
J Plast Reconstr Aesthet Surg ; 63(4): 711-9, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19324598

RESUMO

The problem of allogeneic skin rejection is a major limitation to more widespread application of clinical composite tissue allotransplantation (CTA). Previous research examining skin rejection has mainly studied rejection of conventional skin grafts (CSG) using standard histological techniques. The aim of this study was to objectively assess if there were differences in the immune response to CSG and primarily vascularized skin in composite tissue allotransplants (SCTT) using in vivo techniques in order to gain new insights in to the immune response to skin allotransplants. CSG and SCTT were transplanted from standard Lewis (LEW) ad Wistar Furth (WF) to recipient transgenic green fluorescent Lewis rats (LEW-GFP). In vivo confocal microscopy was used to observe cell trafficking within skin of the transplants. In addition, immunohistochemical staining was performed on skin biopsies to reveal possible expression of class II major histocompatibility antigens. A difference was observed in the immune response to SCTT compared to CSG. SCTT had a greater density cellular infiltrate than CSG (p<0.03) that was focused more at the center of the transplant (p<0.05) than at the edges, likely due to the immediate vascularization of the skin. Recipient dendritic cells were only observed in rejecting SCTT, not CSG. Furthermore, dermal endothelial class II MHC expression was only observed in allogeneic SCTT. The immune response in both SCTT and CSG was focused on targets in the dermis, with infiltrating cells clustering around hair follicles (CSG and SCTT; p<0.01) and blood vessels (SCTT; p<0.01) in allogeneic transplants. This study suggests that there are significant differences between rejection of SCTT and CSG that may limit the relevance of much of the historical data on skin graft rejection when applied to composite tissue allotransplantation. Furthermore, the use of novel in vivo techniques identified characteristics of the immune response to allograft skin not previously described, which may be useful in directing future approaches to overcoming allograft skin rejection.


Assuntos
Movimento Celular/fisiologia , Rejeição de Enxerto/imunologia , Antígenos de Histocompatibilidade Classe II/imunologia , Transplante de Pele/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Animais , Biópsia , Modelos Animais de Doenças , Rejeição de Enxerto/patologia , Imunidade Celular , Imuno-Histoquímica , Microscopia Confocal , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos WF , Transplante de Pele/imunologia , Retalhos Cirúrgicos/imunologia , Retalhos Cirúrgicos/patologia , Transplante Homólogo
18.
J Plast Reconstr Aesthet Surg ; 63(1): 73-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19084486

RESUMO

Psychological distress associated with disfiguring facial lesions is common. However, whilst the intrusive behaviour of observers is commonly reported, for example, staring, comments and questions, these factors which may influence the judgements of observers have not been well described. This is important as it may influence a subject's perception of how their appearance is viewed by the external world. This study is the first to investigate age and gender differences when measuring the importance of location in judgements about facial disfigurement. Observers were asked to rank the impact of simulated lesions in different positions on the face of Caucasian subjects. Age and gender varied in both groups. Our results show that lesions on the young and female subjects are ranked as having a greater impact than those on the old and male subjects. Lesions on central facial features have a higher impact than those located more peripherally. Both of these findings were not significantly influenced by observer age or gender. These results are discussed in terms of culturally derived attributions about appearance. It is also suggested that there is a scope to use feedback on how disfigurement is viewed by others as a therapeutic tool in clinical settings.


Assuntos
Face/anatomia & histologia , Julgamento , Percepção Social , Adulto , Fatores Etários , Expressão Facial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Fatores Sexuais , Estatísticas não Paramétricas , Percepção Visual
19.
Purinergic Signal ; 5(3): 327-33, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19347609

RESUMO

Athymic mice, injected with A375 human melanoma cells, were treated daily with intraperitoneal injections of adenosine 5'-triphosphate (ATP). The tumour volume and animal weight were measured over the course of the experiment and the final tumour nodule weight was measured at the end of the experiment. Tumour volume decreased by nearly 50% by 7 weeks in treated mice. Weight loss in untreated animals was prevented by ATP. Histological examination of the excised tumour nodules showed necrosis in the ATP-treated tumours only. The presence of P2Y(1) and P2X(7) receptors, previously proposed as extracellular targets for melanoma treatment with ATP, were demonstrated in the excised specimens by immunohistochemistry. This paper provides further support for the use of ATP as a treatment for melanoma.

20.
Transplantation ; 86(8): 1104-10, 2008 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-18946349

RESUMO

BACKGROUND: In the event of a composite allograft failure, damage to the recipient tissues may make retransplantation impossible. This study aimed to quantify the damage after composite allograft failure to assess whether retransplantation is feasible. METHODS: Rats (n=6) in the group I received composite musculocutaneous flap allotransplants (WF-->Lew) with immunosuppression allowing healing-in of the allograft before being tapered allowing rejection. At full rejection, the recipient vascular pedicle was examined, biopsies of the recipient tissue bed were taken and graded for damage, and in vitro assays were performed. Groups II (allograft without immunosuppression, n=7), III (isograft with immunosuppression, n=5), and IV (isograft without immunosuppression, n=6) were included to attempt to identify the contributions of the rejection process, immunosuppression, and healing to recipient tissue damage. RESULTS: The vascular pedicle was patent to within 1 mm of the anastomosis in all rejected allografts. Furthermore, it was possible to retransplant after full rejection. There was minimal damage to the recipient tissues at the time of full rejection in group I. In contrast, group II had significantly more damage (P<0.05) to recipient muscle and skin. This correlated with more severe immune reaction with more than 100 times antibody production in group II compared with group I. Groups III and IV had little recipient tissue damage. CONCLUSIONS: These results suggest that it is possible to retransplant after rejection of a musculocutaneous transplant while on immunosuppression. Furthermore, the second transplant will not be limited in form or function by recipient tissue bed damage.


Assuntos
Rejeição de Enxerto/patologia , Músculo Esquelético/transplante , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos/efeitos adversos , Cicatrização , Animais , Vasos Sanguíneos/patologia , Modelos Animais de Doenças , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Imunossupressores/administração & dosagem , Músculo Esquelético/irrigação sanguínea , Ratos , Ratos Endogâmicos Lew , Ratos Endogâmicos WF , Reoperação , Pele/irrigação sanguínea , Tacrolimo/administração & dosagem , Transplante Homólogo , Transplante Isogênico
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