Role of matrix metalloproteinases in non-healing venous ulcers.

Chronic venous ulceration (CVU) of the lower limbs is a common condition affecting 1% of the adult population in Western countries, which is burdened with a high complication rate and a marked reduction in the quality of life often due to prolonged healing time. Several metalloproteinases (MMPs) such as MMP-9 together with neutrophil gelatinase-associated lipocalin (NGAL) appear to be involved in the onset and healing phases of venous ulcer, but it is still unclear how many biochemical components are responsible for prolonged healing time in those ulcers. In this study, we evaluate the role of MMP-1 and MMP-8 in long lasting and refractory venous ulcers. In a 2-year period we enroled 45 patients (28 female and 17 male, median age 65) with CVU. The enroled population was divided into two groups: group I were patients with non-healing ulcers (ulcers that had failed to heal for more than 2 months despite appropriate treatments) and group II were patients with healing ulcers (ulcers in healing phases). MMP-1 and MMP-8 were measured in fluids and tissues of healing and non-healing ulcers by means of enzyme-linked immunosorbent assay (ELISA) and Western blot analysis, respectively. In particular the patterns of the collagenases MMP-1 and MMP-8 in healing wounds were distinct, with MMP-8 appearing in significantly greater amounts especially in the non-healing group. Our findings suggest that MMP-1, and MMP-8 are overexpressed in long lasting CVU. Therefore, this dysregulation may represent the main cause of the pathogenesis of non-healing CVU.

A simple method to inset and position polyurethane-covered breast implants.

BACKGROUND: Polyurethane-covered breast implants have been used increasingly for cosmetic and revision breast surgery. The incision for insertion should be of minimal length and the placement of these implants in the pocket can be more difficult than that of conventional implants because of the highly adherent textured surface of the polyurethane external layer that grasps the surrounding tissues. The use of a sterile plastic insertion sleeve that is open on both sides is suggested by the manufacturer to overcome the friction between the polyurethane implant and the skin and surrounding tissues. METHODS: A new method to facilitate polyurethane implant insertion and adjustment in all cases of primary breast augmentation and revision surgery is presented. After the implant, which is in the sleeve, is located in the pocket, the plastic sleeve is filled with saline and antibiotics so the solution lubricates the surface around the implant. The sleeve is then twisted so that the solution is squeezed inside the pocket while the sleeve itself is pulled back and removed. RESULTS: Between 2010 and 2013, this method was used in 73 cases of primary augmentation and revision breast surgery without any complications. CONCLUSION: The method described here allows for easier removal of the plastic sleeve during polyurethane implant insertion without any complications or evidence of implant migration or rotation at follow-up. LEVEL OF EVIDENCE IV: 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 http://www.springer.com/00266 .

Modified superficial musculoaponeurotic system face-lift: a review of 327 consecutive procedures and a patient satisfaction assessment.

BACKGROUND: A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. METHODS: The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. RESULTS: The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. CONCLUSIONS: The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment.

BACKGROUND: Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction. METHODS: Precapsular reaugmentation was performed in 49 patients who underwent cosmetic breast surgery revisions from 2004 to 2009. All patients had previously received breast implants but complained of implant malposition and dislocation, implant size change, capsular contracture, and symmastia. A precise neoprecapsular pocket was developed above the old anterior implant capsule wall, with dissection limited to create only the space necessary for proper placement of the implant. Patients were evaluated for resolution of symptoms, satisfaction, and complications. RESULTS: Implant malposition and rippling, capsular contracture, breast asymmetry, and symmastia were the most common complaints from the first augmentation. Nineteen women had subpectoral implant placement, 12 had subglandular, and the rest (n = 18) had "dual-plane" location of their implants. We used textured silicone implants in 17 cases and polyurethane-coated prostheses in the remaining 32 cases. The average follow-up time was 24.1 months. Breast augmentation-related complications had resolved in all patients without any recurrence to date. The overall complication rate was very low and patient satisfaction with this procedure was extremely high. CONCLUSION: The creation of a neoprecapsular pocket combined in peculiar cases with the placement of polyurethane-coated implants is a versatile option that offers an effective one-stage solution for the correction of cosmetic mammaplasty-induced deformities.