Innervation of a prefabricated flap: a new experimental model

Introduction. Flap innervation by neoaxonogenesis is a promising field of investigation. The authors evaluated the possibility of innervating an acellular collagen scaffold as component of a potential prefabricated flap. Materials and Methods. Collagen matrix sheets were implanted around the femoral bundle of a murine model to produce two flaps on proximal and distal nerve stumps based on a flow-through model. After thirty days, nerve regeneration and integration into the collagen matrix were evaluated. The specimens were microscopically analyzed to study Schwann cell colonization and axonal integration with the matrix. Axonal count and density were assessed and statistically evaluated. Results. Qualitative structural and ultrastructural evaluation indicated integration, with axonal fibers merged within the collagen matrix, along with a newly formed vascular network on the proximal flap. Wallerian degeneration occurred inside the distal chamber. Axonal count and density did not show statistically significant differences between the nerve inside the proximal flap and the control side. Conclusions. Innervation of an acellular matrix can be obtained by direct nerve stump implantation. The flow-through system was relatively easy to build and reliable to provide adequate blood supply. The collagen scaffold may be a promising support or further studies of preinnervated microsurgical flaps

Signs of Life in the Figure of the Shroud of Turin

En este artículo se exponen varios signos de vida que presenta la Síndone de Turín. En base al desarrollo de la rigidez cadavérica, se analiza la postura del cuerpo impreso en la Síndone. Igualmente, la presencia de surcos faciales indica que la per-sona está viva. Por tanto, la Sábana de Turín muestra a la vez signos de muerte como de vida de una persona que dejó su imagen impresa en un momento en el que estaba viva. Si la Síndone es un fraude, se trataría de una obra de arte realizada por un genio con conocimientos médicos, forenses y procesado de imagen de al menos el siglo XX. Si seguimos el relato evangélico observamos que existe una correcta simetría entre los datos presentes en la imagen y lo descrito en los mismos, tanto de la muerte como de la resurrección

Effect of P144@ (Anti-TGF-B) in a "in vivo" human hypertnophic scars model in nude mice

