Activin A and Follistatin Serum Concentrations in Breast Augmentation Patients.

Background: Capsular contracture is caused by an excessive fibrotic reaction similar as observed in other progressive fibrotic disorders. For their pathogenesis, several studies confirmed the importance of activins and follistatin. The aim of this study was to determine and analyze serum levels of Activin A and follistatin in patients with capsular contracture after aesthetic breast augmentation. Methods: The study included 361 female patients who underwent primary aesthetic breast augmentation, came for control examination after breast augmentation or for revision operation because of capsular contracture. Blood samples were taken and using a specific ELISA to determine the serum concentration levels of Activin A and Follistatin. Results: Ninety-six patients (n = 96), who developed a capsular contracture Baker ≥°III and underwent revision surgery were collected (capsular fibrosis group). One-hundred and fourteen patients (n = 114) were asymptomatic for capsular fibrosis Baker ≥°III after primary breast augmentation and 33 (n = 33) of them had developed no capsular fibrosis after more than 10 years (long-term group). For control group, blood samples were taken from 167 patients (n = 167) before primary aesthetic breast augmentation. Serum Activin A levels were significantly higher in the long-term Group compared with those in the capsular fibrosis- and the control groups. Follistatin levels were significantly lower in the capsular fibrosis group compared to the control- and the long-term groups. A small amount of control group patients (n = 16) developed a capsular fibrosis within 2 years after primary breast augmentation with significant lower follistatin levels. Retrospectively, they showed significantly lower serum follistatin levels than the control group even before the onset of capsular contracture. Conclusions: Capsular fibrosis has no effect on Activin A serum levels. In contrast, follistatin serum levels are lower in patients with capsular fibrosis. These results show that besides many other factors, a dysregulation of the Activin-follistatin axis may have importance on the pathogenesis of capsular contracture.

Contexte : Une coque est causée par une réaction fibreuse excessive semblable à celle observée dans d'autres troubles fibreux évolutifs. Plusieurs études ont confirmé l'importance des activines et de la follistatine dans leur pathogénie. L'objectif de cette étude était de déterminer et d'analyser les taux sériques d'activine A et de follistatine chez des patientes présentant une coque après augmentation mammaire à but esthétique. Méthodes : L'étude a inclus 361 patientes qui avaient subi une augmentation mammaire primaire dans un but esthétique et qui étaient venues pour un examen de contrôle en vue d'une intervention de révision pour cause de coque. Des échantillons de sang ont été prélevés et analysés en utilisant un test ELISA spécifique afin de déterminer les concentrations sériques d'activine A et de follistatine. Résultats : Quatre-vingt-seize patientes (n = 96) ayant développé une coque Baker ≥°III et ayant bénéficié d'une chirurgie de révision ont été identifiées (groupe coque fibreuse). Cent quatorze patientes (n = 114) étaient asymptomatiques pour une fibrose capsulaire Baker ≥°III après l'augmentation mammaire primitive et, parmi elles, trente-trois (n = 33) n'avaient pas développé de coque après plus de 10 ans (groupe à long terme). Des prélèvements de sang ont été effectués sur un groupe témoin de 167 patientes avant l'augmentation mammaire primaire à visée esthétique. Les taux sériques d'activine A étaient significativement plus élevés dans le groupe à long terme, comparativement au groupe coque fibreuse et au groupe contrôle. Les taux de follistatine ont été significativement plus faibles dans le groupe coque fibreuse comparativement au groupe contrôle et au groupe à long terme. Un petit nombre de patientes du groupe contrôle (n = 16) ont développé une coque fibreuse dans les deux ans suivant l'augmentation mammaire primitive avec des taux de follistatine significativement plus faibles. De façon rétrospective, leurs taux sériques de follistatine étaient significativement plus faibles que dans le groupe contrôle, même avant l'apparition de la coque. Conclusions : La coque fibreuse n'a pas d'effet sur les taux sériques d'activine A. En revanche, les taux sériques de follistatine sont plus faibles chez les patientes ayant une coque. Ces résultats montrent qu'en plus de nombreux autres facteurs, une dérégulation de l'axe activine A-follistatine peut avoir de l'importance pour la pathogénie de la coque.

