Harvest site influences the growth properties of adipose derived stem cells

The therapeutic potential of adult stem cells may become a relevant option in clinical care in the future. In hand and plastic surgery, cell therapy might be used to enhance nerve regeneration and help surgeons and clinicians to repair debilitating nerve injuries. Adipose-derived stem cells (ASCs) are found in abundant quantities and can be harvested with a low morbidity. In order to define the optimal fat harvest location and detect any potential differences in ASC proliferation properties, we compared biopsies from different anatomical sites (inguinal, flank, pericardiac, omentum, neck) in Sprague-Dawley rats. ASCs were expanded from each biopsy and a proliferation assay using different mitogenic factors, basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) was performed. Our results show that when compared with the pericardiac region, cells isolated from the inguinal, flank, omental and neck regions grow significantly better in growth medium alone. bFGF significantly enhanced the growth rate of ASCs isolated from all regions except the omentum. PDGF had minimal effect on ASC proliferation rate but increases the growth of ASCs from the neck region. Analysis of all the data suggests that ASCs from the neck region may be the ideal stem cell sources for tissue engineering approaches for the regeneration of nervous tissu

Is Ultracision Knife Safe and Efficient for Breast Capsulectomy? A Preliminary Study

Background: Silicone breast implants are used to a wide extent in the field of plastic surgery. However, capsular contracture remains a considerable concern. This study aimed to analyze the effectiveness and applicability of an ultracision knife for capsulectomy breast surgery. Methods: A prospective, single-center, randomized study was performed in 2009. The inclusion criteria specified female patients 20-80years of age with capsular contracture (Baker 3-4). Ventral capsulectomy was performed using an ultracision knife on one side and the conventional Metzenbaum-type scissors and surgical knife on the collateral side of the breast. Measurements of the resected capsular ventral fragment, operative time, remaining breast tissue, drainage time, seroma and hematoma formation, visual analog scale pain score, and sensory function of the nipple-areola complex were assessed. In addition, histologic analysis of the resected capsule was performed. Results: Five patients (median age, 59.2years) were included in this study with a mean follow-up period of 6months. Three patients had Baker grade 3 capsular contracture, and two patients had Baker grade 4 capsular contracture. The ultracision knife was associated with a significantly lower pain score, shorter operative time, smaller drainage volume, and shorter drainage time and resulted in a larger amount of remaining breast tissue. Histologic analysis of the resected capsule showed no apoptotic cells in the study group or control group. Conclusions: The results suggest that ventral capsulectomy with Baker grade 3 or 4 contracture using the ultracision knife is feasible, safe, and more efficient than blunt dissection and monopolar cutting diathermy and has a short learning curve. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/0026

Adipose-derived stem cells (ADSCs) and muscle precursor cells (MPCs) for the treatment of bladder voiding dysfunction

Purpose: Bladder outflow obstruction (BOO) is common in the elderly and can result in bladder voiding dysfunction (BVD) due to severe bladder muscle damage. The goal of this research was to evaluate the use of adult stem cells for the treatment of BVD due to decreased muscle contractility in a rat model. Materials and methods: Adipose-derived stem cells (ADSCs) and muscle precursor cells (MPCs) were harvested from male Lewis rats and expanded in culture. BOO was induced by tying a suture around the urethra. Six weeks after obstruction, the development of BVD was confirmed by cystometric analysis in conscious rats, histology and molecular investigations. Injection of ADSCs or MPCs into the bladder wall and synchronous deligation was performed 6weeks after the obstruction. After stem-cell treatment, morphological and functional changes were assessed. Age-matched rats and animals without cellular therapy but deligation-only served as controls. Results: Voiding pressures decreased progressively 6weeks after obstruction with increased bladder capacities. Structural changes of the detrusor muscle occurred during the time of obstruction with an increased connective tissue-to-smooth muscle ratio and decreased SMA/smoothelin expression. After stem-cell injection, improved voiding pressures and voiding volumes were observed together with recovered tissue architecture. RT-PCR and Western blotting showed an up-regulation of important contractile proteins. Conclusions: We established a reliable model for BVD and demonstrated that ADSCs and MPCs can prevent pathophysiological remodelling and provide regenerated bladder tissue and function

Reply: Adipose tissue grafts survival and bioactivity in relation to space and internal pressure of the recipient site: a transversal topic in plastic surgery

