The Effects of Vascular Endothelial Growth Factor on Capsule Formation around Silicone Implant in Rats

BACKGROUND: The purpose of this study was to examine the effects of a single administration of vascular endothelial growth factor (VEGF) in promoting the angiogenesis and thereby reducing the formation of capsular contracture. METHODS: We treated 24 female Sprague-Dawley rats with (1) 5 mM Tris Buffer and 150 mM NaCl 0.1 cc, (2) VEGF 15 µg/0.1 cc, (3) VEGF 150 µg/0.1 cc during placement of the implant, or (4) VEGF 150 µg/0.1 cc and VEGF 300 µg/0.2 cc. We histopathologically measured the thickness of the capsule and the number of blood vessels. RESULTS: All experimental groups had a significant difference in the thickness of the capsule compared to the control group (P<0.001). There was no significant difference between experimental group 2 and experimental group 3. The number of blood vessels formed around the capsule was significantly greater in all the experimental groups compared with the control group (P<0.05). There was no significant difference between the experimental groups. There was a significant negative correlation between the thickness of the capsule and the number of blood vessels (Spearman's correlation coefficient, 0.2732; P<0.0001). CONCLUSIONS: A single administration of VEGF reduced formation of the capsule and increased the vascularity around the implant, supporting the hypothesis that prevention of tissue ischemia can be a treatment strategy for capsular contracture.

Flank Reconstruction of Large Soft Tissue Defect with Reverse Pedicled Latissimus Dorsi Myocutaneous Flap: A Case Report

PURPOSE: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. METHODS: A 24-year-old male patient had 13.0x7.0x14.0cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. 24x25cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with 2110cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. RESULTS: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. CONCLUSION: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

Magnetic Resonance Guided Focused Ultrasound Induced Dermal Burn, Case Report

PURPOSE: Authors experienced a case of burn induced by magnetic resonance guided focused ultrasound (MRgFUS) which is performed for treatment of uterine myoma. The patient presented unusual progress from that of usual burns and did not cured by conservative treatment. At last the patient underwent surgical treatment. Authors report this rare case of burn induced by focused ultrasound. METHODS: A 26-year-old woman visited the department of gynecology with a abdominal mass. A 9.0x7.9x8.4 cm sized uterine myoma was found after evaluation. The patient was treated with MRgFUS after hormone therapy. Burn was noted on her lower abdomen immediately after MRgFUS and the patient was send to our department. Authors found 3.7x3.3 cm sized superficial second degree burn on her lower abdomen. The wound was treated with conservative methods but the depth extended to subcutaneous layer. 35 days after burn, debridement and primary repair was performed. RESULTS: The wound was healed clearly without any complication. There was no specific complaints or long-term complications during 6 months of follow-up. CONCLUSION: MRgFUS is known as a safe and reliable method for treatment of soft tissue tumors. Ultrasound is concentrated at inner body and generates high thermal energy. It might induce burn. The burn induced by ultrasound seems to have different progress and traits from usual burn wound. It is hard to make a precise diagnosis with external wound only.