Fibrin Sealant Artiss Compared to Progressive Tension Sutures With Stratafix in the Management of Wound Drainage Following Post-Bariatric Body-Contouring Surgery.

BACKGROUND: Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers. METHODS: We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal. RESULTS: The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group. CONCLUSION: The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.

HISTORIQUE: L'opération de remodelage corporel après une opération bariatrique fait partie des interventions à la croissance la plus rapide en chirurgie plastique. Le sérome en est l'une des principales complications. Il existe plusieurs méthodes pour réduire le drainage des plaies et la formation de sérome. Des méthodes efficaces pour réduire l'espace mort entre les couches de tissus sont une stratégie prometteuse. MÉTHODOLOGIE: Les chercheurs ont réalisé une étude rétrospective pour comparer la colle Artiss à base de fibrine humaine aux sutures de tension progressive (STP) à l'aide du Stratafix, un fil de suture cranté bidirectionnel, pour les patients qui subissent un remodelage corporel après une opération bariatrique. Ils ont évalué 36 patients qui devaient subir une abdominoplastie ou un remodelage du bas du corps. Les patients traités se sont fait appliquer de la colle à base de fibrine humaine pour adapter les couches de tissus. Le groupe témoin a subi la même intervention, mais au moyen de STP. Les mesures de résultats primaires incluaient le drainage total des plaies et la période jusqu'au retrait du drain. RÉSULTATS: En cas d'abdominoplastie, l'utilisation d'Artiss entraînait un volume de drainage moyen considérablement plus élevé et un plus grand nombre de jours avant de retirer tous les drains que la STP. En cas de remodelage corporel, le volume de drainage moyen et le nombre de jours nécessaire avant de retirer tous les drains tendaient à être plus élevés après l'utilisation d'Artiss que de STP. CONCLUSION: Par rapport aux STP, l'Artiss n'a pas réduit le taux de sérome ni la période d'utilisation des drains après des opérations de remodelage corporel suivant une chirurgie bariatrique.

[Minimal Scar Breast Augmentation: Experience with over 500 implants]. / Narbensparende Brustvergrößerung: Erfahrungen mit über 500 Implantaten.

INTRODUCTION: In plastic breast surgery minimal scar techniques are usually associated with some advantages in terms of the aesthetics associated with scar formation and scar visibility. They can also bring benefits in terms of healing and recovery time, which is why minimal scar techniques for breast reduction and mastopexy have long been established. Modern implants and new, adapted surgical techniques enable it now to use minimal scar techniques for breast augmentation with similar advantages. METHOD: 252 patients were included in a retrospective study, which underwent a minimal scar breast augmentation via an inframammary approach over a period of two years. The investigations included the location, the size, the shape and any postoperative complications. In addition, all patients were interviewed about their experiences before and one year after the operation using the Breast-Q Questionnaire (Augmentation Module). The focus was on self-esteem (pre- and postoperative) and satisfaction with the outcome of breast augmentation involving the scar. RESULTS: The assessment of the surgical outcome and the scar were consistently positive. There were no complications with regard to surgical access, the scar or the implant. All patients showed a significant increase in quality of life on the Breast-Q scale from 0-100 (psychological well-being: 44 to 77) and were satisfied with the outcome of breast enlargement (satisfaction with the breasts: 28 to 80; satisfaction with the result: 89 out of 100) involving the scar. CONCLUSION: Minimal scar breast augmentation requires greater technical effort and operative experience. However, the results are consistently positive and promising, both clinically and psychologically.

Validation of Microbiological Testing of Cellular Medicinal Products Containing Antibiotics.

