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Shen J, Ye D, Jin H, Wu Y, Peng L, Liang Y. Porcine nasal septum cartilage-derived decellularized matrix promotes chondrogenic differentiation of human umbilical mesenchymal stem cells without exogenous growth factors. J Mater Chem B 2024; 12:5513-5524. [PMID: 38745541 DOI: 10.1039/d3tb03077f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND In the domain of plastic surgery, nasal cartilage regeneration is of significant importance. The extracellular matrix (ECM) from porcine nasal septum cartilage has shown potential for promoting human cartilage regeneration. Nonetheless, the specific biological inductive factors and their pathways in cartilage tissue engineering remain undefined. METHODS The decellularized matrix derived from porcine nasal septum cartilage (PN-DCM) was prepared using a grinding method. Human umbilical cord mesenchymal stem cells (HuMSCs) were cultured on these PN-DCM scaffolds for 4 weeks without exogenous growth factors to evaluate their chondroinductive potential. Subsequently, proteomic analysis was employed to identify potential biological inductive factors within the PN-DCM scaffolds. RESULTS Compared to the TGF-β3-cultured pellet model serving as a positive control, the PN-DCM scaffolds promoted significant deposition of a Safranin-O positive matrix and Type II collagen by HuMSCs. Gene expression profiling revealed upregulation of ACAN, COL2A1, and SOX9. Proteomic analysis identified potential chondroinductive factors in the PN-DCM scaffolds, including CYTL1, CTGF, MGP, ITGB1, BMP7, and GDF5, which influence HuMSC differentiation. CONCLUSION Our findings have demonstrated that the PN-DCM scaffolds promoted HuMSC differentiation towards a nasal chondrocyte phenotype without the supplementation of exogenous growth factors. This outcome is associated with the chondroinductive factors present within the PN-DCM scaffolds.
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Affiliation(s)
- Jinpeng Shen
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, P. R. China.
- Department of Plastic Surgery and Burn Center, Second Affiliated Hospital, Shantou University Medical College, Shantou, P. R. China.
- Department of Plastic Surgery, Taizhou Enze Medical Center, Zhejiang, P. R. China
| | - Danyan Ye
- Research Center for Translational Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Hao Jin
- Department of Cardiology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Yongxuan Wu
- Department of Plastic Surgery and Burn Center, Second Affiliated Hospital, Shantou University Medical College, Shantou, P. R. China.
| | - Lihong Peng
- Department of Plastic Surgery and Burn Center, Second Affiliated Hospital, Shantou University Medical College, Shantou, P. R. China.
| | - Yan Liang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, P. R. China.
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Farahani PK. Application of Tissue Engineering and Biomaterials in Nose Surgery. JPRAS Open 2024; 40:262-272. [PMID: 38708386 PMCID: PMC11067003 DOI: 10.1016/j.jpra.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 05/07/2024] Open
Abstract
Surgery of the nose involves a series of operations that are directed at restoring the nasal anatomy and physiology. The extent or degree of reconstruction needed is dependent on the appearance-based requirement of the patients and the procedure exploited for the correction such that nasal airflow is preserved. Standard surgical approach includes the use of autologous tissue or implantation alloplastic bio or synthetic/fabricated construct materials to correct the defects. Over the years, tissue engineering has been proven to be a promising technique for reconstructing tissue and organ defects, including the nose. Recently, there has been keen interest in fabricating new tissues and organ scaffolds using 3D printing technology with good control over the micro-architecture and excellent interior architecture suitable for cell seeding. Unviability of the tissue and harvest-associated complications have increased the need for the investigation of tissue engineering based methods for nasal reconstruction using biomaterials, stem cells, and growth factors combined with 3D bioprinting. However, there are only a handful of studies vis-à-vis the application of cartilage tissue engineering, stem cells, and growth factors for the purpose. This review provides highlights about the available studies based on the application of stem cells, biomaterials, and growth factors for nasal reconstruction surgery, as there is limited recent information on the use of these entities in nasal surgeries.
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Nocini R, Abdulraheem M, Galzignato PF, Manzini J, Bernardi P, Conti G, Sbarbati A, Chirumbolo S, Bertossi D. Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty. Facial Plast Surg 2023; 39:679-685. [PMID: 36791802 DOI: 10.1055/s-0042-1749408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.