Reply to a comment by Boriani F. about their initial publication: ORANGES, Carlo Met al. Increasing fat graft retention in irradiated tissue after preconditioning with external volume expansion. In: Plastic and Reconstructive Surgery, 2021, vol. 147, n° 1, p. 158e-159e. doi: 10.1097/PRS.0000000000007445 https://archive-ouverte.unige.ch/unige:15528

The Double-pedicle Tip Anchor Flap (DPTA-Flap) Preservation Technique for Autologous Breast Augmentation Circumvertical Mastopexy

The ultimate breast mastopexy technique allows a reliable and consistent transposition of the nipple-areolar complex (NAC) with preservation of nipple viability, sensation, and lactation potential. Ideally, good upper pole fullness with a durable result is achieved. However, as the inferior pole parenchyma often gravitates downward, the long-term result remains unsatisfactory. Anchoring remains a key procedure in autoaugmentation mammoplasty as the flap needs to be stable against gravity. We hereby describe a further refinement of a chest wall-based flap for the support of the upper pole, namely a double-pedicle tip anchor flap (DPTA-flap). By using this technique, good upper pole fullness is achieved, sensation is preserved, and lactation remains likely. Level of Evidence: V

Prise en charge de l’hypertrophie mammaire symptomatique et réduction mammaire

L’hypertrophie mammaire symptomatique se définit comme un ou plusieurs symptômes en lien avec un volume mammaire augmenté, en général associé à une ptose mammaire. Elle peut avoir un impact majeur sur la santé globale des patientes. Alors que les traitements conservateurs ne permettent pas de soulager les patientes à long terme, la réduction mammaire chirurgicale est un traitement efficace et sûr. De nombreuses techniques ont été décrites, mais reposent sur des principes communs. Certaines mesures permettent une diminution des risques de complications chirurgicales et peuvent être entreprises conjointement à la prise en charge en chirurgie plastique

European Journal of Plastic Surgery Platelet-rich plasma injection is effective and safe for the treatment of alopecia Platelet-rich plasma injection is effective and safe for the treatment of alopecia

Abstract Background Mesotherapy has become a new method for the treatment of different types of alopecia. However, there is a paucity of data in the literature about its efficacy and side effects. In this retrospective study, safety, efficacy, and feasibility of platelet-rich plasma (PRP) injections were assessed. Methods Between October 2009 and October 2010, 42 patients (8 women and 34 men) with hair loss or androgenic alopecia were included in this study. Before each session, the hair pull test was performed three times. A total volume of 8-12 cc was injected by using 32 or 30.5 G needles. The treatment was repeated five times over a period of 2 months. Outcome measures were assessed after 3 months by clinical examination, macroscopic photos, pull clinical test, and the patient's overall satisfaction. Results Before treatment, 90.5 % of our patients had a positive pull test with a mean number of eight hairs. After the third session, the pull test was negative in all patients with an average number of three hairs. Global pictures showed a significant improvement in hair volume and quality, which was confirmed by a high overall patient satisfaction. The results were even more obvious in patients who suffered from alopecia for less than 2 years. Poorer results were found in patients with marked alopecia type VI-VII according Norwood classification in men. Conclusions PRP injections are simple and efficient, have minimal morbidity with a low cost-to-benefit ratio and can be regarded a valuable alternative for the treatment of alopecia. Level of Evidence: Level IV, therapeutic study

'EASIdig' : a digital tool to document disease activity in atopic dermatitis

Different scoring systems have been developed to determine the severity of atopic dermatitis (AD); the SCORAD (Scoring Atopic Dermatitis) and EASI (Eczema Area and Severity Index) are among the best-validated scoring systems. Objective: The aim of this study was to produce a rational quality control for routine clinical use by using the modern facilities of digital imaging. Methods: 63 AD patients were scored by a single person at each visit using the SCORAD and EASI scoring methods. Images were taken and rated by two non-dermatology physicians trained in the scoring system. In addition, blood samples were taken for the determination of total IgE, eosinophils and eosinophilic cationic protein. Results: The EASI score established from the digital images, hereby named ‘EASIdig’, correlated at all visits with the results of the SCORAD and EASI. Together with immunological parameters, they also reflected changes of disease severity during the 3 time points. Conclusion: The digital evaluation of the EASI is a reliable tool for the digital assessment of severity and extent of AD