Antecedentes Las cicatrices hipertróficas suponen una de las complicaciones más relevantes en el campo de la cirugía debido a sus implicaciones cosméticas y funcionales. Transforming Growth Factor-beta (TGF-β) es uno de los reguladores más representativos responsables de una cicatrización anómala. En estudios previos donde se han utilizando inhibidores de la acción del TGF-β1 en enfermedades caracterizadas por exceso de fibrosis han demostrado efectos prometedores. El objetivo del presente estudio es analizar el efecto de la administración tópica del péptido inhibidor del receptor tipo III del TGF-β1 (P144®) sobre cicatrices humanas implantadas en ratones atímicos.Material y métodos Se tomaron muestras de cicatrices hipertróficas de 30 pacientes y se implantaron en 60 ratones atímicos. Los ratones se dividieron en dos grupos, grupo A (placebo) y grupo B (tratamiento). El grupo C (basal) fue constituido por las muestras de las cicatrices hipertróficas sin implantar. Una vez que prendieron todas las cicatrices sobre los ratones se procedió a la aplicación diaria de un lipogel que contenía o bien un vehículo o bien P144 sobre todas las muestras durante 15 días consecutivos. Después de finalizado el tratamiento, los animales fueron sacrificados y se extrajeron dichas cicatrices hipertróficas. El área total, el grosor y el área ocupada por fibras de colágeno fueron cuantificados para su comparación entre los distintos grupos. El estudio inmunohistoquímico se realizó para determinar la expresión de colágeno I, colágeno III y fibrilina-1. Resultados El 83.3% de los xenoinjertos prendieron totalmente. El tiempo medio para el prendimiento fue de 35±5.4 días. Diferencias estadísticamente significativas se encontraron en el área total, grosor de la cicatriz y área ocupada por fibras de colágeno en la comparación entre los tres grupos. La reducción en el área total secundario al tratamiento fue de un 10% en comparación con el grupo placebo. Un aumento significativo en la expresión de fibrillin-1 y una disminución de colágeno I fue hallado en el grupo que recibió el tratamiento comparado con el grupo basal. Conclusiones La aplicación tópica del péptido inhibidor del TGF-β1 en el modelo “in vivo” de cicatrices hipertróficas implantadas en ratones atímicos ha demostrado revertir la cicatrización a su curso normal con la consiguiente disminución del contenido en colágeno y reordenamiento de las fibras elásticas. No cabe duda de que existe un progresivo conocimiento en la fisiopatología de la cicatrización hipertrófica, sin embargo aún sigue siendo necesario la búsqueda de un modelo animal que permita estudiar este desorden de forma global. Con ello, alcanzaremos un conocimiento aún más extenso que facilitara nuevos tratamientos enfocados en bloquear las vías reguladoras presentes en estos desórdenes fibróticos.Background Hypertrophic scars are one of the most relevant complications in surgery due to their cosmetic and functional impairments. Among the cytokines responsible of this anomalous healing, Transforming Growth Factor-beta (TGF-β) has been demonstrated to be one of the most representative. Previous studies in tissue fibrotic disorders have shown promising results by inhibiting the biological activity effect of TGF-β. The objective of the current study is to determine the effect of the inhibition of TGF-β1 signaling in human hypertrophic scars implanted in nude mice by topical application of a TGF-β1 receptor type III inhibitor peptide (P144®). Material and methods 30 human hypertrophic scars were implanted in 60 mice. The animals were divided into two groups, group A (placebo) and group B (treatment). Group C (basal) was considered as the preimplanted scar tissue samples. When all the xenografts were shed, topical application of a lipogel containing placebo (group A) or P144 (group B) was daily administered during 15 consecutive days. After the completion of the treatment, the animals were sacrificed and the total area, scar thickness and collagen fibers area of the scars were compared across all groups. Immunocytochemistry was performed to quantify the collagen type I and III production and fibrillin-1 to determine elastic fibers present in the dermis. Results 83,3% of the xenografts shed successfully. The mean time for shedding was 35±5.4 days. Statistical differences were found in the total area, thickness and collagen fibers area in the comparison between the groups. Reduction in 10% of total area of the scars was achieved with the treatment in comparison with the placebo group. An increase in the expression of fibrillin-1 and decrease in collagen I were found when comparing treatment group with the basal group. Conclusions Topical application of the inhibitor of TGF-β1 seemed to be promising in an “in vivo” model of human hypertrophic scars implanted in nude mice given that enhancing of scar maturation was found with a decrease in dermal collagen fibers and an increase in elastic fibers. Although increasing knowledge in the pathogenesis of hypertrophic scars has been achieved for many decades, it is clear that there is still a lack of an ideal animal model that would allow understanding this disease in a more holistic approach. Consequently, a more extensive knowledge of the pathogenesis would help to focus the new therapies on modulating the fibrotic disorders pathways

Estudio comparativo entre la transferencia del nervio facial cruzado y el nervio masetérico en la reconstrucción de la parálisis facial incompleta

La hipótesis de trabajo es si la reconstrucción de la sonrisa en parálisis fa-ciales incompletas mediante la transferencia masetérico-facial puede con-seguir resultados similares o superiores a los obtenidos mediante el injerto facial cruzado y en una sola intervención quirúrgica. Los objetivos del estudio fueron los siguientes: 1. Comparar el arrastre comisural obtenido por transferencia masetérico-facial frente al injerto facial cruzado. 2. Comparar el porcentaje de simetría del lado rehabilitado con el lado sano entre la transferencia masetérico-facial y el injerto facial cruzado. 3. Evaluar el grado de espontaneidad en la reconstrucción de la parálisis facial incompleta mediante transferencia masetéricofacial y el injerto facial cruzado. 4. Evaluar la satisfacción del paciente con ambos procedimientos

Estudio comparativo entre la transferencia del nervio facial cruzado y el nervio masetérico en la reconstrucción de la parálisis facial incompleta

La hipótesis de trabajo es si la reconstrucción de la sonrisa en parálisis fa-ciales incompletas mediante la transferencia masetérico-facial puede con-seguir resultados similares o superiores a los obtenidos mediante el injerto facial cruzado y en una sola intervención quirúrgica. Los objetivos del estudio fueron los siguientes: 1. Comparar el arrastre comisural obtenido por transferencia masetérico-facial frente al injerto facial cruzado. 2. Comparar el porcentaje de simetría del lado rehabilitado con el lado sano entre la transferencia masetérico-facial y el injerto facial cruzado. 3. Evaluar el grado de espontaneidad en la reconstrucción de la parálisis facial incompleta mediante transferencia masetéricofacial y el injerto facial cruzado. 4. Evaluar la satisfacción del paciente con ambos procedimientos

