Effects of Polynucleotide Dermal Filler in the Correction of Crow's Feet Using an Antera Three-Dimensional Camera.

BACKGROUND: Dermal fillers are gaining interest for tissue enlargement and skin improvement. Among them, polynucleotides have demonstrated multiple skin beneficial effects. The effects of polynucleotide fillers were objectively evaluated using an Antera 3D camera, subjectively evaluated by participants and investigators. METHODS: Thirty subjects with crow's feet were enrolled in the study. The subjects received polynucleotide filler for crow's feet. Crow's feet grading score (CFGS), global esthetic improvement scale (GAIS), and Antera 3D imaging results were evaluated. RESULTS: Twenty-eight subjects (93.3%) completed the study. An improvement in CFGS compared with that at baseline (p < 0.001) was observed 18 weeks after the first injection of polynucleotides. Additionally, at the final visit, there were improvements in wrinkle, texture, pore, depression, and Hb values compared with those at baseline (p < 0.05). However, no significant difference in melanin level was detected between the initial and final visits. CONCLUSIONS: Improvements in wrinkles, pores, texture, depression, and Hb level after polynucleotide filler injection were verified by objective and subjective evaluations. To the best of our knowledge, this is the first report on the objective evaluation of polynucleotide fillers in crow's feet using the Antera 3D camera. 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 .

Long-term follow-up of a severely traumatized leg treated with ipsilateral fracture-united fibular transfer in a patient with amputation of the contralateral leg: a case report.

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

Does reduction of the oncologic safety margin for facial basal cell carcinoma result in higher recurrence rates?

BACKGROUND: Wide surgical excision is the gold standard for basal cell carcinoma (BCC) treatment. Typically, resection requires a safety margin ≥ 4 mm. We aimed to confirm BCC excisions' cancer recurrence rate and safety on the facial region with new safety margins. METHODS: We included patients with primary BCC on the facial region who underwent wide excision with 2- or 3-mm safety margins at our institution between January 2010 and December 2018. Medical records were reviewed to confirm the epidemiology and surgical information. Recurrence was confirmed by physical examination through regular 6-month follow-up. RESULTS: We included 184 out of 233 patients in this study after applying the exclusion criteria. The mean age and follow-up period were 71.2± 10.2 years and 29.3± 13.5 months, respectively. The predominantly affected area was the nose (95 cases); a V-Y advancement flap was the most commonly used surgical method. There were two cases of recurrence in the 2 mm margin group and one recurrence in the group resected with 3 mm margins. CONCLUSION: In this large cohort study, we found 2-3 mm excision margins can yield enough safety in facial BCCs. The recurrence rates were found to be comparable with those reported after wider margins.

Correction of a nasal soft triangle deficiency as a complication of augmentation rhinoplasty.

The soft tissue triangle is an easily recognizable subunit of the nose. Therefore, deformities in this region resulting from trauma or complications after cosmetic surgery can have serious cosmetic impacts. Various reconstruction choices exist for deformities such as depression of the soft triangle but choosing the most appropriate treatment in each case remains a challenge. In the case described herein, a patient underwent augmentation rhinoplasty with a silastic implant and experienced implant exposure in the soft triangle area. After implant removal, the patient complained of depression in this area. The authors effectively solved this problem through a de-epithelialized composite tissue graft. In this report, we present this case and review similar cases of reconstruction of the soft triangle.

Effect of Polydeoxyribonucleotide on Chondrocutaneous Composite Grafts Survival.

BACKGROUND: A composite graft is considered the best choice for facial reconstruction because of proper texture, color, and simple surgical techniques. However, due to revascularization by the bridging phenomenon, it has limitations with unpredictable survival rates and can be applied only to small defects. Polydeoxyribonucleotide (PDRN) plays an important role in multiple vascular processes such as angiogenesis via production of a vascular endothelial growth factor and by providing an anti-inflammatory effect by reducing pro-inflammatory cytokines through the adenosine A2 receptor stimulation. Thus, here, we investigated PDRN as a supportive method to improve survival of composite grafts. METHODS: Chondrocutaneous composite grafts were applied to both ears of 20 New Zealand White rabbits. The grafts were then rotated and returned to their positions to prevent the original blood flow from the base of the grafts. On postoperative days 1, 3, 6, 9, and 12, PDRN was injected intradermally into the experimental group (20 ears) and normal saline was injected into the control group (20 ears) to exclude bias of pressure effect. After 12 days, graft survival and cutaneous blood flow were examined under laser speckle contrast imaging. RESULTS: Gross observation indicated that the graft viability in the PDRN group was significantly higher than that in the control group (p < 0.05). Through laser speckle contrast imaging, signal intensity increased from the periphery and progressed centrally with treatment. CONCLUSION: Our findings suggest that PDRN may increase blood flow around at the base of the graft, restore the perfusion, and improve the survival of the composite grafts. NO LEVEL ASSIGNED: 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 .