1
|
Sin-Hidge C, Bulstrode NW. Management of helical adhesion malformation. J Plast Reconstr Aesthet Surg 2023; 85:264-265. [PMID: 37536193 DOI: 10.1016/j.bjps.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
Congenital auricular anomalies are common, however very few articles in the English literature address helical adhesion malformation, whereby the helix is adhered to the scapha. We describe a surgical approach to correct helical adhesion malformation which, unlike previously described methods, is simpler and results in an inconspicuous scar on the back of the ear. We illustrate our technique with an 11-year-old girl with bilateral helical adhesion malformations. Satisfactory ear shape was achieved bilaterally without complication. Meticulous dissection over the helix and exposure beyond the adhesion is of paramount importance in successfully correcting this malformation. Through a posterior auricular incision, this wide exposure and visualisation of the helix can be attained, with the added benefit of a scar hidden on the back of the ear.
Collapse
Affiliation(s)
- Claire Sin-Hidge
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom.
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom
| |
Collapse
|
2
|
Gardner OFW, Agabalyan N, Weil B, Ali MHI, Lowdell MW, Bulstrode NW, Ferretti P. Human platelet lysate enhances proliferation but not chondrogenic differentiation of pediatric mesenchymal progenitors. Cytotherapy 2023; 25:286-297. [PMID: 36599772 DOI: 10.1016/j.jcyt.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AIMS Cell therapies have the potential to improve reconstructive procedures for congenital craniofacial cartilage anomalies such as microtia. Adipose-derived stem cells (ADSCs) and auricular cartilage stem/progenitor cells (CSPCs) are promising candidates for cartilage reconstruction, but their successful use in the clinic will require the development of xeno-free expansion and differentiation protocols that can maximize their capacity for chondrogenesis. METHODS We assessed the behavior of human ADSCs and CSPCs grown either in qualified fetal bovine serum (FBS) or human platelet lysate (hPL), a xeno-free alternative, in conventional monolayer and 3-dimensional spheroid cultures. RESULTS We show that CSPCs and ADSCs display greater proliferation rate in hPL than FBS and express typical mesenchymal stromal cell surface antigens in both media. When expanded in hPL, both cell types, particularly CSPCs, maintain a spindle-like morphology and lower surface area over more passages than in FBS. Both media supplements support chondrogenic differentiation of CSPCs and ADSCs grown either as monolayers or spheroids. However, chondrogenesis appears less ordered in hPL than FBS, with reduced co-localization of aggrecan and collagen type II in spheroids. CONCLUSIONS hPL may be beneficial for the expansion of cells with chondrogenic potential and maintaining stemness, but not for their chondrogenic differentiation for tissue engineering or disease modeling.
Collapse
Affiliation(s)
- Oliver F W Gardner
- Developmental Biology and Cancer Department, UCL GOS Institute of Child Health, London, UK
| | - Natacha Agabalyan
- Developmental Biology and Cancer Department, UCL GOS Institute of Child Health, London, UK
| | - Ben Weil
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mohammed H I Ali
- Developmental Biology and Cancer Department, UCL GOS Institute of Child Health, London, UK; Department of Zoology, Faculty of Science, South Valley University, Qena, Egypt
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free London NHS Foundation Trust, London, United Kingdom; Cancer Institute, UCL, London, United Kingdom
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Patrizia Ferretti
- Developmental Biology and Cancer Department, UCL GOS Institute of Child Health, London, UK.
| |
Collapse
|
3
|
Lese I, Aldabbas M, Mazeed AS, Bulstrode NW. Lop Ear to Conchal Microtia: An Algorithmic Surgical Approach. Ann Plast Surg 2022; 88:188-194. [PMID: 35023869 DOI: 10.1097/sap.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience. MATERIALS AND METHODS All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded. RESULTS Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears. CONCLUSION We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.
Collapse
Affiliation(s)
| | - Mohammed Aldabbas
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Ahmed S Mazeed
- Department of Plastic and Reconstructive Surgery, Sohag Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, Egypt
| | | |
Collapse
|
4
|
Klassen AF, Rae C, Bulstrode NW, Berenguer B, Cui C, Fisher DM, Kasrai L, Li Y, Lloyd M, Panchapakesan V, Pusic A, Reinsch J, Stewart K, Todd A, Frank R, Tsangaris E, Wang Y, Wong Riff KW, Zhang R, Cano S. An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions. J Plast Reconstr Aesthet Surg 2021; 74:2341-2348. [PMID: 33637465 DOI: 10.1016/j.bjps.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.
Collapse
Affiliation(s)
- Anne F Klassen
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Charlene Rae
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Neil W Bulstrode
- Dept of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Beatriz Berenguer
- Division of Pediatric Plastic Surgery, Hospital General Universitario Gregorio Maranon, Calle de O´Donnell 48, 28009, Madrid, Spain
| | - Chunxiao Cui
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - David M Fisher
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Leila Kasrai
- Department of Surgery, St Joseph's Health Centre, University of Toronto, 30 The Queensway, Toronto, ON M6R 1B5, Canada.
| | - Yiyuan Li
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China
| | - Mark Lloyd
- Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Ln, Birmingham B4 6NH, UK.
| | - Vivek Panchapakesan
- Dept of Surgery, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON M9V 1R8, Canada
| | - Andrea Pusic
- Dept of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
| | - John Reinsch
- Dept of Pediatric Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Stewart
- Dept of Plastic Surgery, Royal Hospital for Sick Children 9 Sciennes Rd, Edinburgh EH9 1LF, UK.
| | - Anna Todd
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Ryan Frank
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada.
| | - Elena Tsangaris
- Dept of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Yi Wang
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
| | - Karen Wy Wong Riff
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Ruhong Zhang
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - Stefan Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
| |
Collapse
|
5
|
Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3213-3234. [PMID: 34489212 DOI: 10.1016/j.bjps.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Auricular reconstruction for microtia is most frequently performed using autologous costal cartilage (ACC) or porous polyethylene (PPE) implants. Short-term results are generally promising, but long-term results remain unclear. Long-term outcomes were explored in this systematic review, and minimal reporting criteria were suggested for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included if postsurgical follow-up was at least 1 year. Outcome reporting was split into separate publications, and results on complications were reported previously. This publication focused on long-term aesthetic, patient-reported, and sensitivity outcomes. RESULTS Forty-one publications reported on these outcomes. Both materials led to aesthetically pleasing results and high rates of patient satisfaction. ACC frameworks grew similarly to contralateral ears, and the anterior surface of auricles regained sensitivity. Furthermore, postoperative health-related quality of life (HRQoL) outcomes were generally good. Data synthesis was limited due to considerable variability between studies and poor study quality. No conclusions could be drawn on the superiority of either method due to the lack of comparative analyses. CONCLUSION Future studies should minimally report (1) surgical efficacy measured using the tool provided in the UK Care Standards for the Management of Patients with Microtia and Atresia; (2) complications including framework extrusion or exposure, graft loss, framework resorption, wire exposure and scalp/auricular scar complications and (3) HRQoL before and after treatment using the EAR-Q patient-reported outcome measure (PROM).
