Tissue expansion for breast reconstruction: Methods and techniques

Objective In this work, the authors review recent data on the different methods and techniques of TE/implant-based reconstruction to determine the complication profiles and the advantages and disadvantages of the different techniques. This information will be valuable for surgeons performing breast reconstructions. Materials and methods A thorough literature review was conducted by the authors concerning the current strategy of tissue expander (TE)/implant-based breast reconstruction following breast cancer surgery. Results Loss of the breast can strongly affect a woman's personal and social life while breast reconstruction reduces the sense of mutilation felt by women after a mastectomy, and provides psychosocial as well as aesthetic benefits. TE/implant-based reconstruction is the most common breast reconstructive strategy, constituting almost 65% of all breast reconstructions in the US. Although numerous studies have been published on various aspects of alloplastic breast reconstructions, most studies are single-center observations. No evidence-based guidelines are available as yet. Conventional TE/implant-based reconstruction can be performed as a two-stage procedure either in the immediate or delayed setting. Moreover, the adjunctive use of acellular dermal matrix further broadened the alloplastic breast reconstruction indication and also enhanced aesthetic outcomes. Conclusions TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction

Ultrastructural effects of topical dimethyl sulfoxide on collage fibers during acute skin expansion in a human ex-vivo model

Background: Despite some studies confirming the effectiveness of dimethyl sulfoxide (DMSO) on acute skin expansion, the precise mechanism through which it quickens tissue expansion is yet unknown. No studies have been carried out to date to thoroughly investigate the ultrastructural effects of DMSO on intraoperative tissue expansion. The aim of the present study was to test the ex vivo ultrastructural effects of topical 60% DMSO on dermal collagen fibers of acutely expanded human cutaneous flaps. Methods: Specimens were obtained and ultrastructurally examined from two groups of ex vivo cutaneous flaps from the anterior thigh: group A (experimental) DMSO-treated and acutely expanded flaps, and group B (control), acutely expanded flaps. Results: A statistically significant difference was observed between groups A and B, with respect to the width of dermal collagen fibers, distance between dermal collagen fibers, and percentage of area not occupied by collagen fibers. Conclusions: These findings demonstrate how DMSO affects collagen cross-linkage in the surrounding dermis, decreasing the mechanical resistance of the acutely expanded skin in this ex-vivo model, supporting its use in intra-operative tissue expansion. Level of Evidence: Not ratable

How to isolate a ready-to-use adipose-derived stem cells pellet for clinical application

Adipose-derived stem cells (ASCs) are multipotent mesenchymal stem cells (MSCs) that show definitive stem cell characteristics such as plastic adherence in culture, ability to maintain multipotency upon in vitro expansion, and self-renewal capacity. ASCs are particularly promising for use in regenerative medicine because they can be harvested easily from adipose tissue by standard liposuction, with minimal donor site morbidity. Since ASCs do not necessitate ex vivo expansion to obtain clinically significant cell numbers, it is critical to identify a standardized method that maximizes the number of ASCs collected. Based on current literature, there is no standardized method to isolate ASCs for clinical application. Furthermore, clinical studies involving ASCs often show inconsistencies in the reported results. Such studies often use research-derived isolation protocols, which are complex, time-consuming, and involve the use of chemical and animal-derived reagents. In this paper, we present an in-depth review of the available data on ASC isolation protocols. Moreover, we describe our isolation protocol that allows the collection of a ready-to-use ASC pellet for clinical application

Quantitative difference of acute intraoperative expansion in various body regions

OBJECTIVE: To investigate the efficacy of intraoperative sustained limited expansion (ISLE) by examining the ex vivo biomechanical properties of acutely expanded skin flaps. MATERIALS AND METHODS: Fourteen fresh male cadavers were tested. On both sides of each cadaver, a 4 7 10 cm, the laterally based flap was raised at the external auditory canal of the scalp and a 15 7 8 cm, the proximately based flap was raised at the lateral arm, anterior thorax, and lateral thigh. For each body region, a flap on one side was subject to acute intermittent expansion, while the corresponding contralateral flap served as the control. Both control and acutely expanded flaps underwent stepwise loading to assess their biomechanical properties. RESULTS: No dimensional changes were observed in the acutely expanded flaps when compared to the controls. Mean stiffness and strain values were not significantly different from control values for flaps raised on the scalp, but statistically significant changes were found for those on the lateral arm, anterior thorax and lateral thigh (p < 0.05). CONCLUSIONS: ISLE produced statistically significant biomechanical improvements when applied to the flaps raised on the arm, thorax and thigh, leading to a significant gain in compliance. We suggest that the ineffectiveness of ISLE, when applied to scalp flaps, was due to the inelasticity of the galea aponeurotica. Our findings confirm the general effectiveness of acute skin expansion as means of reducing wound-closure tension after large skin excisions; at least in regions other than the scalp

