Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study.

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.

Effect of Mortalin on Scar Formation in Human Dermal Fibroblasts and a Rat Incisional Scar Model.

Wound healing is a complicated cascading process; disequilibrium among reparative processes leads to the formation of pathologic scars. Herein, we explored the role of mortalin in scar formation and its association with the interleukin-1α receptor using in vitro and in vivo models. To investigate the effects of mortalin, we performed an MTT cell viability assay, qRT-PCR, and Western blot analyses, in addition to immunofluorescence and immunoprecipitation studies using cultured fibroblasts. A rat incisional wound model was used to evaluate the effect of a mortalin-specific shRNA (dE1-RGD/GFP/shMot) Ad vector in scar tissue. In vitro, the mortalin-treated human dermal fibroblast displayed a significant increase in proliferation of type I collagen, α-smooth muscle actin, transforming growth factor-ß, phospho-Smad2/3-complex, and NF-κB levels. Immunofluorescence staining revealed markedly increased mortalin and interleukin-1α receptor protein in keloid tissue compared to those in normal tissue, suggesting that the association between mortalin and IL-1α receptor was responsible for the fibrogenic effect. In vivo, mortalin-specific shRNA-expressing Ad vectors significantly decreased the scar size and type-I-collagen, α-SMA, and phospho-Smad2/3-complex expression in rat incisional scar tissue. Thus, dE1-RGD/GEP/shMot can inhibit the TGF-ß/α-SMA axis and NF-κB signal pathways in scar formation, and blocking endogenous mortalin could be a potential therapeutic target for keloids.

Effect of Baicalin on Wound Healing in a Mouse Model of Pressure Ulcers.

One of the most frequent comorbidities that develop in chronically ill or immobilized patients is pressure ulcers, also known as bed sores. Despite ischemia-reperfusion (I/R)-induced skin lesion having been identified as a primary cause of pressure ulcers, wound management efforts have so far failed to significantly improve outcomes. Baicalin, or 5,6,7-trihydroxyflavone, is a type of flavonoid which has been shown to possess a variety of biological characteristics, including antioxidative and anti-inflammatory effects and protection of I/R injury. In vitro wound scratch assay was first used to assess the function of baicalin in wound healing. We established a mouse model of advanced stage pressure ulcers with repeated cycles of I/R pressure load. In this model, topically applied baicalin (100 mg/mL) induced a significant increase in the wound healing process measured by wound area. Histological examination of the pressure ulcer mouse model showed faster granulation tissue formation and re-epithelization in the baicalin-treated group. Next, baicalin downregulated pro-inflammatory cytokines (IL-6 and IL-1ß), while upregulating the anti-inflammatory IL-10. Additionally, baicalin induced an increase in several growth factors (VEGF, FGF-2, PDGF-ß, and CTGF), promoting the wound healing process. Our results suggest that baicalin could serve as a promising agent for the treatment of pressures ulcers.

A 45-degree Upward Tension-Releasing Epicanthoplasty Performed in 712 Consecutive Cases.

BACKGROUND: Medial epicanthoplasty is commonly used to enhance the aesthetic outcomes of double-eyelid operations in Asia. However, epicanthoplasty can cause problems such as scarring and excessive exposure of the lacrimal lakes. OBJECTIVES: To resolve the problems associated with epicanthoplasty and to create more natural and long-lasting double-eyelid fold lines while minimizing incisions, we performed a 45-degree upward tension-releasing epicanthoplasty. MATERIALS AND METHODS: A total of 712 patients underwent 45-degree upward tension-releasing epicanthoplasty, with or without double eyelidplasty. A triangular skin flap was elevated at a 45-degree angle from the epicanthal fold. The surrounding area was dissected to eliminate the rigid connective tissue between the orbicularis muscle and the skin, which creates skin tension. The incisions were sutured, and a small incision toward the medial canthus was added to further decrease tension and create space for the triangular flap to be transposed. RESULTS: A total of 707 patients underwent 45-degree upward tension-releasing epicanthoplasty with the double-eyelid procedure, and 5 patients underwent 45-degree upward tension-releasing epicanthoplasty alone. No complications were observed for any patients, and 95% of patients were satisfied with this technique. CONCLUSIONS: The 45-degree upward tension-releasing epicanthoplasty can release the tension in the epicanthal fold, minimize scarring, and control lacrimal lake exposure. In particular, this method was effective for creating an in-out double-fold line starting from the epicanthus and for maintaining the double-eyelid line, which can reduce unnecessary incisional double-eyelid surgery.

