Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature

One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of \u201cthe ideal breast size\u201d, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article

Evaluation of plasma oxidative stress, with or without antioxidant supplementation, in superficial partial thickness burn patients: a pilot study

Background: Oxidative stress is one of the main causes of pathophysiological alterations observed during burn injury. The present pilot study aimed to determine whether a specific oral antioxidant supplementation could in any way influence free radical blood values in patients affected by superficial partial thickness burns. Materials and methods: Plasma oxidants and plasma antioxidant capacity were analysed in 20 superficial partial thickness burn patients for a 2-week period; patients were randomly divided into two groups, one of which was supported with a specifically designed oral antioxidant formula (Squalene 100\u2009mg, Vitamin C 30\u2009mg, Coenzyme Q10 10\u2009mg, Zinc 5\u2009mg, Beta Carotene 3.6\u2009mg, Bioflavonoids 30\u2009mg, Selenium 55\u2009mcg) administered daily, starting from the day of admission, for the whole study period. Results: No significant differences were found in plasma oxidants and plasma antioxidant capacity between the two groups of patients. Conclusions: These results did not reflect any significant benefits of an antioxidant oral supplementation at usual dosages when considering oxidative plasmatic values of superficial partial thickness burn patients

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

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

Plasma Oxidative Stress in Patients With Chronic Vascular Cutaneous Ulcers

Oxidative stress is hypothesized to be one of the main causes of the pathophysiologic alterations observed during impaired healing of wounds. In the present study, we aimed to measure systemic levels of free radicals in blood and anti-oxidant (AO) activity in the plasma of patients with chronic ulcers (venous stasis ulcers and arterial insufficiency ulcers) of lower extremities (CULEs). Oxidants and AO activity were measured in eighty-five consecutive patients with CVSUs of the lower extremities as they arrived randomly for routine visits to our ambulatory clinic. Values of oxidant and AO status in patients with CULEs were significantly different from normal. No significant differences in oxidant and AO values were found between patients with arterial ulcers or those with venous ulcers. A significant difference was found in AO values of diabetic patients with chronic venous ulcers compared with non-diabetic patients with chronic venous ulcers. No significant differences were observed when evaluating oxidant/AO values and smoking habits. Precise reasons why the association of diabetes and venous (but not arterial) ulcers was correlated with defective AO status in plasma are not known. Other data were also intriguing: diminished AO activity was observed in female patients, no significant differences in oxidant and values were found between patients with arterial ulcers or those with venous ulcers, no significant correlation was found between age and oxidant, as well as no significant differences were observed when evaluating oxidant/AO values and smoking habits

From liposuction to adipose-derived stem cells: indications and technique

Adipose tissue is an organ of energy storage, an endocrine organ, a soft tissue filler and a cosmetically unnecessary tissue discarded by liposuction. Liposuction was designed to correct unaesthetic deposits of subcutaneous fat; it produces satisfactory silhouette contouring when performed by appropriately trained operators using properly selected technologies. However, from lipoaspirate it is possible to obtain autologous fat graft and adipose-derived stem cells (ASCs) for reconstructive surgery and regenerative medicine. Autologous fat transplantation uses include the correction of body contour, malformations and post-surgical outcomes. The regenerative properties of ASCs allow treating damaged tissues such as wounds, burns, scars and radiodermatitis. The aim of this study was to perform a literature review highlighting the crucial role of adipose tissue in plastic and reconstructive surgery, from liposuction to lipofilling and ASCs, exposing the indications, procedures and complications of these surgical techniques

Transcutaneous oximetry and laser Doppler flowmetry values in patients with chronic skin ulcers treated with platelet rich plasma and stromal vascular fraction cells: a pilot study

Background Stromal vascular fraction cells (SVFs) hold great promise for use in regenerative medicine applications, as a result of their ability to promote the healing process through in situ differentiation and the secretion of paracrine factors. The aim of this paper was to evaluate whether and how the topical application of SVF with platelet-rich plasma (PRP) for the treatment of chronic skin ulcers modified the cutaneous perfusion of the treated areas. Methods Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO2) values were recorded for a 3-month period in 15 patients with chronic skin ulcers of various etiologies, who had been previously treated with single co-administered perilesional and intralesional injections of SVF+PRP. Results No significant differences were found between pretreatment, 1 month, and 3 month posttreatment values regarding both LDF values (basal: p = 0.10 and declivous: p = 0.0976) and declivous tcpO2 levels (p = 0.0804). The only significant difference reported was between pretreatment and 3-month posttreatment basal tcpO2 levels (p = 0.0466). Conclusions These results may reflect improved subcapillary circulation of the treated areas at 3 months postinjection, without a significant improvement in capillary perfusion

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

A Standardized Method of Isolating Adipose-Derived Stem Cells for Clinical Applications

none5White adipose tissue is the most abundant and accessible source of stem cells in the adult human body. In this paper, we present a standardised and safe method of isolating and maximizing the number of adipose-derived stem cells (ASCs) from conventional liposuction for clinical applications, which was carried out through both mechanical (centrifuge) and enzymatic (collagenase) means. Isolated cells were characterized through flow cytometry assay. Gathered data showed a greater amount (9.06 × 10 ASCs from 100 mL of adipose tissue) of isolated ASCs compared to previous protocol, also with high (99%) cell vitality; the procedure we presented is easy and fast (80 minutes), allowing collecting a significative number of mesenchymal stem cells, which can be used for clinical purposes, such as wound healing.noneRAPOSIO, Edoardo; Caruana, G; Petrella, M; Bonomini, S; GRIECO, Michele PioRaposio, Edoardo; Caruana, G; Petrella, M; Bonomini, S; Grieco, Michele Pi

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