Collapse
Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term complications of microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3235-3250. [PMID: 34481742 DOI: 10.1016/j.bjps.2021.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Microtia is a rare disorder characterized by malformation or even complete absence of the auricle. Reconstruction is often performed using autologous costal cartilage (ACC) or porous polyethylene implants (PPE). However, the long-term outcomes of both methods are unclear. OBJECTIVE This systematic review aimed to analyze long-term complications and suggest minimal reporting criteria for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included provided that the follow-up period was at least one year. This publication focused on long-term complications reported in patients with a postoperative follow-up period of at least one year. RESULTS Twenty-nine publications reported on complications during long-term follow-up. Overall long-term complication rates were not reported. The incidence of individual complications during long-term follow-up was less than 10% after ACC reconstruction and less than 15% in PPE reconstruction. Framework resorption and wire exposure were reported even after an extended follow-up of more than five years after ACC reconstruction, while reports on the extended long-term results of PPE reconstruction are limited. Data synthesis was limited due to heterogeneity and poor study quality. CONCLUSIONS Future studies should report on long-term complications including framework exposure or extrusion, graft loss, framework resorption, wire exposure and scalp and auricular scar complications. We recommend a surgical follow-up of at least five years.
Collapse
Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| |
Collapse
|
7
|
Mazeed AS, O'Hara J, Bulstrode NW. Modification of the cartilaginous framework for autologous ear reconstruction: Construction of a stable complete ring framework with grander highs and lows. J Plast Reconstr Aesthet Surg 2020; 74:1832-1839. [PMID: 33451946 DOI: 10.1016/j.bjps.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/08/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Successful microtia reconstruction involves fabrication of a framework with well-defined ear subunits. Tragal definition and deep conchal bowl are key elements to produce a natural well-defined and contoured ear. We describe a modification in the cartilage framework with the purpose of increasing framework stability, tragal definition and conchal bowl depth. METHODS The tragus is placed on two cartilaginous bars (L-shaped), which are fixed to the framework base block creating a complete ring. These increase tragal projection and conchal depth. The tragus is carved angled posteriorly to have a shadowing effect on the absent auditory canal. Aesthetic outcome was assessed, at least 6 months after the second stage, on a 5-point ordinal scale (1-5) using the scoring system published in the UK microtia care standards and agreed on by the International Society for Auricular Reconstruction (ISAR). RESULTS A total of 406 auricular reconstructions were performed in 363 patients (206 right, 114 left, 43 bilateral). After excluding cases who did not have second stage and those without complete photographs, 290 cases were assessed. The described modification in the framework carving was performed in 255 ears out of these 290 ears. The mean aesthetic score before and after the modification was 2.4 and 3.09 respectively for the tragus (p < 0.001), 2.2 and 2.95 for the intertragal notch (p < 0.001) and 2.77 and 3.49 for the concha (p < 0.001). CONCLUSIONS This technical refinement has resulted in increased permanence and definition of the tragus and deeper and more aesthetic concha.
Collapse
Affiliation(s)
- Ahmed S Mazeed
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom; Department of Plastic and Reconstructive Surgery, Sohag Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, Egypt.
| | - Justine O'Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Neil W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom; Institute of Child Health, University College London, United Kingdom
| |
Collapse
|
8
|
Bulstrode NW, Lese I, Aldabbas M, Glover M, Robertson F, Rennie A. Arterio-venous malformations of the ear: Description of distinct anatomical presentation and multidisciplinary management approach. J Plast Reconstr Aesthet Surg 2020; 74:1574-1581. [PMID: 33293245 DOI: 10.1016/j.bjps.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/15/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arterio-venous malformations (AVMs) of the ear are a rare entity and their management should be decided in a dedicated multidisciplinary team (MDT) setting. The aim of this study is to describe the distinct anatomical patterns of the auricular AVMs in our unit and propose a combined interventional radiological and surgical approach. MATERIALS AND METHODS All consecutive patients presenting with AVMs of the ear and reviewed by the Vascular Anomalies MDT between 2014 and 2019 were included in this study. Signs, symptoms, diagnostic investigations and operative findings were collected prospectively. RESULTS After reviewing our nine patients, we identified four anatomical patterns of auricular AVMs: I: involves just a component of the ear and should undergo embolization followed by excision and reconstruction without significant loss of form; II: affects the superior two-thirds of the ear, sparing the lobule and part of the conchal bowl; these patients should undergo embolization, excision and monitoring before formal reconstruction of the ear is offered; III: involves the entire ear and should undergo embolization and pinnectomy; if there is no recurrence, the patients can be offered either a carved-rib cartilage reconstruction or a prosthesis, depending on the quality of the surrounding soft-tissues; IV: involves the ear and surrounding tissue, making surgical management and subsequent reconstruction extensive. CONCLUSION The management of auricular AVMs is based on the extent of the ear involved. We feel that our combined interventional radiological and surgical approach will aid the management of these complex patients.
Collapse
Affiliation(s)
- Neil W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom; Institute of Child Health, University College London, London, United Kingdom
| | - Ioana Lese
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom; Department of Plastic and Hand Surgery, Inselspital, Bern, Switzerland.
| | - Mohammed Aldabbas
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Mary Glover
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Fergus Robertson
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Adam Rennie
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
9
|
Zucchelli E, Birchall M, Bulstrode NW, Ferretti P. Modeling Normal and Pathological Ear Cartilage in vitro Using Somatic Stem Cells in Three-Dimensional Culture. Front Cell Dev Biol 2020; 8:666. [PMID: 32850801 PMCID: PMC7402373 DOI: 10.3389/fcell.2020.00666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
Microtia (underdeveloped ear) is a rare congenital dysmorphology affecting the development of the outer ear. Although human microtic cartilage has not been fully characterized, chondrogenic cells derived from this tissue have been proposed as a suitable source for autologous auricular reconstruction. The aim of this study was to further characterize native microtic cartilage and investigate the properties of cartilage stem/progenitor cells (CSPCs) derived from it. Two-dimensional (2D) systems are most commonly used to assess the chondrogenic potential of somatic stem cells in vitro, but limit cell interactions and differentiation. Hence here we investigated the behavior of microtic CSPCs in three-dimensional spheroid cultures. Remarkable similarities between human microtic cartilages from five patients, as compared to normal cartilage, were observed notwithstanding possibly different etiologies of the disease. Native microtic cartilage displayed poorly defined perichondrium and hyper-cellularity, an immature phenotype that resembled that of the normal developing human auricular cartilage we studied in parallel. Crucially, our analysis of microtic ears revealed for the first time that, unlike normal cartilage, microtic cartilages are vascularized. Importantly, CSPCs isolated from human microtic and normal ear cartilages were found to recapitulate many characteristics of pathological and healthy tissues, respectively, when allowed to differentiate as spheroids, but not in monolayer cultures. Noteworthily, starting from initially homogeneous cell pellets, CSPC spheroids spontaneously underwent a maturation process in culture, and formed two regions (inner and outer region) separated by a boundary, with distinct cell types that differed in chondrogenic commitment as indicated by expression of chondrogenic markers. Compared to normal ear-derived spheroids, microtic spheroids were asymmetric, hyper-cellularized and the inner and outer regions did not develop properly. Hence, their organization resembled that of native microtic cartilage. Together, our results identify novel features of microtic ears and highlight the importance of 3D self-organizing in vitro systems for better understanding somatic stem cell behavior and disease modeling. Our observations of ear-derived chondrogenic stem cell behavior have implications for choice of cells for tissue engineered reconstructive purposes and for modeling the etiopathogenesis of microtia.