Diagnosis and treatment of positional plagiocephaly.

Positional plagiocephaly is increasing in infants. Positional plagiocephaly is an asymmetric deformation of skull due to various reasons; first birth, assisted labor, multiple pregnancy, prematurity, congenital muscular torticollis and position of head. Positional plagiocephaly can mostly be diagnosed clinically and by physical examinations. The simplest way to assess the severity of plagiocephaly is to use a diagonal caliper during physical examination, which measures the difference between the diagonal lengths on each side of the head. Plagiocephaly can be treated surgically or conservatively. Positional plagiocephaly, which is not accompanied by craniosynostosis, is treated conservatively. Conservative treatments involve a variety of treatments, such as change of positions, physiotherapy, massage therapy, and helmet therapy. Systematic approaches to clinical examination, diagnosis and treatment of positional plagiocephaly can be necessary and the age-appropriate treatment is recommended for patients with positional plagiocephaly.

Ultrasonic dissection versus electrocautery for immediate prosthetic breast reconstruction.

BACKGROUND: Ultrasonic dissection devices cause less thermal damage to the surrounding tissue than monopolar electrosurgical devices. We compared the effects of using an ultrasonic dissection device or an electrocautery device during prosthetic breast reconstruction on seroma development and short-term postoperative complications. METHODS: We retrospectively reviewed the medical records of patients who underwent implant-based reconstruction following mastectomy between March 2017 and September 2018. Mastectomy was performed by general surgeons and reconstruction by plastic surgeons. From March 2017 to January 2018, a monopolar electrosurgical device was used, and an ultrasonic dissection device was used thereafter. The other surgical. METHODS: were the same in both groups. RESULTS: The incidence of seroma was lower in the ultrasonic dissection device group than in the electrocautery group (11 [17.2%] vs. 18 [31.0%]; P=0.090). The duration of surgery, total drainage volume, duration of drainage, overall complication rate, surgical site infection rate, and flap necrosis rate were comparable between the groups. Multivariate analysis revealed that the risk of seroma development was significantly lower in the ultrasonic dissection device group than in the electrocautery group (odds ratio for electrocautery, 3.252; 95% confidence interval, 1.242-8.516; P=0.016). CONCLUSIONS: The findings of this study suggest that the incidence of seroma can be reduced slightly by using an ultrasonic dissection device for prosthesis-based breast reconstruction. However, further randomized controlled studies are required to verify our. RESULTS: and to assess the cost-effectiveness of this technique.

Septo-capsulopalpebral fascial recession flap technique in lower blepharoplasty: An experience of 453 consecutive cases and a review of the literature.

BACKGROUND: Lower blepharoplasty is one of the most common cosmetic rejuvenation procedures. Occasionally, adverse effects of the operation, ranging from operated and somewhat flattened unnatural look of the lower eyelid region to more severe cases of ectropion, retraction leading to functional disabilities, further compound the problem. The author has developed a technique focusing on two aspects in terms of the outcome of the operation in developing a technique that ensures a uniformly consistent and esthetically perceptible result. METHODS: The anatomic basis for the technique is reviewed and described. We performed lower blepharoplasty using the septo-capsulopalpebral fascial recession flap. The procedure requires skin incision, maintenance of pretarsal muscular roll, skin-muscle flap elevation, orbital septum release, orbital fat removal, septo-capsulopalpebral recession flap, skin excision, and closure. RESULTS: No complications have occurred in 453 patients, including hematoma and dry eye. Lid malposition such as entropion or lagophthalmos was not seen in any patient. Regardless of the preoperative variations in the lower lid, the method corrected the prolapsed lower eyelid and provided satisfactory esthetic result after the operation. Recurrences have not been observed during the follow-up period. CONCLUSION: Lower blepharoplasty using the septo-capsulopalpebral fascial recession flap is effective to correct baggy eyelid, with minimal risk of cicatricial ectropion or tarsal capsize and retraction. Further, the esthetic result is enhanced by the author's method of making the pretarsal muscular roll with prevention of its loss.

