Liposuction Aspirate Fluid Adipose-Derived Stem Cell Injection and Secondary Healing in Fingertip Injury: A Pilot Study.

BACKGROUND: Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. The authors compared the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid. METHODS: Forty consecutive patients with a fingertip injury were dichotomized into group A (control group; conservative approach) and group B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStem EVO kit), allowing the nonenzymatic separation of liposuction aspirate fluid, which was then injected at the site of injury. Objective outcomes were time for healing, strength, mobility of joint, and touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability, and aesthetic result. An aliquot of liposuction aspirate fluid was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays. RESULTS: The average healing time was 22.3 days in group B and 24.9 days in group A (p < 0.05). Eighty-five percent of group B patients and 67 percent of group A patients scored normal to diminished superficial sensibility (p < 0.05). Group A had higher pain and cold intolerance scores (p < 0.05). Group B scored greater aesthetic and disabilities outcome results (p < 0.05). The cell isolation yield was 8.3 × 10(5)/ml, with a percentage of viable cells of 74.3 percent. Flow cytometry identified a mesenchymal immunophenotype, and in vitro osteogenic and adipogenic induction confirmed the bilinear potential of the isolated cells. CONCLUSION: This clinical study demonstrates for the first time the regenerative potential of liposuction aspirate fluid adipose-derived stem cells in a clinical application. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Microsurgical teaching: our experience.

Today, microsurgery plays a fundamental role in plastic surgery, expanding surgical possibilities for cancer, trauma and aesthetic-related surgery. However, throughout the years, teaching and training systems for microsurgery have not evolved in the same manner as its operative techniques. The use of rats has been, and still is, the standard model for microsurgery training. However, stringent laws for animals used in experiments, combined with the rising costs of this model, have instigated the need to find alternative methods. To overcome this dilemma, we have developed a three-step approach to optimise microsurgery training, particularly when there is no access to animal laboratories.

Microsurgical anastomosis with the 'PCA' technique.

BACKGROUND: In this study, we introduce a new microvascular anastomosis technique called 'PCA' (Posterior wall first--Continuous interrupted--Airborne). The conventional microvascular anastomosis (CI), with single interrupted stitches, requires a long time to be completed, as each suture must be tied before starting the following stitch. Surgeons are often searching to reduce microsurgery time, particularly when there are multiple vessels to be anastomosed or when there is a prerequisite for the ischemia time to be quick. METHODS: The authors conducted a comparative study of PCA and CI on 40 Wistar-albino rats. The femoral arteries and veins of each rat were used, resulting in a total of 160 vessels, with a diameter of 0.8 to 1mm. The rats were divided into two groups. Patency rates were compared between the two groups, using the chi-square test. The times required to perform the anastomosis were compared using the Student's t test. A p value<0.001 was considered significant. RESULTS: The mean time required for microvascular anastomosis of the femoral arteries was 22 minutes (mins) and 46 seconds (secs) in the PCA group, and 28 mins and 50 secs in the CI group. The mean time required for microvascular anastomosis of veins was 19 mins and 20 secs in the PCA group, and 23 mins and 36 secs in the CI group. CONCLUSION: The combination of the three different techniques (posterior wall first, continuous-interrupted, and airborne), used for the microvascular anastomosis, is safe, secure, and time-saving. The advantages of this combined method are the benefits of a single stitch, the increased speed of a continuous suture, and the reduced time of tying. The PCA technique may be helpful to selected clinical situations, due to a reduction in microsurgical time, as in such cases of multiple digital replantations, multiple "in chain" free flaps, vein grafts, and high metabolic free flaps, such as the intestine free microvascular transfer.

Merkel cell tumour of the finger.

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine tumour. Biologically aggressive, it may be difficult to treat. We report a case of MCC on the dorsal base of the left second finger and we discuss its treatment and prognosis.

Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: comparative evaluation and analysis of output.

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major "fat storage" areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution.

The innervated anterolateral thigh flap: anatomical study and clinical implications.

During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective areas innervated by the superior perforator and median perforator nerves. Alternatively, a large anterolateral thigh flap can be raised with this multiple innervation. This can be helpful if one wants to harvest the flap under local anesthesia. Sensate bilobed flaps can be harvested when dual innervated flaps are required.

Surgical treatment of ulcers caused by extravasation of cytotoxic drugs.

Despite preventive measures, the extravasation of cytotoxic drugs still occurs in 0.6% to 6% of cases. The aetiology is thought to be that tissue necrosis develops into a chronic ulcer, which causes problems if the harmful action of the drug is not blocked. From 1988-2002 at the Department of Plastic Surgery of Rome University "La Sapienza", 240 patients presented with extravasation of cytotoxic drugs; all had been treated with an original conservative protocol first described in 1994, based on the repeated local infiltration of a large quantity of saline solution (90-540 ml) into the area of extravasation. We considered only cases with actively necrotic lesions. Eleven of the 240 patients (5%) had ulcers ranging from small ulcers to extensive areas of tissue necrosis. Of the 11 patients, eight had already had ulcers, while the remaining three were those in whom our conservative protocol had not prevented necrosis. They were all operated on and given grafts, local flaps, reverse radial flaps, and free flaps.

Ultrasound-assisted liposuction for the removal of siliconomas.

In the past, the traditional methods of removing siliconomas have been excision of the affected tissues or suction of the injected silicone. Unfortunately siliconomas are often found in exposed areas, where it is undesirable to leave visible scars, and suction is technically difficult and often unsuccessful because the affected tissues are so hard. Because we have used ultrasound-assisted liposuction for other procedures since 1984, it seemed logical to find out whether this technique would be useful to remove siliconomas. We have used it in three such patients, ranging in age from 36 to 84 years. Our mean follow up is 38 months (range 18 months-4 years). We have found that it results in improvement in all patients. The only problem was a minor burn at the entrance port in one patient.

Extensor digitorum brevis manus muscle in a patient with neurofibromatosis type 1.

The extensor digitorum brevis manus is an uncommon muscle on the dorsum of the hand and can be misdiagnosed, particularly when associated with other clinical conditions such as neurofibromatosis type 1. To our knowledge the two clinical pictures have never been described together. The aim of our report is to increase the clinician's familiarity with these combined conditions, to investigate the available diagnostic tools, and to achieve a correct diagnosis.