The Evolution of Current Concept of the Reconstructive Ladder in Plastic Surgery: The Emerging Role of Translational Medicine

Plastic surgeons have used the reconstructive ladder for many decades as a standard directory for complex trauma reconstruction with the goal of repairing body structures and restoring functionality. This consists of different surgical maneuvers, such as secondary intention and direct tissue closure, as well as more complex methods such as local tissue transfer and free flap. The reconstructive ladder represents widely known options achievable for tissue reconstruction and wound closure that puts at the bottom rung the simplest methods of reconstruction and strengthens the complexity by moving upward. Regenerative medicine and surgery constitute a quickly spreading area of translational research that can be employed by minimally invasive surgical strategies, with the aim of regenerating cells and tissues in vivo in order to reestablish normal function through the intrinsic potential of cells, in combination with biomaterials and appropriate biochemical stimuli. These translational procedures have the aim of creating an appropriate microenvironment capable of supporting the physiological cellular function to generate the desired cells or tissues and to generate parenchymal, stromal, and vascular components on demand, and above all to produce intelligent materials capable of determining the fate of cells. Smart technologies have been grown that give extra “rungs” on the classic reconstructive ladder to integrate a more holistic, patient-based approach with improved outcomes. This commentary presents the evolution of the traditional concept of the reconstructive ladder in the field of plastic surgery into a new course with the aim of achieving excellent results for soft tissue reconstruction by applying innovative technologies and biologically active molecules for a wide range of surgical diseases

SeqBreed : a python tool to evaluate genomic prediction in complex scenarios

Background: Genomic prediction (GP) is a method whereby DNA polymorphism information is used to predict breeding values for complex traits. Although GP can significantly enhance predictive accuracy, it can be expensive and difficult to implement. To help design optimum breeding programs and experiments, including genome-wide association studies and genomic selection experiments, we have developed SeqBreed, a generic and flexible forward simulator programmed in python3. Results: SeqBreed accommodates sex and mitochondrion chromosomes as well as autopolyploidy. It can simulate any number of complex phenotypes that are determined by any number of causal loci. SeqBreed implements several GP methods, including genomic best linear unbiased prediction (GBLUP), single-step GBLUP, pedigree-based BLUP, and mass selection. We illustrate its functionality with Drosophila genome reference panel (DGRP) sequence data and with tetraploid potato genotype data. Conclusions: SeqBreed is a flexible and easy to use tool that can be used to optimize GP or genome-wide association studies. It incorporates some of the most popular GP methods and includes several visualization tools. Code is open and can be freely modified. Software, documentation, and examples are available at https://github.com/miguelperezenciso/SeqBreed

Determinants of surgeon choice in cases of suspected implant rupture following mastectomy or aesthetic breast surgery: Clinical implications

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before

The Impact of COVID-19 on Plastic Surgery Residency Training

Abstract: Nowadays didactic and surgical activities for residents in the surgery field are less and less due to an increasing burden of documentation and \u201cnon-educational work.\u201d Considering the current lockdown due to the COVID-19 pandemic, it has never been so important to find different ways to allow residents to improve their knowledge. We asked all plastic and esthetic surgery residents in our country to fill out a questionnaire to investigate changes in their didactical activity and analyze problems about their professional growth in the last few months. From the results of such questionnaires, we found that most of the residents feel the decrease in surgical activities during this time is a detrimental factor for their training and that even if all the schools have changed their didactical activities no school has introduced the use of virtual simulators to compensate for the decrease in surgical practice. Actually, the majority of residents use webinars to keep updated, stating that such technologies are useful but not sufficient to analyze plastic surgery topics in depth during COVID-19 lockdown. Virtual interactive tools are well known in different clinical and surgical specialties, and they are considered as a valid support, but it seems that in plastic surgery they are not so used. According to the most recent studies about residents\u2019 didactical program, we have investigated the potential of Anatomage Table in combination with Touch Surgery application as physical and mental aids to bypass the decreased number and kind of surgical interventions performed in this particular time. Anatomage is an academic user-friendly touch screen table; it is used by both medical students and residents to learn human anatomy and to master surgical anatomy. Touch Surgery is an application available on smartphones and tablets that gives the possibility to watch real and virtually designed surgical videos, accompanied by explanatory comments on the surgical phases; they are interactive and give the possibility to check what you have learned through tests administered after virtual classes. In our opinion, these tools represent reliable solutions to improve plastic residents\u2019 training, mostly during the COVID-19 pandemic. Level of Evidence V: 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 www.springer.com/00266

Autologous micrografts and methotrexate in plantar erosive lichen planus: healing and pain control. A case report

Erosive lichen planus is an uncommon variant of lichen planus. We report a case of long-standing and refractory plantar ELPs causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts. After approximately 9 months follow-up, no clinical recurrence or pain were observed. Erosive lichen planus (ELP) is an uncommon variant of lichen planus, involving oral cavity and genitalia and, less often plantar areas, where it usually presents with chronic erosions of the soles, along with intense, disabling pain and progressive loss of toenails. An abnormal immune cellular response (CD8+ lymphocytes and macrophages) and the consequent altered production of multiple mediators (interleukin-12, interferon-gamma, tumor necrosis factor-alpha, RANTES and MMP-9), seem to play a crucial role in the pathogenesis, although the etiology remains uncertain. From a histological point of view, ELP shows keratinocyte apoptosis, intense inflammatory response and basal epithelial keratinocytes TNF-alpha overexpression. Several therapies have been proposed, with variable and controversial results. While topical corticosteroids and topical calcineurin inhibitors are the treatments of choice for localized forms, short pulses of systemic glucocorticoids, phototherapy, and systemic immunosuppressants are recommended for generalized cases. Surgery has been reported as a possible therapeutic option in refractory and stable cases with localized lesions, either alone or with cyclosporine. Herein, we report a case of longstanding and refractory plantar ELPS causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts