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Affiliation(s)
- Riccardo Nocini
- Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
| | - Maryam Abdulraheem
- Department of Otolaryngology, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Pier-Francesco Galzignato
- Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
| | - Jessica Manzini
- Azienda Ospedaliera Universitaria Integrata (AOUI) Policlinico GB Rossi, Verona, Italy
| | - Paolo Bernardi
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giamaica Conti
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dario Bertossi
- Unit of Otorhinolaryngology, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
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Aldabaany W. Reconstruction of Congenital Alar Rim Defects (Tessier Number 1 Cleft) Using Laterally Based Alar Subunit Rotation Advancement Flap. Ann Plast Surg 2021; 87:161-164. [PMID: 34253699 DOI: 10.1097/sap.0000000000002670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alar rim defects develop in most cases as a result of burns, trauma, or tumor excision. Congenital alar rim defects are rare, with an incidence of 1 in 20,000 to 40,000 live births. Tessier classification is the most commonly used classification system for craniofacial defects. Facial clefts involving the nose are categorized as types 0, 1, 2, and 3, whereas cranial clefts with nose lesions are categorized as types 11, 12, 13, and 14. The patterns of nasal clefts are extremely variable, ranging from a simple notch of alar margin to complex craniofacial cleft involving the lip, nose, eyelid, brow, forehead, and underlying bone. PATIENTS AND METHODS This study was conducted at Fayoum University Hospital on 8 male patients who present with congenital alar rim defects (Tessier number 1 cleft). Surgeries were performed under general anesthesia with orotracheal intubation. A full-thickness incision was created along the whole alar subunit, keeping the ala attached only laterally (laterally based alar full-thickness flap). The alar flap was advanced and rotated medially and inferiorly and sutured to the anatomical place in 2 layers, skin and mucosa. Follow-up was done at least 1.5 years postoperatively. RESULTS The study was conducted on 8 male patients presenting with congenital alar rim defects (Tessier number 1 cleft). The mean age of patients was 14.2 years, and the cleft was unilateral in 4 patients (50%) and bilateral in 4 patients (50%). The patients were assessed both aesthetically and functionally and followed at 1.5 years postoperatively. The aesthetic outcome was assessed according to both patients' and author's evaluations of the scar appearance, alar symmetry, nostril symmetry, and general satisfaction. CONCLUSIONS Laterally based alar subunit rotation advancement flap is a reliable option for reconstruction of congenital alar rim defects (Tessier number 1 cleft) with the advantages of being an easy single-stage procedure with good tissue matching and nostril symmetry and only limitation of extremely wide defects with deficient tissues between the ala and tip.
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Affiliation(s)
- Waleed Aldabaany
- From the Department of Plastic Surgery, Faculty of Medicine, and Department of Plastic Surgery, Fayoum University Hospital, Fayoum University, Fayoum, Egypt
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Kuhlmann C, Schenck TL, Tluczynski K, Aszodi A, Metzger P, Giunta R, Wiggenhauser PS. Experimental approach to nasal septal cartilage regeneration with adipose tissue-derived stem cells and decellularized porcine septal cartilage. Xenotransplantation 2020; 28:e12660. [PMID: 33350016 DOI: 10.1111/xen.12660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cartilage shortage is a major problem in facial reconstructive surgery. Prior studies have shown that decellularized porcine nasal septal cartilage (DPNC) seeded with primary human nasal chondrocytes enabled cartilage regeneration and showed potential as a replacement material for nasal cartilage. Since adipose tissue-derived stem cells (ASCs) are easily accessible and almost abundantly available, they appear to be a promising alternative to limited chondrocytes making the combination of DPNC and ASCs a feasible approach towards clinical translation. Thus, this study was intended to investigate the interactions between ASCs and DPNC in an in vitro model. METHODS DPNCs were seeded and 3D-cultured with primary human ASCs that were priorly characterized with trilineage differentiation and flow cytometry. Cell vitality and proliferation were evaluated by Live-Dead, alamarBlue, and PicoGreen assays. Chondrogenic differentiation was examined by DMMB assay and cryosectioning-based histology. Cell invasion within DPNC was visualized and quantified by fluorescent histology (DAPI, Phalloidin). RESULTS ASCs showed good adherence to DPNC and Live-Dead assay proved their viability over 2 weeks. AlamarBlueassay showed an increase in metabolic activity compared to 2D cultures, and PicoGreen assay demonstrated an increase of cell number within DPNC over time. Biochemical assays and histology added evidence of chondrogenic differentiation of 3D-cultured ASCs under the influence of chondrogenic induction medium. Fluorescent image analysis showed a significant increase of cell-occupied areas of scaffolds over time (P < .05). CONCLUSIONS DPNC scaffolds provided a suitable environment for ASCs that allowed good cell vitality, high proliferation, and chondrogenic differentiation. Thus, the use of ASCs and DPNC yields a promising alternative to the use of primary human chondrocytes. For facial cartilage tissue engineering, we regard ASCs as an attractive alternative to human nasal chondrocytes due to their better accessibility and availability. Further research will be necessary to determine long-term effects and in vivo outcomes of ASCs and DPNC in cartilage regeneration of the face.
