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Abu Alqam R, Alshammari AJ, Alkhwildi LA, Bamatraf MS, Khashab RM, Al Dwehji AMO, Alsuayri RA, Fadel ZT. Effectiveness of Autologous Fat Grafting in the Treatment of Scars: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04131-w. [PMID: 39014237 DOI: 10.1007/s00266-024-04131-w] [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: 03/17/2024] [Accepted: 05/09/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Autologous fat transfer (AFT) has been proposed as a possible treatment for scar tissue and its associated symptoms. Its effectiveness's evidence is yet unidentified though. The aim of this meta-analysis is to evaluate the currently available evidence on the efficacy and safety of autologous fat transfer in treating post-burn and post-traumatic scars using a validated scar measurement tool. METHODS This study performed a systematic literature review in November 2023 using the following electronic databases: MEDLINE, SCOPUS, Directory of Open Access Journals (DOAJ), PUBMED, and Google Scholar. The following key terms were included: (Fat grafting OR Autologous fat transfer) AND (body scars OR body burns OR body wounds) AND (Efficacy OR Safety OR satisfaction). We evaluated articles according to predefined quality criteria. The following data were included during the extraction period: patient demographics, indications for AFT, the number of AFT sessions, follow-up periods, and changes in the Patient and Observer Scar Assessment Scale (POSAS) scores, which contain both the patient and observer components. RESULTS This study included 1326 patients and 23 published articles. A total of 14 prospective studies, 7 retrospective studies, and 2 Randomized clinical trials studies were evaluated. These 23 articles came from diverse global locations; the earliest was published in 1992, and the most recently published in 2022. CONCLUSION Our findings demonstrated significant enhancements in scar characteristics from both patient and observer perspectives. Overall, AFT holds promise as a valuable treatment option for scar-related conditions as it enhances scar quality ,contributing to improved patient outcomes and satisfaction. LEVEL OF EVIDENCE III 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Rakan Abu Alqam
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | | | - Lama A Alkhwildi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Maha Salem Bamatraf
- College of Medicine and Surgery, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Ranad Mohammed Khashab
- College of Medicine and Surgery, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | | | - Razan A Alsuayri
- College of Medicine, Batterjee Medical College for Sciences and Technology, Jeddah, Saudi Arabia
| | - Zahir T Fadel
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Rong X, Tang J, Yang J, Wang K, Dang J, Yu Z, Zhang Z, Yi C. Immediate SVF-Gel Injection Reduced Incision Scar Formation: A Prospective, Double-Blind, Randomized, Self-control Trial. Aesthetic Plast Surg 2024:10.1007/s00266-024-04126-7. [PMID: 38831065 DOI: 10.1007/s00266-024-04126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Skin incision scars are cosmetically displeasing; the effects of current treatments are limited, and new methods to reduce scar formation need to be found. OBJECTIVE We sought to determine whether immediate postoperative injection of stromal vascular fraction gel (SVF-gel) could reduce scar formation at skin incision sites. METHODS A prospective, randomized, double-blind, self-controlled trial was conducted in patients who underwent breast reduction. SVF-gel was intradermally injected into the surgical incision on one randomly selected side, with the other side receiving saline as a control. At the 6-month follow-up, the incision scars were evaluated using the Vancouver scar scale (VSS) and visual analog scale (VAS). Antera 3D camera was used for objective evaluation. RESULTS The VSS score and VAS score were significantly different between the SVF-gel-treated side (3.80 ± 1.37, 3.37±1.25) and the control side (5.25 ± 1.18, 4.94 ± 1.28). Moreover, the SVF-gel-treated side showed statistically significant improvements in scar appearance, based on evidences from Antera 3D camera. LIMITATIONS This was a single-center, single-race, and single-gender study. Furthermore, the results were available only for the 6-month interim follow-up period. CONCLUSION Postoperative immediate SVF-gel injection in surgical incisions can reduce scar formation, and exert a preventive effect on scars. LEVEL OF EVIDENCE I Evidence obtained from at least one properly designed randomized controlled trial. 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 .
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Affiliation(s)
- Xiangke Rong
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of Plastic Surgery, No. 987 Hospital, Joint Logistics Support Force of PLA, No. 45 Dongfeng Road, Baoji, 721045, China
| | - Jiezhang Tang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jizhong Yang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kai Wang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Juanli Dang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhou Yu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhaoxiang Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chenggang Yi
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
- Department of Plastic Surgery, The Second Affiliated Hospital, Medical School, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China.
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Lu W, Yang Z, Wang M, Li S, Bi H, Yang X. Identification and verification of AK4 as a protective immune-related biomarker in adipose-derived stem cells and breast cancer. Heliyon 2024; 10:e27357. [PMID: 38560200 PMCID: PMC10980947 DOI: 10.1016/j.heliyon.2024.e27357] [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: 08/13/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Breast cancer (BC) remains the most common cancer among women, and novel post-surgical reconstruction techniques, including autologous fat transplantation, have emerged. While Adipose-derived stem cells (ADSCs) are known to impact the viability of fat grafts, their influence on breast cancer progression remains unclear. This study aims to elucidate the genetic interplay between ADSCs and breast cancer, focusing on potential therapeutic targets. Methods Using the GEO and TCGA databases, we pinpointed differentially expressed (DE) mRNAs, miRNAs, lncRNAs, and pseudogenes of ADSCs and BC. We performed functional enrichment analysis and constructed protein-protein interaction (PPI), RNA binding protein (RBP)-pseudogene-mRNA, and lncRNA-miRNA-transcription factor (TF)-gene networks. Our study delved into the correlation of AK4 expression with 33 different malignancies and examined its impact on prognostic outcomes across a pan-cancer cohort. Additionally, we scrutinized immune infiltration, microsatellite instability, and tumor mutational burden, and conducted single-cell analysis to further understand the implications of AK4 expression. We identified novel sample subtypes based on hub genes using the ConsensusClusterPlus package and examined their association with immune infiltration. The random forest algorithm was used to screen DE mRNAs between subtypes to validate the powerful prognostic prediction ability of the artificial neural network. Results Our analysis identified 395 DE mRNAs, 3 DE miRNAs, 84 DE lncRNAs, and 26 DE pseudogenes associated with ADSCs and BC. Of these, 173 mRNAs were commonly regulated in both ADSCs and breast cancer, and 222 exhibited differential regulation. The PPI, RBP-pseudogene-mRNA, and lncRNA-miRNA-TF-gene networks suggested AK4 as a key regulator. Our findings support AK4 as a promising immune-related therapeutic target for a wide range of malignancies. We identified 14 characteristic genes based on the AK4-related cluster using the random forest algorithm. Our artificial neural network yielded excellent diagnostic performance in the testing cohort with AUC values of 0.994, 0.973, and 0.995, indicating its ability to distinguish between breast cancer and non-breast cancer cases. Conclusions Our research sheds light on the dual role of ADSCs in BC at the genetic level and identifies AK4 as a key protective mRNA in breast cancer. We found that AK4 significantly predicts cancer prognosis and immunotherapy, indicating its potential as a therapeutic target.
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Affiliation(s)
- Wei Lu
- Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Zhenyu Yang
- Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Mengjie Wang
- Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Shiqi Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, 4+4 M.D. Program, Beijing, 100144, China
| | - Hui Bi
- Department of Internal Medicine, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Xiaonan Yang
- Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
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Alessandri Bonetti M, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:989-998. [PMID: 38286897 DOI: 10.1007/s00266-023-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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Yuan Y, Chai H, Wang L, Yuan L, Li F, Zhou Y, Cao Y, Liu M, Li Q, Li S. The Buried Guide Suture Method: A Novel Technique to Correct Traumatic Facial Dimples. Plast Reconstr Surg 2024; 153:692-695. [PMID: 37053457 DOI: 10.1097/prs.0000000000010549] [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: 04/15/2023]
Abstract
SUMMARY Facial dimpling, frequently occurring after blunt trauma, presents as soft-tissue depression, which is particularly apparent during facial expression. The displacement of subcutaneous tissue can be detected and measured by high-frequency ultrasound. Limited surgical methods have been applied in these closed-injury cases. Repositioning the subcutaneous tissue without incisions on unscarred skin is challenging. The authors propose a novel three-dimensional technique to suture and fix the subcutaneous tissue at a distance through a concealed incision. The buried guide suture method was used in the treatment of 22 patients with traumatic facial dimples on the cheek. All patients showed great improvement in their depressed deformity with minor complications. This technique provides an option to correct soft-tissue depression without leaving a visible scar, especially for mimetic rupture caused by blunt trauma.