Effect of P144@ (Anti-TGF-B) in a "in vivo" human hypertnophic scars model in nude mice

Antecedentes Las cicatrices hipertróficas suponen una de las complicaciones más relevantes en el campo de la cirugía debido a sus implicaciones cosméticas y funcionales. Transforming Growth Factor-beta (TGF-β) es uno de los reguladores más representativos responsables de una cicatrización anómala. En estudios previos donde se han utilizando inhibidores de la acción del TGF-β1 en enfermedades caracterizadas por exceso de fibrosis han demostrado efectos prometedores. El objetivo del presente estudio es analizar el efecto de la administración tópica del péptido inhibidor del receptor tipo III del TGF-β1 (P144®) sobre cicatrices humanas implantadas en ratones atímicos.Material y métodos Se tomaron muestras de cicatrices hipertróficas de 30 pacientes y se implantaron en 60 ratones atímicos. Los ratones se dividieron en dos grupos, grupo A (placebo) y grupo B (tratamiento). El grupo C (basal) fue constituido por las muestras de las cicatrices hipertróficas sin implantar. Una vez que prendieron todas las cicatrices sobre los ratones se procedió a la aplicación diaria de un lipogel que contenía o bien un vehículo o bien P144 sobre todas las muestras durante 15 días consecutivos. Después de finalizado el tratamiento, los animales fueron sacrificados y se extrajeron dichas cicatrices hipertróficas. El área total, el grosor y el área ocupada por fibras de colágeno fueron cuantificados para su comparación entre los distintos grupos. El estudio inmunohistoquímico se realizó para determinar la expresión de colágeno I, colágeno III y fibrilina-1. Resultados El 83.3% de los xenoinjertos prendieron totalmente. El tiempo medio para el prendimiento fue de 35±5.4 días. Diferencias estadísticamente significativas se encontraron en el área total, grosor de la cicatriz y área ocupada por fibras de colágeno en la comparación entre los tres grupos. La reducción en el área total secundario al tratamiento fue de un 10% en comparación con el grupo placebo. Un aumento significativo en la expresión de fibrillin-1 y una disminución de colágeno I fue hallado en el grupo que recibió el tratamiento comparado con el grupo basal. Conclusiones La aplicación tópica del péptido inhibidor del TGF-β1 en el modelo “in vivo” de cicatrices hipertróficas implantadas en ratones atímicos ha demostrado revertir la cicatrización a su curso normal con la consiguiente disminución del contenido en colágeno y reordenamiento de las fibras elásticas. No cabe duda de que existe un progresivo conocimiento en la fisiopatología de la cicatrización hipertrófica, sin embargo aún sigue siendo necesario la búsqueda de un modelo animal que permita estudiar este desorden de forma global. Con ello, alcanzaremos un conocimiento aún más extenso que facilitara nuevos tratamientos enfocados en bloquear las vías reguladoras presentes en estos desórdenes fibróticos.Background Hypertrophic scars are one of the most relevant complications in surgery due to their cosmetic and functional impairments. Among the cytokines responsible of this anomalous healing, Transforming Growth Factor-beta (TGF-β) has been demonstrated to be one of the most representative. Previous studies in tissue fibrotic disorders have shown promising results by inhibiting the biological activity effect of TGF-β. The objective of the current study is to determine the effect of the inhibition of TGF-β1 signaling in human hypertrophic scars implanted in nude mice by topical application of a TGF-β1 receptor type III inhibitor peptide (P144®). Material and methods 30 human hypertrophic scars were implanted in 60 mice. The animals were divided into two groups, group A (placebo) and group B (treatment). Group C (basal) was considered as the preimplanted scar tissue samples. When all the xenografts were shed, topical application of a lipogel containing placebo (group A) or P144 (group B) was daily administered during 15 consecutive days. After the completion of the treatment, the animals were sacrificed and the total area, scar thickness and collagen fibers area of the scars were compared across all groups. Immunocytochemistry was performed to quantify the collagen type I and III production and fibrillin-1 to determine elastic fibers present in the dermis. Results 83,3% of the xenografts shed successfully. The mean time for shedding was 35±5.4 days. Statistical differences were found in the total area, thickness and collagen fibers area in the comparison between the groups. Reduction in 10% of total area of the scars was achieved with the treatment in comparison with the placebo group. An increase in the expression of fibrillin-1 and decrease in collagen I were found when comparing treatment group with the basal group. Conclusions Topical application of the inhibitor of TGF-β1 seemed to be promising in an “in vivo” model of human hypertrophic scars implanted in nude mice given that enhancing of scar maturation was found with a decrease in dermal collagen fibers and an increase in elastic fibers. Although increasing knowledge in the pathogenesis of hypertrophic scars has been achieved for many decades, it is clear that there is still a lack of an ideal animal model that would allow understanding this disease in a more holistic approach. Consequently, a more extensive knowledge of the pathogenesis would help to focus the new therapies on modulating the fibrotic disorders pathways

