Intraoperative Intradermal Application of Stromal Vascular Fraction into the Abdominal Suture Line: Histological Analysis of Abdominal Scar Tissue.

BACKGROUND: Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration. METHODS: In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography. RESULTS: Cell yield for application and cell viability were 55.9 ± 28.5 × 106 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density. CONCLUSIONS: It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal-dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Validation of preoperative nerve conduction studies by intraoperative studies in patients with ulnar neuropathy at the elbow.

OBJECTIVE: To validate the findings of preoperative motor short-segment nerve conduction studies (SSNCSs) by intraoperative SSNCSs in patients with cubital tunnel syndrome. METHODS: We prospectively recruited patients with ulnar neuropathy at the elbow (UNE) localized distal to the medial epicondyle (ME). Preoperatively, motor SSNCSs and ultrasonography (US) were performed. Immediately after surgical dissection of the humeroulnar aponeurotic arcade (HUA), intraoperative near-nerve motor SSNCSs were performed, and compared to preoperative findings. RESULTS: We studied 36 arms with UNE in the cubital tunnel. Preoperative US localized UNE distal to ME in all operated arms, and demonstrated ulnar nerve constriction in 19 of them. Visual inspection confirmed ulnar nerve swelling in all studied nerves, but was unreliable with regard to ulnar nerve constriction. In all 5 (14%) arms with inconclusive localization by SSNCSs, intraoperative SSNCSs confirmed the preoperative US diagnosis of cubital tunnel syndrome. Intraoperative SSNCSs confirmed the preoperative localization in 24 (67%) arms, and were non-contributive in 7 (19%) arms with intraoperatively non-recordable responses. CONCLUSION: Intraoperative near-nerve SSNCSs did not change the localization in any of 36 arms with UNE distal to ME. Therefore, our data indicate that a combination of preoperative SSNCSs and US reliably localizes UNE in the cubital tunnel. SIGNIFICANCE: Our present study suggests that in arms with consistent preoperative SSNCSs and US studies, no intraoperative near-nerve SSNCSs are needed to confirm ulnar nerve entrapment under the HUA.

Adipose-Derived Stem Cells Respond to Increased Osmolarities.

Cell therapies present a feasible option for the treatment of degenerated cartilaginous and intervertebral disc (IVD) tissues. Microenvironments of these tissues are specific and often differ from the microenvironment of cells that, could be potentially used for therapy, e.g. human adipose-derived stem cells (hASC). To ensure safe and efficient implantation of hASC, it is important to evaluate how microenvironmental conditions at the site of implantation affect the implanted cells. This study has demonstrated that cartilaginous tissue-specific osmolarities ranging from 400-600 mOsm/L affected hASC in a dose- and time-dependent fashion in comparison to 300 mOsm/L. Increased osmolarities resulted in transient (nuclear DNA and actin reorganisation) and non-transient, long-term morphological changes (vesicle formation, increase in cell area, and culture morphology), as well as reduced proliferation in monolayer cultures. Increased osmolarities diminished acid proteoglycan production and compactness of chondrogenically induced pellet cultures, indicating decreased chondrogenic potential. Viability of hASC was strongly dependent on the type of culture, with hASC in monolayer culture being more tolerant to increased osmolarity compared to hASC in suspension, alginate-agarose hydrogel, and pellet cultures, thus emphasizing the importance of choosing relevant in vitro conditions according to the specifics of clinical application.

Fat necrosis in free DIEAP flaps: incidence, risk, and predictor factors.

Fat necrosis within a deep inferior epigastric artery perforator flap reconstructed breast is considered a minor complication from reconstructive point of view, but one that can induce anxiety, inconvenience and concerns about cancer recurrence to the oncologist and the patient. A series of 100 consecutive unilateral deep inferior epigastric artery perforator flap breast reconstructions were reviewed to identify the institutional incidence as well as potential risk and predictor factors of fat necrosis. Examination revealed 37 reconstructed breasts with palpable firmnesses (described as clinical fat necrosis) and ultrasonography and mammography confirmed signs of fat necrosis in 30 reconstructed breasts. Flaps harvested on a single perforator, obese patients with body mass index > or = 30 and revision operations were all statistically significant predictors in our statistical model. Postoperative radiotherapy, a reconstructed breast volume over 500 mL and a pedicle raised on a single row of perforators were statistically significant only after univariate analysis and their statistical strength was lost after introducing them with multivariate model. This study helped us to further clarify criteria for selection of patients undergoing breast reconstruction with flaps from the abdomen.