Clinical use of a new axial chondro-mucosal flap in wide full-thickness eyelid reconstructions.

BACKGROUND AND OBJECTIVE: Full thickness reconstruction of more than half of an eyelid, mainly of the upper one, is a challenge for the surgeon. In 1992, for the first time, the authors reported the use of an axial chondro-mucosal flap from the nose for reconstruction of the tarsoconjunctival plane of a full thickness defect of an eyelid. This article reports and discusses the results of the follow-up of 18 patients operated on using the above technique during the period June 1991-March 1997. PATIENTS AND METHODS: Apart from the oncological evaluation, the following parameters were assessed: position, closure, the presence of epiphora, length of the palpebral rim, rim opening, levator function, an aesthetic balance of the eyelids, and donor site morbidity. The follow-up ranged from 6 to 40 months. RESULTS: The axial chondro-mucosal flap was clinically viable in all patients. One patient showed a 2 mm lagophthalmos. Static parameters were within normal ranges. In upper eyelid reconstruction, an 8 to 18 mm, levator function (mean 13 mm) was shown. CONCLUSION: The authors discuss their complications and results and feel that this flap, associated with full thickness skin grafts, may be considered a first choice technique, in expert hands, in complex full thickness upper eyelid reconstruction, and a possible alternative in lower eyelid reconstruction, for wide defects when the use of other flaps is compromised

Autologous fat transplantation for secondary breast reconstruction: Our experience

Background. Autologous fat transplantation is used after breast reconstruction to improve the breast profile. There are a variety of different methods used for fat harvesting, preparation, and reinjection. This study describes the specific techniques we used in this series of autologous fat transplantations in breast reconstruction patients and reports their outcomes compared with other studies in the literature. Patients and methods. At the University Hospital of Parma between May 2012 and December 2016, we performed 53 autologous fat transplantations for secondary breast reconstruction patients with an average age of 49 years (range: 34\ue2\u80\u9365 y). A tumescent fluid (NaCl, epinephrine, and a local anaesthetic) was injected, and the lipoaspirate was harvested using a closed aspiration\ue2\u80\u93injection system connected to a 50 ml syringe, a 4 mm infiltration cannula, and a -650 mmHg vacuum. The average amount of lipoaspirate obtained was 100 ml (range: 50\ue2\u80\u93200 ml). Centrifugation of the lipoaspirate (3000 rpm for 3 min) was performed to isolate the adipose tissue (average amount obtained, 80 ml; range: 30\ue2\u80\u93180 ml). Under local anaesthesia, the retrograde injection of thin layers of fat graft in multiple tunnels was performed in the subcutaneous and/or subglandular planes. Results. Average follow-up was six months. Comparable to other studies, our complication rate was 7.4% (n = 4/53) and included cyst formation at the injection site (n = 1/53) and hematoma at the donor site (n = 3/53). Repeat fat grafting was performed in 28.3% of patients (n = 15/53) due to fat graft resorption. Conclusions. Autologous fat transplantation is a useful procedure for correcting irregularities in the breast contour in secondary breast reconstruction

The art and science beyond body contouring a solution for massive weight loss patients

The massive weight loss often resulted in an excess of loose skin mainly in the abdomen, upper arms, thighs, chest, back, and laterally on the back. Consequently, most patients sought for a solution, provided by the plastic surgery through the body-contouring surgery. Abdominoplasty, arm lift, tight lift, breast lift, and liposuction are all body contouring procedures that aim to reshape the patients' body. Furthermore, body-contouring surgery can improve the patients' physical discomfort in daily life, also helping in the maintenance of normal BMI (body mass index) in formerly obese patients, thus having a positive aesthetic and psychosocial outcome. A key component of body contouring after massive weight loss is managing patient expectations. Understanding the risks of body contouring's procedures is important for patient counseling and the informed consent process. The goal of this study was to perform a literature review concerning the indication, surgical technique, outcomes and complications of body-contouring surgery