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Affiliation(s)
| | | | - Lianzhao Wang
- Comprehensive Treatment Center of Scar, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Li Yuan
- Ultrasonic Diagnosis Department
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Qian Y, Wei W, Pan T, Lu J, Wei Y. Comparison research on the therapeutic effects of botulinum toxin type A and stromal vascular fraction gel on hypertrophic scars in the rabbit ear model. Burns 2024; 50:178-189. [PMID: 37783633 DOI: 10.1016/j.burns.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/05/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Botulinum toxin type A (BTA) is often used for wrinkles and muscle convulsive diseases due to its blocking of the transmission of nerve impulses. Stromal vascular fraction gel (SVF-gel) prepared from adipose tissue has novel effects on skin depression and poor texture. Both BTA and SVF-gel are proved to possess anti-scar potential. This study aimed to assess and compare their therapeutic effects on hypertrophic scars. MATERIALS AND METHODS The rabbit ear scar model was established and treated with BTA and SVF-gel, alone or in combination. Gross evaluation using Manchester Scar Scale (MSS) was conducted immediately, 4 and 8 weeks after initial treatment. After tissue sample harvest, histological and Western blot analyses were performed. RESULTS All the treatments alleviated scar hyperplasia in different degrees by inhibiting fibroblast activation (Ki-67, α-SMA), tissue inflammation (CD45, IL-1β) and the transforming growth factor-β1 (TGF-β1)/Smad3 pathway. Despite an excellent anti-inflammatory effect, improvement of scar appearance and pathological characteristics in SVF-gel-contained groups was not as good as that in BTA-only group, which might be related to the retention of M2-type macrophages (CD163 +) and partial maintenance of TGF-β1 expression. CONCLUSION Our data suggest that BTA has better anti-scar efficacy than SVF-gel, and the combination of these two treatments shows no obvious combinatorial effect.
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Affiliation(s)
- Yao Qian
- Department of Plastic Surgery, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Wang Wei
- Department of Plastic Surgery, Changxing People's Hospital, Huzhou, China
| | - Tianyun Pan
- Department of Pathology, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China
| | - Jianfeng Lu
- Department of Plastic Surgery, Changxing People's Hospital, Huzhou, China
| | - Ying Wei
- Department of Plastic Surgery, Changxing People's Hospital, Huzhou, China; Department of Plastic Surgery, Jiahui Medical Beauty Clinic Co.Ltd, Huzhou, China.
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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Raktoe R, Kwee AKAL, Rietveld M, Marsidi N, Genders R, Quint K, van Doorn R, van Zuijlen P, Ghalbzouri AEL. Mimicking fat grafting of fibrotic scars using 3D-organotypic skin cultures. Exp Dermatol 2023; 32:1752-1762. [PMID: 37515391 DOI: 10.1111/exd.14893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Wound healing of deep burn injuries is often accompanied by severe scarring, such as hypertrophic scar (HTS) formation. In severe burn wounds, where the subcutis is also damaged, the scars adhere to structures underneath, resulting in stiffness of the scar and impaired motion. Over the recent years, a promising solution has emerged: autologous fat grafting, also known as lipofilling. Previous clinical reports have shown that the anti-fibrotic effect has been attributed to the presence of adipose-derived stromal cells (ADSC). In the proposed study, we aim to investigate the effect of fat grafting in 3D organotypic skin cultures mimicking an HTS-like environment. To this end, organotypic skin cultures were embedded with normal skin fibroblasts (NF) or HTS-derived fibroblasts with or without incorporation of human adipose subcutaneous tissue (ADT) and one part was thermally wounded to examine their effect on epithelialization. The developed skin cultures were analysed on morphology and protein level. Analysis revealed that ADT-containing organotypic skin cultures comprise an improved epidermal homeostasis, and a fully formed basement membrane, similar to native human skin (NHS). Furthermore, the addition of ADT significantly reduced myofibroblast presence, which indicates its anti-fibrotic effect. Finally, re-epithelialization measurements showed that ADT reduced re-epithelialization in skin cultures embedded with NFs, whereas HTS-fibroblast-embedded skin cultures showed complete wound closure. In conclusion, we succeeded in developing a 3D organotypic HTS-skin model incorporated with subcutaneous tissue that allows further investigation on the molecular mechanism of fat grafting.
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Affiliation(s)
- Rajiv Raktoe
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Anastasia K A L Kwee
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Marion Rietveld
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Nick Marsidi
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Koen Quint
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Paul van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
- Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Roohaninasab M, Khodadad F, Sadeghzadeh-Bazargan A, Atefi N, Zare S, Jafarzadeh A, Rahimi ST, Nouri M, Nilforoushzadeh MA, Behrangi E, Goodarzi A. Efficacy of fractional CO 2 laser in combination with stromal vascular fraction (SVF) compared with fractional CO 2 laser alone in the treatment of burn scars: a randomized controlled clinical trial. Stem Cell Res Ther 2023; 14:269. [PMID: 37742019 PMCID: PMC10518108 DOI: 10.1186/s13287-023-03480-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars. METHOD This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings. RESULTS The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group. CONCLUSION The results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions. TRIAL REGISTRATION The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337 .
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Affiliation(s)
- Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Khodadad
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghzadeh-Bazargan
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Zare
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Institute, Sharif University of Technology, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Seyyedeh Tahereh Rahimi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Skin Repair Research Center, Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Vriend L, van der Lei B, Harmsen MC, van Dongen JA. Adipose Tissue-Derived Components: From Cells to Tissue Glue to Treat Dermal Damage. Bioengineering (Basel) 2023; 10:bioengineering10030328. [PMID: 36978719 PMCID: PMC10045962 DOI: 10.3390/bioengineering10030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
In recent decades, adipose tissue transplantation has become an essential treatment modality for tissue (volume) restoration and regeneration. The regenerative application of adipose tissue has only recently proven its usefulness; for example, the method is useful in reducing dermal scarring and accelerating skin-wound healing. The therapeutic effect is ascribed to the tissue stromal vascular fraction (tSVF) in adipose tissue. This consists of stromal cells, the trophic factors they secrete and the extracellular matrix (ECM), which have immune-modulating, pro-angiogenic and anti-fibrotic properties. This concise review focused on dermal regeneration using the following adipose-tissue components: adipose-tissue-derived stromal cells (ASCs), their secreted trophic factors (ASCs secretome), and the ECM. The opportunities of using a therapeutically functional scaffold, composed of a decellularized ECM hydrogel loaded with trophic factors of ASCs, to enhance wound healing are explored as well. An ECM-based hydrogel loaded with trophic factors combines all regenerative components of adipose tissue, while averting the possible disadvantages of the therapeutic use of adipose tissue, e.g., the necessity of liposuction procedures with a (small) risk of complications, the impossibility of interpatient use, and the limited storage options.
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Affiliation(s)
- Linda Vriend
- Department of Plastic Surgery, University of Utrecht, University Medical Center Utrecht, 3584 CS Utrecht, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 AC Groningen, The Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, 9700 AC Groningen, The Netherlands
- Bergman Clinics, 8443 CG Heerenveen, The Netherlands
- Bergman Clinics, 2289 CM Rijswijk, The Netherlands
| | - Martin C. Harmsen
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 AC Groningen, The Netherlands
| | - Joris A. van Dongen
- Department of Plastic Surgery, University of Utrecht, University Medical Center Utrecht, 3584 CS Utrecht, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 AC Groningen, The Netherlands
- Correspondence:
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11
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Yin D, Shen G. Aesthetic Effect of Autologous Fat Transplantation on Frontotemporal Depression Filling and Its Influence on SCL-90 and SES of Patients. Emerg Med Int 2022; 2022:3374780. [PMID: 36267141 PMCID: PMC9578896 DOI: 10.1155/2022/3374780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aimed to study the aesthetic effect of autologous fat transplantation in frontotemporal depression filling as well as the influence on the Symptom Checklist 90 (SCL-90) and the Rosenberg Self-Esteem Scale (SES) score of patients. Methods A total of 100 patients with frontotemporal depression admitted to the outpatient department of burn and plastic surgery in our hospital were selected as the observation group, and all of them received autologous fat transplantation. The filling effect of patients in the observation group was discussed. Simultaneously, 50 volunteers were selected as the control group to compare the SCL-90 and SES scores of the observation group and the control group. Result ① A total of 100 patients with frontotemporal depression were treated with autologous fat transplantation, and the secondary autologous fat transplantation rate was 10%; two cases of fat absorption occurred during the 12-month follow-up after surgery; on the 7th day, 6 months, and 12 months after the operation, the satisfaction rate of the patients who visited the doctor was 96.00%, 97%, and 92.00%; the satisfaction rate of the plastic surgeon was 94.00%, 96%, and 90.00%; the satisfaction rate of the third party was 96.00%, 98%, and 92.00%. ② The preoperative scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychotic factor scores in the observation group were higher than those in the control group (P < 0.05). The scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychotic factor scores in the observation group at 6 months after the operation were lower than those before operation (P < 0.05). The preoperative SES score of the observation group (28.51 ± 9.81) was significantly lower than that of the control group (32.47 ± 5.39) (P < 0.05). The SES score (34.17 ± 9.81) in the observation group at 6 months after the operation was significantly higher than that before the operation (P < 0.05). Conclusion The aesthetic effect of autologous fat transplantation in frontotemporal depression filling is good and safe. Simultaneously, it can improve the mental health and self-esteem of patients and has high clinical value.
