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Li C, Ma LK, Zhang ZY, Tang XJ, Liu W, Xu X, Feng S, Zhao SB, Zhang ZY. Using Auricular Cartilage-fascia Composite Tissue Free Grafting Technique to Improve Cartilage Survival Outcomes. J Craniofac Surg 2024:00001665-990000000-01382. [PMID: 38408322 DOI: 10.1097/scs.0000000000010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES Auricular cartilage graft has a wide range of applications in plastic and reconstructive surgery. However, there is still a risk of absorption of the grafts over time. Intrinsic postauricular fascia (IPF) with a rich vascular network may play an important role in the nutrition and repair of auricular cartilage. This study aimed to investigate the effect of IPF on the survival viability of free auricular cartilage grafts. METHODS 24 auricular cartilages were obtained from 6 New Zealand white rabbits which were divided into the cartilage-fascia composite graft group (FC group, n=12) and the cartilage without fascia group (C group, n=12). Two groups of cartilage were implanted into each side of the subcutaneous pocket of the rabbit's dorsum. The rabbits were sacrificed after 3 months and all cartilage grafts were obtained. Macroscopic observation, histopathological staining, and biomechanical testing were performed on all specimens. RESULTS There were significant differences between the 2 groups regarding proliferating chondrocytes, apoptotic chondrocytes, vascularization, and matrix collagen. Compared to the auricular cartilage grafts without fascia, the auricular cartilage-fascia composite grafts had more neovascularization, proliferative chondrocytes, and type II collagen, with a homogeneous cartilage matrix and no obvious areas of heterogeneous staining. Young's modulus and ultimate tensile strength of cartilage were reduced in both groups compared to pretransplantation, but the composite graft group was superior to the fascia-free group. CONCLUSIONS Auricular cartilage-fascial composite tissue free graft could improve cartilage survival outcomes with higher viability and mechanical properties.
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Affiliation(s)
- Chuan Li
- Departments of Cranio-Maxillofacial Surgery
| | - Lun-Kun Ma
- Departments of Cranio-Maxillofacial Surgery
| | - Ze-Ya Zhang
- Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | | | - Wei Liu
- Departments of Cranio-Maxillofacial Surgery
| | - Xi Xu
- Departments of Cranio-Maxillofacial Surgery
| | - Shi Feng
- Departments of Cranio-Maxillofacial Surgery
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Dong W, Han R, Fan F. Diced Cartilage Techniques in Rhinoplasty. Aesthetic Plast Surg 2021; 46:1369-1377. [PMID: 34731262 DOI: 10.1007/s00266-021-02628-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/10/2021] [Indexed: 11/24/2022]
Abstract
Diced cartilage has been widely applied in rhinoplasty, especially for segmental dorsal augmentation, with favorable outcomes over time. Various techniques were developed to increase both stability and viability of diced cartilage, including wrappings with non-blood material/blood products and changing the shapes of the diced cartilage, while the optimal technique is inconclusive. This article systematically reviews the current strategies of diced cartilage technique for rhinoplasty in the databases and emphasizes different wrapping materials. Free diced cartilage has a potential risk of gathering in certain regions and causing postoperative irregularities. Among non-blood wrapping materials, Surgicel is now rarely used due to severe foreign body reactions. The obvious drawbacks of fascia are donor site morbidity, inadequate quantity, and time-consuming. Although diced cartilage wrapped in tutoplast-processed fascia lata, AlloDerm, or esterified hyaluronic acid has achieved primary encouraging results, the increased inflammation raised controversies regarding their clinical use. Diced cartilage wrapped with blood products, such as platelet-rich fibrin or concentrated growth factor, achieved long-term reliable aesthetic results, and shaved cartilage and ultra-diced cartilage have recently shown satisfactory clinical outcomes, while further study is still needed. 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)
- Wenfang Dong
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Ri Han
- Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Baiyun District, Guangzhou, 510515, China
| | - Fei Fan
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Lo WC, Chang CC, Chan CH, Singh AK, Deng YH, Lin CY, Tsao W, Chien ST, Lin CH, Deng WP. Platelet-Derived Biomaterials Exert Chondroprotective and Chondroregenerative Effects on Diabetes Mellitus-Induced Intervertebral Disc Degeneration. Life (Basel) 2021; 11:1054. [PMID: 34685425 PMCID: PMC8540580 DOI: 10.3390/life11101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
Complications of diabetes mellitus (DM) range from acute to chronic conditions, leading to multiorgan disorders such as nephropathy, retinopathy, and neuropathy. However, little is known about the influence of DM on intervertebral disc degeneration (IVDD). Moreover, traditional surgical outcomes in DM patients have been found poor, and to date, no definitive alternative treatment exists for DM-induced IVDD. Recently, among various novel approaches in regenerative medicine, the concentrated platelet-derived biomaterials (PDB), which is comprised of transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), etc., have been reported as safe, biocompatible, and efficacious alternatives for various disorders. Therefore, we initially investigated the correlations between DM and IVDD, through establishing in vitro and in vivo DM models, and further evaluated the therapeutic effects of PDB in this comorbid pathology. In vitro model was established by culturing immortalized human nucleus pulposus cells (ihNPs) in high-glucose medium, whereas in vivo DM model was developed by administering streptozotocin, nicotinamide and high-fat diet to the mice. Our results revealed that DM deteriorates both ihNPs and IVD tissues, by elevating reactive oxygen species (ROS)-induced oxidative stress, inhibiting chondrogenic markers and disc height. Contrarily, PDB ameliorated IVDD by restoring cellular growth, chondrogenic markers and disc height, possibly through suppressing ROS levels. These data imply that PDB may serve as a potential chondroprotective and chondroregenerative candidate for DM-induced IVDD.
