Adipose-Derived Stem Cells Support Lymphangiogenic Parameters In Vitro.

It is a common complication to develop a secondary lymphedema after surgery or radiation, for example, after axillary lymph node dissection due to breast cancer and current therapies are mainly symptomatic. Since these surgical procedures result in both, loss of adipose tissue and loss of lymphatic nodes and vessels, tissue engineering could be a new promising approach, to create an adipose tissue substitute comprised with a lymphatic network. We have conducted co-culture experiments to investigate the effects of human adipose-derived stem cells (ASCs) on human lymphatic endothelial cells (LECs) in terms of gene expression profile, proliferation, migration, and tube formation in vitro. In this respect, both cell types were co-cultured either indirectly or directly with or without the recombinant growth factor VEGF-C. Indirect co-cultures were performed with the aid of a transwell chamber. In case of direct co-culture, immunomagnetic separation by CD31 magnetic beads allowed examination of the LEC population. Direct and indirect co-culture of ASCs induced mRNA expression of lymphatic marker genes, proliferation, and migration by LECs without affecting tube formation. Thus, we have shown that co-culture of ASCs with LECs might be a feasible approach that could be used in cell-based tissue engineering therapies to heal or improve a secondary lymphedema. J. Cell. Biochem. 117: 2620-2629, 2016. © 2016 Wiley Periodicals, Inc.

Comparison of the Rubin dermal suspension sutures and total parenchymal reshaping technique with a traditional inverted T-scar reduction mammaplasty technique using a superior pedicle.

UNLABELLED: Adipose patients, especially after massive weight loss, pose a challenge to the breast surgeon due to the major loss of volume and the inelasticity of the skin. Rubin described a suitable mammaplasty technique for these patients involving dermal suspension sutures and total parenchymal reshaping. With this technique, the tissue of the prominent axillary skin fold typically found in patients with massive weight loss is used to increase the upper pole volume of the breast. To prove the effectiveness of this technique, the current study compared it with a traditional inverted T-scar technique using a superior pedicle, as described by Höhler. This technique usually is used for a different patient clientele that requires reduction mammaplasty. However, because none of the difficult aforementioned preconditions are found in this clientele, it leads to the best possible outcome and represents the authors' internal "gold standard" for mammaplasty against which all other techniques must be compared. This study retrospectively analyzed the complication rate, lift effect, and upper pole fullness by chart analysis and photometric analysis of 21 Höhler and 24 Rubin mammaplasties. Despite the more challenging patient clientele in the Rubin groups, both therapies achieved a similar lift effect without significant differences (Höhler 4.8 ± 3.3 cm vs Rubin 6 ± 4 cm). In both groups, the upper pole area increased significantly. The ratio of upper pole-to-lower pole area increased from 1.31 preoperatively to 2.1 postoperatively in the Rubin group, suggesting a redistribution of tissue in favor of the upper pole, and it increased from 1.18 to 1.69 in the Höhler group, indicating an even greater increase in upper pole volume in the Rubin group. In conclusion, the technique described by Rubin, despite the dramatically more difficult soft tissue condition of the patients with massive weight loss, results in an outcome similar to that of a traditional reduction mammaplasty technique in terms of increased upper pole volume. It is suitable and preferable for patients who have a lateral axillary roll deformity and can be applied safely for these patients without increasing the complication rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Volar dislocation and hook fracture of the hamate: a case report.

A rare case of isolated traumatic hamate dislocation combined with fracture of the hamate hook is reported. Plain X-rays revealed a volar dislocation of the hamate, but computed tomography was necessary to recognise the fracture of the hamate hook. The injury was successfully treated with open reduction and internal fixation with Kirschner wires. Five weeks after the operation the Kirschner wires were removed and rehabilitation was started. At five months follow-up, the patient had minimal pain and he had resumed working. However, his grip strength was 50% compared to the uninjured side. Cone-beam computed tomography, a novel imaging modality in hand surgery, was successfully used during follow-up. We conclude that computed tomography is essential in emergency preoperative planning in this type of uncommon injuries in order to diagnose concomitant bony lesions which can otherwise be overlooked. Alternative treatment options are discussed, and literature is reviewed.

Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps.

