Composite breast reconstruction: Implant-based breast reconstruction with adjunctive lipofilling.

INTRODUCTION: Options for breast reconstructions enclose autologous tissue transfers or implants. Fat grafting is gaining more interest in this specific field of breast surgery. This study concentrates on the technique and aesthetic results of breast reconstruction with fat grafts combined with implants, in women who have undergone total mastectomy. METHODS: Breast reconstructions (n = 23) was performed using a protocol of intratissular expansion with serial deflation-lipofilling. In order to achieve the best aesthetic outcome, an additional small implant was placed. A retrospective data analysis was performed. In all patients a tissue expander was placed at the time of mastectomy or after removal of a previous breast reconstruction. The mean of lipoaspirate material for the reconstruction was 333 mL (range 120-715 mL). To create an adequate volume of the reconstructed breast, a supplementary small implant was placed, with a mean volume of 222 mL (range 125-375 mL). The mean follow-up was 33 months (range 19-50 months). RESULTS: A MRI analysis was performed in eight patients at least 9 months after the last lipofilling procedure, demonstrating a mean of 171 mL (range 64-538 mL) of transferred fat, a mean fat survival of 53% and a volume ratio of fat graft/implant of 0.97 (range 0,3-3,8). CONCLUSION: This composite technique of using autologous fat tissue and implants shows aesthetic pleasant results and must be considered as a valid alternative in a subset of patients. Further investigations to optimize the fat graft take must be encouraged.

The use of platelet-rich plasma in plastic surgery: a systematic review.

OBJECTIVE: The study's aim was to evaluate the available evidence regarding the use of platelet-rich plasma in plastic and reconstructive surgery, through implementation of a systematic review of the literature. DATA SOURCES: PubMed and The Cochrane Library were searched using MeSH terms: 'platelet rich plasma' and 'plastic surgery' for all publications up to July 2011. All English, German, French and Dutch papers were included. In addition, the reference lists of relevant articles were searched for potentially appropriate publications. STUDY SELECTION: Included studies needed to report on topics related to plastic and reconstructive surgery, mentioning at least one clinical end point. Both in vivo and in vitro comparative studies, performed in humans or animals, were included. A total of 82 publications were found, of which 40 studies met the inclusion criteria and were relevant to be used in this systematic review. DATA EXTRACTION: Data from retrieved studies were reviewed and tabulated according to year of publication, study design, human or animal studies, characteristics of the population, mode of application, outcomes and preparation method. DATA SYNTHESIS: A total of 15 randomised controlled trials and 25 case-control studies were found. Thirty-six publications demonstrated favourable outcomes with the use of platelet-rich plasma. The included articles were divided into three topics related to plastic surgery: wound healing, fat grafting and bone grafting. CONCLUSIONS: This systematic review describes a substantially beneficial effect of platelet-rich plasma for several indications, including a better wound healing rate, an increased survival rate of fat grafts and an enhancement of bone graft regeneration.

The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction.

BACKGROUND: Successful microsurgical free tissue transfer for head and neck reconstruction highly depends on the quality of the recipient vessels. In most cases, vessels near the site of resection are available; however, when the bilateral vascular network in the neck is compromised or inaccessible due to prior surgery and/or irradiation, alternatives have to be sought. METHODS: Secondary or tertiary head and neck reconstruction was performed using the internal mammary vessels (IMVs) as recipient vessels in seven patients who had undergone previous neck dissection and radiation therapy. Indications were: tracheal-oesophageal fistula or stenosis (n = 4), oesophageal-cutaneous fistula (n = 1), saliva fistula (n = 1) and oral cancer (n = 1). Free flaps used for reconstruction were radial forearm flap (FRFF) (n = 5), anterolateral thigh flap (ALT) (n = 3) and transverse rectus abdominis myocutaneous flap (TRAM) (n = 1). Within two patients an additional ALT flap was necessary for soft-tissue coverage and resurfacing of the neck. The IMVs were separately exposed in a standard fashion over the second or third rib. The pedicle of the flap was anastomosed anterograde and end-to-end to the recipient vessels in all cases. Mean pedicle length was 14.3 cm (11-20 cm), with a mean distance of 9.8 cm (7-13 cm) between the resection and recipient vessel site. RESULTS: All patients were tumour free at time of re-operation and no sign of radiation injury was observed in the recipient vessels. All flaps survived and all patients healed without major complications. Mean follow-up time was 18 months. Four patients died of local recurrence or distant metastases during follow-up. CONCLUSION: In the vessel-depleted neck, the IMVs are a reliable and easy accessible recipient area for microsurgical reconstruction of the head and neck. Surgical management and technique refinements for dissection of the vessels are discussed. In combination with free flaps with a long pedicle, especially perforator flaps, vein grafts are unnecessary and microsurgery can safely be performed outside the zone of injury.