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Affiliation(s)
- Constanze Kuhlmann
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany.,Laboratory of Experimental Surgery and Regenerative Medicine, Clinic for General, Trauma and Reconstructive Surgery, Klinikum der Universität München, Martiensried, Germany
| | - Thilo Ludwig Schenck
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
| | - Katharina Tluczynski
- Institute of Bioprocess Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Attila Aszodi
- Laboratory of Experimental Surgery and Regenerative Medicine, Clinic for General, Trauma and Reconstructive Surgery, Klinikum der Universität München, Martiensried, Germany
| | - Philipp Metzger
- Division of Clinical Pharmacology and Center of Integrated Protein Science Munich (CIPSM), Klinikum der Universität München, Munich, Germany
| | - Riccardo Giunta
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
| | - Paul Severin Wiggenhauser
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
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Langdon C, Yuen-Ato K, Pereira-Perez C, Arancibia C, Alobid I. Anterior Pedicled Lateral Nasal Wall Flap for Endonasal Lining: A Radiologic and Anatomical Study. Laryngoscope 2020; 131:E1462-E1467. [PMID: 33140865 DOI: 10.1002/lary.29231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this radiological/anatomical study was to evaluate the feasibility of a new endoscopic technique that uses the anterior pedicled lateral nasal flap (APLNW) for the endonasal lining in complex nasal reconstructions. STUDY DESIGN An anatomical study was performed on 20 nasal fossae of cadaverous specimens to measure the area and lengths of the anterior pedicled nasal lateral wall flap. In addition, a radiological analysis with computed tomography was performed in 150 nostrils to determine the potential donor of the simple and extended flap in the nasal fossa floor. Complex nasal reconstruction with nasofrontal flap and internal lining using the lateral wall pedicled flap was performed in 3 patients. RESULTS Complete reconstruction for the inner lining of the nasal tip and lateral nasal wall was achieved in the cadaveric study (10 specimens). The surface areas of the simple and extended APLNW flaps were 7.53 (standard deviation [SD] 1.25) cm2 and 24.6 (SD 3.14) cm2 , respectively. Using computed tomography scans, we determined that to reconstruct defects secondary to full-thickness nasal defects, the APLNW flap surface for the simple and extended versions was 7.90 (SD 1.68) cm2 and 23.64 (SD 4.7) cm2 . We present one case were the APLNW flap was used. CONCLUSIONS The simple or expanded APLNW flap represents a feasible option to reconstruct the internal lining in complex nasal reconstruction. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1462-E1467, 2021.