Collapse
Affiliation(s)
- Eleonora Zucchelli
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin Birchall
- UCL Ear Institute, University College London, London, United Kingdom
| | - Neil W. Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Patrizia Ferretti
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| |
Collapse
|
10
|
Ibrahim A, Rodriguez-Florez N, Gardner OFW, Zucchelli E, New SEP, Borghi A, Dunaway D, Bulstrode NW, Ferretti P. Three-dimensional environment and vascularization induce osteogenic maturation of human adipose-derived stem cells comparable to that of bone-derived progenitors. Stem Cells Transl Med 2020; 9:1651-1666. [PMID: 32639692 PMCID: PMC7695642 DOI: 10.1002/sctm.19-0207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/26/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022] Open
Abstract
While human adipose‐derived stem cells (hADSCs) are known to possess osteogenic differentiation potential, the bone tissues formed are generally considered rudimentary and immature compared with those made by bone‐derived precursor cells such as human bone marrow‐derived mesenchymal stem cells (hBMSCs) and less commonly studied human calvarium osteoprogenitor cells (hOPs). Traditional differentiation protocols have tended to focus on osteoinduction of hADSCs through the addition of osteogenic differentiation media or use of stimulatory bioactive scaffolds which have not resulted in mature bone formation. Here, we tested the hypothesis that by reproducing the physical as well as biochemical bone microenvironment through the use of three‐dimensional (3D) culture and vascularization we could enhance osteogenic maturation in hADSCs. In addition to biomolecular characterization, we performed structural analysis through extracellular collagen alignment and mineral density in our bone tissue engineered samples to evaluate osteogenic maturation. We further compared bone formed by hADSCs, hBMSCs, and hOPs against mature human pediatric calvarial bone, yet not extensively investigated. Although bone generated by all three cell types was still less mature than native pediatric bone, a fibrin‐based 3D microenvironment together with vascularization boosted osteogenic maturation of hADSC making it similar to that of bone‐derived osteoprogenitors. This demonstrates the important role of vascularization and 3D culture in driving osteogenic maturation of cells easily available but constitutively less committed to this lineage and suggests a crucial avenue for recreating the bone microenvironment for tissue engineering of mature craniofacial bone tissues from pediatric hADSCs, as well as hBMSCs and hOPs.
Collapse
Affiliation(s)
- Amel Ibrahim
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Naiara Rodriguez-Florez
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,TECNUN Escuela de Ingenieros, Universidad de Navarra, San Sebastian, Spain
| | - Oliver F W Gardner
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eleonora Zucchelli
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sophie E P New
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alessandro Borghi
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Dunaway
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Patrizia Ferretti
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
11
|
Mazeed AS, Bulstrode NW. Refinements in autologous ear reconstruction: descriptive surgical technique and experience of 400 consecutive cases at a tertiary referral center in the UK. Eur J Plast Surg 2020. [DOI: 10.1007/s00238-019-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Tsangaris E, Riff KWYW, Berenguer B, Bulstrode NW, Celerier C, Cugno S, Fanous A, Mazeed AS, Marchac A, Stotland MA, Klassen AF. Translation and cultural adaptation of the EAR-Q into Arabic, Chinese, French and Spanish for use in an international field-test study. Eur J Plast Surg 2019. [DOI: 10.1007/s00238-019-01585-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
13
|
Cugno S, Bulstrode NW. Cartilage exposure following autologous microtia reconstruction: An algorithmic treatment approach ✰. J Plast Reconstr Aesthet Surg 2018; 72:498-504. [PMID: 30528282 DOI: 10.1016/j.bjps.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication. METHODS All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to September 2012 were retrospectively reviewed to identify any that developed exposure of the underlying cartilage framework. Details related to timing, location, size and management of the cartilage exposure were collected. RESULTS From a total of 230 autologous auricular reconstructions (median age at first stage, 11.4 years), 15 exposures of the cartilage framework were identified. All exposures occurred following the first stage of reconstruction (mean of post-operative day 29, range, 7-86 days). Large areas of exposure (> 10 mm2) required surgical management, with debridement and coverage with either a cutaneous or fascial flap, depending on the location. Areas < 10 mm2 were managed conservatively. All exposures were successfully treated with no adverse effects on the final aesthetic outcome. CONCLUSION Cartilage exposure following autologous microtia reconstruction can be a devastating complication if not addressed in a prompt and effective manner. The management strategy we propose provides a concise algorithm to guide the treatment of cartilage exposure. LEVEL OF EVIDENCE Therapeutic, grade III.
Collapse
Affiliation(s)
- Sabrina Cugno
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Plastic and Reconstructive Surgery, Montreal Children's Hospital, 1001 boul. Décarie, Montreal, QC H4A 3J1, Canada; Department of Plastic and Reconstructive Surgery, CHU Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada.
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom
| |
Collapse
|
14
|
Longmire NM, Wong Riff KWY, O'Hara JL, Aggarwala S, Allen GC, Bulstrode NW, Forrest CR, French BM, Goodacre TEE, Marucci D, Norris JH, Panchapakesan V, Piplani B, Pusic AL, Vercruysse HJ, Klassen AF. Development of a New Module of the FACE-Q for Children and Young Adults with Diverse Conditions Associated with Visible and/or Functional Facial Differences. Facial Plast Surg 2017; 33:499-508. [PMID: 28962056 DOI: 10.1055/s-0037-1606361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractAppearance and facial function are concepts not well addressed in current pediatric patient-reported outcome measures (PROM) for facial conditions. We aimed to develop a new module of the FACE-Q for children/young adults with facial conditions that include ear anomalies, facial paralysis, skeletal conditions, and soft tissue conditions. Semi-structured and cognitive interviews were conducted with patients aged 8–29 years recruited from craniofacial centers in Canada, USA, UK, and Australia. Interviews were used to elicit new concepts and to obtain feedback on CLEFT-Q scales hypothesized to be relevant to other facial conditions. Interview data were recorded, transcribed, and coded. Experts were emailed and invited to provide feedback via Research Electronic Data Capture (REDCap). Eighty-four participants and 43 experts contributed. Analysis led to the development of a conceptual framework and 14 new scales that measure appearance, facial function, health-related quality of life, and adverse effects of treatment. In addition, 12 CLEFT-Q scales were determined to have content validity for use with other facial conditions. Expert input led to minor changes to scales and items. This new FACE-Q module for children/young adults is being field-tested internationally. Once finalized, we anticipate this PROM will be used to inform clinical practice and research studies.
Collapse
Affiliation(s)
- Natasha M Longmire
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W Y Wong Riff
- Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justine L O'Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital For Children NHS Trust, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Shivani Aggarwala
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gregory C Allen
- Department of Otolaryngology, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Neil W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital For Children NHS Trust, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher R Forrest
- Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brooke M French
- Department of Plastic and Reconstructive Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Timothy E E Goodacre
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | - Damian Marucci
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jonathan H Norris
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | - Vivek Panchapakesan
- Department of Plastic Surgery, William Osler Health System, Brampton, Ontario, Canada
| | - Bhoomika Piplani
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Herman Jr Vercruysse
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital For Children NHS Trust, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
15
|
Pang C, Ibrahim A, Bulstrode NW, Ferretti P. An overview of the therapeutic potential of regenerative medicine in cutaneous wound healing. Int Wound J 2017; 14:450-459. [PMID: 28261962 DOI: 10.1111/iwj.12735] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
The global burden of disease associated with wounds is an increasingly significant public health concern. Current treatments are often expensive, time-consuming and limited in their efficacy in chronic wounds. The challenge of overcoming current barriers associated with wound care requires innovative management techniques. Regenerative medicine is an emerging field of research that focuses on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function. This article provides an overview of the pathophysiology of wound healing and reviews the latest evidence on the application of the principal components of regenerative medicine (growth factors, stem cell transplantation, biomaterials and tissue engineering) as therapeutic targets. Improved knowledge and understanding of the pathophysiology of wound healing has pointed to new therapeutic targets. Regenerative medicine has the potential to underpin the design of specific target therapies in acute and chronic wound healing. This personalised approach could eventually reduce the burden of disease associated with wound healing. Further evidence is required in the form of large animal studies and clinical trials to assess long-term efficacy and safety of these new treatments.