Innervation of a prefabricated flap: a new experimental model

Introduction. Flap innervation by neoaxonogenesis is a promising field of investigation. The authors evaluated the possibility of innervating an acellular collagen scaffold as component of a potential prefabricated flap. Materials and Methods. Collagen matrix sheets were implanted around the femoral bundle of a murine model to produce two flaps on proximal and distal nerve stumps based on a flow-through model. After thirty days, nerve regeneration and integration into the collagen matrix were evaluated. The specimens were microscopically analyzed to study Schwann cell colonization and axonal integration with the matrix. Axonal count and density were assessed and statistically evaluated. Results. Qualitative structural and ultrastructural evaluation indicated integration, with axonal fibers merged within the collagen matrix, along with a newly formed vascular network on the proximal flap. Wallerian degeneration occurred inside the distal chamber. Axonal count and density did not show statistically significant differences between the nerve inside the proximal flap and the control side. Conclusions. Innervation of an acellular matrix can be obtained by direct nerve stump implantation. The flow-through system was relatively easy to build and reliable to provide adequate blood supply. The collagen scaffold may be a promising support or further studies of preinnervated microsurgical flaps

Breast implant capsule: A murine model comparing capsular contracture susceptibility among six breast implants available in the market

Background Breast implant capsule development and behavior are mainly determined by implant surface combined with other external factors such as intraoperative contamination, radiation or concomitant pharmacologic treatment. Thus, there are several diseases: capsular contracture, breast implant illness or Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), that have been correlated with the specific type of implant placed. This is the first study to compare all major implant and texture models available in the market on the development and behave of the capsules. Through a histopathological analysis, we compared the behavior of different implant surfaces and how different cellular and histological properties give rise to different susceptibilities to develop capsular contracture among these devices. Methods A total of 48 Wistar female rats were used to implant 6 different types of breast implants. Mentor®, McGhan®, Polytech polyurethane®, Xtralane®, Motiva® and Natrelle Smooth® implants were employed; 20 rats received Motiva®, Xtralane® and Polytech polyurethane®, and 28 rats received Mentor®, McGhan® and Natrelle Smooth® implants. The capsules were removed five weeks after the implants placement. Further histological analysis compared capsule composition, collagen density and cellularity. Results High texturization implants showed the highest levels of collagen and cellularity along the capsule. However, polyurethane implants capsules behaved differently regarding capsule composition, with the thickest capsules but fewer collagen and myofibroblasts than expected, despite being generally considered as a macrotexturized implant. Nanotextured implants and microtextured implants histological findings showed similar characteristics and less susceptibility to develop a capsular contracture compared with smooth implants. Conclusions This study shows the relevance of the breast implant surface on the definitive capsules’ development, since this is one of the most differentiated factors that determine the incidence of capsular contracture and probably other diseases like BIA-ALCL. A correlation of these findings with clinical cases will help to unify implant classification criteria based on their shell and their estimated incidence of capsule-associated pathologies. Up to this point, the establishment of additional groups is recommended as nanotexturized implants seem to behave differently to pure smooth surfaces and polyurethane implants present diverse features from macro- or microtextured implants. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Author