Reconstruction of a Large Traumatic Medial Cheek Defect Using an Anterior-Based Subcutaneous Cervicofacial Rotation Advancement Flap.

In this article, we describe reconstruction of a large left-side medial cheek defect in a 78-year-old woman using a cervicofacial rotation advancement flap. To our knowledge, this is the second case of reconstruction of a large traumatic medial cheek defect using an anterior-based subcutaneous cervicofacial rotation advancement flap that has ever been reported. We applied retention sutures at the level of the jawline and zygomatic eminence using 3-0 nonabsorbable sutures between the subcutaneous tissue of the flap and the periosteum. Despite the limitation of having partially injured adjacent tissue available for reconstruction, meticulous dissection together with skilled postoperative nursing care yielded a good aesthetic outcome in this case.

Early-Phase Luciferase Signals of Islet Grafts Predicts Successful Subcutaneous Site Transplantation in Rats.

PURPOSE: The transplantation of pancreatic islets is a promising cell replacement therapy for type 1 diabetes. Subcutaneous islet transplantation is currently under investigation as a means to circumvent problems associated with standard intra-hepatic islet transplantation. As modifications are being developed to improve the efficacy of subcutaneous islet transplantation, it is important to have robust methods to assess engraftment. Experimentally, ATP-dependent bioluminescence imaging using luciferase reporter genes has been effective for non-invasively tracking engraftment. However, it was heretofore unknown if the bioluminescence of subcutaneously transplanted luciferase-expressing islet grafts correlates with diabetes reversal, a primary outcome of transplantation. PROCEDURES: A retrospective analysis was conducted using data obtained from subcutaneous islet transplantations in Lewis rats. The analysis included transplantations from our laboratory in which islet donors were transgenic rats ubiquitously expressing luciferase and recipients were wild type, streptozotocin-induced diabetic rats. Data from 79 bioluminescence scans were obtained from 27 islet transplantations during the post-transplant observation period (up to 6 weeks). The bioluminescence intensity of the subcutaneously transplanted grafts, captured after the intravenous administration of luciferin, was correlated with diabetes reversal. RESULTS: After subcutaneous transplantation, islet bioluminescence decreased over time, dropping > 50 % from 1 to 3 weeks post-transplant. Bioluminescence intensity in the early post-transplant phase (1-2 weeks) correlated with the subsequent reversal of diabetes; based on optimized bioluminescence cutoff values, the bioluminescence intensity of islets at 1 and 2 weeks predicted successful transplantations. However, intensity in the late post-transplant phase (≥ 4 weeks) did not reflect transplantation outcomes. CONCLUSIONS: Early-phase bioluminescence imaging of luciferase-expressing islets could serve as a useful tool to predict the success of subcutaneous islet transplantations by preceding changes in glucose homeostasis.

Subcutaneous pedicle transposition flap for nasal ala defect reconstruction: a forgotten technique.

As a central and prominent structure of the face, the nose has particular aesthetic and functional importance and constitutes a true reconstructive challenge. Subcutaneous transposition flaps are rarely used in this region, but the surgical technique can be modified for the use of a simple flap with good aesthetic results, thereby gaining a prominent place in the range of options available for nasal ala reconstruction. We present a unique case report of a modified subcutaneous pedicle transposition flap for nasal ala defect reconstruction, showing that this flap can be applied on this area with good aesthetic results and a simple technique.

Application of in-body tissue architecture-induced Biotube vascular grafts for vascular access: Proof of concept in a beagle dog model.

INTRODUCTION: The first choice of vascular access for hemodialysis is an autogenous arteriovenous fistula, because prosthetic arteriovenous grafts have a high probability of failure. In this study, Biotubes, in-body tissue architecture-induced autologous collagenous tubes, were evaluated for their potential use as vascular access grafts. Three animal implantation models were developed using beagle dogs, and the in vivo performance of Biotubes was observed after implantation in the acute phase as a pilot study. METHODS: Biotubes (internal diameter ca. 4.0 mm, length ca. 5.0 cm, and wall thickness ca. 0.7 mm) were prepared through subcutaneous embedding of specially designed molds in beagle dogs for 8 weeks. The Biotubes were then implanted between the common carotid artery and the jugular vein of beagles via three methods, including side-to-side (in) -end-to-end (out) as type 1 (n = 4), side-to-side (both) as type 2 (n = 4), and side-to-end (in) -end-to-side (out) as type 3 (n = 1 using a composite Biotube). RESULTS: Although two cases in type 1 and 2 resulted in Biotube deformation, all cases were patent for 4 weeks and maintained a continuous turbulent flow. At 4 weeks after implantation, percutaneous puncture could be performed repeatedly without aneurysm formation or hemorrhage. CONCLUSION: Within a short implantation period, with limited animal numbers, this proof-of-concept study showed that Biotubes may have a high potential for use in vascular access.