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Affiliation(s)
- Cristóbal Langdon
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Kathy Yuen-Ato
- Department of Otorhinolaryngology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Carla Pereira-Perez
- Department of Otorhinolaryngology, Barros Luco Trudeu Hospital, Santiago, Chile
| | - Claudio Arancibia
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
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Lavernia L, Brown WE, Wong BJF, Hu JC, Athanasiou KA. Toward tissue-engineering of nasal cartilages. Acta Biomater 2019; 88:42-56. [PMID: 30794988 DOI: 10.1016/j.actbio.2019.02.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
Nasal cartilage pathologies are common; for example, up to 80% of people are afflicted by deviated nasal septum conditions. Because cartilage provides the supportive framework of the nose, afflicted patients suffer low quality of life. To correct pathologies, graft cartilage is often required. Grafts are currently sourced from the patient's septum, ear, or rib. However, their use yields donor site morbidity and is limited by tissue quantity and quality. Additionally, rhinoplasty revision rates exceed 15%, exacerbating the shortage of graft cartilage. Alternative grafts, such as irradiated allogeneic rib cartilage, are associated with complications. Tissue-engineered neocartilage holds promise to address the limitations of current grafts. The engineering design process may be used to create suitable graft tissues. This process begins by identifying the surgeon's needs. Second, nasal cartilages' properties must be understood to define engineering design criteria. Limited investigations have examined nasal cartilage properties; numerous additional studies need to be performed to examine topographical variations, for example. Third, tissue-engineering processes must be applied to achieve the engineering design criteria. Within the recent past, strategies have frequently utilized human septal chondrocytes. As autologous and allogeneic rib graft cartilage is used, its suitability as a cell source should also be examined. Fourth, quantitative verification of engineered neocartilage is critical to check for successful achievement of the engineering design criteria. Finally, following the FDA paradigm, engineered neocartilage must be orthotopically validated in animals. Together, these steps delineate a path to engineer functional nasal neocartilages that may, ultimately, be used to treat human patients. STATEMENT OF SIGNIFICANCE: Nasal cartilage pathologies are common and lead to greatly diminished quality of life. The ability to correct pathologies is limited by cartilage graft quality and quantity, as well as donor site morbidity and surgical complications, such as infection and resorption. Despite the significance of nasal cartilage pathologies and high rhinoplasty revision rates (15%), little characterization and tissue-engineering work has been performed compared to other cartilages, such as articular cartilage. Furthermore, most work is published in clinical journals, with little in biomedical engineering. Therefore, this review discusses what nasal cartilage properties are known, summarizes the current state of nasal cartilage tissue-engineering, and makes recommendations via the engineering design process toward engineering functional nasal neocartilage to address current limitations.
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Affiliation(s)
- Laura Lavernia
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Brian J F Wong
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA; Department of Biomedical Engineering, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA.
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
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Laser surface modification of decellularized extracellular cartilage matrix for cartilage tissue engineering. Lasers Med Sci 2017; 33:375-384. [PMID: 29209868 DOI: 10.1007/s10103-017-2402-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
The implantation of autologous cartilage as the gold standard operative procedure for the reconstruction of cartilage defects in the head and neck region unfortunately implicates a variety of negative effects at the donor site. Tissue-engineered cartilage appears to be a promising alternative. However, due to the complex requirements, the optimal material is yet to be determined. As demonstrated previously, decellularized porcine cartilage (DECM) might be a good option to engineer vital cartilage. As the dense structure of DECM limits cellular infiltration, we investigated surface modifications of the scaffolds by carbon dioxide (CO2) and Er:YAG laser application to facilitate the migration of chondrocytes inside the scaffold. After laser treatment, the scaffolds were seeded with human nasal septal chondrocytes and analyzed with respect to cell migration and formation of new extracellular matrix proteins. Histology, immunohistochemistry, SEM, and TEM examination revealed an increase of the scaffolds' surface area with proliferation of cell numbers on the scaffolds for both laser types. The lack of cytotoxic effects was demonstrated by standard cytotoxicity testing. However, a thermal denaturation area seemed to hinder the migration of the chondrocytes inside the scaffolds, even more so after CO2 laser treatment. Therefore, the Er:YAG laser seemed to be better suitable. Further modifications of the laser adjustments or the use of alternative laser systems might be advantageous for surface enlargement and to facilitate migration of chondrocytes into the scaffold in one step.
