Qualitative and Quantitative Analyses of Donor Site Morbidity Following a Graft of the Acellular Dermal Matrix Versus Primary Fascial Repair After ALT Flap Harvesting.

BACKGROUND: The anterolateral thigh (ALT) flap is one of the most useful flaps in reconstruction because of its reliability, large skin flap territory, and versatility. The relatively small number of side effects is a common reason for preferring this flap. Primary repair is usually performed at the donor site closure; however, this requires substantial tension and causes many donor site morbidities, including pain. We attempted to use acellular dermal matrix graft to overcome these problems. METHODS: We analyzed a total of 41 cases (41 flaps) in this study. Among these flaps, we conducted donor fascia suture with artificial dermis in 20 cases (study group) and primary fascial suture in 21cases (control group). Post-operative ambulation recovery times, pain scores, drainage removals, and wound problems of the donor site were recorded. RESULTS: There were no serious complications, including infection, at the donor sites of all 41 cases. Of 20 cases using the acellular dermal matrix, seroma occurred in 2 cases and partial skin necrosis occurred in 2 cases. In 1 case of skin necrosis, the acellular dermal matrix was removed. However, in comparison to the control group, the group using the artificial dermis recovered ambulatory ability 3.9 days earlier and had a 1.8-point lower visual analogue scale score 5 days post-operatively. CONCLUSIONS: Our study suggested that, if used selectively, the acellular dermal matrix may play an effective role in donor site closure in cases with procedures involving the ALT flap.

HISTORIQUE: Le lambeau antérolatéral de la cuisse est l'un des plus utiles pour la reconstruction à cause de sa fiabilité, de son grand territoire et de sa polyvalence. Le relativement petit nombre d'effets secondaires est une raison courante pour le préférer. La réparation primaire est généralement effectuée à la fermeture du site du donneur, mais il faut une tension importante, ce qui entraîne de nombreuses morbidités au site du donneur, y compris la douleur. Les chercheurs ont tenté d'utiliser une greffe de la matrice dermique acellulaire pour vaincre ces problèmes. MÉTHODOLOGIE: Les chercheurs ont analysé un total de 41 cas (41 lambeaux) dans cette étude. De ce nombre, ils ont effectué une suture du fascia du donneur à l'aide de derme artificiel dans 20 cas (groupe d'étude) et une suture fasciale primaire dans 21 cas (groupe témoin). Ils ont également pris note de la durée de convalescence ambulatoire postopératoire, des scores de douleur, de la désinstallation du drainage, et des problèmes de plaie au site du donneur. RÉSULTATS: Il n'y a pas eu de complications graves, y compris l'infection, aux sites des donneurs des 41 cas. On a observé un sérome dans deux des 20 cas faisant appel à la matrice dermique acellulaire, et une nécrose cutanée partielle dans également deux cas. Dans l'un des cas de nécrose cutanée, la matrice dermique acellulaire a dû être retirée. Cependant, comparativement au groupe témoin, le groupe qui a utilisé le derme artificiel a récupéré sa capacité ambulatoire 3,9 jours plus rapidement et présentait un score de 1,8 point de moins à l'échelle analogique visuelle cinq jours après l'opération. CONCLUSIONS: Selon la présente étude, la matrice dermique acellulaire utilisée sélectivement peut jouer un rôle efficace à la fermeture du site du donneur dans les cas d'intervention faisant appel au lambeau antérolatéral de la cuisse.

In Vitro and in Vivo Biocompatibility and Degradability Evaluation of Modified Polydioxanone Plate.

BACKGROUND: Polydioxanone (PDS) has been widely used in the medical field over the past 30 years. In the 2000s, PDS plate began to be used for rhinoplasty and septoplasty. However, in Asia PDS plates are not widely used due to lack of awareness and high prices. The authors devised a method of producing a modified PDS (m-PDS; Rhinoblock Material & Design Co., Gyeonggi-do, Sothh Korea) at low cost, and compared the biocompatibilities and degradabilities of plates produced with m-PDS and commercial PDS plates (Ethicon, Somerville, NJ) in vivo and in vitro. METHODS: The melting point and decomposition rate of m-PDS were determined by differential scanning calorimetry and thermogravimetric analysis and its tensile strength was also measured. Implants (1 cm × 1 cm × 0.15 mm sized) were inserted subcutaneously into mice and harvested en bloc 2, 5, 10, 15, or 25 weeks later. Tissues were stained with hematoxylin and eosin or Masson's trichrome to evaluate inflammation, extracellular matrix deposition, and vascularization, and plate degradability was also assessed. RESULTS: No significant difference was observed between the thermal analysis and tensile test results of m-PDS and PDS plates. m-PDS started to degrade in vivo from around 10 weeks, and commercial PDS plates from around 15 weeks. After 25 weeks in vivo, both products were completely degraded and not observed in tissue slides. Histologic analysis of excised specimens showed m-PDS and PDS were similar in terms of inflammation, extracellular matrix deposition, and vascularization. CONCLUSION: In vivo and in vitro experiments detected no significant difference between the biocompatibilities and degradabilities of modified and commercial PDS plates. The results of this study suggest that the modified PDS can be used to produce versatile, low cost, absorbable graft materials for rhinoplasty and septoplasty.

The Efficacy of Hyaluronidase in Early Surgery of Nasal Bone Fracture.

A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.