Midface anatomy, aging, and aesthetic analysis.

This article reviews the key anatomic structures in the region of the midface, including important surface and bony landmarks, innervation, blood supply, muscle layers, and fat compartments. It also discusses changes in these structures related to the aging process and aesthetic analysis of the midface to aid with operative planning.

Facelifting: anatomical considerations.

Facelifting techniques continue to evolve as our understanding of facial aging improves. Improved technology to affect changes on skin for tightening and volume restoration with fat grafting or fillers have improved results and safety for our patients. Success with facelifting and facial rejuvenation requires an understanding of the underlying anatomy and allows restoration of the anatomy to the younger more youthful status while avoiding complications.

The impact of a standardized consultation form for facial trauma on billing and evaluation and management levels.

BACKGROUND: Facial trauma is among the most frequent consultations encountered by plastic surgeons. Unfortunately, the reimbursement from these consultations can be low, and qualified plastic surgeons may exclude facial trauma from their practice. An audit of our records found insufficient documentation to justify higher evaluation and management (EM) levels of service resulting in lower reimbursement. Utilizing a standardized consultation form can improve documentation resulting in higher billing and EM levels. METHODS: A facial trauma consultation form was developed in conjunction with the billing department. Three plastic surgery residents completed 30 consultations without the aid of the consult form followed by 30 consultations with the aid of the form. The EM levels and billing data for each consultation were obtained from the billing department for analysis. The 2 groups were compared using χ2 analysis and t tests to determine statistical significance. RESULTS: Using our standardized consultation form, the mean EM level increased from 2.97 to 3.60 (P = 0.002). In addition, the mean billed amount increased from $391 to $501 per consult (P = 0.051) representing a 28% increase in billing. CONCLUSIONS: In our institution, the development and implementation of a facial trauma consultation form has resulted in more complete documentation and a subsequent increase in EM level and billed services.

Outpatient lipoabdominoplasty: review of the literature and practical considerations for safe practice.

BACKGROUND: Lipoabdominoplasty, popularized by Saldanha et al in 2001, is a powerful technique to contour the abdomen and flanks. It has not gained widespread use as concerns exist about increased complications related to wound healing and thromboembolism. OBJECTIVES: The authors review the existing literature on lipoabdominoplasty and discuss their experiences with the technique in a retrospective case series. METHODS: A literature search of PubMed/MEDLINE using the search terms lipoabdominoplasty and abdominoplasty was performed by 2 independent investigators. The charts of 85 consecutive patients who underwent lipoabdominoplasty between February 2007 and July 2012 were reviewed. RESULTS: A combined 1316 lipoabdominoplasty patients had results reported in the literature. Of these patients, 21 of 1316 (1.6%) developed seroma, 5 of 1032 (0.5%) experienced hematoma, 6 of 1032 (0.6%) experienced venous thromboembolism, and 3 of 1032 (0.3%) developed pulmonary embolism. In our case series, all patients were women with an average age of 48 years (range, 27-70 years), average body mass index of 25.2 (17.7-35.5), average follow-up of 8 months (range, 1-54 months), average lipoaspirate of 1605 mL (range, 150-5350 mL), and average weight of resected tissue of 1039 g (range, 128-4838 g). The average operative time was 225 minutes (range, 88-435 minutes), and average time in recovery prior to discharge was 124 minutes (range, 33-270 minutes). Seroma occurred in 20 of 85 patients, 1 patient developed deep venous thrombosis (DVT), 1 patient developed cellulitis, and 1 patient developed an abscess. CONCLUSION: Lipoabdominoplasty is a safe and effective procedure in appropriately selected patients. Performing the procedure in an outpatient setting requires attention to multiple factors in the perioperative period to ensure safe patient outcomes. Larger prospective studies should be performed to evaluate best practices regarding rare complications such as DVT or pulmonary embolism.

Beard reconstruction using hair grafts in a free flap.

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.

Assessing macroinvertebrate biodiversity in freshwater ecosystems: advances and challenges in DNA-based approaches.

Assessing the biodiversity of macroinvertebrate fauna in freshwater ecosystems is an essential component of both basic ecological inquiry and applied ecological assessments. Aspects of taxonomic diversity and composition in freshwater communities are widely used to quantify water quality and measure the efficacy of remediation and restoration efforts. The accuracy and precision of biodiversity assessments based on standard morphological identifications are often limited by taxonomic resolution and sample size. Morphologically based identifications are laborious and costly, significantly constraining the sample sizes that can be processed. We suggest that the development of an assay platform based on DNA signatures will increase the precision and ease of quantifying biodiversity in freshwater ecosystems. Advances in this area will be particularly relevant for benthic and planktonic invertebrates, which are often monitored by regulatory agencies. Adopting a genetic assessment platform will alleviate some of the current limitations to biodiversity assessment strategies. We discuss the benefits and challenges associated with DNA-based assessments and the methods that are currently available. As recent advances in microarray and next-generation sequencing technologies will facilitate a transition to DNA-based assessment approaches, future research efforts should focus on methods for data collection, assay platform development, establishing linkages between DNA signatures and well-resolved taxonomies, and bioinformatics.

Successful incorporation of tissue-engineered porcine small-intestinal submucosa as substitute flexor tendon graft is mediated by elevated TGF-beta1 expression in the rabbit.