BACKGROUND: The risk of microbial contamination of cellular products can be reduced when cultured in the presence of antibiotics. This however, may impact the sensitivity of microbiological tests. Given that the addition of antibiotics to cell/tissue products does not guarantee sterility but may just reduce the proliferation rate of microorganisms, microbiological testing of medicinal products remains obligatory. Thus, an appropriate method to test for microbial contamination of antibiotic-containing products has to be validated. OBJECTIVES: In the context of microbiological testing of a cellular advance therapy medicinal product, the method was validated and approved by German competent authorities for four different matrices with three matrices containing antibiotics. The paper shall provide help for establishing test methods for other investigational medicinal products which contain antibiotics. METHODS: Matrices were spiked individually with Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Streptococcus pyogenes, Escherichia coli, Clostridium sporogenes, Propionibacterium acnes, Candida albicans, and Aspergillus brasiliensis. Samples were pretreated with penicillinase for 1 h before inoculation and incubation in BacT/ALERT iFA Plus and iFN Plus culture bottles using 3D BacT/ALERT automates. Microorganisms within positive BacT/ALERT bottles were specified. The procedure was performed in two different laboratories to prove robustness of test. RESULTS: All nine tested microorganisms were detected within 14 days of incubation in accordance with requirements of the European Pharmacopoiea in terms of sensitivity, specificity and robustness of the test. Penicillin and streptomycin did not have any influence on specifications defined within the investigational medicinal product dossier. CONCLUSIONS: Culturing cellular products in the presence of antibiotics can serve as an effective method to reduce contamination risk but only if the chosen antibiotics neither have any influence on specifications of the investigational medicinal product nor interfere with microbiological tests. Consequently, cells and tissues primarily contaminated with microorganisms, like placenta, may be considered as a source of cellular therapeutics when cultured for a sufficient time with antibiotics and tested with a validated method. The choice of microorganisms for the validation of the microbiological test should always consider all conceivable scenarios and should not be reduced to minimal criteria defined in European Pharmacopoiea, wrongfully believing to thus save time and effort.

Recombinant Silk Hydrogel as a Novel Dermal Filler Component: Preclinical Safety and Efficacy Studies of a New Class of Tissue Fillers.

BACKGROUND: Hyaluronic acid-based tissue fillers are commonly utilized in reconstructive surgery as well as for aesthetic augmentation. A new type of recombinant silk-based tissue filler might pose a beneficial alternative for surgeons and patients. OBJECTIVES: The aim of this study was to compare injectability, reshaping, tolerability, and postimplantation behavior of dermal filler preparations containing recombinant silk hydrogel with a commercially available hyaluronic acid filler in 2 different animal models. METHODS: Recombinant silk hydrogel as standalone preparation or as a mixture with commercial stabilized hyaluronic acid was tested in rodent and porcine animal models. The preparations were analyzed in detail and administered subdermally followed by clinical, volumetric, and histological monitoring of the subdermal depots over several months. RESULTS: Applicability, dosing, and tissue distribution of the filler preparations were facilitated in the presence of silk hydrogel. No clinical complications attributable to tissue filler application were recorded. State-of-the art methods, such as high-performance magnetic resonance imaging, were applied successfully to monitor the volumetric development of the filler depots in live animals. CONCLUSIONS: The preclinical data demonstrate the basic suitability of recombinant silk hydrogel as safe and convenient tissue filler ingredient. Due to its shear thinning properties, recombinant silk hydrogel has the potential for less painful application, comfortable aesthetic reshaping immediately after administration, and negligible postoperative discomfort.

Modified Treatment Algorithm for Pseudogynecomastia After Massive Weight Loss.

BACKGROUND: Pseudogynecomastia is the increased aggregation of fatty tissue in the area of the male breast with resultant female appearance. Two forms can appear: pseudogynecomastia after massive weight loss (pseudogynecomastia obese [PO]) and pseudogynecomastia, which is caused only by adipose tissue (pseudogynecomastia fat). For PO, only the Gusenoff classification with corresponding operative treatment options exists. However, this classification is limited by the fact that it underestimates the extensive variability of residual fat tissue and skin excess, both crucial factors for operative planning. For this reason, we propose a modification of the treatment algorithm for the Gusenoff classification based on our results to achieve more masculine results. MATERIALS AND METHODS: A total of 43 male patients with PO were included in this retrospective study (grade 1a, n = 1; grade 1b, n = 1; grade 2, n = 17; grade 3, n = 24). Forty-two mastectomies with a free nipple-areola complex (NAC) transposition (grades 2 and 3) and 1 with a subcutaneous mastectomy (grade 1a) with periareolar lifting were performed. A retrospective chart review was performed to obtain data regarding age, body mass index, body mass index loss, weight loss, reason for weight loss, comorbidities, nicotine, and additional procedures, postoperative sensitive on the NAC transplants and complications. RESULTS: None of the free-nipple grafts were lost. Forty (95%) of 42 patients with mastectomy had a resensitivity on the NAC. CONCLUSIONS: For pseudogynecomastia, the treatment algorithm of the Gusenoff classification should be modified and adapted according to our recommendations to achieve more optimal masculine results.

