The Evidence for Adjunctive Facelift Procedures.

Facelift surgery is a popular treatment but exhibits high variation among practitioners in terms of both core technique and adjunctive measures. This review identified significant evidence addressing the role of pre-infiltration, drains, fat grafting, fibrin tissue adhesives, hilotherapy, and other miscellaneous adjuncts. Based on the authors' assessment of the current literature, there is reasonable supportive evidence for pre-infiltration, fat grafting and laser skin resurfacing, which appear to be safe and effective in appropriately selected patients. Drain use is not mandatory but may confer some benefit. Conversely the evidence for the use of fibrin tissue adhesives and hilotherapy is not compelling.

Adipose-Derived Stem Cells in Aesthetic Surgery: A Mixed Methods Evaluation of the Current Clinical Trial, Intellectual Property, and Regulatory Landscape.

BACKGROUND: Adipose tissue, which can be readily harvested via a number of liposuction techniques, offers an easily accessible and abundant source of adipose-derived stem cells (ASCs). Consequently, ASCs have become an increasingly popular reconstructive option and a novel means of aesthetic soft tissue augmentation. OBJECTIVES: This paper examines recent advances in the aesthetic surgery field, extending beyond traditional review formats to incorporate a comprehensive analysis of current clinical trials, adoption status, and the commercialization pathway. METHODS: Keyword searches were carried out on clinical trial databases to search for trials using ASCs for aesthetic indications. An intellectual property landscape was created using commercial software (Thomson Reuters Thomson Innovation, New York, NY). Analysis of who is claiming what in respect of ASC use in aesthetic surgery for commercial purposes was analyzed by reviewing the patent landscape in relation to these techniques. Key international regulatory guidelines were also summarized. RESULTS: Completed clinical trials lacked robust controls, employed small sample sizes, and lacked long-term follow-up data. Ongoing clinical trials still do not address such issues. In recent years, claims to intellectual property ownership have increased in the "aesthetic stem cell" domain, reflecting commercial interest in the area. However, significant translational barriers remain including regulatory challenges and ethical considerations. CONCLUSIONS: Further rigorous randomized controlled trials are required to delineate long-term clinical efficacy and safety. Providers should consider the introduction of patient reported outcome metrics to facilitate clinical adoption. Robust regulatory and ethical policies concerning stem cells and aesthetic surgery should be devised to discourage further growth of "stem cell tourism."

Quantitative assessment of tissue sections by Reverse Colour Coding.

Stains and dyes are frequently used to emphasise tissue structures for viewing under microscopy but few simple objective quantification methods exist. We describe the derivation of a mathematical formula enabling calculation of the relative contribution of three different coloured components to an image, which can be applied to rapid batch assessment of tissue sections for quantification of area proportions of differently stained elements. In order to validate this method, termed Reverse Colour Coding (RCC), we compared RCC estimations with known area proportions in artificially created images to calculate absolute accuracy, and compared RCC with panel visual estimation (VE) for the assessment of actual NCAM-stained muscle slides. Our results indicate that RCC has an absolute accuracy of 98-98.5% and superior inter-observer agreement and both inter- and intra-observer variability compared with VE. Results also suggest that cognitive bias occurring with VE may be eliminated by use of RCC. We submit RCC as a more accurate and less labour-intensive method of quantifying area proportions of stained tissues on microscopic images.

Practical nerve morphometry.

Histopathological examination of peripheral nerves is often complemented by morphometric analysis in both clinical and research settings. However, existing manual or semi-automated methods are highly tedious, labour intensive and time-consuming, whereas fully automated morphometry is prone to error from the conversion of maldetected particles to spurious data. Both fully and interactive-automated morphometry have significant hardware requirements and may be difficult to implement. A new method for nerve morphometry is described aiming to combine the speed of automated morphometry with the accuracy of manual or semi-automated methods, and requiring only a digital image of the nerve section and two widely available software packages. Comparison with a standard digitizer pen method of nerve morphometry without sampling yielded statistically similar axon counts, mean area assessments and axonal area frequency distribution histograms, with assessment times of the new method between 35% and 45% of those of the standard method. This has widespread potential experimental and clinical applications and offers a means of relieving much of the tedium currently associated with nerve morphometry.

Use of the interposed nerve graft to reduce differences in functional muscle transfer outcome arising from variability in motor input.

Regulation of functional muscle transfer outcome by means of an interposed nerve graft: The gold standard treatment of chronic unilateral facial palsy is a functional muscle transfer (FMT) reinnervated by a branch of the contralateral facial nerve via a cross-facial nerve graft, but clinical outcome varies from underactivity to overactivity of the transferred muscle. Work in an animal model has established that the magnitude of donor motor input received by heterotopically transferred muscle correlates with reinnervation and force production, the corollary being that standardising donor motor input could standardise outcome. We hypothesise that a 'low-capacity' interposed nerve graft could deliver a fixed motor input to an FMT despite variable motor input, thereby standardising force production and clinical outcome. To test this hypothesis, we compared reinnervation and force production by FMTs reinnervated with different-sized motor inputs via high- and low-capacity interposed nerve grafts. Force production was measured in vivo after recovery of transplanted muscle, and reinnervation quantified by both nerve morphometry and intramuscular immunohistochemical staining for protein gene product 9.5. Both reinnervation and force production data suggest that outcome correlates with donor motor nerve magnitude only when a high-capacity interposed nerve graft is used, this correlation being lost when using a low-capacity interposed nerve graft. The implications for human facial reanimation surgery are discussed.

The 'Butter Test' to guide effective tissue cleansing after high-pressure injection injury.

A case of high-pressure fingertip injury with an unknown paint primer injectate, and the use of a simple test to determine whether it is water- or solvent-based in order to guide subsequent optimal debridement, is presented. The favourable outcome achieved was felt to have resulted, in part, from the effective single debridement thus achieved.

Cutaneous scarring: a clinical review.

Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a preventative or curative antiscarring agent. Such a discovery would be of enormous medical and commercial importance, not least because it may have application in other tissues. In the clinical context the assessment of scars is becoming more sophisticated and new physical, medical and surgical therapies are being introduced. This review aims to summarise some of the recent developments in scarring research for non-specialists and specialists alike.

Effect of caffeine on microsurgical technical performance.

Microsurgeons may choose to avoid caffeine to prevent potentially deleterious caffeine tremor, although an adverse effect on surgical skill has never been shown. This double-blind placebo-controlled crossover study investigated the effect of moderate caffeine intake on microsurgical ability among microsurgical training course attendees. Subjects were randomized to receive either morning placebo and afternoon caffeine, or the reverse, thereby acting as their own controls. Performance in end-to-end vessel anastomosis was graded by a single observer during both sessions using a global rating scale. Subjects consuming caffeine in the morning demonstrated significantly improved scores from morning to afternoon, whereas subjects consuming caffeine in the afternoon showed no such improvement. These results are consistent with an adverse effect of caffeine on microsurgical skill combined with a learning curve among the study population of novice microsurgeons, and support the view that caffeine has a detrimental effect on microsurgical ability among this study group.