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9
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Princz S, Wenzel U, Tritschler H, Schwarz S, Dettmann C, Rotter N, Hessling M. Automated bioreactor system for cartilage tissue engineering of human primary nasal septal chondrocytes. ACTA ACUST UNITED AC 2017; 62:481-486. [PMID: 27701132 DOI: 10.1515/bmt-2015-0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/19/2016] [Indexed: 11/15/2022]
Abstract
An automated bioreactor system for three-dimensional (3D) cultivation of facial cartilage replacement matrices (e.g. whole human auricles) with automatised medium exchange, gas flow and temperature control was developed. The measurement of O2 saturation and pH value in the medium was performed with a non-invasive optical method. The whole system can be observed via remote monitoring worldwide. First results demonstrated that the complete system remained sterile throughout a period of 42 days. Human chondrocytes migrated into the employed cartilage replacement matrix consisting of decellularised porcine nasoseptal cartilage (pNSC). Furthermore, an improved migration and new synthesis of aggrecan was detected. A first evaluation of the system was conducted by comparison of the results from laboratory analysis with computational fluid dynamics (CFD).
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Nasal Reconstruction: A Simplified Approach Based on 419 Operated Cases. Aesthetic Plast Surg 2015; 39:91-9. [PMID: 25413009 DOI: 10.1007/s00266-014-0417-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this review is to examine a single surgeon's 10-year experience with nose defects and offer a simplified approach for nasal reconstruction to close most nasal defects following Mohs micrographic surgery (MMS). PATIENTS AND METHODS A retrospective chart review was performed on patients undergoing repair of MMS defects of the nose over a 10-year period. Data collected included patients' age and sex, anatomic location of the defect, type of reconstruction, and number of operations required. RESULTS A total of 419 patients were included in this study. The most common location for nasal reconstruction was the nasal dorsum and sidewalls (66.35 %). Complications mainly related to reconstruction of defects of the tip ± ala (n = 31), followed by the ala (n = 15) and the dorsum and sidewalls (n = 13). Bulkiness of the flap used (n = 32) and hypertrophic scar (n = 13) were the most common complications. The bilobed flap was the most commonly used flap (n = 145), followed by nasolabial flap (n = 69), FTSGs (n = 63), forehead flap (n = 62), and dorsal glabellar flap (n = 44). CONCLUSIONS In this article, a simplified approach for nasal defects reconstruction is presented, which is based on commonly performed local flaps and skin grafting. This algorithm can be useful for the novice plastic surgeons in planning a reconstructive strategy that will be efficient, easy to perform, and produces an acceptable esthetic and functional outcome.
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11
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Abstract
Currently, the gold standard for reconstruction after rhinectomy or severe trauma to the nose, includes transposition of autologous mucosal flaps plus autologous cartilage grating and coverage using a skin flap. Difficulties with this approach arise where; cartilage and mucosa harvested from autologous donor sites is insufficient to achieve a passable aesthetic and functional reconstruction. Skin flaps are often bulky, poor color matches with hair follicles that reduce the aesthetic quality of the reconstruction. We suggest that tissue engineering could be a source of functional replacement tissues for nasal reconstructive surgery. However, the advancement of such an approach is dependent on the dissemination of scientific information into the clinical community, regarding the engineering of tissues such as mucosa, skin, and cartilage. This paper therefore reviews how the tissue engineering strategies available for producing clinically viable tissues could help resolve issues around reconstructing the human nose.
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12
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Abstract
Alar rim defects are most commonly acquired as a result of trauma, burns, tumor excision or sometimes accompanying craniofacial clefts. However, isolated congenital alar defects are extremely rare occurring in about 1 in 20,000 to 40,000 live births. We are presenting a case report of an isolated congenital cleft of the alar rim. The defect was closed by the use of a rotation advancement full-thickness flap. With this technique, both symmetry and desired thickness of the nostrils were achieved. The skin color and texture of the alar rim were good with minimal scars.
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Affiliation(s)
- R Kannan
- Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu, India
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13
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Abstract
A 77-year-old man was referred for treatment of a biopsy-proven multirecurrence basal cell carcinoma on the dorsum of the nose. The lesion was removed and the resulting surgical defect involved the full thickness of the nasal skin leaving intact the underlying perichondrium and cartilages of the whole nasal dorsum including both sidewalls (Figure 1). The authors performed a reconstruction of a surgical defect greater than two-thirds of the nose using a single-staged bilateral Burow's wedge flap and a full-thickness skin graft from the glabella. All scars were camouflaged in the natural facial boundaries and the surgical reconstruction was performed in a single stage. The final nasal contour, symmetry and function were still good when the patient was seen 1 year after surgery.
