Lipofilling (fat grafting) in the secondary prevention of ischial tuberosity and pelvic pressure ulcers.

STUDY DESIGN: Retrospective study. OBJECTIVES: Lipofilling was proposed to adult chronic spinal cord injury patients with history of ischial tuberosity pressure ulcers surgery, at risk of recurrence of pressure ulcers due to unsatisfactory adipose tissue thickness. SETTING: Fondation Hopale, Berck, France. METHODS: The three staged (Coleman) procedure for fat grafting consisted of water-jet assisted liposuction (Harvest-Jet), decantation, and reinjection of the autologous fat in three-dimensional plan. RESULTS: Ten consecutive patients (eight paraplegics and two tetraplegics) benefited from bilateral ischial lipofilling, with additional lipofilling of the sacrum (three patients) and the trochanters (two patients). All patients attended the seating clinic with pressure mapping before and after lipofilling for appropriate cushion prescription. Mean follow-up time was 16 months (4-24 months). Complications were limited to stage I (two patients) and stage II (one patient) pressure ulcers, due to negligence. Excellent results with minimal fat wasting (between 10% and 25%) underneath the ischial tuberosity were seen in eight patients, with significant improvement of adipose tissue thickness. Total fat waste was seen in two patients, one of whom following dramatic weight loss. Results were always good in the sacrum and trochanteric areas. Lipofilling allowed longer sitting times (three patients), improved skin quality (nine patients), improved quality of life (six patients), 'a better feeling of positioning in their wheelchair' (four patients), and decrease in pelvic pain (three patients). DISCUSSION AND CONCLUSION: Pelvic lipofilling is safe, cost-effective, and can now be considered in the primary prevention of pelvic pressure ulcers in patients with insufficient adipose tissue.

[Method of esthetic evaluation of the reconstructed breast after cancer. Report of 76 cases]. / Intérêt d'une méthode d'évaluation esthétique du sein reconstruit après cancer. A propos de 76 cas.

The authors propose a simple method of aesthetic evaluation of breast reconstructions after cancer, based on a 20-point score. In the 76 patients included in this study and mainly reconstructed by implant, the following seven criteria were evaluated by a score: the reconstructed breast, the symmetrized breast, symmetry of the 2 breasts, the areola, the nipple, the areolo-nipple complex (ANC) and the overall reconstruction. The first score was established during the visit by the patient and independently by the same plastic surgeon. The score was then established during two sessions of projection of standardized photographs, by two groups, A and B, composed of 9 nurses and secretaries and 10 plastic surgeons, respectively. Statistical analysis of the results showed that the scores for these criteria were all correlated for all examiners. This study confirms the reliability of aesthetic evaluation of breast reconstruction after cancer, by a group composed of 2 men and 2 women, surgeons or non-surgeons, on photographs or on clinical examination, based on a 20-point score.

Use of [35S]methionine-labelled rat lymphoblasts in micro-cytotoxic and limiting dilution assays.

When only limited numbers of effector cells are available for in vitro T cytotoxic determinations, standard assays cannot be performed. 51Cr is still the most commonly used marker of target cells in cytotoxicity assays but since the incorporation of this marker is low, especially in non-tumor cells such as lymphoblasts, larger numbers of both target and effector cells are required. Here we report the use of [35S]methionine-labelled rat ConA blasts in cytotoxic, micro-cytotoxic and limiting dilution assays. Regardless of whether [35S]methionine or 51Cr targets were employed, cytotoxic activities were identical when large numbers of target cells (10(4)) were used. The high uptake of [35S]methionine by ConA blasts (9 cpm/cell) permitted the use of a small number of target cells without any loss of sensitivity. Therefore, the number of effectors and targets required was dramatically reduced, especially with high E : T ratios such as 100 : 1. The use of low number of [35S]methionine-labelled rat ConA blasts as targets was also suitable for the measurement of alloreactive T cell precursor frequencies. This technique illustrates the possibility of studying T cytotoxicity in animal species lacking tumor target cell lines under experimental conditions where the availability of effector cells is limited and the optimal use of such cells becomes critical.