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Affiliation(s)
- Dongjing Yin
- Department of Burns and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
- Department of Burns and Plastic Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226000, Jiangsu, China
| | - Guoliang Shen
- Department of Burns and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
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12
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Vriend L, van Dongen JA, Pijpe A, Nieuwenhuis MK, Jongen SJM, Harmsen MC, van Zuijlen PPM, van der Lei B. Stromal vascular fraction-enriched fat grafting as treatment of adherent scars: study design of a non-randomized early phase trial. Trials 2022; 23:575. [PMID: 35854356 PMCID: PMC9295521 DOI: 10.1186/s13063-022-06514-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background In the last decades, autologous fat grafting has been used to treat adherent dermal scars. The observed regenerative and scar-reducing properties have been mainly ascribed to the tissue-derived stromal vascular fraction (tSVF) in adipose tissue. Adipose tissue’s components augment local angiogenesis and mitosis in resident tissue cells. Moreover, it promotes collagen remodeling. We hypothesize that tSVF potentiates fat grafting-based treatment of adherent scars. Therefore, this study aims to investigate the effect of tSVF-enriched fat grafting on scar pliability over a 12-month period. Methods and design A clinical multicenter non-randomized early phase trial will be conducted in two dedicated Dutch Burn Centers (Red Cross Hospital, Beverwijk, and Martini Hospital, Groningen). After informed consent, 46 patients (≥18 years) with adherent scars caused by burns, necrotic fasciitis, or degloving injury who have an indication for fat grafting will receive a sub-cicatricic tSVF-enriched fat graft. The primary outcome is the change in scar pliability measured by the Cutometer between pre- and 12 months post-grafting. Secondary outcomes are scar pliability (after 3 months), scar erythema, and melanin measured by the DSM II Colormeter; scar quality assessed by the patient and observer scales of the Patient and Observer Scar Assessment Scale (POSAS) 2.0; and histological analysis of scar biopsies (voluntary) and tSVF quality and composition. This study has been approved by the Dutch Central Committee for Clinical Research (CCMO), NL72094.000.20. Conclusion This study will test the clinical efficacy of tSVF-enriched fat grafting to treat dermal scars while the underlying working mechanism will be probed into too. Trial registration Dutch Trial Register NL 8461. Registered on 16 March 2020
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Affiliation(s)
- Linda Vriend
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Plastic Surgery, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
| | - Joris A van Dongen
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Plastic Surgery, University of Utrecht, and University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Martini Hospital, Groningen, the Netherlands.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.,Department of Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Sandra J M Jongen
- Association of Dutch Burn Centers, Martini Hospital, Groningen, the Netherlands
| | - Martin C Harmsen
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul P M van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands. .,Bergman Clinics, Rijswijk, the Netherlands. .,Bergman Clinics, Heerenveen, the Netherlands.
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13
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van Dongen JA, van Boxtel J, Uguten M, Brouwer LA, Vermeulen KM, Melenhorst WB, Niessen FB, Harmsen MC, Stevens HP, van der Lei B. Tissue Stromal Vascular Fraction Improves Early Scar Healing: A Prospective Randomized Multicenter Clinical Trial. Aesthet Surg J 2022; 42:NP477-NP488. [PMID: 34967864 DOI: 10.1093/asj/sjab431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Wound healing and scar formation depends on a plethora of factors. Given the impact of abnormal scar formation, interventions aimed to improve scar formation would be most advantageous. The tissue stromal vascular fraction (tSVF) of adipose tissue is composed of a heterogenous mixture of cells embedded in extracellular matrix. It contains growth factors and cytokines involved in wound-healing processes, eg, parenchymal proliferation, inflammation, angiogenesis, and matrix remodeling. OBJECTIVES The aim of this study was to investigate the hypothesis that tSVF reduces postsurgical scar formation. METHODS This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2020. Forty mammoplasty patients were enrolled and followed for 1 year. At the end of the mammoplasty procedure, all patients received tSVF in the lateral 5 cm of the horizontal scar of 1 breast and a placebo injection in the contralateral breast to serve as an intrapatient control. Primary outcome was scar quality measure by the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes were obtained from photographic evaluation and histologic analysis of scar tissue samples. RESULTS Thirty-four of 40 patients completed follow-up. At 6 months postoperation, injection of tSVF had significantly improved postoperative scar appearance as assessed by the POSAS questionnaire. No difference was observed at 12 months postoperation. No improvement was seen based on the evaluation of photographs and histologic analysis of postoperative scars between both groups. CONCLUSIONS Injection of tSVF resulted in improved wound healing and reduced scar formation at 6 months postoperation, without any noticeable advantageous effects seen at 12 months. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Joris A van Dongen
- Department of Plastic Surgery, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Joeri van Boxtel
- Department of Plastic Surgery, Catharina Hospital Eindhoven , Eindhoven , the Netherlands
| | - Mustafa Uguten
- Department of Plastic Surgery, Haga Hospital , the Hague , the Netherlands
| | - Linda A Brouwer
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center of Groningen , Groningen , the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen and University Medical Center of Groningen , Groningen , the Netherlands
| | - Wynand B Melenhorst
- Department of Plastic Surgery, Diakonessenhuis Utrecht , Utrecht , the Netherlands
| | | | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center of Groningen , Groningen , the Netherlands
| | | | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen and University Medical Center of Groningen , Groningen , the Netherlands
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14
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Favorable Transverse Maxillary Development after Covering the Lateral Raw Surfaces with Buccal Fat Flaps in Modified Furlow Palatoplasty: A 3D Imaging-Assisted Long-Term Comparative Outcome Study. Plast Reconstr Surg 2022; 150:396e-405e. [PMID: 35687419 DOI: 10.1097/prs.0000000000009353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This 3D imaging-assisted study assessed its impact on posterior transverse maxillary development. METHODS Cone beam computerized tomography scans from patients with unilateral cleft lip, alveolus and palate who received buccal fat flap (buccal fat group; n=22) or Surgicel (Surgicel group; n=32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9-10 months old and had reached 9 years old were retrieved for analysis. Patients with unilateral cleft lip and alveolus (non-palatoplasty group; n=24) were also included for comparison. Using 3D maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and non-cleft posterior maxillary sides as well as for total posterior transverse maxillary dimension. RESULTS The buccal fat group had significantly (all p<0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and non-cleft sides, with exception for U6J-MSP and posterior palatal area parameters on the cleft side (p>0.05). The buccal fat group had significantly (all p<0.05) wider total transverse maxillary dimensions compared with Surgicel and non-palatoplasty groups. CONCLUSION Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure.
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15
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Al Qurashi AA, Siddiqi AK, Alghamdi AA, Aljalfan AAN, Almenhali AA, Al Jabr FA, Rashid AM, Almas T, Menezes RG. Effectiveness of Autologous Fat Transfer in the Treatment of Scar-Related Conditions: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:2564-2572. [PMID: 35411408 DOI: 10.1007/s00266-022-02869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions. METHODS PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model. RESULTS 9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036). CONCLUSION Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ritesh G Menezes
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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16
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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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17
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Gronovich Y, Maisel Lotan A. Treatment of scars with autologous fat grafting and 1540 nm non-ablative erbium laser. J COSMET LASER THER 2022; 24:80-83. [PMID: 35318875 DOI: 10.1080/14764172.2022.2055078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Scars may be devastating for patients. Fat grafting and non-ablative lasers are available options for improvement. The former reshapes and improves scar quality by adding volume and regenerative adipose-derived stem cells, whereas the latter facilitates synthesis and deposition of new dermal collagen. The combination may be synergic, leading to better cosmetic outcome.This was a prospective study of 16 consecutive patients treated with autologous fat grafting and non-ablative 1540-nm erbium laser for facial scars between January 2015 and December 2015. Treatment protocol included fat injection followed by five treatments with 1540-nm erbium laser (ICONTM Cynosure; Westford, MA, USA) a month later. We evaluated patients before, after treatments, and 6 months after the final treatment.Sixteen patients participated in our study. Mean patient age was 42 years (range 16-59 years). Scars were either traumatic (73%) or acne induced (27%). Traumatic scars were mainly new scars, with the majority of patients were treated within 30 days of injury. There were no reported complications. Scars improved in both texture and appearance and patient satisfaction was high in all cases.Treatment of scars with autologous fat grafting and fractional non-ablative 1540-nm erbium laser is safe and efficient and results in improved scar appearance and texture.