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Affiliation(s)
- João Goulão
- Dermatology Department, Garcia de Orta Hospital , Almada , Portugal
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14
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Oseni AO, Butler PE, Seifalian AM. Optimization of chondrocyte isolation and characterization for large-scale cartilage tissue engineering. J Surg Res 2012; 181:41-8. [PMID: 22819310 DOI: 10.1016/j.jss.2012.05.087] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/22/2012] [Accepted: 05/31/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Advancements in cartilage tissue engineering have the potential to ameliorate facial and joint reconstructive surgery as we know it. The translation of in vitro models of cartilage regeneration into clinical scenarios is the next phase of cartilage tissue engineering research. To engineer larger, more robust, and clinical relevant constructs, a great number of viable chondrocytic cells are needed. However, there is a paucity of literature concerning the most favorable method of chondrocyte isolation. Isolation methods are inconsistent, resulting in small yields and poor cell quality, and thus unreliable neocartilage formation. This study aimed to optimize the chondrocyte isolation protocol to give a maximum yield with optimal cell viability for the engineering of large cartilaginous constructs such as the human nose and ear. METHODS We employed several enzymes (pronase, dispase, hyaluronidase, and collagenase), enzyme concentrations, and digest lengths to digest freshly harvested ovine nasoseptal cartilage. We used automated trypan blue live/dead staining, immunofluorescent labeling of CD44, collagenase II, collagenase I, and Aggrecan, and alamarBlue to assess cell yield and viability. RESULTS Incubation length in enzymatic solutions had the greatest effect on cell viability, whereas concentrations of enzymes had a lesser effect. Isolated cells maintained their expression of chondrocyte-specific cell surface markers. CONCLUSIONS The optimum incubation period was 10 h using collagenase at a 0.2% (w/v) solution. An average of 1-1.5 × 10(6) cells could be harvested per gram of cartilage using this method.
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Affiliation(s)
- Adelola O Oseni
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
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15
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Oseni A, Crowley C, Lowdell M, Birchall M, Butler PE, Seifalian AM. Advancing nasal reconstructive surgery: the application of tissue engineering technology. J Tissue Eng Regen Med 2011; 6:757-68. [PMID: 22095677 DOI: 10.1002/term.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/20/2011] [Accepted: 07/12/2011] [Indexed: 12/17/2022]
Abstract
Cartilage tissue engineering is a rapidly progressing area of regenerative medicine with advances in cell biology and scaffold engineering constantly being investigated. Many groups are now capable of making neocartilage constructs with some level of morphological, biochemical, and histological likeness to native human cartilage tissues. The application of this useful technology in articular cartilage repair is well described in the literature; however, few studies have evaluated its application in head and neck reconstruction. Although there are many studies on auricular cartilage tissue engineering, there are few studies regarding cartilage tissue engineering for complex nasal reconstruction. This study therefore highlighted the challenges involved with nasal reconstruction, with special focus on nasal cartilage tissue, and examined how advancements made in cartilage tissue engineering research could be applied to improve the clinical outcomes of total nasal reconstructive surgery.
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Affiliation(s)
- Adelola Oseni
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery and Interventional Sciences, University College London, London, UK
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Skouras A, Skouras G, Karypidis D, Asimakopoulou FA. The use of Medpor© alloplastic material in rhinoplasty: experience and outcomes. J Plast Reconstr Aesthet Surg 2011; 65:35-42. [PMID: 21873131 DOI: 10.1016/j.bjps.2011.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 07/22/2011] [Accepted: 08/02/2011] [Indexed: 11/18/2022]
Abstract
UNLABELLED Surgeons often avoid the use of alloplastic materials in functional rhinoplasty due to potential complications. The aim of the present study is to present the outcomes following the use of alloplastic materials in a large series of patients, to identify and document the possible complications and to offer insight regarding the safety and the indications of the method. MATERIALS AND METHOD Between February 2005 and August 2009, 58 patients underwent functional rhinoplasty using Medpor(®) alloplastic materials by a single surgeon (A.S). The majority of the alloplastic materials were used to reconstruct defects of the nasal dorsum as well as to augment the columella and support the nasal tip. RESULTS Medpor(®) was used in the nasal dorsum in eight patients and in the columella in 50 patients. There were 10 cases of primary and 48 cases of secondary rhinoplasty. Follow-up time ranged from 1 to 5 years (mean: 3 years). Complications concerned three cases of postoperative infection and material rejection. All cases were successfully re-operated. CONCLUSION The use of Medpor(®) alloplastic material in functional rhinoplasty comprises a safe method in selected patients due to the low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic due to low quality or lack of available autologous grafts.