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Affiliation(s)
- Wen-Cheng Lo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Chun-Hao Chan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-H.C.); (A.K.S.); (Y.-H.D.)
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
| | - Abhinay Kumar Singh
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-H.C.); (A.K.S.); (Y.-H.D.)
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
| | - Yue-Hua Deng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-H.C.); (A.K.S.); (Y.-H.D.)
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
| | - Chia-Ying Lin
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Wen Tsao
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Shaw-Ting Chien
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
| | - Chang-Hsien Lin
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Win-Ping Deng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-H.C.); (A.K.S.); (Y.-H.D.)
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan; (C.-Y.L.); (W.T.); (S.-T.C.)
- Graduate Institute of Basic Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
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Lo WC, Chiou CS, Tsai FC, Chan CH, Mao S, Deng YH, Wu CY, Peng BY, Deng WP. Platelet-Derived Biomaterials Inhibit Nicotine-Induced Intervertebral Disc Degeneration Through Regulating IGF-1/AKT/IRS-1 Signaling Axis. Cell Transplant 2021; 30:9636897211045319. [PMID: 34586895 PMCID: PMC8485278 DOI: 10.1177/09636897211045319] [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] [Indexed: 12/13/2022] Open
Abstract
Apart from aging process, adult intervertebral disc (IVD) undergoes various degenerative processes. However, the nicotine has not been well identified as a contributing etiology. According to a few studies, nicotine ingestion through smoking, air or clothing may significantly accumulate in active as well as passive smokers. Since nicotine has been demonstrated to adversely impact various physiological processes, such as sympathetic nervous system, leading to impaired vasculature and cellular apoptosis, we aimed to investigate whether nicotine could induce IVD degeneration. In particular, we evaluated dose-dependent impact of nicotine in vitro to simulate its chronic accumulation, which was later treated by platelet-derived biomaterials (PDB). Further, during in vivo studies, mice were subcutaneously administered with nicotine to examine IVD-associated pathologic changes. The results revealed that nicotine could significantly reduce chondrocytes and chondrogenic indicators (Sox, Col II and aggrecan). Mice with nicotine treatment also exhibited malformed IVD structure with decreased Col II as well as proteoglycans, which was significantly increased after PDB administration for 4 weeks. Mechanistically, PDB significantly restored the levels of IGF-1 signaling proteins, particularly pIGF-1 R, pAKT, and IRS-1, modulating ECM synthesis by chondrocytes. Conclusively, the PDB impart reparative and tissue regenerative processes by inhibiting nicotine-initiated IVD degeneration, through regulating IGF-1/AKT/IRS-1 signaling axis.
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Affiliation(s)
- Wen-Cheng Lo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Neurosurgery, Taipei Medical University Hospital, Taipei
| | - Chi-Sheng Chiou
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei
| | - Feng-Chou Tsai
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301.,Division of Plastic Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City
| | - Chun-Hao Chan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei
| | - Samantha Mao
- Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei
| | - Yue-Hua Deng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei
| | - Chia-Yu Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Division of Oral and Maxillofacial Surgery, Department of Dentistry, Taipei Medical University Hospital, Taipei
| | - Bou-Yue Peng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Division of Oral and Maxillofacial Surgery, Department of Dentistry, Taipei Medical University Hospital, Taipei
| | - Win-Ping Deng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,Stem Cell Research Center, College of Oral Medicine, Taipei Medical University, Taipei.,Graduate Institute of Basic Medicine, Fu Jen Catholic University, New Taipei City.,Department of Life Science, Tunghai University, Taichung
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Gürsoy K, Teymur H, Göktaş Demircan FB, Tanas Işikçi Ö, Gümüş M, Koçer U. Effect of Platelet-Derived Concentrated Growth Factor on Single-Layer, Multi-Layer, and Crushed Onlay Cartilage Grafts. Aesthet Surg J 2021; 41:537-547. [PMID: 33186439 DOI: 10.1093/asj/sjaa306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The main concern with utilizing cartilage grafts to achieve structural integrity and volume restoration is the loss of volume over time and their unpredictable viability. Preservation of the volume of cartilage grafts is necessary to ensure their long-term success. OBJECTIVES The main aim of this study was to investigate the effect of concentrated growth factor (CGF) sheet on single-layer, multi-layer, and crushed block cartilage grafts. METHODS Cartilage grafts obtained from the ears of rabbits were prepared in 3 different forms: single-layer, triple-layer, and crushed. After measuring the weight and thickness of the cartilage grafts, the grafts in the experimental group were wrapped with the prepared autologous CGF. These cartilage grafts were placed in subcutaneous pouches created on the backs of the rabbits. After 4 months, the rabbits were killed. The weight and thickness of the cartilage grafts were measured and the cartilage viability and peripheral changes were examined microscopically. RESULTS The percentage changes in the weights and thicknesses of the single-layer, multi-layer, and crushed cartilage grafts wrapped with CGF were found to be statistically significantly lower than in the control group. When the cartilage viability and changes in peripheral tissue were evaluated, CGF-wrapped cartilage groups did not achieve statistically significantly better scores than the untreated control groups. CONCLUSIONS In cases planned to receive a block cartilage graft, especially if graft resorption is not desired or should be minimized, wrapping the graft with autologous CGF is a feasible option.
