Fat Grafting for Improved Ileostomy Ostomy Device Fit: A Case Report

For patients with an ostomy, a poor fitting appliance may cause leakage, peristomal dermatitis, and frequent appliance changes.

PURPOSE

The purpose of this case study was to report the outcome of fat grafting to augment peristomal soft tissue and improve appliance fit.

CASE STUDY

A 57-year-old woman with a history of Crohn's disease presented with soft-tissue deficiency and uneven contour around her ileostomy site. She was unable to properly fit an ostomy appliance, which resulted in leakage, chronic skin irritation, and frequent appliance changes. The patient underwent 2 rounds of fat grafting using fat harvested from her medial thighs and knees infused with dilute lidocaine with epinephrine. The patient noted immediate improvement after 34 cc of processed fat was injected in the first round. Appliance change frequency decreased from daily to every 3 to 4 days. A second graft of 32 cc provided 3 months later further improved appliance fit, reducing appliance change frequency to every 5 to 7 days and obviating the need to use adjustment rings and glue. Pre- and postoperative computed tomography showed increased thickness of abdominal wall subcutaneous tissues.

CONCLUSION

Fat grafting around an ostomy site presents a viable option to improve contour and appliance fit with reduced skin irritation and leakage.

Acellular Dermal Matrix as an Adjunct Material in Cleft Le Fort I Osteotomies

PURPOSE

To evaluate the use of acellular dermal matrix in the management of nasal lining deficiency at the time of Le Fort I osteotomy.

METHODS

This was a retrospective cohort study of patients with residual/recurrent oronasal fistulae who underwent Le Fort I osteotomy. In instances where there was an inadequate volume of nasal mucosa for tension-free closure or for defects >1 cm in width, the acellular dermal matrix was used for augmentation. Demographic and cleft-related factors were recorded. Complications (recurrent fistula, infection, seroma, and wound dehiscence) were recorded.

RESULTS

Over the 3-year period, the authors used acellular dermal matrix to augment nasal lining in 8 subjects. The sample's mean age was 18.7 ± 3.1 years; 5 subjects were male. Six patients had bilateral cleft defects. The mean follow-up time was 20.2 ± 3.2 years. There were no episodes of infection, seroma, wound dehiscence, or recurrent fistula.

CONCLUSION

Acellular dermal matrix is a useful adjunct for managing nasal liningdeficiency at the time of Le Fort I osteotomy. There were no episodes of bone graft extrusion, infection, tooth loss, or bone graft loss. The Enemark scores improved significantly across both subsets (P <0.001). There was 1 recurrent fistula in the allograft bone alone group.Residual alveolar clefts and oronasal fistulae can be successfully managed at the time of Le Fort I osteotomy using allograft bone and acellular dermal matrix.

Transforming growth factor beta 1 augments calvarial defect healing and promotes suture regeneration

BACKGROUND

Repair of complex cranial defects is hindered by a paucity of appropriate donor tissue. Bone morphogenetic protein 2 (BMP2) and transforming growth factor beta 1 (TGFβ1) have been shown separately to induce bone formation through physiologically distinct mechanisms and potentially improve surgical outcome for cranial defect repair by obviating the need for donor tissue. We hypothesize that a combination of BMP2 and TGFβ1 would improve calvarial defect healing by augmenting physiologic osteogenic mechanisms.

METHODS/RESULTS

Coronal suturectomies (3×15 mm) were performed in 10-day-old New Zealand White rabbits. DermaMatrix™ (3×15mm) patterned with four treatments (vehicle, 350 ng BMP2, 200 ng TGFβ1, or 350 ng BMP2+200 ng TGFβ1) was placed in suturectomy sites and rabbits were euthanized at 6 weeks of age. Two-dimensional (2D) defect healing, bone volume, and bone density were quantified by computed tomography. Regenerated bone was qualitatively assessed histologically. One-way analysis of variance revealed significant group main effects for all bone quantity measures. Analysis revealed significant differences in 2D defect healing, bone volume, and bone density between the control group and all treatment groups, but no significant differences were detected among the three growth factor treatment groups. Qualitatively, TGFβ1 treatment produced bone with morphology most similar to native bone. TGFβ1-regenerated bone contained a suture-like tissue, growing from the lateral edge of the defect margin toward the midline. Unique to the BMP2 treatment group, regenerated bone contained lacunae with chondrocytes, demonstrating the presence of endochondral ossification.

CONCLUSIONS/SIGNIFICANCE

Total healing in BMP2 and TGFβ1 treatment groups is not significantly different. The combination of BMP2+TGFβ1 did not significantly increase bone healing compared with treatment with BMP2 or TGFβ1 alone postoperatively at 4 weeks. We highlight the potential use of TGFβ1 to regenerate calvarial bone and cranial sutures. TGFβ1 therapy significantly augmented bony defect healing at an earlier time point when compared with control, regenerated bone along the native intramembranous ossification pathway, and (unlike BMP2 alone or in combination with TGFβ1) permitted normal suture reformation. We propose a novel method of craniofacial bone regeneration using low-dose, spatially controlled growth factor therapies to minimize potentially harmful effects while maximizing local bioavailability and regenerating native tissues.