Influence of patient age on capsular contracture after aesthetic breast augmentation.

The influence of age on capsular contracture rates remains unclear. Most studies have only investigated early capsule development and not whether a link between age at primary surgery and the later development of capsular fibrosis exists. To clarify whether patient age impacts the development of late capsular fibrosis, the authors conducted a retrospective case study involving 43 patients who presented for surgical revision of capsular contracture (Baker grade ≥III) between four and 40 years after primary breast augmentation. Possible correlations between age and implant placement were analyzed. Late presentation of capsular fibrosis occurred a mean of 15.6 years after primary augmentation, with a slightly negative, but not significant, correlation between age at primary operation and duration of implant placement. Patients <40 years of age underwent an operative revision after a mean of 18.9 years, while patients ≥40 years of age needed an operative revision a mean of 11.9 years after primary breast augmentation (P=0.0368). The results suggest that with advancing age, the average time to develop capsular fibrosis is significantly shorter in individuals who develop capsular contracture. As more data are collected, appropriate advice can be provided to patients regarding factors that influence the long-term outcomes of breast augmentation.

On ne connaît pas l'influence de l'âge sur le taux de contractures capsulaires. La plupart des études portent seulement sur l'apparition précoce de capsules et n'abordent pas la possibilité d'un lien entre l'âge au moment de la chirurgie primaire et l'apparition ultérieure de fibrose capsulaire. Pour établir si l'âge des patientes influe sur l'apparition de fibrose capsulaire tardive, les auteurs ont réalisé une étude rétrospective auprès de 43 patientes qui ont demandé une révision chirurgicale de la contracture capsulaire (grade ≥ III selon l'échelle de Baker) de quatre à 40 ans après l'augmentation mammaire primaire. Ils ont analysé les corrélations possibles entre l'âge et la pose des implants. La présentation tardive de la fibrose capsulaire se produisait en moyenne 15,6 ans après l'augmentation primaire, et la corrélation était légèrement négative, mais non significative, entre l'âge au moment de l'opération primaire et la durée de mise en place des implants. Les patientes de moins de 40 ans subissaient une révision opératoire au bout d'une moyenne de 18,9 ans, tandis que celles de 40 ans ou plus s'y soumettaient en moyenne 11,9 ans après l'augmentation mammaire primaire (P=0,0368). Selon ces résultats, avec le vieillissement, le délai moyen d'apparition d'une fibrose capsulaire est considérablement plus court chez les personnes qui présentent une contracture capsulaire. L'accumulation de données permettra de mieux conseiller les patientes quant aux facteurs qui influent sur les résultats à long terme de l'augmentation mammaire.

Two-stage posterior cross-labial transposition flap: a novel technique for labium minus reconstruction.

Distinctive asymmetry of the labia minora is an underestimated complication that can be congenital, post-traumatic, or occur after oncological intervention or aesthetic labioplasty. Affected women can be restricted functionally and in their sense of self-worth, aesthetic appearance and sexual life. In presenting this case of post-oncological labia minora asymmetry, we demonstrate our method of the two-stage posterior cross-labial transposition flap as a reliable technique for unilateral labium minus reconstruction.

Local inhibition of angiogenesis by halofuginone coated silicone materials.