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Affiliation(s)
- Koray Gürsoy
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Hakan Teymur
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | | | | | - Murat Gümüş
- Samsun Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Samsun, Turkey
| | - Uğur Koçer
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
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Chai J, Ge J, Zou J. Effect of Autologous Platelet-Rich Plasma Gel on Skin Flap Survival. Med Sci Monit 2019; 25:1611-1620. [PMID: 30824681 PMCID: PMC6408867 DOI: 10.12659/msm.913115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Skin flap grafting is one of the most common tissue transplantations for wound repair and organ reconstruction. Thus, improving the survival rate of the transplanted skin flap is important. Platelet-rich plasma (PRP) is an autologous platelet concentrate obtained from whole blood. It has been widely used in repairing tissue defects. Considering that the PRP gel has similar biological characteristics, this study used PRP gel for skin flap transplantation. MATERIAL AND METHODS PRP gel from Sprague-Dawley (SD) rats was prepared and the growth factor concentration was determined. A rat skin flap model was established to evaluate the survival rate of skin flap. Morphologic evaluation was also done. RESULTS We found that the PRP gel increased the survival rate of the skin flap. In addition, it reduces the inflammation response in skin flap transplantation and has better effects in terms of generating new soft tissue. CONCLUSIONS The effectiveness PRP gel in skin flap transplantation is satisfactory. The possible mechanisms by which PRP gel promotes the survival of the skin flap includes platelets, growth factors, immune activity factor, and fibrin. PRP could be a new clinical method for promoting skin flap survival.
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Affiliation(s)
- Jun Chai
- Department of Plastic Surgery, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Jun Ge
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jun Zou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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The Role of Platelet-Rich Plasma in Cartilage Pathology: An Updated Systematic Review of the Basic Science Evidence. Arthroscopy 2019; 35:961-976.e3. [PMID: 30733026 DOI: 10.1016/j.arthro.2018.10.125] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To review the basic science studies on platelet-rich plasma (PRP) for cartilage and determine whether there has been an improvement in methodology and outcome reporting that would allow for a more meaningful analysis regarding the mechanism of action and efficacy of PRP for cartilage pathology. METHODS The PubMed/MEDLINE and EMBASE databases were screened in May 2017 with publication dates of January 2011 through May 2017 using the following key words: "platelet-rich plasma OR PRP OR autologous conditioned plasma (ACP) OR ACP AND cartilage OR chondrocytes OR chondrogenesis OR osteoarthritis OR arthritis." Two authors independently performed the search, determined study inclusion, and extracted data. Data extracted included cytology/description of PRP, study design, and results. RESULTS Twenty-seven studies (11 in vitro, 13 in vivo, 3 in vitro and in vivo) met the inclusion criteria and were included in the study. All of the studies (100%) reported the method by which PRP was prepared. Two studies reported basic cytologic analysis of PRP, including platelet, white blood cell, and red blood cell counts (6.7%). Nine studies reported both platelet count and white blood cell count (30.0%). Twelve studies reported platelet count alone (40.0%). Nine studies (30.0%) made no mention at all as to the composition of the PRP used. PRP was shown to increase cell viability, cell proliferation, cell migration, and differentiation. Several studies demonstrated increased proteoglycan and type II collagen content. PRP decreased inflammation in 75.0% of the in vitro studies reporting data and resulted in improved histologic quality of the cartilage tissue in 75.0% of the in vivo studies reporting data. CONCLUSIONS Although the number of investigations on PRP for cartilage pathology has more than doubled since 2012, the quality of the literature remains limited by poor methodology and outcome reporting. A majority of basic science studies suggest that PRP has beneficial effects on cartilage pathology; however, the inability to compare across studies owing to a lack of standardization of study methodology, including characterizing the contents of PRP, remains a significant limitation. Future basic science and clinical studies must at a minimum report the contents of PRP to better understand the clinical role of PRP for cartilage pathology. CLINICAL RELEVANCE Establishing proof of concept for PRP to treat cartilage pathology is important so that high-quality clinical studies with appropriate indications can be performed.
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Viability and Biomechanics of Diced Cartilage Blended With Platelet-Rich Plasma and Wrapped With Poly (Lactic-Co-Glycolic) Acid Membrane. J Craniofac Surg 2017; 28:1418-1424. [DOI: 10.1097/scs.0000000000003739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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