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Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells. Aesthetic Plast Surg 2020; 44:1258-1265. [PMID: 32766920 DOI: 10.1007/s00266-020-01819-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 05/22/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.
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Abstract
Hydrodynamic motion can generate a flux of electron-spin’s angular momentum via the coupling between fluid rotation and electron spins. Such hydrodynamic generation, called spin hydrodynamic generation (SHDG), has recently attracted attention in a wide range of fields, especially in spintronics. Spintronics deals with spin-mediated interconversion taking place on a micro or nano scale because of the spin-diffusion length scale. To be fully incorporated into the interconversion, SHDG physics should also be established in such a minute scale, where most fluids exhibit a laminar flow. Here, we report electric voltage generation due to the SHDG in a laminar flow of a liquid-metal mercury. The experimental results show a scaling rule unique to the laminar-flow SHDG. Furthermore, its energy conversion efficiency turns out to be about 105 greater than of the turbulent one. Our findings reveal that the laminar-flow SHDG is suitable to downsizing and to extend the coverage of fluid spintronics. In spin hydrodynamic generation originating from the coupling of mechanical rotation in a fluid and electron spin, fluid vorticity can be converted into an electric voltage via a spin current. Here, the authors demonstrate experimentally that the energy conversion in a laminar flow regime is strongly enhanced over the turbulent regime.
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Patient satisfaction after levator aponeurosis surgery for the treatment of involutional blepharoptosis. J Plast Reconstr Aesthet Surg 2018; 72:848-862. [PMID: 30579909 DOI: 10.1016/j.bjps.2018.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
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Integrated Forehead and Temporal Augmentation Using 3D Printing-Assisted Methyl Methacrylate Implants. Aesthet Surg J 2018; 38:1157-1168. [PMID: 29596570 DOI: 10.1093/asj/sjy075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Achieving aesthetic results with forehead augmentation procedures remains challenging. We have developed a method of integrated forehead and temporal augmentation using a three-dimensional (3D) printing-assisted methyl methacrylate implant. OBJECTIVES The study objective was to assess the importance of combined temporal augmentation when performing forehead augmentation. METHODS We identified 34 patients (from 2000 to 2010) who underwent forehead augmentation with a methyl methacrylate implant contoured in situ during surgery and 41 patients (from 2010 to 2016) who underwent integrated forehead and temporal augmentation with a prefabricated methyl methacrylate implant. We conducted a retrospective chart review of patient data including operation time, complications, and instances of revision surgery. Two blinded plastic surgeons scored the aesthetic results of the operations on a 4-point scale (1, poor, to 4, excellent) based on preoperative and posttreatment photographs. RESULTS The integrated augmentation method resulted in a lower frequency of posttreatment implant removal (one [2%] vs. six [18%]; P < .05), a lower frequency of filler injection for touch up (one [2%] vs. six [18%]; P < .05), and higher mean aesthetic scores (3.7 ± 0.5 vs. 2.2 ± 1.0; P < . 001) compared to the forehead augmentation method. There was no statistically significant difference in surgical complications between the two groups. CONCLUSIONS Integrated forehead and temporal augmentation using a 3D printing-assisted methyl methacrylate implant may be the optimal available procedure, enabling the custom fabrication of contours requested by the patient and providing a rejuvenating and balancing effect on facial appearance. LEVEL OF EVIDENCE 3
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A Simple and Reliable Submental Intubation Technique for Maxillofacial Fractures. J Craniofac Surg 2018; 29:1952-1955. [PMID: 30113420 PMCID: PMC6200376 DOI: 10.1097/scs.0000000000004628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/01/2018] [Indexed: 11/26/2022] Open
Abstract
In 1986, Altemir first reported the use of submental intubation to avoid tracheotomy in patients with panfacial and midfacial fractures for whom intermaxillary fixation is necessary, but orotracheal and nasotracheal intubations are not recommended. This novel technique allowed intraoperative access to perform dental occlusion and reconstruction of the nasal pyramid in patients with skull base fractures. Herein, we describe a refined technique based on Altemir's original procedure. Seven male patients with panfacial fractures underwent submental intubation using our refined technique. The technique was developed after encountering a technical error with Altemir's original procedure. In this new technique, we employed a 2-0 silk suture guide to allow the passage of both the endotracheal and cuff-inflation tubes through the same tunnel created from the oral cavity to the submental area. The success rate of the refined technique was 100%, and there were no intraoperative or postoperative complications. There was 20 seconds of ventilation outage time in total. Endotracheal and cuff-inflation tubes were easily and quickly passed through the same submental tunnel. Our refined technique is simple, easy, safe, fast, inexpensive, and does not require specific materials. Submental scars were smaller and relatively inconspicuous in this study, compared to those reportedly associated with other modified techniques.