Anti-angiogenic therapy is a promising approach for the treatment of increased angiogenesis in certain diseases. We aimed to investigate the local anti-angiogenic effect of silicone implants coated with Halofuginone, an angiogenesis inhibitor that inhibits synthesis of collagen-type-I and matrix metalloproteinases. The degree of angiogenesis was observed after implantation of surface modified Halofuginone eluting silicone implants into a submuscular pocket in rats over a period of 3 months. Subsequently, key mediators of angiogenesis (TGF-beta-1, bFGF, COL1A1, MMP-2, MMP-9, VEGF and PDGF) were established by immunohistological staining and RT-PCR and statistically evaluated. In comparison to uncoated silicone implants, Halofuginone eluting silicone implants lead to a significant local decrease of angiogenesis. Halofuginone eluting hybrid surface silicone implants have a significant local anti-angiogenic effect by down-regulating the expression activity of key mediators of angiogenesis.

Reduction of burn scar formation by halofuginone-eluting silicone gel sheets: a controlled study on nude mice.

Burn scar formations can cause disfiguration and loss of dermal function. The purpose of this study was to examine whether application of modified silicone gel sheets with an antifibrotic drug halofuginone-eluting hybrid surface produce an effect on scar development. There were a total of 2 animal groups. The athymic nude mice (nu/nu) of both groups underwent transplantation of full-thickness human skin grafts onto their backs and setting of partial thickness burn injury. The status of local scar development was observed over a period of 3 months after the application of silicone gel sheets and also after application of surface-modified halofuginone-eluting silicone gel sheets. Subsequently, via real-time polymerase chain reaction, the cDNA levels from key mediators of scar formation (transforming growth factor beta, COL1A1, connective tissue growth factor, fibroblast growth factor 2, matrix metalloproteinase 2, matrix metalloproteinase 9) were established and statistically evaluated. In comparison with uncoated silicone gel sheets, the application of halofuginone-eluting silicone gel sheets lead to a significant difference in gene expression activity in scar tissue. Halofuginone-eluting hybrid surface silicone gel sheets significantly increase the antiscarring effect of adhesive silicone gel sheets by deceleration and downregulation of scar development by normalization of the expression activity.

Subfascial directionality of perforators of the distal lower extremity: an anatomic study regarding selection of perforators for 180-degree propeller flaps.

BACKGROUND: The 180-degree propeller flaps allow closure of soft-tissue defects of the distal lower extremity. In addition to twist, the pedicle is often subject to additional kinking which increases proportionally to the angle at which the perforator pierces through the fascia. This study evaluates the directionality of the perforators at the fascial level to guide in the selection process of the best perforator. MATERIAL AND METHODS: Perforators were identified in the lower extremities of 16 fresh cadavers. The angle of fascial perforation was measured. Perforators were grouped according to source vessel and location. Results were analyzed statistically regarding angle of fascial perforation along the source vessel and region. RESULTS: A total of 324 perforators were identified. Distal perforators pierced the fascia at a significantly greater angle than in the proximal and middle segment of the peroneal and anterior tibial vessels (P < 0.005). Perforators originating from the posterior tibial artery pierced the fascia at less acute angles distally. When grouped according to the region of the perforators, no significant difference was found between perforators from all source vessels in the proximal region of the distal lower extremity. Even distally, perforators from the posterior tibial artery traveled almost perpendicular (P < 0.005). CONCLUSION: Perforators traveling in a near perpendicular manner are ideal to serve as a pedicle for 180-degree propeller flaps as solely the twist has to be distributed along the vessel. The posterior tibial artery was the source to perforators with the most constant, near-perpendicular course, predisposing them for use in 180-degree propeller flaps.

Tensile strength of flexor tendon repair using barbed suture material in a dynamic ex vivo model.

The purpose of this study was to compare two sutures; a knotted polydioxane with a knotless barbed in a 4-strand Kirchmayr-Kessler suture technique. Human flexor digitorum tendons were separated into four groups. Group 1 - polydioxane; Group 2 - barbed suture; Group 3 and 4 - same as group 1 and 2 with an additional peripheral running suture. In each group the repaired tendons were subjected to linear and cyclical loads. No difference in maximum tensile strength after linear and cyclical force could be detected between the knotted polydioxane suture and the knotless barbed suture. On linear force tests an additional circumferential repair increased the maximum tensile strength of both sutures. Cyclical force loading did not lead to a reduction of maximum strength. Following linear and cyclical loading the 4-strand barbed suture achieved maximum tensile strengths comparable to the 4-strand repair using the polydioxane suture. Barbed suture repair may offer the advantage of knotless suture techniques.