The effect of combination therapy on critical-size bone defects using non-activated platelet-rich plasma and adipose-derived stem cells.

PURPOSE: Non-activated platelet-rich plasma (nPRP) slowly releases growth factors that induce bone regeneration. Adipose tissue-derived stem cells (ASCs) are also known to induce osteoblast differentiation. In this study, we investigated the combined effect of nPRP and ASC treatment compared with single therapy on bone regeneration. METHODS: Thirty New Zealand white rabbits with 15 × 15 mm2 calvarial defects were randomly divided into four treatment groups: control, nPRP, ASC, or nPRP + ASC groups. For treatment, rabbits received a collagen sponge (Gelfoam®) saturated with 1 ml normal saline (controls), 1 ml non-activated PRP (nPRP group), 2 × 106 ASCs (ASCs group), or 2 × 106 ASCs plus l ml nPRP (nPRP + ASCs group). After 16 weeks, bone volume and new bone surface area were measured, using three-dimensional computed tomography and digital photography. Bone regeneration was also histologically analyzed. RESULTS: Bone surface area in the nPRP group was significantly higher than both the control and ASC groups (p < 0.001 and p < 0.01, respectively). The percentage of regenerated bone surface area in the nPRP + ASC group was also significantly higher than the corresponding ratios in the control group (p < 0.001). The volume of new bone in the nPRP group was increased compared to the controls (p < 0.05). CONCLUSION: Our results demonstrate that slow-releasing growth factors from nPRP did not influence ASC activation in this model of bone healing. PRP activation is important for the success of combination therapy using nPRP and ASCs.

Ideal scaffold design for total ear reconstruction using a three-dimensional printing technique.

Ear reconstruction using three-dimensional (3D) printing technique has been considered as a good substitute for conventional surgery, because it can provide custom-made 3D framework. However, there are difficulties with its application in clinical use. Researchers have reported 3D scaffolds for ear cartilage regeneration, but the designs of the 3D scaffolds were not appropriate to be used in surgery. Hence, we propose the design of an ideal 3D ear scaffold for use in ear reconstruction surgery. Facial computed tomography (CT) images of the unaffected ear were extracted using a "segmentation" procedure. The selected data were converted to a 3D model and mirrored to create a model of the affected side. The design of 3D model was modified to apply to Nagata's two-stage surgery. Based on the 3D reconstructed model, a 3D scaffold was 3D printed using polycaprolactone. The 3D scaffold closely resembled the real cartilage framework used in current operations in terms of ear anatomy. To account for skin thickness, the 3D scaffold was made 4 mm smaller than the real ear. Furthermore, 2 mm pores were included to allow the implantation of diced cartilage to promote regeneration of the cartilage. 3D printing technology can overcome the limitations of previous auricular reconstruction methods. Further studies are required to achieve a functional and stable substitute for auricular cartilage and to extend the clinical use of the 3D-printed construct. Additionally, the ethical and legal issues regarding the transplantation of 3D-printed constructs and cell culture technologies using human stem cells remain to be solved. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1295-1303, 2019.

Hairline Lowering Surgery With Bone Tunneling Suture Fixation: Effectiveness and Safety in 91 Patients.

