The role of frozen storage in preserving adipose tissue obtained by suction-assisted lipectomy for repeated fat injection procedures.

BACKGROUND: The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures. OBJECTIVE: To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures. METHODS: Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at -18 degrees C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection. RESULTS: Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined. CONCLUSION: Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.

Using the Ilizarov external fixation device for skin expansion.

Addressing war injuries requires tailoring treatment that provides the best functional and aesthetic results within a reasonable period of time. The authors report a young soldier who sustained a gunshot injury that caused an open fracture of the proximal tibia and patella (Gustilo type B-III). A local muscle flap could not be used, and thus the authors decided to use the already applied Ilizarov device for gradual expansion of the wound edge. The expanded skin covered the exposed fracture successfully, and later enabled solid union of the fracture. This reconstructive method seems to be an original solution for the management of open fractures, and additional proof that well-vascularized skin may be equivalent to a muscle flap, and may be considered for selected patients.

[Treatment of phenylketonuria due to dihydropteridine reductase deficiency].

Most cases of hyper-phenylalaninemia are due to deficiency of phenyl-alanine hydroxylase that converts phenyl-alanine to tyrosine. This enzymic reaction is facilitated by the co-factor tetrahydrobiopterin (BH4). A defect in the latter substrate leads to increased phenyl-alanine in 1-2 cases per million live births. Such cases are characterized by a degenerative brain process, and pronounced neurologic symptoms that cannot be prevented by a low phenyl-alanine diet alone. In 3 male newborns a deficiency of dihydropteridine reductase (DHPR) activity was diagnosed, the last of a sequence of 3 enzymes involved in the formation of BH4. Successful outcome of treatment, as well as the results of failure to diagnose and treat affected newborns, are described, with emphasis on the logistic problems involved in mass screening.

The effect of hyperbaric oxygenation on the viability of human fat injected into nude mice.

Autologous free-fat injection for the correction of soft-tissue defects has become a common procedure in plastic surgery. The main shortcoming of this method for achieving permanent soft-tissue augmentation is the partial absorption of the injected fat, an occurrence that leads to the need for both overcorrection and repeated fat reinjection. Improving the oxygenation of the injected fat has been suggested as a means of helping to overcome the initial critical phase that occurs postinjection (when the fat cells are nourished by osmosis), increasing phagocyte activity, accelerating fibroblast activity and collagen formation, and enhancing angiogenesis. In addition, the hyperbaric oxygen-mediated decrement in endothelial leukocyte adhesion will decrease cytokine release, thereby reducing edema and inflammatory responses. The purpose of the present study was to examine the effect of hyperbaric oxygenation on improving the viability of injected fat. Adipose tissue obtained from human breasts by suction-assisted lipectomy was injected into the subcuticular nuchal region in nude mice. The mice were then exposed to daily hyperbaric oxygen treatments, breathing 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes. The duration of the administered hyperbaric oxygen therapy was 5, 10, or 15 days, according to the study group. Mice exposed to normobaric air alone served as the control group, and each group included 10 animals. The rats were killed 15 weeks after fat injection. The grafts were dissected out, weight and volume were measured, and histologic evaluation was performed. In all of the study groups, at least part of the injected fat survived, giving the desired clinical outcome. No significant differences could be found between the groups regarding fat weight and volume. Histopathologic examination of the dissected grafts demonstrated a significantly better integrity of the fat tissue in the group that received hyperbaric oxygen for 5 days (p = 0.047). This finding was manifested by the presence of well-organized, intact fat cells, along with a normal appearance of the fibrous septa and blood vessels. The worst results were found in animals treated by hyperbaric oxygenation for 15 consecutive days. An inverse correlation was found between an increased dose of the high-pressure oxygen and fat tissue integrity (r = -0.87, p = 0.076). The toxic effects of highly reactive oxygen species on fat cells might explain the failure of an excessively high dose of hyperbaric oxygen to provide any beneficial outcome. The clinical relevance of these results should be further investigated.

Evaluation and comparison of aesthetic results and patient satisfaction with bilateral breast reduction using the inferior pedicle and McKissock's vertical bipedicle dermal flap techniques.