Biomechanical evaluation of flexor tendon repair using barbed suture material: a comparative ex vivo study.

PURPOSE: Barbed suture material for tendon repair opens up the possibility of a knotless reconstruction due to an increased suture-tendon interaction. The aim of this study was to compare the tensile strength of a knotted technique with a monofilament polydioxane suture to that of a knotless technique with a barbed suture material, by using a multistrand, modified Kirchmayr-Kessler tenorrhaphy. METHODS: Sixty human flexor digitorum tendons were randomized into 4 groups. A modified, knotted, multistrand Kirchmayr-Kessler technique with an absorbable, monofilament polydioxane suture was compared with a modified, knotless, multistrand Kirchmayr-Kessler technique with an absorbable, unidirectional barbed glycolic-carbonate suture. Tendons were distracted to failure. Mode of failure and load to failure were recorded. RESULTS: The knotless 2-strand Kirchmayr-Kessler barbed suture shows a significantly lower tensile strength than the knotted 2-strand polydioxane suture (p < .001). The comparison of the maximum tensile strength of the knotless (glycolic-carbonate) technique with that of the knotted (polydioxane) 4-strand technique resulted in no significant difference in either technique utilized (p = .737). The tensile strength of the 4-strand technique was greater than that of the corresponding 2-strand technique (p < .001). CONCLUSIONS: The 2-strand Kirchmayr-Kessler barbed suture proved to be insufficient and significantly weaker than the 2-strand polydioxane suture, and therefore it cannot be recommended. With the knotless 4-strand Kirchmayr-Kessler technique, the barbed suture material has the potential to be used in flexor tendon surgery, but it has no advantage over the 4-strand polydioxane suture.

Phosphorylcholine-coated silicone implants: effect on inflammatory response and fibrous capsule formation.

INTRODUCTION: The formation of capsular fibrosis around silicone breast implants is a common complication in reconstructive and plastic surgery. Foreign body reaction-induced infections are quite common because of the hydrophobic surface properties of silicone and are, in addition, considered to be a causative factor of capsular fibrosis. METHODS: In this experimental pilot study, 2 groups of 7 Sprague-Dawley rats were established to evaluate the periprosthetic collagen synthesis after implantation of coated silicone implants. In the first group, the textured minisilicone implants were implanted submuscularly. The second group received the biotechnologically, surface-modified phosphorylcholine (PC)-coated implants. After a 3-month period, all the rats were killed, and the capsules were examined in a histologic (hematoxylin-eosin and Masson-trichrom) and immunohistologic way (CD4, CD8, CD68, TGF-beta, fibroblasts, collagen type I, and collagen type III). RESULTS: Significant differences were found to occur between the PC-coated and standard, textured implants with respect to the inflammatory reaction and collagen synthesis. CONCLUSIONS: The production of hydrophilic surfaces in silicone implants by way of PC-coating causes a decrease in the inflammatory reaction, and thus, a reduction of periprosthetic fibrosis. This could form the basis of a cost-effective, preventive, and therapeutic strategy with respect to the decrease in capsular fibrosis occurrence.

Symptomatic congenital pisiform hamate coalition.

Congenital fusions of the carpal bones are rare anomalies, which occur in less than 1% of the population. This article describes a congenital pisiform hamate coalition which became symptomatic when caused by a trauma. The condition was successfully treated with the resection of the synchondrosis, autogenous bone graft, and screw stabilization.

Surface modification of silicone breast implants by binding the antifibrotic drug halofuginone reduces capsular fibrosis.