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Affiliation(s)
- Yoav Gronovich
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Maisel Lotan
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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18
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Spiekman M, Francia DL, Mossel DM, Brouwer LA, Diercks GFH, Vermeulen KM, Folkertsma M, Ghods M, Kzhyshkowska J, Klüter H, Krenning G, van der Lei B, Harmsen MC. Autologous Lipofilling Improves Clinical Outcome in Patients With Symptomatic Dermal Scars Through Induction of a Pro-Regenerative Immune Response. Aesthet Surg J 2022; 42:NP244-NP256. [PMID: 34270698 PMCID: PMC8922688 DOI: 10.1093/asj/sjab280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Autologous lipofilling is an emerging procedure to treat and possibly reverse dermal scars and to reduce scar-related pain, but its efficacy and mechanisms are poorly understood. OBJECTIVES The aim of this study was to test the hypothesis that repeated lipografts reverse dermal scars by reinitiation of wound healing. METHODS In a prospective, non-placebo-controlled clinical study, 27 adult patients with symptomatic scars were given 2 lipofilling treatments at 3-month intervals. As primary outcome, clinical effects were measured with the Patient and Observer Scar Assessment Scale (POSAS). Scar biopsies were taken before and after treatments to assess scar remodeling at a cellular level. RESULTS Twenty patients completed the study. Patients' scars improved after lipofilling. The total POSAS scores (combined patient and observer scores) decreased from 73.2 [14.7] points (mean [standard deviation]) pretreatment to 46.1 [14.0] and 32.3 [13.2] points after the first and second lipofilling treatment, respectively. Patient POSAS scores decreased from 37.3 [8.8] points to 27.2 [11.3] and 21.1 [11.4] points, whereas observer POSAS scores decreased from 35.9 [9.5] points to 18.9 [6.0] and 11.3 [4.5] points after the first and second treatment, respectively. After each lipofilling treatment, T lymphocytes, mast cells, and M2 macrophages had invaded scar tissue and were associated with increased vascularization. In addition, the scar-associated epidermis showed an increase in epidermal cell proliferation to levels similar to that normal in skin. Moreover, lipofilling treatment caused normalization of the extracellular matrix organization towards that of normal skin. CONCLUSIONS Autologous lipofilling improves the clinical outcome of dermal scars through the induction of a pro-regenerative immune response, increased vascularization, and epidermal proliferation and remodeling of scar tissue extracellular matrix. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Maroesjka Spiekman
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Delia L Francia
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Dieuwertje M Mossel
- University of Heidelberg, Medical Faculty Mannheim, Institute of Transfusion Medicine and Immunology, Mannheim, Germany
| | - Linda A Brouwer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gilles F H Diercks
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mark Folkertsma
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mojtaba Ghods
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Julia Kzhyshkowska
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Harald Klüter
- Ruprecht Karls Universität Heidelberg Medizinische Fakultät Mannheim, Institute of Transfusion Medicine and Immunology, Mannheim, Germany
| | - Guido Krenning
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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19
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Complications and Disasters After Minimally Invasive Tissue Augmentation with Different Types of Fillers: A Retrospective Analysis. Aesthetic Plast Surg 2021; 46:1388-1397. [PMID: 34939150 PMCID: PMC9411215 DOI: 10.1007/s00266-021-02691-9] [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: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The interest in youthful appearance and rejuvenating procedures is unbroken in our society. Besides surgical procedures, permanent fillers are utilized. The incorrect and unprofessional use of these substances, auto-injections in particular, have devastating results for patients and are challenging for the plastic surgeon. The aim of this retrospective study was to delineate the differences between permanent and non-permanent filler complications and appropriate treatment options. METHODS We conducted a retrospective study and researched the hospital information system in the time period from 2001 to 2020. Patients with unprofessional use of permanent fillers, auto-injections and injections of unformulated substances were determined. Age, gender, localization, complications, length of hospital stay, comorbidities, histopathological workups and surgical salvage procedures were noted. Descriptive statistics were calculated. RESULTS Seventeen patients were identified from 2001 till 2020. In four cases, auto-injections by the patients were the cause, whereas in the other patients the injections were performed by medical staff. Ages range from 18 to 57 years. Fourteen patients were female and three were male. The injected substances could be recognized as synthol, silicone, vaseline, fat tissue, hyaluronic acid as well as non-medical substances. Surgical procedures were necessary in eleven cases. One patient died because of the underlying diseases. CONCLUSION Our results indicate different sequels of filler materials injected in an unprofessional way, possible complications, conservative and surgical techniques to resolve these rare complications. We suggest a staged therapy adjusted to the clinical symptoms. Milder symptoms can be handled conservatively, whereas severe infections, skin breakdowns or persistent granuloma are justifying indications for surgical treatment. 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 .
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20
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The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study. Aesthetic Plast Surg 2021; 45:2397-2405. [PMID: 32221675 PMCID: PMC8481185 DOI: 10.1007/s00266-020-01633-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/25/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. LEVEL OF EVIDENCE IV 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 . TRIAL REGISTRY NAME The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6.
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Stachura A, Paskal W, Pawlik W, Mazurek MJ, Jaworowski J. The Use of Adipose-Derived Stem Cells (ADSCs) and Stromal Vascular Fraction (SVF) in Skin Scar Treatment-A Systematic Review of Clinical Studies. J Clin Med 2021; 10:3637. [PMID: 34441935 PMCID: PMC8396936 DOI: 10.3390/jcm10163637] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, lipofilling became a popular scar treatment method. Its beneficial outcomes have been partly attributed to the regenerative capacity of adipose-derived stem cells (ADSCs), suspended in an extracellular matrix-the stromal vascular fraction (SVF). The aim of this review was to verify if existing data support the clinical use of ADSC-related interventions in scar treatment. A systematic search of the literature was performed in July 2020 in five databases (Medline, Cochrane, Web of Science, Scopus and Embase). Articles written in English, except for reviews, letters and editorials, were identified and screened for eligibility. We looked for reports of any outcomes in scars treated with ADSCs or SVF. Data from selected articles were extracted and the quality of each study was assessed. Five hundred and fourteen studies were identified in the primary search, of which nineteen were eventually included in the systematic review. Extracted data pointed to beneficial microscopic, functional and aesthetic outcomes in a total of 665 patients. Six studies included comparative interventions-platelet-rich plasma or CO2 fractional laser. Collected data give low-to-average quality evidence for beneficial effects of ADSC-related interventions in scar treatment. Some studies suggest that these interventions are noninferior to PRP or fractional CO2 laser.
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Affiliation(s)
- Albert Stachura
- Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Timeless Plastic Surgery Clinic, 02-091 Warsaw, Poland; (M.J.M.); (J.J.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Wiktor Paskal
- Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Timeless Plastic Surgery Clinic, 02-091 Warsaw, Poland; (M.J.M.); (J.J.)
| | - Weronika Pawlik
- Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Maciej J. Mazurek
- Timeless Plastic Surgery Clinic, 02-091 Warsaw, Poland; (M.J.M.); (J.J.)
- West Pomeranian Center for Severe Burns and Plastic Surgery, 72-300 Gryfice, Poland
- Plastic Surgery Department, Centre for Postgraduate Medical Education, 02-091 Warsaw, Poland
| | - Janusz Jaworowski
- Timeless Plastic Surgery Clinic, 02-091 Warsaw, Poland; (M.J.M.); (J.J.)
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van Dongen JA, Boxtel JV, Willemsen JC, Brouwer LA, Vermeulen KM, Tuin AJ, Harmsen MC, van der Lei B, Stevens HP. The Addition of Tissue Stromal Vascular Fraction to Platelet-Rich Plasma Supplemented Lipofilling Does Not Improve Facial Skin Quality: A Prospective Randomized Clinical Trial. Aesthet Surg J 2021; 41:NP1000-NP1013. [PMID: 33687052 DOI: 10.1093/asj/sjab109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lipofilling has become popular as a treatment to improve aging-related skin characteristics (eg, wrinkles, pigmentation spots, pores, or rosacea). Different additives such as platelet-rich plasma (PRP) or stromal vascular fraction (SVF) have been combined with lipofilling to increase the therapeutic effect of adipose-derived stromal cells (ASCs). OBJECTIVES The aim of this study was to examine the hypothesis that mechanically isolated SVF augments the therapeutic effect of PRP-supplemented lipofilling to improve facial skin quality. METHODS This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2019. In total, 28 female subjects were enrolled; 25 completed the follow-up. All patients received PRP-supplemented lipofilling with either mechanically isolated SVF or saline. SVF was isolated by fractionation of adipose tissue (tSVF). Results were evaluated by changes in skin elasticity and transepidermal water loss, changes in skin-aging-related features, ie, superficial spots, wrinkles, skin texture, pores, vascularity, and pigmentation, as well as patient satisfaction (FACE-Q), recovery, and number of complications up to 1 year postoperative. RESULTS The addition of tSVF to PRP-supplemented lipofilling did not improve skin elasticity, transepidermal water loss, or skin-aging-related features. No improvement in patient satisfaction with overall facial appearance or facial skin quality was seen when tSVF was added to PRP-supplemented lipofilling. CONCLUSIONS In comparison to PRP-supplemented lipofilling, PRP-supplemented lipofilling combined with tSVF does not improve facial skin quality or patient satisfaction in a healthy population. PRP-supplemented lipofilling combined with tSVF can be considered a safe procedure. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | - Joeri V Boxtel
- Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Joep C Willemsen
- Albert Schweitzer Hospital Dordrecht, Dordrecht, the Netherlands
| | - Linda A Brouwer
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
| | - Aartje Jorien Tuin
- Department of Maxillofacial Surgery, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
| | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen and University Medical Center of Groningen, Groningen, the Netherlands
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Ferry AM, Chamata E, Dibbs RP, Rappaport NH. Avoidance and Correction of Deformities in Body Contouring. Semin Plast Surg 2021; 35:110-118. [PMID: 34121946 DOI: 10.1055/s-0041-1727207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Body contouring procedures are highly impactful because of their potential to improve a patient's quality of life. These procedures, particularly when performed on patients following massive weight loss, may require secondary intervention to treat residual contour abnormalities. Presently, there is a paucity of information in the literature detailing the avoidance and correction of body contouring deformities. Herein, we will discuss the management of patients seeking revisional body contouring procedures.