Collapse
Affiliation(s)
- Calver Pang
- Department of Surgery Surgical Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amel Ibrahim
- Stem Cells and Regenerative Medicine Section, UCL GOS Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital for Children, London, UK
| | - Neil W Bulstrode
- Stem Cells and Regenerative Medicine Section, UCL GOS Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital for Children, London, UK
| | - Patrizia Ferretti
- Stem Cells and Regenerative Medicine Section, UCL GOS Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
16
|
Ibrahim A, Bulstrode NW, Whitaker IS, Eastwood DM, Dunaway D, Ferretti P. Nanotechnology for Stimulating Osteoprogenitor Differentiation. Open Orthop J 2016; 10:849-861. [PMID: 28217210 PMCID: PMC5299582 DOI: 10.2174/1874325001610010849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/25/2016] [Accepted: 05/31/2016] [Indexed: 12/25/2022] Open
Abstract
Background: Bone is the second most transplanted tissue and due to its complex structure, metabolic demands and various functions, current reconstructive options such as foreign body implants and autologous tissue transfer are limited in their ability to restore defects. Most tissue engineering approaches target osteoinduction of osteoprogenitor cells by modifying the extracellular environment, using scaffolds or targeting intracellular signaling mechanisms or commonly a combination of all of these. Whilst there is no consensus as to what is the optimal cell type or approach, nanotechnology has been proposed as a powerful tool to manipulate the biomolecular and physical environment to direct osteoprogenitor cells to induce bone formation. Methods: Review of the published literature was undertaken to provide an overview of the use of nanotechnology to control osteoprogenitor differentiation and discuss the most recent developments, limitations and future directions. Results: Nanotechnology can be used to stimulate osteoprogenitor differentiation in a variety of way. We have principally classified research into nanotechnology for bone tissue engineering as generating biomimetic scaffolds, a vector to deliver genes or growth factors to cells or to alter the biophysical environment. A number of studies have shown promising results with regards to directing ostroprogenitor cell differentiation although limitations include a lack of in vivo data and incomplete characterization of engineered bone. Conclusion: There is increasing evidence that nanotechnology can be used to direct the fate of osteoprogenitor and promote bone formation. Further analysis of the functional properties and long term survival in animal models is required to assess the maturity and clinical potential of this.
Collapse
Affiliation(s)
- A Ibrahim
- Department of Plastic Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK; Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Hospital Institute of Child Health, University College London, UK; Reconstructive Surgery and Regenerative Medicine Research Group, The Welsh Centre for Burns & Plastic Surgery, Swansea, UK; European Centre of Nano Health, Swansea University Medical School, Swansea, UK
| | - N W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK; Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Hospital Institute of Child Health, University College London, UK
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, The Welsh Centre for Burns & Plastic Surgery, Swansea, UK; European Centre of Nano Health, Swansea University Medical School, Swansea, UK
| | - D M Eastwood
- Department of Plastic Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - D Dunaway
- Department of Plastic Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK; Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Hospital Institute of Child Health, University College London, UK
| | - P Ferretti
- Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Hospital Institute of Child Health, University College London, UK
| |
Collapse
|
17
|
New SEP, Ibrahim A, Guasti L, Zucchelli E, Birchall M, Bulstrode NW, Seifalian AM, Ferretti P. Towards reconstruction of epithelialized cartilages from autologous adipose tissue-derived stem cells. J Tissue Eng Regen Med 2016; 11:3078-3089. [PMID: 27804241 DOI: 10.1002/term.2211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/01/2016] [Accepted: 04/14/2016] [Indexed: 12/27/2022]
Abstract
Deformities of the upper airways, including those of the nose and throat, are typically corrected by reconstructive surgery. The use of autologous somatic stem cells for repair of defects could improve quality and outcomes of such operations. The present study explored the ability of paediatric adipose-derived stem cells (pADSCs), a readily available source of autologous stem cells, to generate a cartilage construct with a functional epithelium. Paediatric ADSCs seeded on the biodegradable nanocomposite polymer, polyhedral oligomeric silsesquioxane poly(ϵ-caprolactone-urea) urethane (POSS-PCL), proliferated and differentiated towards mesenchymal lineages. The ADSCs infiltrated three-dimensional POSS-PCL nanoscaffold and chondroid matrix was observed throughout chondrogenically induced samples. In ovo chorioallantoic membrane-grafted ADSC-nanoscaffold composites were enwrapped by host vessels indicating good compatibility in an in vivo system. Furthermore, pADSCs could be induced to transdifferentiate towards barrier-forming epithelial-like cells. By combining differentiation protocols, it was possible to generate epithelial cell lined chondrogenic micromasses from the same pADSC line. This proof-of-concept study appears to be the first to demonstrate that individual pADSC lines can differentiate towards two different germ lines and be successfully co-cultured. This has important implications for bioengineering of paediatric airways and further confirms the plastic nature of ADSCs. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Sophie E P New
- Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Amel Ibrahim
- Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK.,UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, UCL, London, UK
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London, Queen Mary University of London, London, UK
| | - Eleonora Zucchelli
- Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Martin Birchall
- UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, UCL, London, UK
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London, UK
| | - Alexander M Seifalian
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, UCL, London, UK
| | - Patrizia Ferretti
- Stem Cell and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| |
Collapse
|
18
|
Ibrahim A, Suttie M, Bulstrode NW, Britto JA, Dunaway D, Hammond P, Ferretti P. Combined soft and skeletal tissue modelling of normal and dysmorphic midface postnatal development. J Craniomaxillofac Surg 2016; 44:1777-1785. [PMID: 27720275 DOI: 10.1016/j.jcms.2016.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/02/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Midface hypoplasia as exemplified by Treacher Collins Syndrome (TCS) can impair appearance and function. Reconstruction involves multiple invasive surgeries with variable long-term outcomes. This study aims to describe normal and dysmorphic midface postnatal development through combined modelling of skeletal and soft tissues and to develop a surgical evaluation tool. MATERIALS AND METHODS Midface skeletal and soft tissue surfaces were extracted from computed tomography scans of 52 control and 14 TCS children, then analysed using dense surface modelling. The model was used to describe midface growth, morphology, and asymmetry, then evaluate postoperative outcomes. RESULTS Parameters responsible for the greatest variation in midface size and shape showed differences between TCS and controls with close alignment between skeletal and soft tissue models. TCS children exhibited midface dysmorphology and hypoplasia when compared with controls. Asymmetry was also significantly higher in TCS midfaces. Combined modelling was used to evaluate the impact of surgery in one TCS individual who showed normalisation immediately after surgery but reversion towards TCS dysmorphology after 1 year. CONCLUSION This is the first quantitative analysis of postnatal midface development using combined modelling of skeletal and soft tissues. We also provide an approach for evaluation of surgical outcomes, laying the foundations for future development of a preoperative planning tool.