BACKGROUND: People with a wide forehead often look older. Hairline lowering surgery is a good treatment option, which is generally performed utilizing Endotine. OBJECTIVES: We describe our hairline lowering surgical technique involving bone tunneling without Endotine, a method designed to produce comparable outcomes with fewer side effects. We evaluated the effectiveness and safety of our technique. METHODS: Charts of 91 patients who underwent hairline lowering surgery without Endotine were reviewed retrospectively. We utilized standardized preoperative and postoperative photographs to measure the proportions of 3 face parts and the length of the forehead. We also determined changes in forehead length at various times after surgery, occurrence of postoperative complications, and overall patient satisfaction with their surgical results. RESULTS: Of the 91 patients, 80 were female and the mean age was 28.67 ± 7.15 years. Preoperatively, the mean forehead length was 8.09 ± 0.69 cm and ratio of facial part lengths was 1.08:1:0.99 (cranial to caudal). The hairline was advanced 18.37 ± 2.90 mm. One month postoperatively, the mean forehead length was 6.57 ± 0.52 cm and facial parts ratio was 1:1:0.99. Compared with preoperatively, forehead length was significantly reduced at 1, 3, 6, and 12 months postoperatively. Forehead length was not significantly different at 1 and 12 months postoperatively. All patients were satisfied or very satisfied with their overall surgical results. CONCLUSIONS: Hairline lowering surgery with bone tunneling was effective and safe, and patients were satisfied with the results. The effects appeared immediately following surgery and were sustained over time.

Effects of Hat-Shaped Mortised Genioplasty with Genioglossus Muscle Advancement on Retrogenia and Snoring: Assessment of Esthetic, Functional, and Psychosocial Results.

BACKGROUND: An increasing number of patients undergo genioplasty for esthetic purposes to correct micrognathism or retrognathism. However, these conditions are considered an important risk factor for snoring. The purpose of this study was to evaluate both esthetic improvement and functional changes of snoring symptoms in patients who underwent hat-shaped mortised advancing genioplasty with genioglossus muscle advancement. MATERIALS AND METHODS: This retrospective study enrolled 25 patients. We evaluated scores for subjective snoring classification (Stanford scale) and questionnaire findings for esthetic results. RESULTS: Most people (96%) were satisfied with the esthetic improvement after surgery. The grade of subjective snoring classification (Stanford scale) improved from 8.68 (range 0-10) to 4.08 (range 0-10) after surgery. Twenty-four patients had an improved snoring grade. All patients reported a positive impact on their daily activity and self-confidence, and they were willing to recommend the same operation to someone with the same clinical problems. CONCLUSION: We conclude that hat-shaped mortised advancing genioplasty with genioglossus muscle advancement can relieve the symptoms of snoring for patients with hypoplastic chin or retrogenia. Patients were satisfied with the functional and esthetic results. 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 .

Comparison of Outcomes between Direct-to-Implant Breast Reconstruction Following Nipple-Sparing Mastectomy through Inframammary Fold Incision versus Noninframammary Fold Incision.

PURPOSE: In properly selected patients with breast cancer, nipple-sparing mastectomy (NSM) is generally considered safe by oncologic standards. We examined two groups of patients who underwent direct-to-implant (DTI) reconstruction after NSM, comparing complications encountered, revision rates, and aesthetic outcomes. The patients were stratified based on type of surgical incision and assigned to inframammary fold (IMF) and non-IMF groups. METHODS: We investigated 141 patients (145 breasts) subjected to NSM and immediate DTI reconstruction between 2013 and 2016. A total of 62 breasts (in 58 patients) were surgically removed via IMF incisions, with the other 83 breasts (in 83 patients) removed by non-IMF means. RESULTS: Complications associated with IMF (n=62) and non-IMF (n=83) incisions were as follows: skin necrosis (IMF, 9; non-IMF, 18); hematoma (IMF, 3; non-IMF, 4); seroma (IMF, 8; non-IMF, 4); mild capsular contracture (IMF, 4; non-IMF, 7); and tumor recurrence (IMF, 2; non-IMF, 8). Surgical revisions were counted as duplicates (IMF, 18; non-IMF, 38). Aesthetic outcomes following IMF incisions were rated as very good (44.2%), good (23.1%), fair (23.1%), or poor (9.6%). CONCLUSION: IMF incision enables complete preservation of the nipple-areolar complex, yielding superior aesthetic results in immediate DTI breast reconstruction after NSM. The nature of incision used had no significant impact on postoperative complications or reoperation rates and had comparable oncologic safety to that of non-IMF incisions. IMF incisions produced the least visible scarring and did not affect breast shape. Most patients were satisfied with the aesthetic outcomes.