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In vivo reprogramming of wound-resident cells generates skin epithelial tissue. Nature 2018; 561:243-247. [PMID: 30185909 DOI: 10.1038/s41586-018-0477-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 08/03/2018] [Indexed: 01/07/2023]
Abstract
Large cutaneous ulcers are, in severe cases, life threatening1,2. As the global population ages, non-healing ulcers are becoming increasingly common1,2. Treatment currently requires the transplantation of pre-existing epithelial components, such as skin grafts, or therapy using cultured cells2. Here we develop alternative supplies of epidermal coverage for the treatment of these kinds of wounds. We generated expandable epithelial tissues using in vivo reprogramming of wound-resident mesenchymal cells. Transduction of four transcription factors that specify the skin-cell lineage enabled efficient and rapid de novo epithelialization from the surface of cutaneous ulcers in mice. Our findings may provide a new therapeutic avenue for treating skin wounds and could be extended to other disease situations in which tissue homeostasis and repair are impaired.
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OnabotulinumtoxinA (Botox) in the Treatment of Crow's Feet Lines in Japanese Subjects. Aesthetic Plast Surg 2017; 41:1186-1197. [PMID: 28733805 PMCID: PMC5605642 DOI: 10.1007/s00266-017-0844-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/28/2017] [Indexed: 11/21/2022]
Abstract
Background This study evaluated the safety and efficacy of onabotulinumtoxinA in Japanese subjects with crow’s feet lines (CFL). Methods This phase 3, multicenter, double-blind, randomized study included 2 treatment periods: 6-month placebo-controlled period followed by a 7-month open-label period. In period 1, subjects with moderate to severe CFL received onabotulinumtoxinA 24 U (n = 104) or 12 U (n = 99), or placebo (n = 97). In period 2, placebo subjects switched to onabotulinumtoxinA 24 U or 12 U (double-blind dose). Up to 5 total treatments were permitted for subjects meeting re-treatment criteria. The primary efficacy measure was the proportion of investigator-assessed responders (achieving CFL severity of none or mild at maximum smile using the Facial Wrinkle Scale with Asian Photonumeric Guide [FWS-A] at day 30 of treatment 1). Additional endpoints included other responders (achieving at least 1-grade improvement at maximum smile and at rest using the FWS-A at day 30), responders at other time points, duration of effect, subject-reported outcomes, and safety. Results All efficacy endpoints were met. At day 30, the proportion of subjects achieving none or mild severity at maximum smile was significantly greater (P < 0.001) in the onabotulinumtoxinA 24 and 12 U groups (68.3 and 56.6%, respectively) compared with the placebo group (8.2%). Efficacy results were consistent over repeated treatments, and subjects’ self-assessed outcomes were similar to investigator-assessed results. Conclusions Treatment with onabotulinumtoxinA 24 and 12 U improved the appearance of CFL in Japanese subjects and was well tolerated, with no new safety findings. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Efficient isolation and culture of endothelial cells from venous malformation using the Rho-associated protein kinase inhibitor Y27632. J Plast Surg Hand Surg 2017; 52:60-66. [PMID: 28554252 DOI: 10.1080/2000656x.2017.1330754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The investigation of primary cells from a pathological lesion can elucidate the pathogenesis of diseases, but, for vascular malformations in humans, such basic research is still stagnant, because the isolation and culture of vascular endothelial cells (ECs) is very difficult. To obtain a sufficient amount of ECs from venous malformation (VM) this study took advantage of a Rho-associated protein kinase inhibitor, Y27632, which had been used for the efficient procurement of primary keratinocytes. METHODS ECs were isolated and cultured from VM lesions, combining enzymatic digestion, cell sorting, and Y27632. The proliferative effect of Y27632 on ECs was examined by proliferation assay. The characteristics of the ECs cultured with Y27632 by EC marker expression and tube formation assay were also examined. RESULTS Y27632 enhanced the proliferation of ECs and elongated the senescence of the cells. The expression of specific markers of ECs such as von Willebrand factor, endothelin-1, and VE-cadherin, was confirmed in the cells cultured with Y27632. In a tube formation assay, the cells cultured with Y27632 showed higher tube formation ability compared to the cells cultured without Y27632, indicating that Y27632 promoted the angiogenic capability of ECs. CONCLUSIONS The protocol using Y27632 offers a new EC culture methodology and provides a new option for the biological investigation of vascular malformations. This new method will contribute to other types of vascular biology research as well.