Suspected breast implant rupture: our experience, recommendations on its management and a proposal for a model of informed consent

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Human Adipose-Derived Stem Cells in Madelung's Disease: Morphological and Functional Characterization

Madelung Disease (MD) is a syndrome characterized by the accumulation of aberrant symmetric adipose tissue deposits. The etiology of this disease is yet to be elucidated, even though the presence of comorbidities, either genetic or environmental, has been reported. For this reason, establishing an in vitro model for MD is considered crucial to get insights into its physiopathology. We previously established a protocol for isolation and culture of stem cells from diseased tissues. Therefore, we isolated human adipose-derived stem cells (ASC) from MD patients and compared these cells with those isolated from healthy subjects in terms of surface phenotype, growth kinetic, adipogenic differentiation potential, and molecular alterations. Moreover, we evaluated the ability of the MD-ASC secretome to affect healthy ASC. The results reported a difference in the growth kinetic and surface markers of MD-ASC compared to healthy ASC but not in adipogenic differentiation. The most commonly described mitochondrial mutations were not observed. Still, MD-ASC secretome was able to shift the healthy ASC phenotype to an MD phenotype. This work provides evidence of the possibility of exploiting a patient-based in vitro model for better understanding MD pathophysiology, possibly favoring the development of novel target therapies

Evaluation of botanical insecticides to control whitefly (Bemisia tabaci Gennadius) and tomato flee (Halticu ssp) in tomato (Solanum lycopersicum Mill.), in Nicaragua

El complejo mosca blanca (Bemisia tabaci)-Geminivirus y Halticus sp son las principales plagas causantes de pérdidas económicas en el cultivo de tomate (Solanum lycopersicum Mill) en el municipio de Tisma-Masaya. En base a esta situación se realizó un estudio para evaluar la efectividad que tiene para controlar estas y otras plagas secundarias los tratamientos botánicos: chile + ajo + jabón, madero negro, crisantemo, extracto alcohólico + chile, extracto alcohólico + chile + ajo y testigo en el período comprendido entre diciembre 2013 a febrero 2014. De los tratamientos evaluados, el menor número de moscas blancas por planta y el menor porcentaje de severidad a los cien después de trasplante lo obtuvo el tratamiento extracto alcohólico + chile + ajo. El tratamiento madero negro presentó la mayor efectividad en el manejo de poblaciones de Halticus sp. El mayor rendimiento se obtuvo con extracto alcohólico + chile + ajo con 34 685.18 kg ha-1 seguido del tratamiento chile + ajo + jabón con 30 614.28 kg ha-1. De acuerdo al análisis de tasa de retorno marginal, el tratamiento chile+ajo+jabón es el que obtuvo la mejor tasa de retorno marginal con 1 476%, es decir, USD 14.76 por cada dólar invertido. Además el análisis de biotipo de mosca blanca realizado en la Universidad de Tucson, Arizona muestra que un 66.66% corresponde a la mosca blanca autóctona (biotipo A), y el 33.33% corresponde al biotipo B, el cual es más agresivo que el A. Según el análisis de los begomovirus se determinó: enrollamiento severo de la hoja de tomate (ToSLCV) con al menos 96% de identidad en las muestras y el virus del mosaico dorado de la chiltoma (PepGMV) con un 98% de identidad.The whitefly-virus complex (Bemisia tabaci)-Geminivirus and Halticus sp. are the main cause of economic losses in tomato (Solanum Lycopersicum Mill) in the municipality of Tisma, Masaya. Due to this situation, a study was conducted to evaluate the effectiveness of botanical insecticides such as: Chile + Garlic + Soap, Madero Negro, Chrysanthemum, alcoholic extract + Chili and alcoholic extract + Chili + Garlic in the period from December 2013 to February 2014. Of the treatments evaluated, the lowest number of whiteflies per plant and lower percentage of severity at one hundred days after transplanting was obtained with the treatment Alcoholic extract+Chili+Garlic. The treatment Madero Negro had the highest effectiveness in managing populations of Halticus sp. The economic analysis showed that the highest yield was obtained by the Alcoholic extract+Chili+Garlic with 34 685.18 kg/ha-1 followed by the treatment Chili+Garlic+Soap with 30 614.28 kg/ha-1. According to the marginal return analysis, this proved that the treatment Chili+Garlic+Soap is the one who obtained the best marginal rate of return with 1 476 %, which means that USD 14.76 is obtained for every dollar invested. According to samples of tomato tissue and whiteflies insect samples sent for analysis to at the University of Arizona in Tucson, this determined that the 66.66% of white flies samples from Tisma are indigenous whitefly, biotype “A”, and the 33.33% corresponds to the “B” biotype, the one that is more aggressive than “A”. The Begomoviruses analysis found that severe curl leaf tomato (ToSLCV) with at least 96% and golden mosaic virus of pepper (PepGMV) with 98% identity were identified in this stud