Forehead reconstruction with a custom-made three-dimensional titanium implant in a Parry-Romberg syndrome patient.

Parry-Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues usually on only one side of the face. It is usually difficult to restore the facial contour due to skin tightness. In this case report, we report a forehead reconstruction with custom-made three-dimensional (3D) titanium implant of a Parry-Romberg syndrome patient who was treated with multiple fat grafts but had limited effect. A 36-year-old man presented with hemifacial atrophy. The disease progressed from 5 to 16 years old. The patient had alopecia on frontal scalp and received a surgery using tissue expander. The alopecia lesion was covered by expanded scalp flap done 22 years ago. Also, he was treated with fat grafts on depressed forehead 17 years ago. However, it did not work sufficiently, and there was noted depressed forehead. We planned to make 3D titanium implant to cover the depressed area (from the superior orbital rim to the vertex). During the operation, we confirmed that the custom-made 3D implant accurately fit for the depressed area without any dead spaces. Previously depressed forehead and glabella were elevated, and the forehead contour was improved cosmetically. A custom-made 3D titanium implant is widely used for skull reconstruction and bring good results. In our case, the depressed forehead of a Parry-Romberg syndrome patient was improved by a 3D titanium implant.

Complication of AQUAfilling® Gel Injection for Breast Augmentation: Case Report of One Case and Review of Literature.

INTRODUCTION: Augmentation mammoplasty is one of the most popular aesthetic operations in the world. In Korea, one of the fillers used for breast augmentation is AQUAfilling® gel (Biomedica. spol, s,r,o, Czech Republic). AQUAfilling® gel is a hydrophilic gel composed of 98% sodium chloride solution (0.9%) and 2% cation copolyamide. METHODS: This is a case report describing a patient that suffered complications after AQUAfilling® gel injection for breast augmentation. RESULTS: A 32-year-old female patient was referred to our plastic surgery department with a chief complaint of repeated wound dehiscence and fluid discharge involving both breasts. She was treated via surgical intervention for removal of necrotic infected tissue and filler, as well as massive irrigation three times. After the third surgery, there were no complications, including infection or dehiscence, during a 1-year follow-up period. CONCLUSIONS: Although AQUAfilling® gel is easy to inject and is natural looking, once a complication occurs, treatment is difficult. Also, there are concerns regarding toxicity of the gel material and its influence on surrounding tissues. Hence, sufficient evidences of long-term safety must be accumulated and proved, until which time the aesthetic use of the unapproved filler must be restricted. LEVEL OF EVIDENCE V: 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 .

Salvage of Infected Breast Implants.

BACKGROUND: Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. METHODS: We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. RESULTS: The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. CONCLUSIONS: Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.

Effect of Relaxin Expressing Adenovirus on Scar Remodeling: A Preliminary Study.

BACKGROUND: Relaxin is a transforming growth factor ß1 antagonist. To determine the effects of relaxin on scar reduction, we investigated the scar remodeling process by injecting relaxin-expressing adenoviruses using a pig scar model. METHODS: Scars with full thickness were generated on the backs of Yorkshire pigs. Scars were divided into two groups (relaxin [RLX] and Control). Adenoviruses were injected into the RLX (expressing relaxin) and Control (not expressing relaxin) groups. Changes in the surface areas, color index and pliability of scars were compared. RESULTS: Fifty days after treatment, the surface areas of scars decreased, the color of scars was normalized, and the pliability of scars increased in RLX group. CONCLUSION: Relaxin-expressing adenoviruses improved the surface area, color, and pliability of scars. The mechanism of therapeutic effects on scar formation should be further investigated.

Variance of the pectoralis major in relation to the inframammary fold and the pectoralis minor and its application to breast surgery.