BACKGROUND: We recently established negative pressure wound therapy (NPWT) as a safe postoperative care concept for free muscle flaps; however, the molecular effects of NPWT on free muscle flaps remain elusive. Here we investigated the effects of NPWT on pathological changes associated with ischaemia/reperfusion injury in free flap tissue. METHODS: From July 2008 to September 2010, 30 patients receiving skin-grafted free muscle transfer for defect coverage were randomly assigned to two treatment groups: In one group the skin-grafted free flap was covered by a vacuum dressing (NPWT); in the second group, flaps were covered by conventional petroleum gauze dressings (conv). Biopsies were taken intra-operatively prior to clipping of the pedicle and on postoperative day 5. Samples were analysed by immunohistochemistry for infiltration of inflammatory cells, real-time polymerase chain reaction (RT-PCR) for the analysis of expression levels of interleukin-1ß (IL-1ß) and tumour necrosis factor (TNF)-alpha as markers of inflammation. Histological samples were also examined for interstitial oedema formation, and apoptosis was detected by a terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay. RESULTS: NPWT leads to a significantly reduced tissue infiltration of CD68 + macrophages and reduced expression of the inflammatory cytokines IL-1ß and TNFα. None of these parameters was significantly elevated in the pre-ischaemic biopsies. Furthermore, NPWT reduced the interstitial oedema formation and the number of apoptotic cells in free flap tissue. CONCLUSION: NPWT of skin-grafted free muscle flaps leads to a reduced inflammatory response following ischaemia/reperfusion, resulting in reduced oedema formation improving the microcirculation and ultimately reduced tissue damage. We thereby deliver new insight into the effects of NPWT.

[Soft tissue reconstruction with a temporoparietal fascial flap (TPFF)]. / Der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten.

OBJECTIVE: Soft tissue reconstruction with a temporoparietal fascial flap (TPFF). INDICATIONS: Defect coverage with thin, pliable, and well-vascularized tissue. A bilayered TPFF provides a gliding surface in tendon reconstruction. Further options include TPFF harvest with overlying skin or subjacent bone for composite tissue reconstruction or the application as a sensate local fascial flap. Maximum defect dimensions: 17 × 14 cm. CONTRAINDICATIONS: Absolute: prior injury to the flap or flap pedicle, temporal arteritis, Moyamoya syndrome, defects with volume deficit. Relative: alopecia along the planned incision. SURGICAL TECHNIQUE: Pedicle location is outlined using Doppler ultrasound. Injection of the incision line with diluted epinephrine solution. Skin incision with subsequent visualization of the temporoparietal fascia and supplying vessels. Skin flaps are raised carefully paying special attention to the hair follicles (CAVE: postoperative alopecia). Primary closure of the donor site. Defect coverage with pedicled or free TPFF with subsequent full or split-thickness skin grafting. Dressing: Bolster or V.A.C. POSTOPERATIVE MANAGEMENT: Immobilization/elevation in the setting of extremity reconstruction. Removal of bolster dressing or V.A.C. on postoperative day 5. Dangling protocol instituted on postoperative day 7. Removal of sutures/staples at the donor site on postoperative day 5-7 and at the recipient site on postoperative day 12-14. RESULTS: The TPFF was utilized for soft tissue reconstruction in 8 patients. A pedicled TPFF was used in 2 patients. Mean time to healing was 16.3 days. Mean follow-up was 13.4 months. Successful reconstructive results with satisfactory functional and aesthetic appearance were obtained in all patients. Complications were encountered in 3 patients and included alopecia at the donor site and iatrogenic injury to the frontal branch of the facial nerve. Vascular compromise was observed in the early postoperative period in a third patient. However, operative revision resulted in successful flap salvage.

Resorption rate assessment of adipose tissue-engineered constructs by intravital magnetic resonance imaging.