Collapse
Affiliation(s)
- Amel Ibrahim
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Michael Suttie
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Neil W Bulstrode
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Jonathan A Britto
- Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - David Dunaway
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Peter Hammond
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford OX3 7DQ, United Kingdom.
| | - Patrizia Ferretti
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom.
| |
Collapse
|
19
|
|
20
|
Firmin F, Bulstrode NW. Ear reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
21
|
Cugno S, Kinsler V, Bulstrode NW. Congenital melanocytic naevi. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
22
|
|
23
|
Cugno S, Barnacle A, Harper J, Bulstrode NW. Vascular anomalies. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
24
|
|
25
|
Quong WL, Bulstrode NW, Thompson DNP. The use of de-epithelialized skin flap in the surgical repair of terminal myelocystoceles. Childs Nerv Syst 2015; 31:473-9. [PMID: 25480697 DOI: 10.1007/s00381-014-2598-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Terminal myelocystocele is a severe form of spinal dysraphism characterized by cystic expansion of the terminal spinal cord that herniates through a deficiency of the posterior sacral spinal elements to fuse with the subcutaneous fat. Postnatal enlargement of the subcutaneous fluid-filled sac may result in progressive neurological deficit and threaten the viability of the overlying skin. Surgical repair entails spinal cord untethering, resection of nonfunctional neural elements and watertight reconstruction of the terminal thecal sac. Young age at the time of surgery, large dural defect, attenuated tissues and locally altered CSF dynamics frequently mean that wound complications including CSF leakage and pseudomeningocele formation are common. TECHNIQUE With consideration of these requirements, we describe our surgical technique in terminal myelocystocele repair, which combines a novel surgical incision and for the first time in a neurosurgical setting, the use of a de-epithelialized skin flap to augment the closure. We report successful operative outcomes in three infant patients with terminal myelocystocele.
Collapse
Affiliation(s)
- Whitney L Quong
- Department of Plastic and Reconstructive Surgery, The Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
26
|
Guasti L, Silvennoinen S, Bulstrode NW, Ferretti P, Sankilampi U, Dunkel L. Elevated FGF21 leads to attenuated postnatal linear growth in preterm infants through GH resistance in chondrocytes. J Clin Endocrinol Metab 2014; 99:E2198-206. [PMID: 25137423 DOI: 10.1210/jc.2014-1566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The hormone fibroblast growth factor 21 (FGF21) is a key metabolic regulator in the adaptation to fasting. In food-restricted mice, inhibition of skeletal growth is mediated by the antagonistic effect of FGF21 on GH action in the liver and growth plate. OBJECTIVE The objective of the study was to assess the role of FGF21 in growth regulation in humans using postnatal growth failure of very preterm infants as a model. DESIGN FGF21 levels were measured serially in very preterm infants, and their linear growth evaluated from birth to term-equivalent age. Primary chondrocytes obtained from pediatric donors were used to test whether FGF21 can directly interfere with GH signaling. RESULTS A negative association (β -.415, P < .005, linear regression model) of FGF21 levels with the change in SD score for length was found. In primary chondrocytes, FGF21 upregulated basal and GH-induced SOCS2 expression and inhibited GH-induced signal transducer and activator of transcription 5 (STAT5) phosphorylation as well as GH-induced COLII and ALP expression. Finally, FGF21 inhibited GH-induced IGF-1 expression and cell proliferation, indicating GH resistance. However, FGF21 did not affect IGF-1-induced cell proliferation. CONCLUSIONS Elevated FGF21 serum levels during the first weeks of life are independently associated with postnatal growth failure in preterm infants. Furthermore, our data provide mechanistic insights into GH resistance secondary to prematurity and may offer an explanation for the growth failure commonly seen in chronic conditions of childhood.
Collapse
Affiliation(s)
- Leonardo Guasti
- Centre for Endocrinology (L.G., L.D.), William Harvey Research Institute, Barts and the London, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pediatrics (S.S., U.S.), Kuopio University Hospital, 70210 Kuopio, Finland; Department of Plastic Surgery (N.W.B.), Great Ormond Street Hospital for Children National Health Service Trust, London WC1N 3JH, United Kingdom; and Developmental Biology Unit (P.F.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom
| | | | | | | | | | | |
Collapse
|
27
|
Guasti L, Vagaska B, Bulstrode NW, Seifalian AM, Ferretti P. Chondrogenic differentiation of adipose tissue-derived stem cells within nanocaged POSS-PCU scaffolds: A new tool for nanomedicine. Nanomedicine: Nanotechnology, Biology and Medicine 2014; 10:279-89. [DOI: 10.1016/j.nano.2013.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 02/06/2023]
|
28
|
Cugno S, Farhadieh RD, Bulstrode NW. Autologous microtia reconstruction combined with ancillary procedures: a comprehensive reconstructive approach. J Plast Reconstr Aesthet Surg 2013; 66:1487-93. [PMID: 23938195 DOI: 10.1016/j.bjps.2013.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/14/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Autologous microtia reconstruction is generally performed in two stages. The second stage presents a unique opportunity to carry out other complementary procedures. The present study describes our approach to microtia reconstruction, wherein the second stage of reconstruction is combined with final refinements to the ear construct and/or additional procedures to enhance facial contour and symmetry. METHODS Retrospective analysis of patients who underwent two-stage microtia reconstruction by a single surgeon (NWB) was conducted in order to ascertain those that had ancillary procedures at the time of the second stage. Patient and operative details were collected. RESULTS Thirty-four patients (male, 15, median age and age range at second stage, 11 and 10-18 years, respectively) who had complementary procedures executed during the second stage of auricular reconstruction were identified. Collectively, these included centralizing genioplasty (n = 1), fat transfer (n = 22), ear piercing (n = 7), and contralateral prominauris correction (n = 7). Six patients had correction for unilateral isolated microtia and in the remaining 28 patients, auricular reconstruction for microtia associated with a named syndrome. All patients reported a high rate of satisfaction with the result achieved and the majority (85%) reported no perceived need for additional surgical refinements to the ear or procedure(s) to achieve further facial symmetry. No peri- or post-operative complications were noted. CONCLUSION Combining the final stage of autologous microtia reconstruction with other ancillary procedures affords a superior aesthetic outcome and decreased patient morbidity.
Collapse
Affiliation(s)
- S Cugno
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom.
| | | | | |
Collapse
|
29
|
Cobb AR, Koudstaal MJ, Bulstrode NW, Lloyd TW, Dunaway DJ. Free groin flap in hemifacial volume reconstruction. Br J Oral Maxillofac Surg 2013; 51:301-6. [DOI: 10.1016/j.bjoms.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
|
30
|
Kinsler VA, Thomas AC, Ishida M, Bulstrode NW, Loughlin S, Hing S, Chalker J, McKenzie K, Abu-Amero S, Slater O, Chanudet E, Palmer R, Morrogh D, Stanier P, Healy E, Sebire NJ, Moore GE. Multiple congenital melanocytic nevi and neurocutaneous melanosis are caused by postzygotic mutations in codon 61 of NRAS. J Invest Dermatol 2013; 133:2229-36. [PMID: 23392294 PMCID: PMC3678977 DOI: 10.1038/jid.2013.70] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/06/2012] [Accepted: 01/02/2013] [Indexed: 01/01/2023]
Abstract
Congenital melanocytic nevi (CMN) can be associated with neurological abnormalities and an increased risk of melanoma. Mutations in NRAS, BRAF, and Tp53 have been described in individual CMN samples; however, their role in the pathogenesis of multiple CMN within the same subject and development of associated features has not been clear. We hypothesized that a single postzygotic mutation in NRAS could be responsible for multiple CMN in the same individual, as well as for melanocytic and nonmelanocytic central nervous system (CNS) lesions. From 15 patients, 55 samples with multiple CMN were sequenced after site-directed mutagenesis and enzymatic digestion of the wild-type allele. Oncogenic missense mutations in codon 61 of NRAS were found in affected neurological and cutaneous tissues of 12 out of 15 patients, but were absent from unaffected tissues and blood, consistent with NRAS mutation mosaicism. In 10 patients, the mutation was consistently c.181C>A, p.Q61K, and in 2 patients c.182A>G, p.Q61R. All 11 non-melanocytic and melanocytic CNS samples from 5 patients were mutation positive, despite NRAS rarely being reported as mutated in CNS tumors. Loss of heterozygosity was associated with the onset of melanoma in two cases, implying a multistep progression to malignancy. These results suggest that single postzygotic NRAS mutations are responsible for multiple CMN and associated neurological lesions in the majority of cases.
