Composite tissue vasculopathy and degeneration following multiple episodes of acute rejection in reconstructive transplantation.

Transplant vasculopathy has not been systematically investigated in composite tissue allotransplantation (CTA). The impact of multiple acute rejections (ARs) on long-term graft outcomes in reconstructive transplantation remains unknown. This study in a rat hind-limb allotransplantation model systematically analyzes vasculopathy and tissue-specific pathological changes secondary to multiple AR episodes. LEW rats were transplanted with BN rat hind limbs and treated as follows: Group 1 (Iso): isografts. Group 2 (CsA): Cyclosporine (CsA) qd; Group 3 (mult AR): CsA and dexamethasone only when AR was observed. No AR was observed in Groups 1 and 2. Multiple AR were observed in Group 3, and each episode was completely reversed (clinically) with pulsed CsA + dexamethasone treatment. Group 3 animals demonstrated significant vascular lesions along with skin and muscle atrophy, upregulation of profibrotic gene expression and fibrosis when compared to Groups 1 and 2. In addition, allograft bone was sclerotic, weak and prone to malunion and nonunion. Interestingly, vasculopathy was a late finding, whereas muscle atrophy with macrophage infiltration was seen early, after only a few AR episodes. Taken together, multiple AR episodes lead to vasculopathy and tissue-specific pathology in CTA. This is the first evidence of 'composite tissue vasculopathy and degeneration (CTVD)' in CTA.

Dendritic cell therapy in composite tissue allotransplantation.

Dendritic cells (DCs) are bone marrow-derived, professional antigen-presenting cells, with inherent tolerogenic function. The ability of immature or maturation-resistant DCs to regulate alloantigen-specific T-cell responses and to promote tolerance induction has been well demonstrated in organ and bone marrow transplantation. Recent data suggest that DCs can also promote long-term survival of composite tissue allografts in the absence of continued immunosuppressive drug therapy.

Pronounced nasolabial fold: a surgical correction.

A surgical treatment for pronounced nasolabial fold correction through aponeurotic galea, fatty dermic, and dermic autogenous grafts by intraoral access is presented. The results obtained with 20 patients, with up to five years of postoperative observation, are discussed.

Lifting of the eyebrows in blepharoplasties.

Excessive skin in the upper eyelid may be totally or partially a result of ptosis of the eyebrows. In this case, blepharoplasty corrects this deformity insufficiently and may even increase the sagging of the eyebrows, giving the face a sad expression. A technique for lifting the eyebrows during a blepharoplasty is presented. It consists of affixing the dermis and galea to the aponeurosis of the temporal muscle through a subgalean tunnel in the scalp. We believe that this is an anatomically based procedure, is easy to execute, has few complications, yields lasting results with hidden scars, and is of low cost. Among the 100 cases in which this technique was used, the majority showed highly satisfactory results.

Ritidoplastias e lamina conjuntivomuscular. / Rhytidoplasty and conjunctive-muscular layer

Os autores descrevem uma tecnica de ritidoplastia baseada na disseccao, em conjunto, de lamina conjuntiva da regiao pre-auricular e do musculo platisma. Essa unidade e seccionada obliquamente ao nivel do lobulo auricular, formando dois retalhos, sendo o anterior tracionado superiormente e o posterior fixado na regiao mastoidea.Salientam a seguranca do metodo, por evitar disseccao das regioes anatomicas ocupadas pelo nervo facial. Finalmente referem como vantagens do metodo a pequena disseccao cutanea, menor tempo cirurgico e cura mais rapida. Em 60 casos nao tiveram nenhuma lesao do nervo facial ou outras complicacoes mais serias