Understanding the anatomy of the muscles and other structures of the chest is of great importance in breast surgery. We have conducted the first analysis of the overall variations and relationships among the pectoralis major (PM), inframammary fold (IMF), and pectoralis minor (Pm). We studied 30 patients and 10 cadavers, leading to a total of 50 breasts. Preoperatively, the breast width was measured, and the costal origin of the lowest IMF point was marked. Intraoperatively, we recorded the costal origins of the PM and IMF, PM width, the distance between the PM and IMF, and the relationship and distance between the PM and Pm. Among the patients, PMs originated from the sixth rib in 80% and above the IMF in 66.67%. The mean distances between the PM and IMF were 10.5 mm in the patients and 16 mm in the cadavers. The mean PM/breast width ratio was 0.82 in the patients and 0.85 in the cadavers. The PM and Pm mostly crossed on the fourth or fifth rib, and the average angles between the two muscles were 23.5° and 21.4° in the patients and cadavers, respectively. This study is the first to analyze the anatomical variations of the PM, IMF, and Pm simultaneously. We also examined the differences between Western and Asian populations. Understanding the anatomy is undoubtedly crucial for breast surgery, and here we provide a firm guide to the variations to be expected during operations, which can lead to successful outcomes. Clin. Anat. 30:357-361, 2017. © 2017 Wiley Periodicals, Inc.

Effect of botulinum toxin A on vasoconstriction and sympathetic neurotransmitters in a murine random pattern skin flap model.

Blood supply is the most important factor determining the survival of a skin flap. Botulinum toxin-A (Botox-A) is used as pharmacologic agent not only for aesthetic purposes, but also for its vasomotor actions. This study was conducted to establish whether local application of Botox-A increased survival of random pattern skin flaps in rats by changing the expression of neurotransmitters. Forty adult Sprague-Dawley rats with a caudally-based random pattern skin flap were divided into two groups: Botox-A group and saline group. Surviving flap area and cutaneous blood flow in the flap were evaluated on postoperative days 3 and 7. After injection of Botox-A, changes in vessels were analyzed using immunohistochemical staining. Levels of norepinephrine, neuropeptide-Y, nitric oxide, and endothelial nitric oxide synthase were analyzed quantitatively by high performance liquid chromatography, Western blot, and colorimetric assay. The survived area in the Botox-A group was significantly higher than that in the control group on postoperative days 3 and 7. Blood flow in the Botox-A group was significantly high in the proximal and middle areas immediately after the operation. The number of CD31-positive vessels in the Botox-A group was significant greater than that in the control group. Norepinephrine level in the Botox-A group decreased significantly immediately after flap elevation and at postoperative day 3. There were no significant differences in neuropeptide-Y level between the two groups. Nitric oxide level did not change significantly in either group despite the increase in endothelial nitric oxide synthase immediately after flap elevation and at 3 days postoperatively. In conclusion, Botox-A increased vascular blood flow and viable flap area in rats by reducing norepinephrine level. In contrast, neuropeptide-Y, another vasoconstrictor, was not affected by Botox-A. Nitric oxide, a vasodilator, was also not affected by Botox-A, despite the significant increase in endothelial nitric oxide synthase expression in the flaps.

Acceleration of osteogenesis by platelet-rich plasma with acellular dermal matrix in a calvarial defect model.

PURPOSE: The effects of platelet-rich plasma (PRP) on improvement of bone regeneration have been widely investigated. However, use of a proper scaffold is also important to the delivery of bioactive materials. The aim of this study was to analyze the effects of PRP with acellular dermal matrix (ADM) as a bone substitute in a cranial defect model. METHODS: Twenty-nine New Zealand white rabbits were randomly divided into four groups including control, PRP, ADM, and PRP with ADM. A 15 × 15-mm(2) bony defect was carefully created in the cranium. The experimental materials were applied in each group. After 16 weeks, the volume and surface area of new bone were measured using three-dimensional computed tomography and digital photography, and the new bone was analyzed histologically. RESULTS: The PRP with ADM group exhibited a statistically significant increase in volume and surface area of newly formed bone compared with the other groups (p < 0.05). Histological findings revealed compact lamellar bone in the PRP with ADM group. In contrast, scattered bone islands were detected within the fibrous connective tissue in the other groups. CONCLUSIONS: The regeneration of mature and augmented bone was achieved following the application of PRP mixed with ADM. The results indicated that the PRP combined with ADM could be a potentially useful substitute for bone and may aid in the elimination of additional donor-site harvest procedures.