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17
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Denewer A, Farouk O, Fady T, Shahatto F. Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours. World J Surg Oncol 2011; 9:23. [PMID: 21333010 PMCID: PMC3046908 DOI: 10.1186/1477-7819-9-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 02/18/2011] [Indexed: 11/30/2022] Open
Abstract
Background surgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps. Methods Ninety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients. Results Wound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all. Conclusions Immediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.
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Affiliation(s)
- Adel Denewer
- Surgical Oncology Department, Oncology Center, Mansoura University, Egypt.
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18
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19
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van Hemert FJB, de Bree R, Leemans CR, Middelweerd MJ. Gangplank flap reconstruction of the nose. ACTA ACUST UNITED AC 2007; 9:201-4. [PMID: 17519209 DOI: 10.1001/archfaci.9.3.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In subtotal nose reconstruction, different tissues have to be reconstructed. We report the case of a 51-year-old man with a severe deformity of the nose (shortening and collapse of the nose, retraction of the right alar area, and a total septal defect after surgery and radiotherapy for a septum nasi carcinoma). Reconstruction with good results was performed with a "gangplank" flap technique (using a U-shaped skin flap for inner lining and for lengthening), rib cartilage for the nasal skeleton, and skin coverage with a paramedian forehead flap.
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Affiliation(s)
- Frits Jan Bas van Hemert
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
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20
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Romaní J, Yébenes M. Resolución de los defectos quirúrgicos de la pirámide nasal. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70073-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Romaní J, Yébenes M. Repair of Surgical Defects of the Nasal Pyramid. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Lofêgo Filho JA, Dadalti P, Souza DCD, Souza PRCD, Silva MALD, Takiya CM. Enxertia de pele em oncologia cutânea. An Bras Dermatol 2006. [DOI: 10.1590/s0365-05962006000500010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Em oncologia cutânea depara-se freqüentemente com situações em que a confecção de um enxerto é uma boa alternativa para o fechamento do defeito cirúrgico. Conhecer aspectos referentes à integração e contração dos enxertos é fundamental para que os cirurgiões dermatológicos procedam de maneira a não contrariar princípios básicos do transplante de pele. Os autores fazem uma revisão da classificação e fisiologia dos enxertos de pele, acrescendo considerações cirúrgicas determinantes para o sucesso do procedimento.
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Affiliation(s)
| | - Paula Dadalti
- Universidade Federal do Rio de Janeiro, Brasil; Hospital Central Aristarcho Pessoa, Brasil
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Mamelak AJ, Kouba DJ, Miller SJ. Inverted island pedicle transposition for closure of full-thickness nasal mucosa defects. Dermatol Surg 2006; 32:730-4. [PMID: 16706771 DOI: 10.1111/j.1524-4725.2006.32147.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Inverted Island Pedicle Transposition for Closure of Full-Thickness Nasal Mucosa Defects. Dermatol Surg 2006. [DOI: 10.1097/00042728-200605000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rice MA, Dodson BT, Arthur JA, Anseth KS. Cell-based therapies and tissue engineering. Otolaryngol Clin North Am 2005; 38:199-214, v. [PMID: 15823589 DOI: 10.1016/j.otc.2004.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tissue engineering is a rapidly evolving discipline that may some-day afford surgeons a limitless supply of autologous tissue for transplantation or allow in situ tissue regeneration. A number of biologic, engineering, and clinical challenges continue to face tissue engineers and surgeons alike. One important example is the choice of an appropriate cell scaffold that promotes growth and is eventually resorbed by the body. Although the application of bioengineered tissue is specific to the anatomic areas of interest,continued advances bring tissue engineering closer to reality in all areas of otolaryngology.
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Affiliation(s)
- Mark A Rice
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO 80309, USA
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