In Vitro Analysis of Histology, Mechanics, and Safety of Radiationfree Pre-hydrated Human Acellular Dermal Matrix / 한국유방암학회지

Purpose@#Acellular dermal matrix (ADM) supports tissue expanders or implants in implant-based breast reconstruction. The characteristics of ADM tissue are defined by the manufacturing procedure, such as decellularization, preservation, and sterilization, and are directly related to clinical outcomes. This study aimed to compare the properties of a new pre-hydrated-ADM (H-ADM-low) obtained using a decellularization reagent reduction process with a low concentration of detergent with those of radiation-sterilized H-ADM and freeze-dried ADM (FD-ADM). @*Methods@#ADMs were evaluated in terms of structure, mechanical quality, and cytotoxicity using histochemical staining, tensile strength testing, and in vitro cell viability analysis. @*Results@#The tissue structure of H-ADM-low (CGDERM ONE-STEP) was similar to that of native skin despite complete decellularization. By contrast, in FD-ADM, the tissue structure was damaged by the freeze-drying process, and radiation-sterilized H-ADM showed a compact fibrillar arrangement. Furthermore, matrix components such as collagen and elastin were preserved in H-ADM-low, whereas a loss of elastin fibers with fragmented distribution was observed in radiation-sterilized H-ADMs. H-ADM-low's tensile strength (58.84 MPa) was significantly greater than that of FD-ADM (38.60 MPa) and comparable with that of radiationsterilized H-ADMs. The residual detergent content in H-ADM-low (47.45 mg/L) was 2.67-fold lower than that of H-ADM decellularized with a conventional detergent concentration (126.99 mg/mL), and this finding was consistent with the cell viability results (90.7% and 70.7%, respectively), indicating that H-ADM-low has very low cytotoxicity. @*Conclusions@#H-ADM-low produced through aseptic processes retains the original tissue structure, demonstrates excellent mechanical properties, and does not affect cell viability.Therefore, this newer H-ADM is suitable for use in implant-based breast reconstruction.

In Vitro Analysis of Histology, Mechanics, and Safety of Radiationfree Pre-hydrated Human Acellular Dermal Matrix / 한국유방암학회지

Purpose@#Acellular dermal matrix (ADM) supports tissue expanders or implants in implant-based breast reconstruction. The characteristics of ADM tissue are defined by the manufacturing procedure, such as decellularization, preservation, and sterilization, and are directly related to clinical outcomes. This study aimed to compare the properties of a new pre-hydrated-ADM (H-ADM-low) obtained using a decellularization reagent reduction process with a low concentration of detergent with those of radiation-sterilized H-ADM and freeze-dried ADM (FD-ADM). @*Methods@#ADMs were evaluated in terms of structure, mechanical quality, and cytotoxicity using histochemical staining, tensile strength testing, and in vitro cell viability analysis. @*Results@#The tissue structure of H-ADM-low (CGDERM ONE-STEP) was similar to that of native skin despite complete decellularization. By contrast, in FD-ADM, the tissue structure was damaged by the freeze-drying process, and radiation-sterilized H-ADM showed a compact fibrillar arrangement. Furthermore, matrix components such as collagen and elastin were preserved in H-ADM-low, whereas a loss of elastin fibers with fragmented distribution was observed in radiation-sterilized H-ADMs. H-ADM-low's tensile strength (58.84 MPa) was significantly greater than that of FD-ADM (38.60 MPa) and comparable with that of radiationsterilized H-ADMs. The residual detergent content in H-ADM-low (47.45 mg/L) was 2.67-fold lower than that of H-ADM decellularized with a conventional detergent concentration (126.99 mg/mL), and this finding was consistent with the cell viability results (90.7% and 70.7%, respectively), indicating that H-ADM-low has very low cytotoxicity. @*Conclusions@#H-ADM-low produced through aseptic processes retains the original tissue structure, demonstrates excellent mechanical properties, and does not affect cell viability.Therefore, this newer H-ADM is suitable for use in implant-based breast reconstruction.

Analysis of prognostic factors affecting poor outcomes in 41 cases of Fournier gangrene

PURPOSE: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. METHODS: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. RESULTS: A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24–79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. CONCLUSION: Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.