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Affiliation(s)
- Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Norman H Rappaport
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Houston Center for Plastic Surgery, Houston, Texas
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Perineural fat grafting in end-neuroma pain treatment: long-term outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Wang ZH, Sun XY, Zhang JJ, Giampieri F, Jiang CJ, Feng TT, Wang ZW, Chen RY, Battino M, Zhou Y. A six-herb Chinese medicine composition ointment as a promising candidate for treatment of hypertrophic scars. CHINESE HERBAL MEDICINES 2021; 13:210-220. [PMID: 36117509 PMCID: PMC9476741 DOI: 10.1016/j.chmed.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To study the anti-hypertrophic scar effect of the six-herb Chinese medicine composition (SCMC) ointment on the rabbit ear hypertrophic scar models. Methods The optimal formulation of SCMC ointment matrix was screened by the orthogonal designs and a series of evaluation tests. The SCMC ointment was prepared through emulsifying method. The rabbit ear hypertrophic scar models were established and used to investigate the anti-hypertrophic scar effect of SCMC ointment. Results Our results demonstrated that all the quality control indications of the SCMC ointment met the requirements. Anti-hypertrophic scar activity results showed that all the rabbit ear scar tissues appeared different degrees of shrink and fading, and took an unobvious but palpable shift from hard to soft texture with the low, middle and high concentration SCMC ointments treatments in vivo. Additionally, on 21st day the scar area and thickness in different concentrations of SCMC ointment groups were significantly reduced than control group, in a concentration-dependent manner. The immunohistochemical results also indicated that the SCMC ointment had good anti-hypertrophic scar properties and could inhibit hypertrophic scar formation. Conclusion The SCMC ointment could improve the blood circulation condition of hypertrophic scar tissues. Our research has demonstrated the Chinese medicine composition ointment with good anti-hypertrophic scar properties that could be used to treat hypertrophic scars. Meanwhile, it provides a theoretical basis for further clinical application.
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Affiliation(s)
- Zu-hua Wang
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Xue-yan Sun
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Jiao-jiao Zhang
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Department of Clinical Sciences, Faculty of Medicine, Università Politecnica delle Marche, Ancona 60131, Italy
- School of Medicine, Southern Medical University, Guangzhou 510091, China
| | - Francesca Giampieri
- Department of Clinical Sciences, Faculty of Medicine, Università Politecnica delle Marche, Ancona 60131, Italy
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Cheng-ju Jiang
- QianDongNan Vocational & Technical College for Nationalities, Kaili 556000, China
| | - Ting-ting Feng
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Zhi-wei Wang
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Rong-yi Chen
- School of Medicine, Southern Medical University, Guangzhou 510091, China
| | - Maurizio Battino
- Department of Clinical Sciences, Faculty of Medicine, Università Politecnica delle Marche, Ancona 60131, Italy
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Corresponding authors at: Department of Clinical Sciences, Faculty of Medicine, Università Politecnica delle Marche, Ancona 60131, Italy.
| | - Ying Zhou
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Corresponding authors at: Department of Clinical Sciences, Faculty of Medicine, Università Politecnica delle Marche, Ancona 60131, Italy.
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Louis F, Piantino M, Liu H, Kang DH, Sowa Y, Kitano S, Matsusaki M. Bioprinted Vascularized Mature Adipose Tissue with Collagen Microfibers for Soft Tissue Regeneration. CYBORG AND BIONIC SYSTEMS 2021; 2021:1412542. [PMID: 36285131 PMCID: PMC9494725 DOI: 10.34133/2021/1412542] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
The development of soft tissue regeneration has recently gained importance due to safety concerns about artificial breast implants. Current autologous fat graft implantations can result in up to 90% of volume loss in long-term outcomes due to their limited revascularization. Adipose tissue has a highly vascularized structure which enables its proper homeostasis as well as its endocrine function. Mature adipocytes surrounded by a dense vascular network are the specific features required for efficient regeneration of the adipose tissue to perform host anastomosis after its implantation. Recently, bioprinting has been introduced as a promising solution to recreate in vitro this architecture in large-scale tissues. However, the in vitro induction of both the angiogenesis and adipogenesis differentiations from stem cells yields limited maturation states for these two pathways. To overcome these issues, we report a novel method for obtaining a fully vascularized adipose tissue reconstruction using supporting bath bioprinting. For the first time, directly isolated mature adipocytes encapsulated in a bioink containing physiological collagen microfibers (CMF) were bioprinted in a gellan gum supporting bath. These multilayered bioprinted tissues retained high viability even after 7 days of culture. Moreover, the functionality was also confirmed by the maintenance of fatty acid uptake from mature adipocytes. Therefore, this method of constructing fully functional adipose tissue regeneration holds promise for future clinical applications.
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Affiliation(s)
- Fiona Louis
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Japan
| | - Marie Piantino
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan
| | - Hao Liu
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan
| | - Dong-Hee Kang
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Japan
| | - Shiro Kitano
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Japan
- Toppan Printing Co., Ltd., Tokyo, Japan
| | - Michiya Matsusaki
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Japan
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan
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Couto-González I, Vila I, Brea-García B, Soldevila-Guilera S, Fernández-Marcos AÁ, Pardo M, Taboada-Suárez A. Safety of Large-Volume Immediate Fat Grafting for Latissimus Dorsi-Only Breast Reconstruction: Results and Related Complications in 95 Consecutive Cases. Aesthetic Plast Surg 2021; 45:64-75. [PMID: 32778932 DOI: 10.1007/s00266-020-01882-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Breast reconstruction with implants has proven serious complications, mostly in patients who have undergone radiotherapy. In these cases, autologous reconstruction is the technique of choice. OBJECTIVES To study if breast reconstruction using latissimus dorsi and immediate fat grafting (LIFG) is a widely applicable technique for those cases in which an autologous reconstruction is desirable, but the use of microsurgical perforator flaps is not available. METHODS Data of 95 consecutive breast reconstructions from May 2014 to December 2018 were prospectively collected. All patients included in the study had a minimum follow-up of one year after completion of the reconstructive process. RESULTS The mean age of the patients was 48.57 years with an average follow-up of 20.65 months. The mean number of surgeries per patient was 1.61. In 47.4% of the cases, only LIFG surgery was required to accomplish the reconstructive process. The mean volume of fat graft used was 416.00 ± 145.79 cc. Relevant statistically significant differences in the volume of graft were found regarding the use of previous radiotherapy and the timing of reconstruction. Radiological fat necrosis nodes were the main complication (15.8%). However, their presence was significantly lower if no additional fat grafting sessions were necessary, though, unexpectedly, no relation was found in relation to the total amount of fat graft needed. CONCLUSIONS LIFG has proved to be a safe and reliable method for total autologous breast reconstruction. Even when a medium to large size is required, a large volume of fat graft is accepted; thus, excellent results can be obtained. It is an interesting alternative for breast reconstruction, in addition to abdominal perforator flaps. LEVEL OF EVIDENCE IV 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 Authors www.springer.com/00266 . Breast Surgery.
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Local Treatment of Burns with Cell-Based Therapies Tested in Clinical Studies. J Clin Med 2021; 10:jcm10030396. [PMID: 33494318 PMCID: PMC7864524 DOI: 10.3390/jcm10030396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Effective wound management is an important determinant of the survival and prognosis of patients with severe burns. Thus, novel techniques for timely and full closure of full-thickness burn wounds are urgently needed. The purpose of this review is to present the current state of knowledge on the local treatment of burn wounds (distinguishing radiation injury from other types of burns) with the application of cellular therapies conducted in clinical studies. PubMed search engine and ClinicalTrials.gov were used to analyze the available data. The analysis covered 49 articles, assessing the use of keratinocytes (30), keratinocytes and fibroblasts (6), fibroblasts (2), bone marrow-derived cells (8), and adipose tissue cells (3). Studies on the cell-based products that are commercially available (Epicel®, Keraheal™, ReCell®, JACE, Biobrane®) were also included, with the majority of reports found on autologous and allogeneic keratinocytes. Promising data demonstrate the effectiveness of various cell-based therapies; however, there are still scientific and technical issues that need to be solved before cell therapies become standard of care. Further evidence is required to demonstrate the clinical efficacy and safety of cell-based therapies in burns. In particular, comparative studies with long-term follow-up are critical.