BACKGROUND: Capsular fibrosis is one of the most severe complications that can occur in connection with silicone breast implants. Should this case arise, a periprosthetic deposition of fibroid tissue may evolve. Transforming growth factor (TGF)-beta is one of the most important mediators in relation to such processes. METHODS: The chinazolinone derivative halofuginone is a type I collagen synthesis inhibitor that interferes with the TGF-beta signaling pathway. The work at hand examines the local antifibrotic effectiveness of halofuginone lactate, which has been biotechnologically bound to the silicone implant's surface. The experiments in relation to this were conducted in vivo on two groups of seven Sprague-Dawley rats. Group I received untreated silicone implants, and group II received halofuginone-coated silicone implants. RESULTS: Submusculary embedded halofuginone-coated silicone implants have shown no systemic side effects. The histologic and immunohistologic examinations of the periprostatic capsules revealed a significant decrease of CD68 histiocytes, TGF-beta, fibroblasts, collagen type I and type III, and capsular thickness after a 3-month period. CONCLUSION: The results confirmed a decrease in foreign body responses to halofuginone surface-modified silicone implants and mark their potential for obtaining a lessened capsular fibrosis by way of a local antifibrotic effect.

Comparison of various methods and materials for treatment of skin laceration by a 3-dimensional measuring technique in a pig experiment.

BACKGROUND: The ability to obtain an objective comparison of scar formations by reproducible and quantitatively measurable results have posed a longstanding problem. This was especially troublesome when conclusions were to be drawn about the materials and methods applied. Two-dimensional methods (photography) gave no plastic impression about the spatial coherences in an examined scar. However, a quantifiable and reproducible recording of volumes and a 3-dimesional visualization of scars should provide the basis of any evaluation of methods and materials. METHODS: The OPTOCAT 3-dimensional scanning technique that was used was provided by the Breuckmann GmbH Company (Meersburg, Germany), and it permits a 3-dimensional, contact-free recording of data. The experiment animal was the Goettinger minipig. A total of 10 animals were used to examine the process of wound healing and scar development in full skin incisions. Every animal was incised 20 times with a 10-cm long and 20 times with a 2-cm long wound. In our investigation, comparable suture materials (skin adhesive, absorbing and nonabsorbing suture materials) of the companies Braun (Histaocryl, Monosyn, Safil, Premilene) and Ethicon (Dermabond, Monocryl, Vicryl, Prolene) as well as various suture techniques were used (continuous, mattress suture, and over-and-over/interrupted suture; each once with and once without an intracutaneous suture). In the course of the trial, numerous images of all wounds-a total 1200-were taken. Thanks to the 3-dimensional software, the resulting scar volumes of lacerations, which received different wound management, were quantifiably recorded, compared, and evaluated. RESULTS: In total, dehiscence occurred in 2.5% of all treated wounds. The greatest share (15%) fell to wounds treated with Histoacryl skin adhesive. In the end, skin adhesive, mattress, and interrupted suture all delivered similar results. An additional intracutaneous suture had, with an increasing wound length, a positive effect on the intention/wound healing, especially in connection with the application of skin adhesive. Except the combination of continuous absorbable suture and intracutaneous suture, the scar volume dwindled over time and adapted to the surrounding skin level. Continuous sutures were, by comparison, more inclined to an increased scarring (absorbable suture > nonabsorbable suture). It did not escape our notice that in case of small wounds, all various suturing materials and methods led to almost identical results. With respect to scarring, no significant difference regarding the suturing material was proven. CONCLUSIONS: If possible, the wound closure, treated with common suturing techniques and especially with skin adhesive, should be enhanced by an intracutaneous suture with an increasing length of the wound. Under certain circumstances, skin adhesive is an adequate substitute for common suturing materials and methods. The final decision about the method and material is as much closely related to the length and localization of the wound as to time exposure, efficiency, and the comfort of the patient. SUMMARY: For objective comparison of intention and scarring, a scanning technique was used that permits a quantifiable, contact-free, single-session recording of volume differences. For this purpose, various suture materials and methods were used. Altogether, it could be shown that, if possible, wound closure treated with common suturing techniques, and especially with skin adhesive, should be enhanced by an intracutaneous suture with an increase in wound length. At the same time and under certain circumstances, skin adhesive poses an adequate substitute for the common suturing materials and methods. In the end, however, the final decision about the choice of method and material should be made depending on the localization and expanse of the wound as well as on the comfort of the patient (eg, absorbable suture/nonabsorbable suture), the time of exposure (eg, skin adhesive vs suture), and the economic efficiency (eg, producer of suture material).