Development and Characterization of an Acellular Porcine Small Intestine Submucosa Scaffold for Use in Corneal Epithelium Tissue Engineering.

Purpose: To produce an acellular small intestine submucosa (SIS) that would be a suitable scaffold for corneal epithelium tissue engineering.Methods: The SIS was decellularized by immersion in 0.1% (wt/vol) sodium dodecyl sulfate (SDS). The efficacy of acellularization was confirmed by histological observation and DNA quantification. The mechanical properties were evaluated by uniaxial tensile testing. ELISA was performed to assess the growth factor contents. The cytotoxicity of SIS scaffolds and extracts to rabbit corneal epithelial cells was determined by CCK-8 assay. We also investigated the inflammatory reaction of SIS implanted subcutaneously in a rat. The biocompatibility was studied by rabbit interlamellar corneal transplantation and reseeding assay with cornea-derived cells. Immunofluorescent staining was used to detect the expression of CK3, ZO-1 and K13.Results: Histological analyses showed that complete cell removal was achieved, and the DNA quantity, which reflects the presence of cellular materials, was significantly diminished in acellular SIS. Collagen fibers were properly preserved and appeared in an orderly fashion. The tissue structure, the mechanical properties and the growth factor contents within the acellular SIS were well retained. The CCK8 assay demonstrated that the acellular SIS scaffolds and extracts had no cytotoxicity to rabbit corneal epithelial cells. There was no sign that an immune reaction occurred with acellular SIS implanted subcutaneously in a rat. In fact, in vivo implantation to rabbit interlamellar stromal pockets showed good biocompatibility. We also observed that clusters of rabbit corneal epithelial cells were growing well on the surface of the SIS in vitro and the distinctive CK3, ZO-1 for corneal epithelial cells was detected.Conclusions: The decellularized SIS retained the major structural components. The matrix is biocompatible with cornea-derived cells and might be a suitable scaffold for corneal epithelium tissue engineering.

Treatment of Critical-Sized Calvarial Defects in Rats with Preimplanted Transplants.

The local environment and the defect features have made the skull one of the most difficult regions to repair. Finding alternative strategies to repair large cranial defects, thereby avoiding the current limitations of autograft or polymeric and ceramic prostheses constitute an unmet need. In this study, the regeneration of an 8 mm critical-sized calvarial defect treated by autograft or by a monetite scaffold directly placed in the defect or preimplanted (either cranial bone transplant or subcutaneous pocket) and then transplanted within the bone defect is compared. The data reveal that transplantation of preimplanted monetite transplant scaffolds greatly improves the skull vault closure compared to subcutaneously preimplanted or directly placed materials. Autografts, while clearly filling the defect volume with bone appear effective since bone volume inside the defect volume is obviously high, but are not well fused to the skull. The preimplantation site has a large influence on the regeneration of the defect. Transplantation of induced bone inside materials has the potential to reduce the need for autograft harvest without damaging the skeleton. This first demonstration indicates that cranial repair may be possible without recourse to bioactives or cultured cell therapies.

Subcutaneous Implantable Cardioverter Defibrillators: An Overview of Implantation Techniques and Clinical Outcomes.

Sudden Cardiac Death (SCD) is a significant health problem worldwide. Multiple randomized controlled trials have shown that Implantable Cardioverter Defibrillators (ICDs) are effective life-saving management option for individuals at risk of SCD in both primary and secondary prevention. Although the conventional transvenous ICDs (TV-ICDs) are safe and effective, there are potential complications associated with its use, including localized pocket or wound infection or systematic infection, a vascular access related complication such as pneumothorax, and venous thrombosis, and lead related complications such as dislodgement, malfunction, and perforation. Furthermore, transvenous leads placement may not be feasible in certain patients like those with venous anomaly or occlusion, or with the presence of intracardiac shunts. Transvenous leads extraction, when needed, is associated with considerable morbidity & mortality and requires significant skills and costs. Totally subcutaneous ICD (S-ICD) is designed to afford the same life-saving benefit of the conventional TV-ICDs while avoiding the shortcomings of the TV-leads and to simplify the implant techniques and hence expand the use of ICDs in clinical practice. It becomes commercially available after receiving CE mark in 2009, and its use increased significantly after its FDA approval in 2012. This review aims to give an overview of the S-ICD system components, implantation procedure, clinical indications, safety, efficacy, and future directions.

Refinements in Elevation of the Reconstructed Auricle: The "Zigzag Incision".