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He X, Zhang J, Luo L, Shi J, Hu D. New Progress of Adipose-derived Stem Cells in the Therapy of Hypertrophic Scars. Curr Stem Cell Res Ther 2020; 15:77-85. [PMID: 31483236 DOI: 10.2174/1574888x14666190904125800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/01/2018] [Accepted: 07/10/2019] [Indexed: 12/30/2022]
Abstract
Burns are a global public health issue of great concern. The formation of scars after burns and physical dysfunction of patients remain major challenges in the treatment of scars. Regenerative medicine based on cell therapy has become a hot topic in this century. Adipose-derived stem cells (ADSCs) play an important role in cellular therapy and have become a promising source of regenerative medicine and wound repair transplantation. However, the anti-scarring mechanism of ADSCs is still unclear yet. With the widespread application of ADSCs in medical, we firmly believe that it will bring great benefits to patients with hypertrophic scars.
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Affiliation(s)
- Xiang He
- Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi' an, Shaanxi, China
| | - Julei Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi' an, Shaanxi, China
| | - Liang Luo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi' an, Shaanxi, China
| | - Jihong Shi
- Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi' an, Shaanxi, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi' an, Shaanxi, China
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A Systematic Review of Autologous Fat Grafting in the Treatment of Acute and Chronic Cutaneous Wounds. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2835. [PMID: 33154876 PMCID: PMC7605858 DOI: 10.1097/gox.0000000000002835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 03/12/2020] [Indexed: 12/27/2022]
Abstract
There is a growing interest in the regenerative potential of autologous fat. Adipose-derived stem cells, within the stromal vascular fraction of lipoaspirate samples, demonstrate anti-inflammatory, immunomodulatory, and angiogenic properties. This systematic review aimed to determine the efficacy and safety of autologous fat therapies for wound healing, with an evaluation of the quality of evidence provided by the literature.
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Reply: The Effects of Facial Lipografting on Skin Quality: A Systematic Review. Plast Reconstr Surg 2020; 146:93e-94e. [PMID: 32590670 DOI: 10.1097/prs.0000000000006942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Francesco F, Busato A, Mannucci S, Zingaretti N, Cottone G, Amendola F, De Francesco M, Merigo F, Riccio V, Vaienti L, Parodi PC, Sbarbati A, Riccio M. Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates. J Int Med Res 2020; 48:300060520945508. [PMID: 32790486 PMCID: PMC7427157 DOI: 10.1177/0300060520945508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Artificial dermal substitutes (DSs) are fundamental in physiological wound healing to ensure consistent and enduring wound closure and provide a suitable scaffold to repair tissue. We compared the clinical and histological features of two DSs, Pelnac and Integra, in the treatment of traumatic and iatrogenic skin defects. METHODS This prospective observational study involved 71 randomly selected patients from our hospital. Wound healing was analyzed using the Wound Surface Area Assessment, the Vancouver Scar Scale, and a visual analog scale. Histological and immunohistochemical evaluations were also performed. RESULTS At 2 weeks, greater regeneration with respect to proliferation of the epidermis and renewal of the dermis was observed with Pelnac than with Integra. At 4 weeks, the dermis had regenerated with both DSs. Both templates induced renewed collagen and revascularization. Differences in the Vancouver Scar Scale score were statistically significant at 4 weeks and 1 year. Pelnac produced a significant increase in contraction at 2 weeks with increasing effectiveness at 4 weeks. Integra produced a higher percentage reduction in the wound surface area and a shorter healing time than Pelnac for wounds >1.5 cm deep. CONCLUSION Our observational data indicate that both DSs are effective and applicable in different clinical contexts.
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Affiliation(s)
- Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
| | - Alice Busato
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Silvia Mannucci
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Nicola Zingaretti
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), University of Udine, Italy
| | - Giuseppe Cottone
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Francesco Amendola
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | - Flavia Merigo
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Valentina Riccio
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Luca Vaienti
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pier Camillo Parodi
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), University of Udine, Italy
| | - Andrea Sbarbati
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
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Borrelli MR, Patel RA, Blackshear C, Vistnes S, Diaz Deleon NM, Adem S, Shen AH, Sokol J, Momeni A, Nguyen D, Longaker MT, Wan DC. CD34+CD146+ adipose-derived stromal cells enhance engraftment of transplanted fat. Stem Cells Transl Med 2020; 9:1389-1400. [PMID: 32543083 PMCID: PMC7581443 DOI: 10.1002/sctm.19-0195] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/24/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Fat grafting is a surgical technique able to reconstruct and regenerate soft tissue. The adipose‐derived stromal cells (ASCs) within the stromal vascular fraction are believed to drive these beneficial effects. ASCs are increasingly recognized to be a heterogeneous group, comprised of multiple stem and progenitor subpopulations with distinct functions. We hypothesized the existence of an ASC subpopulation with enhanced angiogenic potential. Human ASCs that were CD34+CD146+, CD34+CD146−, or CD34+ unfractionated (UF) were isolated by flow cytometry for comparison of expression of proangiogenic factors and endothelial tube‐forming potential. Next, lipoaspirate was enriched with either CD34+CD146+, CD34+CD146−, CD34+ UF ASCs, or was not enriched, and grafted beneath the scalp skin of immunodeficient CD‐1 Nude mice (10 000 cells/200 μL/graft). Fat retention was monitored radiographically more than 8 weeks and fat grafts were harvested for histological assessment of quality and vascularization. The CD34+CD146+ subpopulation comprised ~30% of ASCs, and exhibited increased expression of vascular endothelial growth factor and angiopoietin‐1 compared to CD34+CD146− and CD34+ UF ASCs, and increased expression of fibroblast growth factor‐2 compared to CD34+CD146− ASCs. The CD34+CD146+ subpopulation exhibited enhanced induction of tube‐formation compared to CD34+CD146− ASCs. Upon transplantation, fat enriched CD34+CD146+ ASCs underwent less resorption and had improved histologic quality and vascularization. We have identified a subpopulation of CD34+ ASCs with enhanced angiogenic effects in vitro and in vivo, likely mediated by increased expression of potent proangiogenic factors. These findings suggest that enriching lipoaspirate with CD34+CD146+ ASCs may enhance fat graft vascularization and retention in the clinical setting.
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Affiliation(s)
- Mimi R Borrelli
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ronak A Patel
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Charles Blackshear
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Stephanie Vistnes
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nestor M Diaz Deleon
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sandeep Adem
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Abra H Shen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jan Sokol
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Dung Nguyen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA.,Stanford Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California, USA
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Dolan RT, Moosa A, Giele HP. The Adipofascial Deltopectoral Flap to Cover the Brachial Plexus in Thoracic Outlet Syndrome and Radiation Plexitis. J Plast Reconstr Aesthet Surg 2020; 73:1465-1472. [PMID: 32467081 DOI: 10.1016/j.bjps.2020.02.039] [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: 07/25/2019] [Revised: 11/28/2019] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
Revascularisation of the brachial plexus is controversial. Traditional techniques use free tissue transfer of omentum, groin fat or muscle, on the principle of supplying rich quantities of vascularised tissue to wrap around the nerves permitting neural gliding and revascularising the scarred nerves. However, the complexity of an additional microsurgical procedure coupled with uncertainty of their effectiveness have curtailed their clinical application. We describe a local pedicled transposition flap that is a novel modification of the deltopectoral (DP) flap using only the subcutaneous adipofascial tissue vascularised by the medial pectoral perforators. This flap is harvested through the supraclavicular brachial plexus access incision. This avoids free tissue transfer and additional donor scarring, yet provides adequate volumes of well-vascularised tissue for mechanical protection and revascularisation of the plexus. We reviewed sixteen consecutive patients who underwent a pedicled adipofascial DP flap to protect the brachial plexus over the 20-year study period. Inclusion criteria were patients with recurrent thoracic outlet compression and patients with radiation plexitis. At latest follow-up (average 3.6 years), 75% of patients reported the improvement or resolution of symptoms. The majority of patients reported improved pain scores (82%) with an average pain visual analogue scale (VAS) score of 5.1. Patients were very satisfied with scar outcomes, reporting low Vancouver Scar Scale Scores and low scar VAS scores. Post-operative MR imaging, available in 31% of the cohort, demonstrates the maintenance of flap position and vascularity at an average of 2.1 years. This novel and simple technique is recommended in aiding revascularisation and cover of the brachial plexus in recurrent and recalcitrant plexopathy.