Engineering of adipose tissue by implantation of preadipocytes within biodegradable materials has already been extensively reported. However, a method that allows to accurately determine the resorption rate of adipose tissue constructs has not been described to date. The purpose of this study was to determine whether the non-invasive and non-destructive technique of magnetic resonance imaging (MRI) could be used to assess the resorption rate of adipose tissue substitutes after injection of human preadipocytes within fibrin into athymic nude mice. Different concentrations of undifferentiated preadipocytes were injected within fibrin into athymic nude mice. Two days, 3 months and 6 months post-implantation, the mice were anaesthetised and an MRI was performed using a 9.4 Tesla device in order to determine both volume and resorption rate of the implants. Subsequently, the specimens were explanted and qualitative analysis of adipose tissue formation was performed by histological examination. After implantation, a progressive resorption of all constructs was macroscopically observed. Implants could be easily visualised and delimited from the surrounding tissues by MRI. Magnetic resonance analysis demonstrated a resorption rate of the implants of 99-100% at 6 months, which was also confirmed by histological analysis. In the remaining implants, formation of human adipose tissue could be immunohistologically confirmed. Here, we show that MRI provides an efficient and non-invasive method for the assessment of implant resorption in adipose tissue engineering.

Comparison of pre-adipocyte yield, growth and differentiation characteristics from excised versus aspirated adipose tissue.

Adipose tissue precursor cells (pre-adipocytes) are part of a stromal vascular fraction that can be easily isolated from fat tissue. Adipose tissue can be harvested by 2 methods: aspiration and excision. We analyzed whether the pre-adipocyte yield, growth characteristics and ability to differentiate into mature adipose tissue are influenced by the type of harvesting procedure. Adipose tissue was simultaneously harvested from the abdomen by surgical excision or aspiration according to the Coleman procedure in 10 individuals. This permitted inter- and intra-individual comparisons. Cell viability and yield were determined directly after isolation of pre-adipocytes. The growth kinetics were investigated in culture. Furthermore, pre-adipocytes were cultured under adipogenic conditions to compare their differentiation potential. The number of viable pre-adipocytes was significantly higher after excision of adipose tissue compared to aspiration. The proliferation kinetic was not influenced by the type of harvesting. No differences were observed in the differentiation potential of the pre-adipocytes between both groups. Compared to excision, aspiration of adipose tissue negatively affects the yield of pre-adipocytes. However, growth characteristics and differentiation potential of viable cultured cells are not influenced by the type of surgical harvesting. Due to its reduced donor site morbidity, we conclude that aspiration of adipose tissue is a valid harvesting method for isolation of pre-adipocytes.

[Body contouring after massive weight loss]. / Körperformende plastisch-chirurgische Eingriffe nach massiver Gewichtsreduktion.

With the advent of bariatric surgery, body contouring has grown to a new speciality in plastic surgery. Following massive weight loss, patients generally have skin redundancy on the trunk, buttocks, breast, upper arms, thighs and face, leading to a poor quality of life and social acceptance. This condition motivates many patients to consult a plastic surgeon to address these problems. Thus, plastic surgery has become an integral part of the surgical treatment of the morbidly obese. The aim of post-bariatric plastic surgery should be to restore a normal body image of the patient with as few surgeries as possible and with a tolerable risk. This article addresses different plastic surgery procedures that can be successfully applied in order to correct various body contouring deformities. Patient selection, technical details, pre- and postoperative care, possible complications and expected results are all discussed.

Controlled trials in aesthetic plastic surgery: a 16-year analysis.

Aesthetic surgery is one pillar of plastic surgery. Thus, not surprisingly, journals exist that focus predominantly on advances within this subspecialty. However, rarely has the process of systematic reviewing that identified randomized controlled trials (RCTs) and controlled clinical trials (CCTs) been conducted within this subspecialty. All original articles published in Aesthetic Plastic Surgery were analyzed to identify all RCTs and CCTs. The proportion of RCTs and CCTs in all original articles was determined, and the quality of reporting was assessed on the basis of established quality items. Additional parameters were investigated including reporting of statistically significant differences, type of institution, and country affiliation of the first author. Of the 1,048 original articles analyzed, 11 (1%) and 24 (2.3%) articles met the inclusion criteria for RCTs and CCTs, respectively. Only two studies were single blinded, whereas only one study reported on successful double blinding and appropriate allocation concealment. Notably, these trials were RCTs. Participant dropout was reported in one study. Statistically significant differences were reported in 18 trials, 6 of which were RCTs. The annual publication of RCTs has increased over the past 5 years. North America and Europe contributed a total of 28 controlled trials (80%). Controlled trials are being conducted in aesthetic surgery at a strikingly low rate. However, a recent increase in published RCTs reflects the recognition that performing outcome studies is pivotal in moving practice toward a foundation based on assessment by outcome. The quality of reporting, however, needs improvement.