OBJECTIVE: Auricular elevation with superficial temporal fascia and skin graft is widely used in microtia reconstruction using costal cartilage. However, in some patients, there has been occurrence of contraction of skin graft, which led to insufficient projection of the elevated auricle and diminished auriculocephalic angle with unfavorable long-term results. In this article, the authors introduce their multiple triangular flaps with zigzag incision to maintain stable projection and natural retroauricular sulcus appearance in auricular reconstruction patients. METHODS: The authors have designed zigzag incision along the lateral margin of the ear framework to prepare triangular flaps targeting the root of the helix or inferior half of the auricle. Depending on the extent of remnant skin coverage, the number of triangular flaps is varied. The posterior raw surface of the ear framework was covered with triangular flaps and full-thickness skin graft. RESULTS: Zigzag incision was conducted in 22 microtia patients who underwent auricular elevation using superficial temporal fascia and skin graft. Mean follow-up period was 2 years and there were no reports of occurrence of surgery-related complications, specifically skin necrosis, infection, or hematoma. The auricular projections were well maintained and auriculocephalic angle of the constructed auricles was similar to the healthy ears. CONCLUSIONS: The author's method comprises comparatively easy techniques and leads to good projection of the auricular angle. A zigzag incision using the triangular flaps could be an attractive surgical option for preventing shrinkage of grafted site and in achieving sufficient projection in autologous reconstructed auricle.

Tunneled island flaps in facial defects reconstruction.

The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

Autologous Tissue Graft in Revision Medial Epicanthoplasty Using Subciliary Fat and Orbicularis Oculi Muscle.

The medial epicanthal fold is one of the racial anatomic characteristics of Asians. As medial epicanthoplasty has become one of the most common cosmetic surgeries among Asians, the need for revision of overcorrected medial epicanthus also increased. In revision medial epicanthoplasty, an autologous tissue graft to the subcutaneous plane is used to reduce postoperative scar. Medial epicanthoplasty, using V-Y advancement and rotation flap, was performed in 93 patients (revision medial epicanthoplasty with autologous tissue graft, 60 patients; revision medial epicanthoplasty only, 33 patients). A V-Y and rotation flap was designed to cover the overexposed lacrimal lake. A small amount of fat tissue and orbicularis oculi muscle were harvested from the upper eyelid through the double-fold line and grafted to the subcutaneous space of the medial epicanthal area. We evaluated the patients' satisfaction with the overall outcome and scar. The mean intercanthal distance increased from 32.3 mm before surgery to 34.6 mm after surgery. Satisfaction with the scar and overall outcome was higher in the patient group who underwent medial epicanthoplasty with autologous tissue graft. No complication was observed in the autologous tissue graft group, whereas 1 patient who underwent medial epicanthoplasty without autologous tissue graft showed recurrence of the medial epicanthal fold, 5 months after surgery. Medial epicanthoplasty with autologous tissue graft is a simple and reliable method to repair the overcorrected medial epicanthus that can efficiently increase the intercanthal distance and prevent scar contracture.

Colgajo fasciocutáneo por pérdida del pulpejo. Presentación de un caso / Fasciocutaneous flap by soft flesh losses. Case Presentation

Introducción: Las pérdidas de sustancia de los pulpejos constituyen uno de los motivos de consulta más frecuentes en las salas de urgencias de traumatología. El pulpejo es el área del dedo con mayor densidad de terminaciones sensoriales, que constituyen el primer eslabón de conexión entre nuestro sistema nervioso central y el medio externo en cuanto a la sensación táctil se refiere. Objetivo: Evidenciar las ventajas del uso del colgajo fasciocutáneo pectoral presentando un caso con lesión del pulpejo del pulgar. Presentación del caso: Un paciente con pérdida traumática del pulpejo del pulgar, a quien se le realiza un colgajo fasciocutáneo pectoral, revisando las particularidades morfofisiológicas del sitio operatorio y el proceder. Conclusiones: Los conocimientos de Morfofisiología Humana tienen importancia y aplicación en diferentes procederes médico-quirúrgicos(AU)

Introduction: Soft flesh losses is one of the most frequent consult's reasons in traumatology's emergency wards. Soft flesh is the at;the finger with higher density of sensorial endings, which constitute the first link between our central nervous system and the external environment in terms of tactile sensation. Objective: to remark the advantage of the use of Pectoral fasciocutaneous flap through a Case Presentation. Case presentation: patient suffering a soft flesh traumatic loss of the tactile pad of the thumb, reviewing the morphophysiological specificities of surgery area and procedure. Conclusions: it is concluded that Human Morphophysiological knowledge are important in several medical-surgical procedures(AU)

Clinical application of subdermal areolar tissue and superficial fascia graft as a new material for coverage of small exposure of bone cortex or orthopaedic fixation device.