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Affiliation(s)
- Roisin T Dolan
- Oxford Reconstructive Plastic Hand surgery Innovation Collaboration (ORPHIC), Department of Plastic, Reconstructive and Hand Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
| | - Aliabbas Moosa
- Oxford Reconstructive Plastic Hand surgery Innovation Collaboration (ORPHIC), Department of Plastic, Reconstructive and Hand Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Henk P Giele
- Oxford Reconstructive Plastic Hand surgery Innovation Collaboration (ORPHIC), Department of Plastic, Reconstructive and Hand Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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Pietruski P, Paskal W, Paluch Ł, Paskal AM, Nitek Ż, Włodarski P, Walecki J, Noszczyk B. The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study. Aesthetic Plast Surg 2020:10.1007/s00266-020-01730-1. [PMID: 32424535 DOI: 10.1007/s00266-020-01730-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/25/2020] [Indexed: 09/29/2022]
Abstract
BACKGROUND Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. TRIAL REGISTRY NAME The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6 LEVEL OF EVIDENCE IV: 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.
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Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Wiktor Paskal
- Laboratory of Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, Stefana Banacha 1B, 02-097, Warsaw, Mazowieckie, Poland
| | - Łukasz Paluch
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Adriana M Paskal
- Laboratory of Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, Stefana Banacha 1B, 02-097, Warsaw, Mazowieckie, Poland
| | - Żaneta Nitek
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Paweł Włodarski
- Laboratory of Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, Stefana Banacha 1B, 02-097, Warsaw, Mazowieckie, Poland.
| | - Jerzy Walecki
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Bartłomiej Noszczyk
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
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Klietz ML, Kückelhaus M, Kaiser HW, Raschke MJ, Hirsch T, Aitzetmüller M. Stammzellen in der Regenerativen Medizin – Translationale Hürden und Möglichkeiten zur Überwindung. HANDCHIR MIKROCHIR P 2020; 52:338-349. [DOI: 10.1055/a-1122-8916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ZusammenfassungDer Einsatz von mesenchymalen Stammzellen in der regenerativen Medizin wird immer populärer. Nichtsdestotrotz ist ihre Anwendung im klinischen Alltag noch immer limitiert. Zahlreiche ethische, rechtliche und translationale Probleme sowie Ungewissheit bzgl. der Sicherheit hemmen noch immer die Entstehung von entsprechenden Therapien aus vielversprechenden wissenschaftlichen Ansätzen.Diese Arbeit soll die Hauptprobleme bei der Translation von stammzellbasierten Therapien aus der Grundlagenforschung und Präklinik in den klinischen Alltag darstellen, sowie Ansätze aufzeigen, diese zu überwinden.
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Affiliation(s)
- Marie-Luise Klietz
- Abteilung für Plastische-, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster
| | - Maximilian Kückelhaus
- Abteilung für Plastische-, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster
| | | | - Michael J. Raschke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
| | - Tobias Hirsch
- Abteilung für Plastische-, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide, Münster
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster
| | - Matthias Aitzetmüller
- Sektion Plastische Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster
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Säljö K, Orrhult LS, Apelgren P, Markstedt K, Kölby L, Gatenholm P. Successful engraftment, vascularization, and In vivo survival of 3D-bioprinted human lipoaspirate-derived adipose tissue. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.bprint.2019.e00065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
BACKGROUND Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue-derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this "skin rejuvenation" effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality. METHODS The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications. RESULTS Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue-derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported. CONCLUSION Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue-derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.
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Shih L, Abu-Ghname A, Davis MJ, Xue AS, Dempsey RF, Buchanan EP. Applications of Fat Grafting in Pediatric Patients. Semin Plast Surg 2020; 34:53-58. [PMID: 32071580 DOI: 10.1055/s-0039-3402517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autologous fat grafting has become a widely utilized technique for a variety of cosmetic and reconstructive procedures. Its potential for volume restoration and tissue regeneration has made it a popular method for treating soft tissue defects in both adult and pediatric populations. While autologous fat grafting in the pediatric setting is not as well characterized as it is in the adult setting, various reports have demonstrated the safety and utility of its applications in nonadult patient populations. In this article, we present the first comprehensive review of the current applications of autologous fat grafting in pediatric patients. Specific challenges to fat grafting in the pediatric setting and future applications will also be discussed.
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Affiliation(s)
- Linden Shih
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amy S Xue
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F Dempsey
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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Gu Z, Li Y, Li H. Use of Condensed Nanofat Combined With Fat Grafts to Treat Atrophic Scars. JAMA FACIAL PLAST SU 2019; 20:128-135. [PMID: 28975248 DOI: 10.1001/jamafacial.2017.1329] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance In addition to the physical deformity, there is often great psychological burden of facial scars for patients. In this study, we use condensed nanofat combined with fat grafts in a novel technique to improve atrophic facial scars by raising both the surface and the bottom of the affected area. Objective To assess whether the use of condensed nanofat combined with fat grafting can be effective in treating atrophic facial scars from both an aesthetic and a functional perspective. Design, Setting, and Participants In this prospective case series of 20 patients with 25 atrophic facial scars, each scar was treated with condensed nanofat combined with fat grafts at the Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China. Postoperative results were evaluated by the patients themselves and by 3 senior plastic surgeon observers. Main Outcomes and Measures Multiple preoperative and postoperative examinations included the use of the Patient and Observer Scar Assessment Scale (POSAS) to evaluate both the functional and aesthetic aspects of the atrophic facial scars. Punch biopsy specimens were stained for the presence of melanin, elastic fibers, and cytokeratin (CK) 14 and CK19. Images were analyzed using ImageJ software, and the data were analyzed by paired sample t test. Results Twenty patients (6 men and 14 women; mean age, 38.25 years; age range, 21-62 years) with a total of 25 atrophic facial scars were treated between March 2014 and December 2016. The patients' mean (SD) scar assessment scores were significantly decreased postoperatively in the final examination for color, 6.40 (0.51) vs 2.40 (0.24) (P < .001); stiffness, 7.20 (0.37) vs 3.20 (0.20) (P < .001); thickness, 5.80 (0.73) vs 1.80 (0.37) (P = .001); and irregularity, 5.20 (0.49) vs 2.20 (0.37) (P = .003); and the observers' scores were also significantly decreased for pigmentation, 4.40 (0.51) vs 2.00 (0.32) (P = .004); thickness, 3.00 (0.32) vs 1.80 (0.20) (P = .03); relief, 4.40 (0.51) vs 2.40 (0.24) (P = .003); and pliability, 4.20 (0.37) vs 1.40 (0.24) (P < .001). In the final follow-up examinations, a significantly improved overall POSAS score was found among both patients, 28.80 (1.02) vs 12.20 (0.80) (P < .001), and observers, 18.00 (0.71) vs 9.20 (0.37) (P = .001). Enhancement of Fontana-Masson staining of melanin in the basal cell layer was observed postoperatively, and a significant postoperative change was detected for the mean (SD) values of average optical density from the preoperative measurement, 0.671 (0.083) vs 0.844 (0.110) (P = .01). The sebaceous glands and sweat glands that were not found in the preoperative images were seen postoperatively by immunohistochemical staining with CK14 and CK19. Conclusions and Relevance Our preliminary clinical and pathological results indicate that the use of condensed nanofat combined with fat grafts may be an effective approach to treating atrophic facial scars from both an aesthetic and a functional perspective. Level of Evidence 4.
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Affiliation(s)
- Zichun Gu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yirun Li
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Li
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence. Plast Reconstr Surg 2019; 143:1099-1107. [PMID: 30921129 DOI: 10.1097/prs.0000000000005403] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several methods to prepare the recipient site in fat grafting have been proposed in recent decades. However, to date, these procedures have never been reviewed exhaustively. The purpose of the present study is to provide a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in preclinical studies, with resulting outcomes and underlying mechanisms of action. METHODS The PubMed/MEDLINE database was queried to search for preclinical investigations on the preparation of the recipient site in fat grafting using the following algorithm: ((recipient site) AND (fat grafting) OR (lipofilling) OR (lipograft)). A priori criteria were applied to review the resulting articles. RESULTS Thirteen animal studies met inclusion criteria. Overall, five techniques were identified: external volume expansion, implantation of alloplastic material (silicone sheets), administration of cell-proliferation factors (i.e., vascular endothelial growth factor, adipose tissue-derived stromal vascular fraction, and interleukin-8), ischemia, and microneedling. A positive effect on cellular activity (cell proliferation and angiogenesis) was demonstrated by all studies and achieved with all techniques. Seven of the eight authors who examined this aspect reported enhancement of fat graft survival. CONCLUSIONS Improvement of fat grafting surgical outcomes is documented preclinically using different recipient-site preparation techniques, particularly through enhancement of vascularization and soft-tissue expansion. This understanding will lead to further clinical research, especially for those cases where improvement of the recipient site is recommended, such as contracted scars or preirradiated tissues.