Collapse
Affiliation(s)
- Veronica A Kinsler
- Paediatric Dermatology Department, Great Ormond Street Hospital for Children, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kinsler VA, Abu-Amero S, Budd P, Jackson IJ, Ring SM, Northstone K, Atherton DJ, Bulstrode NW, Stanier P, Hennekam RC, Sebire NJ, Moore GE, Healy E. Germline melanocortin-1-receptor genotype is associated with severity of cutaneous phenotype in congenital melanocytic nevi: a role for MC1R in human fetal development. J Invest Dermatol 2012; 132:2026-32. [PMID: 22572819 PMCID: PMC3398254 DOI: 10.1038/jid.2012.95] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Congenital melanocytic nevi (CMN) are pigmented birthmarks that affect up to 80% of the skin surface area. The increased frequency of CMN in families of severely affected individuals is suggestive of a predisposing germline genotype. We noted a high prevalence of red hair in affected families, and considered a role for MC1R in this condition. A cohort of 166 CMN subjects underwent pigmentary phenotyping, with MC1R genotyping in 113. Results were compared with a local control group of 60 unrelated children and with 300 UK children without CMN. CMN subjects had higher prevalences of red hair and a red-haired parent than local controls and had a higher rate of compound heterozygosity and homozygosity for MC1R variants. The presence of a V92M or R allele (D84E, R151C, R160W, D294H) was associated with increasing size of the CMN, implying a growth-promoting effect of these alleles. Unexpectedly, the V92M and R151C alleles were also strongly associated with birth weight in the CMN cohort, a finding confirmed in the control group. The effect of germline MC1R genotype on development and severity of CMN led us to investigate potential broader effects on growth, revealing a role for MC1R in normal fetal development.
Collapse
Affiliation(s)
- Veronica A Kinsler
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Guasti L, Prasongchean W, Kleftouris G, Mukherjee S, Thrasher AJ, Bulstrode NW, Ferretti P. High plasticity of pediatric adipose tissue-derived stem cells: too much for selective skeletogenic differentiation? Stem Cells Transl Med 2012. [PMID: 23197817 DOI: 10.5966/sctm.2012-0009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stem cells derived from adipose tissue are a potentially important source for autologous cell therapy and disease modeling, given fat tissue accessibility and abundance. Critical to developing standard protocols for therapeutic use is a thorough understanding of their potential, and whether this is consistent among individuals, hence, could be generally inferred. Such information is still lacking, particularly in children. To address these issues, we have used different methods to establish stem cells from adipose tissue (adipose-derived stem cells [ADSCs], adipose explant dedifferentiated stem cells [AEDSCs]) from several pediatric patients and investigated their phenotype and differentiation potential using monolayer and micromass cultures. We have also addressed the overlooked issue of selective induction of cartilage differentiation. ADSCs/AEDSCs from different patients showed a remarkably similar behavior. Pluripotency markers were detected in these cells, consistent with ease of reprogramming to induced pluripotent stem cells. Significantly, most ADSCs expressed markers of tissue-specific commitment/differentiation, including skeletogenic and neural markers, while maintaining a proliferative, undifferentiated morphology. Exposure to chondrogenic, osteogenic, adipogenic, or neurogenic conditions resulted in morphological differentiation and tissue-specific marker upregulation. These findings suggest that the ADSC "lineage-mixed" phenotype underlies their significant plasticity, which is much higher than that of chondroblasts we studied in parallel. Finally, whereas selective ADSC osteogenic differentiation was observed, chondrogenic induction always resulted in both cartilage and bone formation when a commercial chondrogenic medium was used; however, chondrogenic induction with a transforming growth factor β1-containing medium selectively resulted in cartilage formation. This clearly indicates that careful simultaneous assessment of bone and cartilage differentiation is essential when bioengineering stem cell-derived cartilage for clinical intervention.
Collapse
Affiliation(s)
- Leonardo Guasti
- Developmental Biology Unit, UCL Institute of Child Health, London UK.
| | | | | | | | | | | | | |
Collapse
|
33
|
Fattah A, Sebire NJ, Bulstrode NW. Donor site reconstitution for ear reconstruction. J Plast Reconstr Aesthet Surg 2010; 63:1459-65. [DOI: 10.1016/j.bjps.2009.07.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 11/26/2022]
|
34
|
Tonkin MA, Bulstrode NW. The Bilhaut-Cloquet procedure for Wassel types III, IV and VII thumb duplication. J Hand Surg Eur Vol 2007; 32:684-93. [PMID: 17993432 DOI: 10.1016/j.jhse.2007.05.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 05/28/2007] [Accepted: 05/31/2007] [Indexed: 02/03/2023]
Abstract
Five cases of Wassel types III, IV and VII thumb duplication underwent a Bilhaut-Cloquet procedure. A stable and mobile metacarpophalangeal joint was achieved in all cases. Interphalangeal joint motion was limited but this joint was stable in all cases. The nail ridge in these thumbs was minimal. A strong, stable thumb of normal size and good appearance can result from the Bilhaut-Cloquet procedure. When one nail is 70% of normal width, a modified procedure using the whole of one nail will avoid the nail ridge, but the nail will still differ from normal.
Collapse
Affiliation(s)
- M A Tonkin
- Department of Hand Surgery and Peripheral Nerve Surgery, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
| | | |
Collapse
|
35
|
O'Leary EJP, Bulstrode NW, Gschwind C. Acute bilateral forearm compartment syndrome of unknown aetiology. ACTA ACUST UNITED AC 2007; 11:147-9. [PMID: 17405196 DOI: 10.1142/s0218810406003243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 11/10/2006] [Indexed: 11/18/2022]
Abstract
This is the first reported case of non-traumatic, acute bilateral forearm compartment syndrome. Despite a delay of over 24 hours until surgical decompression and 50% muscle fibre necrosis in the histopathological examination, the clinical outcome was excellent after fasciotomy, delayed primary wound closure and early institution of a range of motion exercise programme. The literature on non-traumatic causes of compartment syndrome is reviewed.
Collapse
Affiliation(s)
- E J P O'Leary
- Department of Hand Surgery, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | | |
Collapse
|
36
|
Abstract
BACKGROUND The modified lateral superficial musculoaponeurotic system (SMAS)-ectomy is an evolution of the technique described by Baker. This modification of the lateral SMASectomy improves and simplifies the procedure by addressing the SMAS and platysma in one surgical procedure. METHODS A rectangle of SMAS and platysma, parallel to the nasolabial fold (1 cm inferior to the zygomatic arch, 4 to 5 cm below the jaw line, and 3 cm wide), was marked. This plane was undermined anteriorly with blunt dissection, leaving the facial nerve deep to the deep cervical fascia. After excision of the rectangle, the defect was closed, leading to a correction of the neck, jowl, and nasolabial folds. Superolateral elevation of the inferior portion of the flap in particular addresses the problem of neck laxity and platysma redundancy. RESULTS A total of 359 patients have undergone this procedure performed by the senior author (N.W.). CONCLUSION This technique gives pleasing, durable results, with minimal morbidity.