In the last two decades, McKissock's technique for reduction mammaplasty was largely replaced by Robbins's inferior pedicle technique. However, a substantial number of plastic surgeons still perform McKissock's technique in the belief that it is superior to the inferior pedicle technique in terms of aesthetic results and complication rate. In this study, the authors compared the aesthetic results, complication rates, and patient satisfaction with the two techniques. Numerous studies in the past few years have shown an improvement in physical symptoms in addition to excellent patient satisfaction after breast reduction. However, almost all of these studies have used questionnaires that were mailed to the patients for evaluation. In the present study, aesthetic evaluations by the surgeon and an objective observer were performed in addition to evaluations by the patients themselves, thereby increasing the objectivity and the significance of the patients' evaluations. Two groups of 24 and 27 patients were compared. The groups were almost identical in terms of demographic data and the amount of breast tissue removed. The aesthetic results were good to excellent in both groups, and the groups had similar complication rates. When the patients' evaluations were compared with those of the surgeon and the objective observer, no significant difference was found between the observer and the patients. In one of the groups, the surgeon's evaluations were significantly higher than those of the patients, although they were not significantly higher than the observer's. In terms of aesthetic results, complication rates, and patient satisfaction, no differences existed between the groups. In addition, the patients' evaluations were determined to be a reliable index of aesthetic results and, in these cases, they were often identical to objective evaluations.

Prophylactic antibiotics in aesthetic and reconstructive surgery.

The widespread use of antibacterial agents for prophylaxis has altered surgical practice markedly in the past 20 years and now represents one of the most frequent uses of antibiotics in hospitals, accounting for as many as half of all antibiotics prescribed. The present study was undertaken to determine the patterns of and reasons for antibacterial agent usage by today's practicing plastic surgeons in Israel. A survey of 78 Israeli plastic surgeons certified by the Israeli Association of Plastic Surgery was conducted. Questionnaires were mailed to all the certified plastic surgeons; 66 (84.6%) were completed and returned. The results indicate that prophylactic antibiotics are administered in a high percentage of aesthetic and reconstructive surgeries except for those in eyelids and nose. Most of the surgeons prefer to prescribe cephalosporins as their antibiotics of choice and the timing of administration is before or at the beginning of surgery. Placement of drains did not change the decision to use prophylaxis. Diabetes mellitus, steroid treatment, and chronic lung disease have a direct influence on the decision to use antibiotics; however, conditions such as ischemic heart disease, hypertension, and cigarette smoking do not influence their use. Personal experience was the main reason for prescribing antimicrobial agents. We conclude that although the infection rate in aesthetic and reconstructive operations is extremely low, most Israeli plastic surgeons still prefer to administer prophylactic antibiotics though no scientific hard data is available.

A multifaceted mental health training program in reducing burnout among occupational social workers.

This article looks at ways of reducing stress through a multifaceted training program involving the acquisition of mental health knowledge and skills and experiential training in a group of occupational social workers. The training group of 13 occupational workers was compared to a group of occupational social workers not attending the program. Post-training revealed statistically significant increases in professional self-efficacy associated with awareness of psychological and psychopathological issues and professional social support. Reduction in cognitive weariness and listlessness associated with burnout was also found. Gaining competence in mental health issues relating to the occupational setting coupled with emotional sharing helped to reduce professional burnout.

Improved vitality of experimental random dorsal skin flaps in rats treated with enriched cell culture medium.

A defined, serum-free cell culture medium supplemented with nonsteroidal anabolic hormones, insulin, thyroxin, and growth hormone was found to accelerate wound healing by stimulating vascularized granulation tissue formation, epithelialization, and angiogenesis. The aim of this work was to study the effect of cell culture medium on the survival rate of cephalically based random dorsal skin flaps in an animal model. A total of 77 Sprague-Dawley rats were randomized into five treatment groups: pharmacologic delay with cell culture medium, flap enhancement with cell culture medium, surgical delay, biological delay with saline, and control. Statistically significant differences in distal flap necrosis were found among all groups (p<0.003). The rats treated with cell culture medium before flap elevation showed a significant increase in flap viability: a survival rate of 83 percent, compared with the control group, which demonstrated a survival rate of only 58 percent (p<0.0001). The surgical delay and the groups treated with cell culture medium yielded similar results with no significant difference between them. This study indicates that preoperative injection of cell culture medium may play a role in decreasing skin flap necrosis.

Aesthetics and function in lip reconstruction.

Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2-T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.

Purse-string suture for nipple projection.

A simple and useful technique for nipple projection is reported. A buried, subcutaneous, purse-string suture is placed through prick holes and, when tied, gives a nipple mound, without the need of skin incisions, flaps, or undermining. This procedure can be applied to inverted, missing, and/or ill-defined nipples.