Microsurgery in the hypercoagulable patient: review of the literature.

Improved techniques in microvascular surgery over the last several decades have led to the increased use of free tissue transfers as a mode of reconstructing difficult problems with a high success rate. However, undiagnosed thrombophilias have been associated with microsurgery free flap failures. We present a case of successful free tissue transfer in a patient with lupus anticoagulant and review the literature.

The intercartilaginous graft for actual and potential alar retraction.

BACKGROUND: Alar retraction deformities occasionally require significant soft-tissue release and relatively large cartilage grafts. In addition, correction of the short nose by only lengthening the septum can result in potential postoperative alar retraction. Consequently, both types of cases, true and potential alar retraction (in short noses), would benefit from a technique that lengthens the sidewall of the nose. METHODS: The intercartilaginous graft technique is a modification of the lateral crural strut graft technique. An intercartilaginous graft is inserted between the upper lateral cartilage and what remains of the lateral crus (lateral crus element). The technique emphasizes maximum soft-tissue release to insert a cartilaginous graft that spans the gap between the upper lateral cartilage and the lateral crus element. The graft is inserted under slight tension to maintain maximum lengthening of the sidewall of the nose. RESULTS: Thirteen patients had intercartilaginous grafts placed. Seven patients had actual alar retraction and six patients had short noses with potential alar retraction. There was no postoperative alar retraction in 10 patients. Two patients with actual alar retraction were not completely corrected, and one required surgical revision. One patient with a short nose exhibited postoperative alar retraction, but it was not significant enough to warrant reoperation. CONCLUSIONS: The intercartilaginous graft technique, a modification of the lateral crural strut graft technique, corrects moderate to severe alar retraction and prevents alar retraction after lengthening of very short noses. Its success depends on substantial soft-tissue release and insertion of a maximal sized graft between the upper lateral cartilage and the lateral crus element under slight tension.

A comparison of tenocytes and mesenchymal stem cells for use in flexor tendon tissue engineering.

PURPOSE: Tissue-engineered tendon grafts will meet an important clinical need. To engineer tendons, we used acellularized allogeneic tendon as scaffold material. To determine the ideal cell type to seed the scaffolds, we studied in vitro characteristics of epitenon tenocytes, tendon sheath fibroblasts, bone marrow-derived mesenchymal stem cells (BMSCs), and adipoderived mesenchymal stem cells (ASCs). Subsequently, we implanted reseeded acellularized tendons in vivo as flexor tendon grafts. METHODS: Tenocytes, sheath fibroblasts, BMSCs, and ASCs were obtained from adult rabbits. For all cell lines, collagen 1, 2, and 3 immunocytochemistry was performed, and proliferation was assessed by hemacytometry and senescence by beta-galactosidase staining. Flexor tendons were acellularized after harvest. Tendons were assessed by histology after in vitro reseeding with each of the cell types after 1, 4, and 8 weeks. Finally, reseeded tendons and controls were implanted in a flexor profundus tendon defect. After 6 weeks, the reseeded tendons were harvested and assessed by histology. Statistical analysis for cell proliferation was performed using analysis of variance and t-tests with Bonferroni correction. RESULTS: All cell types had similar collagen expression. Cell proliferation was higher in ASCs in late passage compared with early passage and in ASCs compared with epitenon tenocytes at late passage. The other cell types were similar in growth characteristics. No senescence was detected. In vitro assessment of reseeded constructs showed the presence of cells on the construct surface. In vivo assessment after implantation showed viable cells seen within the tendon architecture in all cell types. CONCLUSIONS: This study suggests that the four cell types may be successfully used to engineer tendons. Adipoderived mesenchymal stem cells proliferate faster in cell culture, but the cell types were similar in other respects. All could be used to successfully repopulate acellularized tendon in vivo as flexor tendon grafts.