[The application of endoscopy in aesthetic breast surgery]. / Endoskopische Verfahren in der ästhetischen Mammachirurgie.

During the last decades, numerous surgical techniques have been described for breast augmentation. In addition to the very popular inframammary and the periareolar approaches, the transaxillary technique provides an elegant means of conducting a safe and accurate implant placement without producing visible scars on the breast mound. Due to a questionable lack of intraoperative visualisation with resultant higher complication rates,we conducted a retrospective analysis comparing the endoscopy-assisted transaxillary approach with the inframammary technique. A retrospective analysis was conducted comparing the endoscopy-assisted transaxillary approach with the more commonly chosen inframammary aditus. Patients undergoing breast augmentation from 1997 to 2005 were analysed retrospectively. The analysis was conducted in patients undergoing this procedure for aesthetic reasons only. Underlying breast pathology as well as previously performed breast surgery were among the exclusion criteria. The Client Satisfaction Questionnaire (CSQ-8) was applied for assessment of patient satisfaction. From 1997 to 2005, 96 patients underwent breast augmentation at our institution. Implant volumes ranged from 150 to 400 ml.62.5% preferred the transaxillary technique vs. 37.5% who chose the inframammary route. Complication rates were low in both patient subsets, the statistics revealing no differences. Assessment of patient satisfaction displayed high levels of satisfaction in both groups without any significant differences. The endoscopy-assisted transaxillary breast augmentation is a safe technique which generates high levels of patient satisfaction. Predictable results can be achieved by this approach which is preferred by the majority of patients when offered.

[Angiogenesis investigations in tissue engineering. The cylinder model on the chorioallantois membrane]. / Untersuchung der Angiogenese im Tissue Engineering. Das Zylindermodell auf der Chorioallantoismembran.

INTRODUCTION: Tissue engineering (TE) applications include the isolation, culture, and seeding of cells into a suitable matrix or scaffold prior to in vivo transplantation. After transplantation, vascularization of the scaffold is a principal factor limiting cell viability for the first 6-8 days post transplantation. A model has been developed for systematic analysis of this process. METHODS: Fertilized white Leghorn eggs were incubated and opened at day 3 of incubation. Preadipocyte-seeded fibrin constructs were implanted in a specially designed plastic cylinder and placed through the opening onto the surface of the chorioallantoic membrane (CAM) at day 8 of incubation. Vascularization of the constructs by chorioallantoic blood vessels was assessed for up to 8 days post transplantation. RESULTS: The survival rate for embryos receiving constructs was about 90%. Histology confirmed transplant cell viability at day 4 post transplantation, and vascularization of the constructs by avian endothelial cells progressively increased thereafter. CONCLUSION: A new in vivo model to study the effect of angiogenesis in TE constructs including assessments of viability, proliferation, and differentiation of transplanted cells and biomaterial properties is presented. Advantages include easy access to the CAM vascular network, lack of immunocompetence, low cost, and avoidance of animal experiments.

Aplicaciones de la ingeniería tisular en cirugía plástica y estética / Applications of tissue engineering in plastic and aesthetic surgery

La ingeniería tisular podría ofrecer en un futuro cercano nuevas opciones de tratamiento en Cirugía Plástica. Mientras que tejidos carecientes de una red vascular propia, como el cartílago o la epidermis, ya han sido introducidos clínicamente, la implantación de constructos tridimensionales de gran tamaño se encuentra hasta el momento limitada. Posibles soluciones sería la inducción de angiogénesis a través del cocultivo con células endoteliales y/o la terapia génica con factores de crecimiento angiogénicos. El cuerpo humano es un "biorreactor" ideal, lo cual posibilita que la ingeniería tisular pueda actuar a modo de medicina regenerativa utilizando la relevante pérdida de componentes celulares, matriciales o bioquímicos (factores de crecimiento, genes) para inducir la reconstrucción tisular in vivo. Entre los prometedores resultados experimentales relevantes para su aplicación en Cirugía Plástica se encuentran: piel, cartílago, hueso, constructos osteocartilaginosos, urotelio, tejido adiposo, nervios periféricos y melanocitos (AU)