Reduction of Closed Frontal Sinus Fractures through Suprabrow Approach

BACKGROUND: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. METHODS: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. RESULTS: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. CONCLUSION: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.

Surgical Correction of a Median Cleft of the Upper Lip Associated with Enlarged Frenulum and Palatal Masses

PURPOSE: Median cleft of upper lip is defined as any congenital vertical cleft through the midline of the upper lip. It is uncommon, its embryological pathogenesis remains unexplained to date. The authors hereby report a rare case of median cleft of the upper lip associated with enlarged frenulum and palatal mass. This case offers some understanding of the possible embryologic development of this anomaly. METHODS: A 10-month-old boy born by normal vaginal delivery at full-term had a notch in the midline of the upper lip with widened philtrum along with enlarged median frenulum, alveolar cleft, and mass of the hard palate. We performed en bloc resection of the enlarged frenulum and palatal mass and cheiloplasty under general anesthesia. RESULTS: Histological examination revealed that the frenulum and palatal mass was consisted of fibrous tissue with normal mucous membrane. The postoperative course was satisfactory. CONCLUSION: A rare case of median cleft of the upper lip with associated enlarged frenulum and palatal mass was presented with proper surgical management. The surgical technique includes marginal excision of the clefted epithelium and reconstruction of orbicularis oris muscle, in addition to en bloc resection of the palatal mass and frenulotomy.

Treatment of Complex Open Wounds Using AlloDerm(R) in Hand and Foot

PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.

Acceleration of Wound Healing Using Adipose-derived Stem Cell Therapy with Platelet Concentrates: Platelet-rich Plasma (PRP) vs. Platelet-rich Fibrin (PRF)

PURPOSE: Although platelet-rich plasma (PRP) potentiate the wound healing activity of adipose-derived stem cells (ADSCs), its effect cannot be sustained for a prolonged period of time due to short duration of action. This led us to design and produce platelet-rich fibrin (PRF), in an effort to develop a tool which lasts longer, and apply it on wound healing. METHODS: Two symmetrical skin defects were made on the back of seven nude mice. ADSCs were applied to each wound, combined with either PRP or PRF. The wound area was measured over 14 days. By day 16, the wound was harvested and histologic analysis was performed including counting of the blood vessel. RESULTS: The healing rate was more accelerated in PRP group in the first 5 days (p<0.05). However, PRF group surpassed PRP group after 6 days (p<0.05). The average number of blood vessels observed in the PRF group was 6.53 +/- 0.51, compared with 5.68 +/- 0.71 for the PRP group. CONCLUSION: PRF exerts a slow yet pervasive influence over the two-week course of the wound healing process. Thus, PRF is probably more beneficial for promoting the activity of ADSCs for a sustained period of time.

The Effectiveness of Percutaneous Transarterial Embolization for Arteriovenous Malformation

PURPOSE: To determine the effectiveness of percutaneous transarterial embolization for the treatment of arteriovenous malformation (AVM). MATERIALS AND METHODS: Seven patients with AVMs located in the kidney, liver, lung, chest wall, uterus and paraspinal region underwent angiography and percutaneous transarterial embolization. The embolic materials used were steel coil, gelfoam, contour emboli, and absolute alcohol; in some cases, more than one of these were employed. The analysed the angiographic findings and clinical status following embolization were assessed and analysed. RESULTS: The AVMs had tortuous, dilated feeding arteries (n=7) and veins with early venous drainage (n=6). In the hepatic AVM, a grape-like dilated vessel arose from the hepatic artery and was connected to the portal vein. In the uterine AVM, numerous dilated feeding arteries formed a honeycomb. In the feeding arteries of the chest wall AVM and in the nidus of the pulmonary AVM, aneurysms were present. In simple AVMs, the patient's symptoms were relieved by first embolization. Complex AVMs, however, required repeated embolizations for symptomatic relief. Although extensive, complex AVMs of the chest wall and uterus recurred after initial embolization, repeated treatment successfully improved the clinical status of such patients. The complications developing after emboliation were fever (n=3) and pain (n=3), but these were relieved by conservative care. CONCLUSION: Percutaneous transarterial embolization is a safe and effective therapeutic method for the treatment of AVM. In a case of inoperable complex AVM, repeated embolization is the only method for symptomatic relief and the maintenance of life.