Artery only microanastomosis in nose replantation: a report of two cases.

The nose is a central, prominent unit of the face. The surgical approach to complete nasal amputations is challenging and an experienced microsurgical team should always attempt microvascular replantation. This one-stage procedure could result in a superior clinical outcome compared to delayed reconstructive procedures. Two successful microvascular replantations of the distal half of the nose were performed. Both amputations were the result of two completely different aetiologies (sharp guillotine-like vs. avulsion trauma). However, we were not able to re-establish the venous drainage, which was managed through medicinal leeching. Both replantations resulted in an aesthetically pleasing result and no additional surgery was needed. A microsurgical replantation attempt should always be attempted in nasal amputations and the inability to perform venous anastomosis should not preclude the replant attempt.

Necrotizing fasciitis complicated by fatal multiple organ dysfunction due to Pasteurella multocida infection: a case report.

Necrotizing fasciitis is rarely caused by Pasteurella multocida, a facultative anaerobic gram-negative coccobacillus found in the flora of the oro-gastrointestinal tract of many animals. We describe a rare case with overwhelming septicaemia resulting in multiple organ failure.

The inframammary extending lateral intercostal artery perforator flap for reconstruction of axillary contractures: a case report.

SUMMARY: Release and reconstruction of axillary scar contractures can be challenging due to the specific anatomic site and contouring of the axillary region. Pliable and unscarred skin coverage of resulting defects after scar release is needed which enhances the postoperative recovery and revalidation. When traditional donor regions of fasciocutaneous flaps are involved in the scarred area, options are few. We describe the design and versatility of an inframammary extended lateral intercostal artery perforator (LICAP) flap to reconstruct an axillary defect after wide scar release and debridement. The postoperative recovery was uneventful with restoration of the range of motion of the shoulder joint.

Human clinical experience with adipose precursor cells seeded on hyaluronic acid-based spongy scaffolds.

Histioconductive approaches to soft-tissue defects use scaffolds seeded with lineage- and tissue-specific progenitors to generate tissue which should reside in equilibrium with adjacent tissue. Scaffolds guide histiogenesis by ensuring cell-cell and cell-matrix interactions. Hyaluronic acid-based (HA) preadipocyte-seeded scaffolds were evaluated for their adipo-conductive potential and efficacy in humans. Preadipocytes were isolated from lipoaspirate material and seeded on HA scaffolds. The cellular bio-hybrid (ADIPOGRAFT) and an acellular control scaffold (HYAFF11) were implanted subcutaneously. At specific time points (2, 8 and 16 weeks) explants were analyzed histopathologically with immunohistochemistry. No adverse tissue effects occurred. Volume loss and consistent degradation of the HYAFF11 scaffolds compared to the ADIPOGRAFT group indicated progressive tissue integration. No consistent histological differences between both groups were observed. By 8 weeks all void spaces within the scaffolds were filled with cells with pronounced matrix deposition in the ADIPOGRAFT bio-hybrids. Here we show that HA scaffolds were stable cell carriers and had the potential to generate volume-retaining tissue. However, no adipogenic differentiation was observed within the preadipocyte-seeded scaffolds.