Collapse
|
37
|
|
38
|
Bulstrode NW, Kotronakis I, Baldwin MAR. Free tensor fasciae latae musculofasciocutaneous flap in reconstructive surgery: a series of 85 cases. J Plast Reconstr Aesthet Surg 2006; 59:130-6. [PMID: 16703856 DOI: 10.1016/j.bjps.2005.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of tensor fasciae latae was first described as a rotation or island flap and evolved into a free flap in the late 1970s. This series of 85 patients undergoing free tensor fasciae latae transfer includes complex head and neck, abdominal wall and lower limb reconstruction. The overall success rate was 93% (79 patients), partial flap loss, 5% (four cases), and flap failure, 2% (two patients). Twelve patients (14%) required unplanned return to theatre for exploration resulting in a 75% salvage rate. We believe this series demonstrates the great versatility of this flap and highlights particular indications for its use.
Collapse
Affiliation(s)
- N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Prince of Wales Hospital, Randwick, NSW 2011, Australia
| | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Fibroproliferative disorders, such as Dupuytren's contracture of the hand, are characterized by excessive production of collagen. 5-Fluorouracil has been used to treat fibroproliferative disorders of the eye and skin and is thought to inhibit thymidylate synthetase blocking DNA replication. 5-Fluorouracil has been shown to down-regulate fibroblast proliferation and differentiation in vitro. METHODS This study investigated the dose-dependent effect of 5-fluorouracil on fibroblast extracellular matrix production. Fibroblasts were derived from tendon and primary Dupuytren's disease of the hand, a fibroproliferative disorder of the palmar aponeurosis (n = 4 patients). Total collagen synthesis was determined by means of the incorporation of radiolabeled proline. Fibroblast secretion of the profibrotic factor transforming growth factor-beta1 (TGF-beta1) was measured by a sandwich enzyme-linked immunosorbent assay. Gene expression of collagen types I and III and TGF-beta1 were quantified by means of reverse-transcriptase polymerase chain reaction assays. RESULTS The authors found that 5-fluorouracil caused a dose-dependent, selective, and specific decrease in collagen production by Dupuytren's fibroblasts compared with noncollagenous protein synthesis. By contrast, procollagen types I and III mRNA were unaffected by 5-fluorouracil treatment. These changes did not appear to be mediated by alterations in the endogenous secretion of TGF-beta1 or its autocrine effect on collagen metabolism. CONCLUSIONS The clinical implication is that 5-fluorouracil could possibly reduce extracellular matrix production and therefore reduce recurrence of Dupuytren's disease of the hand.
Collapse
Affiliation(s)
- Neil W Bulstrode
- RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Middlesex, United Kingdom
| | | | | | | | | |
Collapse
|
40
|
Abstract
PURPOSE To determine the complication rate of a modified Skoog's technique in the surgical treatment of Dupuytren's contracture. METHODS A retrospective analysis was performed on 253 patients who had surgery by 1 surgeon using 1 technique with a mean follow-up period of 3.6 years. We studied the complication rate of the modified Skoog's procedure, relating it to a grading system for disease severity. A separate prospective long-term study was performed with an unselected cohort in which disease recurrence producing contracture was investigated prospectively in a group of 75 patients. RESULTS Complications occurred in 46 patients. Thirty-five patients had 1 complication and 11 patients had more than 1 complication. Intraoperative complications included 6 patients with nerve injury and 1 patient with an arterial injury. Early postoperative complications before wound healing included 5 patients with digital hematoma, 24 patients with wound infection, 6 patients with sympathetic dystrophy, and 6 patients with skin slough. Late postoperative complications included 3 patients with scar contraction and 2 patients with carpal tunnel syndrome. There were 3 non-hand-related complications: 1 urinary retention, 1 left ventricular failure, and 1 myocardial infarction. Recurrence of Dupuytren's disease occurred in 23 of 75 patients after a mean follow-up period of 9.4 years. CONCLUSIONS The complication rate increased with the severity of disease particularly if the proximal interphalangeal joint contracture was 60 degrees or more. There was no difference in the complication rate for patients who had surgery for primary or recurrent disease.
Collapse
Affiliation(s)
- Neil W Bulstrode
- Department of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK
| | | | | |
Collapse
|
41
|
Bulstrode NW, Burr N, Pratt AL, Grobbelaar AO. Extensor tendon rehabilitation a prospective trial comparing three rehabilitation regimes. ACTA ACUST UNITED AC 2005; 30:175-9. [PMID: 15757771 DOI: 10.1016/j.jhsb.2004.10.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2002] [Accepted: 10/12/2004] [Indexed: 11/19/2022]
Abstract
Forty-two patients with 46 complete extensor tendon injuries were prospectively allocated to one of three rehabilitation regimes: static splintage; interphalangeal joint mobilization with metacarpophalangeal joint immobilization or; the "Norwich" regime. All 42 patients were operated on by one surgeon and assessed by one hand therapist. At 4 weeks the total active motion in the static splintage group was significantly reduced but by 12 weeks there was no difference between the regimes. There was no difference in total active motion between the repaired and uninjured hand at 12 weeks, with all patients achieving good or excellent results. However, grip strength at 12 weeks was significantly reduced compared to the uninjured hand after static splintage. There was no difference in hand therapy input between the regimes.
Collapse
Affiliation(s)
- N W Bulstrode
- Department of Plastic Surgery and Hand Therapy Unit, Mount Vernon Hospital, Northwood, Middlesex, HA6 2RN, UK
| | | | | | | |
Collapse
|
42
|
Bulstrode NW, Kotronakis I, Lotz N, Baldwin MAR. The use of the Siamese combined free flap to reconstruct challenging defects: twin and triplet variants. ACTA ACUST UNITED AC 2005; 58:449-54. [PMID: 15897026 DOI: 10.1016/j.bjps.2004.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2004] [Accepted: 11/08/2004] [Indexed: 11/22/2022]
Abstract
The reconstruction of large and intricate defects may need the use of combined flaps due to either the size or requirement for multiple surfaces. The combination may be between free and pedicled tissue transfer, and combined or connected free flaps classified by Koshima. We will discuss the use of the Siamese combined free flap as a method of the reconstructing challenging cases, including one of the largest free tissue transfer reported.
Collapse
Affiliation(s)
- N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Prince of Wales Hospital, Randwick NSW 2011, Australia
| | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Bell's palsy is an idiopathic neuropathy of cranial nerve VII, and the incidence ranges from 15 to 40 per 100,000. The majority of patients recover, but up to 16 percent of patients have significant sequelae. The phenomenon of the "late recovered" Bell's palsy has the following specific features and has not formerly been described: (1) tightening of the facial muscles, with a deepening nasolabial fold and reduced palpebral fissure; (2) blepharospasm; and (3) incomplete recovery of peripheral VIIth nerve branches, with ipsilateral forehead paralysis, reduced depressor anguli oris function, and poor excursion of the angle of the mouth on smiling. METHODS Nonsurgical treatment involved four monthly botulinum toxin injections. Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness. The effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. RESULTS Twenty-three patients were followed up for a mean period of 37 months. The difference in brow height and teeth exposure after injection was less than preinjection measurements, but this did not reach statistical significance. Patient self-assessments showed improvements in their appreciation of the facial symmetry, ability to go out in public, and feelings of self-worth (visual analogue scale). Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty. CONCLUSIONS The true benefit of botulinum toxin injections was more apparent during facial animation and not when the face was static. The patients greatly appreciated the improvement in facial symmetry. Various treatment options are available to improve the quality of life for patients with late recovered Bell's palsy.
