Regenerative assisted microsurgery (RAM) and regenerative assisted supermicrosurgery (RASM): the future of microsurgery?

New perspectives in regenerative medicine and surgery: the bioactive composite therapies (BACTs)

Regenerative medicine and surgery is a rapidly expanding branch of translational research in tissue engineering, cellular and molecular biology. To date, the methods to improve cell intake, survival, and isolation need to comply with a complex and still unclear regulatory frame, becoming everyday more restrictive and often limiting the effectiveness and outcome of the therapeutic choices. Thus, the authors developed a novel 360° regenerative strategy based on the synergic action of several new components called the bioactive composite therapies (BACTs) to improve grafted cells intake, and survival in total compliance with the legal and ethical limits of the current regulatory frame. The rationale at the origin of this new technology is based on the evidence that cells need supportive substrate to survive in vitro and this observation, applying the concept of translational medicine, is true also in vivo. Bioactive composite mixtures (BACMs) are tailor-made bioactive mixtures containing several bioactive components that support cells' survival and induce a regenerative response in vivo by stimulating the recipient site to act as an in situ real bioreactor. Many different tissues have been used in the past for the isolation of cells, molecules, and growth factors, but the adipose tissue and its stromal vascular fraction (SVF) remains the most valuable, abundant, safe, and reliable source of regenerative components and particularly of adipose-derived stems cells (ADSCs). The role of plastic surgeons as the historical experts in all the most advanced techniques for harvesting, manipulating, and grafting adipose tissue is fundamental in this constant process of expansion of regenerative procedures. In this article, we analyze the main causes of cell death and the strategies for preventing it, and we present all the technical steps for preparing the main components of BACMs and the different mixing modalities to obtain the most efficient regenerative action on different clinical and pathological conditions. The second section of this work is dedicated to the logical and sequential evolution from simple bioactive composite grafts (BACGs) that distinguished our initial approach to regenerative medicine, to BACTs where many other fundamental technical steps are analyzed and integrated for supporting and enhancing the most efficient regenerative activity. Level of Evidence: Not gradable.

Vacuum sealing drainage combined with free anterolateral femoral skin flap grafting in 16 cases of pediatric soft tissue damage to the foot and ankle

BACKGROUND

To investigate the clinical experience and discuss the use of vacuum sealing drainage (VSD) combined with free anterolateral femoral flap grafting to treat pediatric foot and ankle soft tissue traumas.

METHODS

This was a retrospective analysis of 16 pediatric patients with foot and ankle soft tissue traumas treated with free anterolateral femoral flap grafting from January 2015 to January 2018. After successful debridement and VSD, the clinical efficacy of the procedure was evaluated by observing parameters such as the color, shape, and texture of the flap on the receptor site.

RESULTS

All patients were followed up for 23-32 months after surgery. Of the 16 patients, six had a flat flap appearance, while the remaining ten patients required flap repair surgery 6-9 months after the procedure. Eight of these ten patients had a satisfactory repair, and the remaining two patients had further repair surgery 9-10 months after the flap grafting. The postoperative results of all patients were satisfactory; no local infection, good flap survival, soft texture, glossy elasticity, and flat appearance. Statistical results showed only one case of local necrosis at the distal end of the flap, and the wound healed at stage II after redebridement and dressing change.

CONCLUSIONS

VSD combined with free anterolateral femoral flap grafting is an easy and reliable operation with a good prognosis and excellent clinical utility and feasibility for treating pediatric patients with foot and ankle soft tissue traumas.