PURPOSE: Ideal tendon repair materials combine minimal donor-site morbidity and ready availability with excellent healing and postoperative function. Bioengineered porcine small-intestinal submucosa (SIS) was compared with tendon autografts as a potential human flexor tendon graft substitute. METHODS: Rabbit zone II flexor digitorum profundus segments were excised in 40 rabbits. Randomized tendon repair consisted of either interposition reversed autograft or SIS, passed beneath the A2 and A4 pulleys. Forepaws were statically splinted for 3 weeks followed by unrestricted motion. Animals were killed at 7, 14, 28, and 56 days. Specimens were analyzed for hydroxyproline content (absorption spectroscopy) and tensile strength. Hematoxylin-eosin and Movat-stained sections of the central graft and distal repair site were semiquantitatively scored for total cellularity, inflammatory cell content, foreign-body reaction, vascularity, mature collagen content, and new collagen deposition. Transforming growth factor-beta (TGF-beta1) and TGF-beta1 receptor immunostaining was performed. RESULTS: At week 1, SIS hydroxyproline content was significantly reduced compared with autograft hydroxyproline content. However, week 2 SIS hydroxyproline content increased to equivalent values. Collagen deposition was evident in SIS by week 1 but negligible in autograft. More rapid total and inflammatory cell increases occurred in SIS by 4 weeks. A stronger early inflammatory reaction also occurred. More rapid SIS neovascularization occurred despite a greater foreign-body reaction. Small-intestinal submucosa vascularity was markedly greater at weeks 1 and 2 and equivalent thereafter. At week 4, SIS intrinsic tensile strength (suture removed) exceeded that of both autograft and suture material. Preoperative TGF-beta1 immunostaining in SIS was less than that of autograft but greater during weeks 2 and 4. CONCLUSIONS: Earlier neovascularization, increased TGF-beta1 levels, and increased collagen deposition, along with greater intrinsic repair strength relative to both autograft and suture strength at week 4, make SIS a promising flexor tendon graft substitute. Future studies examining tendon excursion are planned.

Rhizosphere persistence of three Pythium oligandrum strains in tomato soilless culture assessed by DNA macroarray and real-time PCR.

In tomato soilless culture, plant-disease optimal control and growth promotion are achieved when the rhizosphere is heavily colonized by the biocontrol agent Pythium oligandrum. Discrepancies in performance are generally attributed to the poor persistence of P. oligandrum on roots. In this study, three selected strains of P. oligandrum were introduced into the rhizosphere of greenhouse-grown tomato plants, and their persistence was assessed by DNA macroarray hybridization and real-time PCR. The experimental data from DNA detection and plate counting were compared. PCR-based methods detected P. oligandrum throughout the 6-month growing season, whereas plate counting indicated its presence only over the first 3 months. Moreover, the DNA array method provided information about the various Pythium species present in the rhizosphere: P. dissotocum was frequently detected on roots of plants, without distinction between plants inoculated or not inoculated with the antagonist. The detection of other Pythium species was noticed sporadically (P. ultimum, P. sylvaticum and P. intermedium), independent of the treatment. Even though the yield enhancement is not significant throughout the entire growing season, data obtained from epidemiological studies demonstrate an enhancement of P. oligandrum persistence on the rhizosphere of plants and less use of mycoparasitism.

Intraspecific variability of Pythium myriotylum isolated from cocoyam and other host crops.

Intraspecific variability within 51 isolates of Pythium myriotylum from cocoyam (Xanthosoma sagittifolium) and other host crops was analysed using optimum growth temperature, esterase banding patterns, AFLPs, rDNA-ITS sequencing, and virulence to cocoyam. P. myriotylum isolates virulent to cocoyam could easily be differentiated from other isolates of P. myriotylum by their optimum growth temperature. Isolates from cocoyam grew best at 28 degrees C with no growth at 37 degrees C, while P. myriotylum isolates from other host crops had their optimum growth temperature at 37 degrees C. Esterases produced consistent zymograms with 18 discrete esterase markers, but no monomorphic markers were produced for isolates virulent to cocoyam. Isozyme profiles based on esterase analysis showed that isolates that infect cocoyam plantlets formed a related group, irrespective of their geographic origin. P. myriotylum isolates from other host plants also grouped together, but could clearly be distinguished from the cocoyam cluster. AFLPs produced 189 scorable bands for the cocoyam isolates, of which 77% are monomorphic. Phenetic analysis of AFLP data grouped all isolates originating from cocoyam together except for the isolates C103-04, CMR17, CMR22, and CMR25. These isolates regrouped with isolates of Pythium myriotylum from other host crops or the outgroup and were found not to be pathogenic for cocoyam. ITS sequences of isolates of P. myriotylum from cocoyam were 99.1-99.7% identical to sequences deposited in GenBank. However, alignments of ITS sequences revealed a base transition at position 824 from adenine in typical isolates of P. myriotylum to guanine in isolates that could infect cocoyam plantlets. In a limited pathogenicity test, all isolates from cocoyam having guanine at position 824 were able to infect tissue culture derived cocoyam but not those exhibiting adenine. This study demonstrates for the first time, molecular evidence that isolates of P. myriotylum that infect cocoyam are distinct from P. myriotylum isolates from other crops and have developed a certain degree of host adaptation.