Collapse
Affiliation(s)
- Neil W Bulstrode
- Department of Plastic Surgery, Mount Vernon Hospital, Middlesex HA6 2 RN, United Kingdom.
| | | |
Collapse
|
44
|
Bulstrode NW, Bisson M, Jemec B, Pratt AL, McGrouther DA, Grobbelaar AO. A prospective randomised clinical trial of the intra-operative use of 5-fluorouracil on the outcome of dupuytren's disease. ACTA ACUST UNITED AC 2004; 29:18-21. [PMID: 14734063 DOI: 10.1016/j.jhsb.2003.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
5-Fluorouracil reduces proliferation rates of fibroblasts, myofibroblast differentiation and contractility of ocular fibroblasts in vitro. This double-blind randomized clinical trial assesses whether intra-operative topical treatment with 5-fluorouracil reduces the recurrence rate after limited excision of Dupuytren's tissue. Patients with two-digit disease were randomized to having 5-fluorouracil (25mg/ml) treatment for 5 minutes on one digit and placebo on the other. Fifteen patients were enrolled with 18 months follow-up. There were no peri-operative complications. Wound healing was not delayed and there was no deterioration in the flexion deformity of the 5-fluorouracil treated digits. Patients were subsequently assessed by joint angle measurement at 3, 6, 12 and 18 months. There was no significant difference between control and 5-fluorouracil treated digits.
Collapse
Affiliation(s)
- N W Bulstrode
- From the RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, HA6 2RN, UK
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Granular cell tumour of the glans penis is a rare finding with only two other cases reported. This case highlights the importance of achieving the correct diagnosis, as differing excision margins are critical, particularly in this site.
Collapse
Affiliation(s)
- N W Bulstrode
- Department of Plastic Surgery, Chelsea and Westminster Hospital, Fulham Road, London, UK.
| | | | | |
Collapse
|
46
|
Bulstrode NW, Huang S, Martin DL. Otoplasty by percutaneous anterior scoring. Another twist to the story: a long-term study of 114 patients. Br J Plast Surg 2003; 56:145-9. [PMID: 12791359 DOI: 10.1016/s0007-1226(03)00030-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A large number of techniques have been described for the correction of prominent ears to improve the cosmetic outcome and reduce the complication rates. The procedure favoured by the senior author brings together a number of refinements, notably, percutaneous anterior scoring using a modified green needle, control over the degree of fold created and a simple but effective dressing. 114 consecutive patients underwent the correction of 214 ears, with a mean follow up of 3 years and 11 months (9 months to 9 years and 6 months). The senior author performed 100 of these procedures and supervised a senior trainee for the remainder. The mean patient age was 18 years 3 months (3 to 66 years). 57 males and 57 females. 56 general anaesthetic and 58 local anaesthetic. Post-operative complications were; haemorrhage, one ear (required a dressing change); infection, four ears (treated with antibiotics); hypertrophic scarring, two ears which settled (no keloid); recurrence one ear (repeated surgery); continued prominence six ears (two had repeated surgery). No prominent sutures, no anterior skin necrosis, no visible irregularity of the anterior surface of the cartilage and no haematoma occurred. We feel that the low complication rate is due to maximising the advantages and minimising the disadvantages of the different techniques and refinements. We recommend this technique for the routine correction of prominent ears due to a poorly formed antihelical fold or deep conchal bowl.
Collapse
Affiliation(s)
- N W Bulstrode
- Department of Plastic Surgery, Chelsea and Westminster Hospital, Fulham Road, London, UK
| | | | | |
Collapse
|
47
|
Abstract
Some wrinkles and unsightly facial expressions are due to hyperactivity of the underlying facial musculature. Clostridium botulinum type A exotoxin reversibly paralyzes selected muscles and is a safe, helpful adjunct to many other treatments for facial rejuvenation. Fifty-two patients were treated and all data recorded in a prospective fashion. Only areas requested by the patient were treated. The dosage and dilution given in each area were carefully noted and all patients had pretreatment and posttreatment photographs. The effect of botulinum toxin injections on the horizontal brow rhytides was recorded by measuring the distance from the frontal hairline to the superior edge of the eyebrow in the mid-pupillary line. Patients were followed for one to three years (mean 16.3 months). One patient was not responsive to botulinum toxin in spite of repeated injections. Three further patients required touch-up injections two weeks after the initial treatment due to a weak initial response. Repeat injections were required every three to six months (mean 4.05) to maintain the desired improvement. Asymmetry of the brow was seen in two patients and corrected with further administration of botulinum toxin. Twenty-five patients had their forehead rhytides injected and the appropriate measurements taken. Brow ptosis occurred in 22 of the 25 patients and varied 1-6 mm with a mean value of 2.3 mm. This difference was statistically significant (paired t-test p <0.001). Two patients reported dryness and flakiness of the frontal area after injections. No cases of eyelid ptosis or hypersensitivity were seen. Botulinum toxin injections are safe and all undesired effects are reversible. Great care has to be taken not to aggravate the degree of brow ptosis. Injection of the forehead depressors minimizes the risk of brow ptosis. Careful planning of injection sites and doses avoids a mask-like upper face. The use of botulinum toxin provides a useful adjunct to laser and surgical procedures for facial rejuvenation.
Collapse
|
48
|
|
49
|
Abstract
This study was undertaken to examine the feasibility of breast volume estimation as a predictor of cosmetic outcome. We looked at the cosmetic result of conservative surgery related to the percentage of breast tissue removed. The breast tissue excised was calculated by comparing the breast volume, calculated from the mammogram, and the specimen volume. A total of 24 patients were recalled to a special clinic and were assessed for their cosmetic result by the clinician, independent observer and the patient. The assessment was based on a scale of 1 to 4 (poor to excellent). Our results show that if less than 20% of the breast was removed, all assessors felt that the cosmetic result was at least fair. If more than 20% of the breast was removed, the cosmetic score was poor as assessed by the clinician and independent observer. When excision of greater than 20% of breast tissue is anticipated, then a breast reconstruction procedure should be considered, if cosmetic outcome is to be enhanced.
Collapse
|
50
|
Bradbury AW, Bulstrode NW, Gilling-Smith G, Stansby G, Mansfield AO, Wolfe JH. Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases. Eur J Vasc Endovasc Surg 1999; 17:160-5. [PMID: 10063413 DOI: 10.1053/ejvs.1998.0753] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The risks and benefits of operating on patients with ruptured thoracoabdominal aortic aneurysm (TAAA) have not been defined. The aim of the present study is to report this unit's experience with operations performed for ruptured TAAA over a 10-year period. METHODS Interrogation of a prospectively gathered computerised database. PATIENTS Between 1 January 1983 and 30 June 1996, 188 consecutive patients with TAAA were operated on, of whom 23 (12%) were operated for rupture. RESULTS There were nine survivors (40%). Patients whose preoperative systolic blood pressure remained above 100 mmHg were significantly more likely to survive (4/8 vs. 13/15, p = 0.03 by Fisher's exact test). Survival was also related to Crawford type: type I (two of three survived); II (none of six); III (two of six); and IV (five of eight). All non-type II, non-shocked patients survived operation. Survivors spent a median of 28 (range 10-66) postoperative days in hospital, of which a median of 6 (range 2-24) days were spent in the intensive care unit. Survivor morbidity comprised prolonged ventilation (> 5 days) (n = 3); tracheostomy (n = 1); and temporary haemofiltration (n = 2). No survivor developed paraplegia or required permanent dialysis. CONCLUSIONS Patients in shock with a Crawford type II aneurysm have such a poor prognosis that intervention has to be questioned except in the most favourable of circumstances. However, patients with types I, III and IV who are not shocked on presentation can be salvaged and, where possible, should be transferred to a unit where appropriate expertise and facilities are available.
Collapse
Affiliation(s)
- A W Bradbury
- Regional Vascular and Academic Surgery Unit, Imperial College of Medicine, St. Mary's Hospital, London, U.K
| | | | | | | | | | | |
Collapse
|