Innesti adiposi autologhi nella chirurgia ricostruttiva della mammella: Tecnica chirurgica

BACKGROUND: Autologous fat grafting can be considered an ideal filler to correct breast contour deformities, scars and loss of volume. The major advantage was the presence of virtually limitless donor tissue that was soft and malleable. Moreover, autologous fat is rich on adipose tissue-derived stem cells (ADSCs) that can be differentiate in various cell types and have also a lot of biological property like secretion of trophic factors, low immunogenicity and immunesuppression, which make them an important resource for many clinical applications. METHODS: We performed a conventional liposuction using a centrifuge with a closed-circuit pump system. The aspiration was carried out with appropriate 50-mL disposable syringes, FPU (Fat Processing Unit calls), which have inside a particular piston containing a filter from 50-100 microns and a metallic weight, which function to exert a greater pressure on the adipose tissue during the centrifugation process. After infiltration with Klein solution with a 2.5\uc3\u97260-mm cannula, we proceed to the liposuction of adipose tissue with a 4\uc3\u97260-mm tube, without the need to change the tools. Finally, the syringes containing the fat collected were centrifuged at 3000 rpm for 3 minutes. After that, the layer of intact, viable and concentrate adipocytes were injected into areas of interest with a 4\uc3\u97170-mm cannula. RESULTS: 80% of patients considered themselves satisfied with the result after the first intervention of lipofilling and saw no need to undergo further treatment. In 15% of cases, a second surgery to achieve a functional and aesthetic effect more than acceptable for the patients it was necessary to run. In a small percentage of cases (5%), we were practiced three interventions of lipofilling before being able to achieve the desired improvement. CONCLUSIONS: The proposed surgical technique gives perfect filling results and definition, high-satisfaction on the part of patients after the first intervention by lipofilling

Laser Doppler Flowmetry and Transcutaneous Oximetry in Chronic Skin Ulcers: A Comparative Evaluation

INTRODUCTION/OBJECTIVE: Laser Doppler Flowmetry (LDF) and transcutaneous oximetry (TcpO2) are established methods for investigating cutaneous perfusion. To date, no study previously performed has compared data obtained from these 2 methodologies in cases of chronic cutaneous ulcers. MATERIALS AND METHODS: Laser Doppler Flowmetry and TcpO2 were performed in 25 consecutive outpatients with chronic lower limb ulcers (group A, experimental; 9 women and 16 men; mean age 67 years [range, 52-81 years]) and 25 age- and sex-matched healthy control subjects (group B, control) enrolled for the study. Ulcer aetiologies included 12 peripheral arterial occlusive disease, 9 chronic venous insufficiencies, and 4 pressure ulcers. Data were analyzed with Shapiro-Wilk and Wilcoxon-Mann-Whitney tests. RESULTS: A statistically significant difference (P < .05) was found between LDF values of the 2 groups. No statistically significant differences were found between the 2 groups regarding the TcpO2 measurements. CONCLUSION: The data confirmed the soundness of LDF while investigating local perfusion in patients with chronic cutaneous ulcers. The same diagnostic accuracy was not obtained by means of TcpO2

Reduction mammoplasty techniques in post-bariatric patients: our experience

none7Excessive body weight represents a huge problem affecting a wide part of world population, causing significant physical and psychological consequences. To solve their obesity-related problems, patients should begin a bariatric treatment to lose an adequate percentage of their body mass and therefore, they should be subjected to body contouring surgery. In this article we describe our experience in applying breast remodeling techniques to post-bariatric patients.nonePolotto, Susanna; GRIECO, Michele Pio; SIMONACCI, FRANCESCO; BERTOZZI, NICOLO'; MARCHESI, Federico; GRIGNAFFINI, Eugenio; RAPOSIO, EdoardoPolotto, Susanna; Grieco, Michele Pio; Simonacci, Francesco; Bertozzi, Nicolo'; Marchesi, Federico; Grignaffini, Eugenio; Raposio, Edoard