Resolución de tumores de canto interno mediante la utilización de colgajos locales / Resolution of internal canthal tumors by using local flaps

En la reconstrucción del canto interno palpebral es importante mantener la ininterrupción del color, la textura y del grosor del tejido que vamos a sustituir. El carcinoma basocelular es la patología maligna más frecuentemente hallada en esta región, la edad promedio de presentación es de 60 años. Se propone presentar algunos casos clínicos para demostrar la resolución de las diferentes formas de presentación de los tumores de dicha ubicación. Se recurre como metodología a la revisión de casos clínicos y presentación de resultados quirúrgicos. El diseño del plan quirúrgico reconstructivo de esta región es complejo debido a las estructuras anatómicas involucradas en el canto interno, al contorno único de la zona, y la multitud de técnicas disponibles.

In reconstruction of the medial canthal region it is of the uttermost importance to maintaincolor, texture and thickness of the tissue bound to be replaced. Basal cell carcinoma is the histological malignancy most frequently found in this region, the average decade of presentation is 60-70 years.It is proposed to present representative clinical cases to demonstrate the resolution of the different forms of presentation of the tumors of said location.Methodology is used as a review of clinical cases, treatment and follow-up of patients.Thedesign of the reconstructive surgical plan of this region is complex due to the anatomical structures involved in the internal canthus, the unique contour of the area, and the abundance of available techniques.

Adipose-derived stem cell transplantation for therapeutic lymphangiogenesis in a mouse secondary lymphedema model.

AIM: Secondary lymphedema is observed in common after postmalignancy treatment of the breast and the gynecologic organs but effective therapies are not established. Adipose-derived stem cells (ADSCs), which are pluripotent, regenerative in local injection, are tested for murine hindlimb secondary lymphedema by regenerative method. METHODS & RESULTS: Mice were divided into four groups: no ADSCs, 1 × 10(6) ADSCs, 1 × 10(5) ADSCs and 1 × 10(4) ADSCs (each group, n = 20) in a stringent surgical resection and irradiation. Circumferential measurement, lymphatic flow assessment and quantification of lymphatic vessels were performed. RESULTS: The numbers of lymphatic vessels by LYVE-1 immunohistochemistry, and VEGF-C- or VEGFR3-expressing cells were significantly increased in transplanted groups (p < 0.05). CONCLUSION: ADSCs can restore the lymphatic vascular network in secondary lymphedema with increased collecting vessels.

Breast Reconstruction After Radiotherapy.

It was once common practice in the treatment of breast cancer for total mastectomy and axillary lymph node dissection to be conventionally performed. However, breast-conserving surgery is increasingly being performed with marked improvement in a multidisciplinary treatment approach, including surgery, chemotherapy, irradiation, and antihormonal therapy. We must choose the optimal reconstructive methods with the reduction of the excision range. Furthermore, we also consider the local chronic radiation injury after adjuvant radiotherapy on breast reconstruction. As for breast reconstruction, the use of autologous tissues or artificial prostheses is common. However, after radiotherapy or if radiotherapy is planned, the complications such as infection, skin necrosis, or exposure of the implant are increased in breast reconstruction with implants. Therefore, the breast is reconstructed with autologous tissue mainly with radiotherapy using an autologous flap transfer. Meanwhile, the autologous fat transfer with adipose-derived regenerative cells for repair and regeneration has recently been investigated in reconstructive surgery. We discuss the autologous flap and fat transfer for breast reconstruction.

One-stage, simultaneous skin grafting with artificial dermis and basic fibroblast growth factor successfully improves elasticity with maturation of scar formation.

The efficacy of one-stage artificial dermis and skin grafting was tested in a nude rat model. Reconstruction with artificial dermis is usually a two-stage procedure with 2- to 3-week intermission. If one-stage use of artificial dermis and split-thickness skin grafting are effective, the overall burden on patients and the medical cost will markedly decrease. The graft take rate, contraction rate, tissue elasticity, histology, morphometric analysis of the dermal thickness, fibroblast counting, immunohistochemistry of α-smooth muscle actin, matrix metalloproteinase-2, CD31, and F4/80, as well as gelatin zymography, real-time reverse transcriptase polymerase chain reaction for matrix metalloproteinase-2, and electron microscopy, were investigated from day 3 to 3 months postoperatively. The graft take rate was good overall in one-stage artificial dermis and skin grafting groups up to 3 weeks, and the contraction rate was greater in the two-staged artificial dermis and skin grafting group than in the skin grafting alone or one stage of artificial dermis and skin grafting groups. Split-thickness skin grafting with artificial dermis and basic fibroblast growth factor at a concentration of 1 µg/cm(2) showed significantly greater elasticity by Cutometer, and the dermal thickness was significantly thinner, fibroblast counting was significantly greater, and the α-smooth muscle actin expression level was more notable with a more mature blood supply in the dermis and more organized dermal fibrils by electron microscopy at 3 weeks. Thus, one-stage artificial dermis and split-thickness skin grafting with basic fibroblast growth factor show a high graft take rate and better tissue elasticity determined by Cutometer analysis, maturity of the dermis, and increased fibroblast number and blood supply compared to a standard two-stage reconstruction.

The usefulness of basic fibroblast growth factor for radiation-exposed tissue.

A high dose of ionizing external radiation damage to the skin and soft tissue results in changes in function as well as in the general body condition. Once radiation surpasses the tissue safety or survival level, progressive alteration in the damaged tissue results in tissue loss and then flap loss. Local expression and action of stem cells or local growth factors in the irradiated tissue is mitigated, and external administration is sought to investigate the possibility of skin and soft tissue survival after an elevating flap. Basic fibroblast growth factor (bFGF) is primarily considered as a potent angiogenic growth factor. In burns, resurfacing with a dermal component is required, and bFGF stimulates wound healing and enhances human skin-derived mesenchymal stem cells under serum-free conditions in a dose-dependent manner. Thirty-five male, 4- to 8-week-old CLAWN miniature pigs received radiation exposure to assess the effectiveness of bFGF in terms of the progressive clinical course relevant to human skin and soft tissue. At 2 weeks following 10-Gy irradiation, tissue was preserved in the group receiving subcutaneous placement of a round-type tissue expander and bFGF. The expander plus bFGF group demonstrated significantly greater dermo-epidermal proliferation than the radiation alone, radiation plus bFGF, or expander plus radiation plus vehicle-solution groups, and new blood vessel formation was significantly increased in the expander tissue with bFGF after irradiation (p < 0.01). Electron microscopy revealed that tissue with expander and bFGF maintained more stable skin adnexae with preserved intact epidermis and dermis. Thus, bFGF improved and maintained the tissue viability after immediate irradiation in the skin and soft tissue.