Amniotic fluid for ex vivo skin preservation: a comparative study of tissue preservation solutions.

Ex vivo skin preservation is important for skin banks, burn centers, and in research; however, the optimal preservation solution is not known. Human amniotic fluid (HAF), in addition to its role in fetal wound healing, has promise as an effective and readily available preservation solution. The purpose of this study was to compare the efficacy of several solutions, including HAF, in full-thickness skin preservation. Human amniotic fluid was obtained from patients undergoing amniocentesis. Full-thickness skin obtained during abdominoplasty was divided into 1-cm(2) samples. These specimens were preserved in either saline, HAF from a single patient, pooled HAF, University of Wisconsin solution, or custodial histidine-tryptophan-ketoglutarate solution at 4°C. There were 5 samples in each group. Specimens were examined for keratinocyte survival at 7, 14, 21, 28, and 35 days using the trypan blue assay. The first 200 cells identified were counted to calculate the degree of cell death. Comparisons were made between the groups, and a multivariable repeated-measures analysis was performed to determine statistical significance, which was defined as P < 0.05. The individual and pooled HAF showed greater keratinocyte survival than the other solutions, at each time point. The difference was statistically significant (P < 0.05) when compared to saline and custodial solution but not statistically significant when compared to University of Wisconsin solution. When used as a tissue preservation solution, HAF produces superior keratinocyte survival than several commercially available solutions. Amniotic fluid, nature's tissue preservation solution, may be an inexpensive, readily available alternative for use in skin banks, burn centers, and research.

Comparison of sterile versus nonsterile acellular dermal matrices for breast reconstruction.

BACKGROUND: Acellular dermal matrix (ADM) has been associated with an increased incidence of complications after implant-based breast reconstruction. Recently, sterile ADM has been introduced in an attempt to minimize these complications. To analyze the impact of this product on patient outcomes, we created a database of patients undergoing implant-based breast reconstruction. METHODS: Patients undergoing implant-based breast reconstruction at the University of Kentucky Medical Center from January 1, 2011, to December 31, 2011 were identified. A database of patient characteristics and outcomes was created. Outcomes investigated included mastectomy flap necrosis, dehiscence, infection, red breast, capsular contracture, hematoma, and seroma. Statistical analysis was performed. RESULTS: Fifty-eight patients underwent breast reconstruction with implants or tissue expanders. Of the 58 patients, 9 had the sterile form of ADM placed, 25 had the original aseptic but not sterile ADM, and 24 were not reconstructed with ADM. The most frequent complication noted was seroma, occurring in 6/9 patients with sterile ADM as compared to 2/25 with the aseptic ADM. This was statistically significant (P = 0.003). CONCLUSIONS: The use of sterile ADM is associated with a statistically significant increase in seroma formation. The etiology of this increased incidence remains unknown, but it correlates with the introduction of the sterile form of ADM at our institution. A different preparation or sterilization process, or some other variable as yet unknown, may be responsible. Further studies comparing the different forms of ADM in an animal model may serve to clarify this issue.

Infectious complications associated with the use of acellular dermal matrix in implant-based bilateral breast reconstruction.

BACKGROUND: The use of acellular dermal matrix (ADM) has become a routine practice in implant-based breast reconstruction. Bilateral mastectomy is becoming more popular in cases of unilateral breast cancer. ADM has been associated with an increased incidence of complications. METHODS: We identified cases of bilateral implant-based breast reconstruction over a 5-year period. Data collection included medical comorbities, details of operative management, and details of postoperative cancer treatment. RESULTS: On univariate analysis, the use of ADM (31% vs. 7%, P = 0.018), smoking (37% vs. 13%, P = 0.045), and open wound (55% vs. 13%, P = 0.006) were significantly associated with increased risk of infection. Multivariate analysis revealed open wound as the strongest predictor of infection. CONCLUSIONS: The use of ADM is associated with an increased risk of infection in bilateral implant-based breast reconstruction. However, it does not appear to be an independent risk factor by itself.

Risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction.

BACKGROUND: Attempts to identify risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction have yielded inconsistent results, and no clear patient selection criteria have emerged. The authors identified patient- and procedure-related characteristics that predict unfavorable postoperative outcomes. Knowledge of these risk factors will facilitate preoperative patient screening to reduce the rate of implant loss and other postoperative complications. METHODS: The authors retrospectively evaluated the postoperative outcomes of implant loss and major and minor complications in 102 patients (155 breasts) undergoing the combined operation from January of 2005 to December of 2010. Univariate logistic regression analysis was performed to determine the influence of six patient-related and three procedure-related characteristics on implant loss and postoperative complications. RESULTS: The use of acellular dermis was associated with a greater than three-fold increased risk of postoperative complications. Radiotherapy exposure was found to have a significant association with implant loss. None of the patient-related characteristics studied behaved as risk factors for postoperative complications, and none of the procedure-related characteristics acted as risk factors for implant loss. CONCLUSIONS: A cautious and conservative approach to using acelluar dermal matrix in this setting is warranted until its effect on postoperative outcomes is more clearly defined. The authors' data support findings from other studies of the deleterious effect of breast radiotherapy on postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.

Management of facial soft tissue injuries in children.

Pediatric facial trauma can present a challenge to even the more experienced plastic surgeon. Injuries to the head and neck may involve bone and soft tissues with an assortment of specialized organs and tissue elements involved. Because of the active nature of children, facial soft tissue injuries can be diverse and extensive as well as some of the more common injuries a plastic surgeon is asked to treat. In 2007, approximately 800,000 patients younger than 15 years presented to emergency departments around the country with significant open wounds of the head that required treatment.In this review, we present the different types and regions of pediatric soft tissue facial trauma, as well as treatment options and goals of plastic surgery wound management. Special aspects, such as bite wounds, burns, pediatric analgesia, and antibiotic therapy, are also discussed.