BACKGROUND: The presence of cortical bone, tendon that has been exposed by defects, may result in infection or osteomyelitis. In such cases, perifascial areolar tissue grafting (PATG) may be performed as a minimally invasive surgical procedure. However, perifascial areolar tissue (PAT) is located deep in the subcutaneous layer. It was considered that grafting of the superficial vascular network might enable less invasive surgery. This study reports use of subdermal areolar tissue (SAT) and superficial fascia (SF) to close avascular areas. METHODS: This study treated eight areas of exposed bone, tendon, or orthopaedic fixation device in seven patients treated in the department between 2010-2013. The patients included five men and two women aged 15-80 years. Subdermal areolar tissue grafting (SATG) was performed on four areas, and superficial fascia grafting (SFG) on the remaining four areas. In all cases, split thickness skin graft (STSG) was used to cover the grafted tissue in a single procedure. RESULT: The tissue grafted successfully in seven areas, and primary engraftment of the skin grafts was also achieved in three areas treated with SATG and one area treated with SFG. Additional skin grafting was performed to achieve closure in one site treated with SATG and two sites treated with SFG. The tissue graft became necrotic in one site treated with SFG. There were no problems at any donor sites and no graft site infections or other complications. CONCLUSION: SATG and SFG achieved good clinical results for the closure of exposed avascular tissue or artifacts.

Tunneled island flaps in facial defects reconstruction

Abstract The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

Aging hair follicles rejuvenated by transplantation to a young subcutaneous environment.

We demonstrate in the present study that young host mice rejuvenate aged hair follicles after transplantation. Young mice promote the hair shaft growth of transplanted old hair follicles, as well as young follicles, in contrast to old host mice, which did not support hair-shaft growth from transplanted old or young follicles. Nestin-expressing hair follicle-associated pluripotent (HAP) stem cells of transplanted old and young hair follicles remained active in young host nude mice. In contrast, the nestin-expressing HAP stem cells in young and old hair follicles transplanted to old nude mice were not as active as in young nude host mice. The present study shows that transplanted old hair follicles were rejuvenated by young host mice, suggesting that aging may be reversible.

Investigation of Factors Determining the Enhanced Permeability and Retention Effect in Subcutaneous Xenografts.

Liposomal chemotherapy offers several advantages over conventional therapies, including high intratumoral drug delivery, reduced side effects, prolonged circulation time, and the possibility to dose higher. The efficient delivery of liposomal chemotherapeutics relies, however, on the enhanced permeability and retention (EPR) effect, which refers to the ability of macromolecules to extravasate leaky tumor vessels and accumulate in the tumor tissue. Using a panel of human xenograft tumors, we evaluated the influence of the EPR effect on liposomal distribution in vivo by injection of pegylated liposomes radiolabeled with (111)In. Liposomal accumulation in tumors and organs was followed over time by SPECT/CT imaging. We observed that fast-growing xenografts, which may be less representative of tumor development in patients, showed higher liposomal accumulation than slow-growing xenografts. Additionally, several other parameters known to influence the EPR effect were evaluated, such as blood and lymphatic vessel density, intratumoral hypoxia, and the presence of infiltrating macrophages. The investigation of various parameters showed a few correlations. Although hypoxia, proliferation, and macrophage presence were associated with tumor growth, no hard conclusions or predictions could be made regarding the EPR effect or liposomal uptake. However, liposomal uptake was significantly correlated with tumor growth, with fast-growing tumors showing a higher uptake, although no biological determinants could be elucidated to explain this correlation.

Flap or graft: The best of both in nasal ala reconstruction.

UNLABELLED: The area of the nose immediately medial to the nasofacial groove is a common site for relatively small but penetrating basal cell carcinomas (BCCs). Although larger lesions may necessitate formal subunit reconstruction, smaller lesions pose a considerable dilemma. Full-thickness skin grafts (FTSGs) often result in an unsightly contour defect. Local flap options exist, but they frequently violate subunit boundaries or anatomical landmarks. In particular, the single-stage nasolabial transposition flap is particularly prone to blunting of the nasofacial angle and fullness or pin-cushioning of the flap with concomitant loss of facial symmetry. METHOD: We present a consecutive case series of 21 patients with lesions at this site who underwent reconstruction with a combination of a subcutaneous flap from the adjacent cheek fat, which is then resurfaced with an overlying FTSG. RESULTS: A range of defects of dimensions up to 17 mm diameter were included in the series. There were no instances of haematoma, post-operative infection or graft failure. A single patient, who smoked 30 cigarettes daily, underwent a complex reconstruction combining a cartilage graft with a fat flap and a skin graft. He experienced some epidermal loss that healed without intervention, with a remarkable outcome. The results show this to be a reliable and reproducible method that delivers excellent restoration of the contour without disrupting the symmetry of the nasofacial sulcus. CONCLUSION: Augmenting a skin graft with a subcutaneous fat transposition flap is a simple technique that is quick to learn and straightforward to execute. Excellent outcomes were consistently obtained without the asymmetry and pin-cushioning often associated with local flaps at this site.