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van Dongen JA, Getova V, Brouwer LA, Liguori GR, Sharma PK, Stevens HP, van der Lei B, Harmsen MC. Adipose tissue-derived extracellular matrix hydrogels as a release platform for secreted paracrine factors. J Tissue Eng Regen Med 2019; 13:973-985. [PMID: 30808068 PMCID: PMC6593768 DOI: 10.1002/term.2843] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/28/2019] [Accepted: 02/21/2019] [Indexed: 12/21/2022]
Abstract
Fat grafting is an established clinical intervention to promote tissue repair. The role of the fat's extracellular matrix (ECM) in regeneration is largely neglected. We investigated in vitro the use of human adipose tissue‐derived ECM hydrogels as release platform for factors secreted by adipose‐derived stromal cells (ASCs). Lipoaspirates from nondiabetic and diabetic donors were decellularized. Finely powdered acellular ECM was evaluated for cell remainders and DNA content. Acellular ECM was digested, and hydrogels were formed at 37°C and their viscoelastic relaxation properties investigated. Release of ASC‐released factors from hydrogels was immune assessed, and bio‐activity was determined by fibroblast proliferation and migration and endothelial angiogenesis. Acellular ECM contained no detectable cell remainders and negligible DNA contents. Viscoelastic relaxation measurements yielded no data for diabetic‐derived hydrogels due to gel instability. Hydrogels released several ASC‐released factors concurrently in a sustained fashion. Functionally, released factors stimulated fibroblast proliferation and migration as well as angiogenesis. No difference between nondiabetic and diabetic hydrogels in release of factors was measured. Adipose ECM hydrogels incubated with released factors by ASC are a promising new therapeutic modality to promote several important wound healing‐related processes by releasing factors in a controlled way.
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Affiliation(s)
- Joris A van Dongen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vasilena Getova
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Linda A Brouwer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gabriel R Liguori
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM-11), Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Prashant K Sharma
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Bergman Clinics, Heerenveen, Zwolle, and Groningen, The Netherlands
| | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Maruccia M, Elia R, Ciudad P, Nacchiero E, Nicoli F, Vestita M, Chen HC, Giudice G. Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study. J Plast Reconstr Aesthet Surg 2019; 72:892-901. [PMID: 30819649 DOI: 10.1016/j.bjps.2019.01.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/15/2018] [Accepted: 01/18/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Lymphedema resulting from breast cancer treatment is a chronic condition that can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced-stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, the authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in the reduction of limb circumference and health-related quality of life between a combined strategy, namely, VLN transfer (VLNT) and axillary scar release with fat grafting, and only VLNT for patients affected by postmastectomy upper limb lymphedema. The idea. MATERIALS AND METHODS All patients with stage II and III breast cancer-related lymphedema operated between January 2012 and January 2016 were retrospectively identified, and only those treated by combined VLNT and scar release (Group A) or only VLNT (Group B) were included. The outcomes were assessed clinically by limb circumference measurement and radiologically by lymphoscintigraphy. Lymphedema-related quality of life was evaluated preoperatively and at 1 year follow-up through the LYMQOL questionnaire. RESULTS Thirty-nine patients met inclusion criteria (Group A = 18; Group B = 21). Mean follow-up was 29 months for Group A and 32 months for Group B. Flap survival rate was 100%, with no donor site morbidity in all patients. A statistically significant difference between the circumference reduction rates (RR) at above elbow level was observed at 3 and 6 months of follow-up comparing the two groups (p<0.00001), with higher values in Group A than in Group B. No significant difference was detected comparing RR values at above and below elbow at 12 and 24 months postoperatively. LYMQOL metrics showed significantly better scores (p<0.0001) in all domains at all follow-up appointments in Group A. CONCLUSIONS Patients with postmastectomy upper limb lymphedema can benefit from combined lymph node transfer and axillary scar release with fat graft, as this approach seems to fasten the onset of improvement and to have a positive impact on patients' quality of life.
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Affiliation(s)
- M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - R Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy.
| | - P Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - E Nacchiero
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - F Nicoli
- Department of Plastic and Reconstructive Surgery, University of Rome ``Tor Vergata'', Rome, Italy
| | - M Vestita
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - H C Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - G Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
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Reconstruction of Wegener Granulomatosis Nose Deformity Using Fascia Lata Graft. J Craniofac Surg 2019; 29:2179-2181. [PMID: 30277948 DOI: 10.1097/scs.0000000000004807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose.The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment.Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse.The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result.Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.
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45
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Walocko FM, Eber AE, Kirsner RS, Badiavas E, Nouri K. Systematic review of the therapeutic roles of adipose tissue in dermatology. J Am Acad Dermatol 2018; 79:935-944. [DOI: 10.1016/j.jaad.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 05/13/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
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46
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Lee HJ, Jang YJ. Recent Understandings of Biology, Prophylaxis and Treatment Strategies for Hypertrophic Scars and Keloids. Int J Mol Sci 2018; 19:ijms19030711. [PMID: 29498630 PMCID: PMC5877572 DOI: 10.3390/ijms19030711] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars and keloids are cosmetically problematic, and in combination with functional problems such as contractures and subjective symptoms including pruritus, these significantly affect patients’ quality of life. There have been many studies on hypertrophic scars and keloids; but the mechanisms underlying scar formation have not yet been well established, and prophylactic and treatment strategies remain unsatisfactory. In this review, the authors introduce and summarize classical concepts surrounding wound healing and review recent understandings of the biology, prevention and treatment strategies for hypertrophic scars and keloids.
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Affiliation(s)
- Ho Jun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea.
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
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47
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Predictors of Autologous Free Fat Graft Retention in the Management of Craniofacial Contour Deformities. Plast Reconstr Surg 2018; 141:457e-458e. [PMID: 29485596 DOI: 10.1097/prs.0000000000004151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1649. [PMID: 29616164 PMCID: PMC5865941 DOI: 10.1097/gox.0000000000001649] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 01/29/2023]
Abstract
Background: The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes. Methods: PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion. Results: Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon. Conclusions: External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.
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Tang S, Wu X, Shen H, Wang Y, Li J, Zhang J. Use of small needle knife in autologous fat grafting for the treatment of depressed scar: A case report. Medicine (Baltimore) 2017; 96:e9266. [PMID: 29390374 PMCID: PMC5815786 DOI: 10.1097/md.0000000000009266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Scars always related to functional limitations, cosmetic impairment, and social and emotional problems. Clinical improvements in scar characteristics after autologous fat grafting are well described. In this paper, we present an innovative approach to treat depressed scars. PATIENT CONCERNS We presented a 29-year-old woman with multiple depressed scars in the left upper arm and near the elbow joint after trauma in childhood. DIAGNOSES The patient was diagnosed as having multiple depressed scars accompanied with retraction and pain. INTERVENTIONS We used small needle knife during fat grafting to treat the depressed scar. Vancouver Scar Scale was used to assess the effect. OUTCOMES Aesthetic and functional improvements were observed. Resolution of pain and improvement in scar elasticity were objectively assessable. Improvement of both clinical evaluation and patient perception was obtained. LESSONS Use of small needle knife during fat grafting is a good alternative for the treatment of depressed scars.
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Affiliation(s)
- Songjia Tang
- Plastic and Aesthetic Surgery Department of Hangzhou First People's Hospital
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Haiyan Shen
- Plastic and Aesthetic Surgery Department of Hangzhou First People's Hospital
| | - Yuyan Wang
- Plastic and Aesthetic Surgery Department of Hangzhou First People's Hospital
| | - Jinsheng Li
- Plastic and Aesthetic Surgery Department of Hangzhou First People's Hospital
| | - Jufang Zhang
- Plastic and Aesthetic Surgery Department of Hangzhou First People's Hospital
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50
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Autologous Tissue Graft in Revision Medial Epicanthoplasty Using Subciliary Fat and Orbicularis Oculi Muscle. J Craniofac Surg 2017; 28:1972-1975. [PMID: 28953160 DOI: 10.1097/scs.0000000000004031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The medial epicanthal fold is one of the racial anatomic characteristics of Asians. As medial epicanthoplasty has become one of the most common cosmetic surgeries among Asians, the need for revision of overcorrected medial epicanthus also increased. In revision medial epicanthoplasty, an autologous tissue graft to the subcutaneous plane is used to reduce postoperative scar. Medial epicanthoplasty, using V-Y advancement and rotation flap, was performed in 93 patients (revision medial epicanthoplasty with autologous tissue graft, 60 patients; revision medial epicanthoplasty only, 33 patients). A V-Y and rotation flap was designed to cover the overexposed lacrimal lake. A small amount of fat tissue and orbicularis oculi muscle were harvested from the upper eyelid through the double-fold line and grafted to the subcutaneous space of the medial epicanthal area. We evaluated the patients' satisfaction with the overall outcome and scar. The mean intercanthal distance increased from 32.3 mm before surgery to 34.6 mm after surgery. Satisfaction with the scar and overall outcome was higher in the patient group who underwent medial epicanthoplasty with autologous tissue graft. No complication was observed in the autologous tissue graft group, whereas 1 patient who underwent medial epicanthoplasty without autologous tissue graft showed recurrence of the medial epicanthal fold, 5 months after surgery. Medial epicanthoplasty with autologous tissue graft is a simple and reliable method to repair the overcorrected medial epicanthus that can efficiently increase the intercanthal distance and prevent scar contracture.
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