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Preoperative asymmetry is a risk factor for reoperation in involutional blepharoptosis. J Plast Reconstr Aesthet Surg 2017; 70:686-691. [DOI: 10.1016/j.bjps.2017.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/31/2017] [Indexed: 11/17/2022]
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Onabotulinumtoxina in the treatment of crow’s feet lines in Japanese subjects. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Safety and efficacy of onabotulinumtoxinA in the treatment of crow’s feet lines and glabellar lines in Japanese subjects. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fingertip Replantation with the Use of a Long Vein Graft: Training Young Surgeons in a Feasible Technique to Maintain Optimal Results. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2016. [DOI: 10.1055/s-0036-1587339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Toxic Shock Syndrome Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) After Expander-Based Breast Reconstruction. EPLASTY 2016; 16:e2. [PMID: 26813150 PMCID: PMC4711340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Toxic shock syndrome is a rare but life-threatening complication after plastic surgery procedures. METHODS We experienced 2 cases of toxic shock syndrome after expander-based breast reconstruction caused by methicillin-resistant Staphylococcus aureus. RESULTS The first patient took a severe clinical course due to the delayed diagnosis and treatment, and the second patient recovered rapidly after the early diagnosis and treatment based on our experience of the first case. Fever, rash, and gastrointestinal symptoms (diarrhea and/or vomiting) were characteristic and important for the early diagnosis of toxic shock syndrome. CONCLUSIONS Considering the increased prevalence of methicillin-resistant Staphylococcus aureus, we should suspect methicillin-resistant Staphylococcus aureus in cases of toxic shock syndrome that occur postoperatively, and the empiric administration of vancomycin should be initiated in such cases.
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Examination of tissue oxygen saturation (StO2) changes associated with vascular pedicle occlusion in a rat Island flap model using near-Infrared spectroscopy. Microsurgery 2015; 35:393-8. [PMID: 25639265 DOI: 10.1002/micr.22385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to perform continuous StO(2) monitoring of rat island flaps during pedicle vessel occlusion using near-infrared spectroscopy (NIRS) in order to collect experimental data for StO(2) flap monitoring under optimized conditions. MATERIALS AND METHODS Twenty rats were used in this study. The 3 × 3 cm(2) epigastric skin island flaps were elevated on either side. The animals were randomly assigned to two groups; an arterial occlusion group (n = 10) and a venous occlusion group (n = 10). The StO(2) values of the flaps were observed for over 30 min for the pedicle artery or venous occlusion, followed by an additional 30 min release. RESULTS The baseline StO(2) value was 78.4% ± 3.2% in the arterial occlusion group, compared to 78.5% ± 5.8% in the venous occlusion group, with no significant differences (P > 0.05). The StO(2) values decreased immediately after arterial occlusion, whereas a temporal StO(2) increase was initially observed after venous occlusion, followed by a StO(2) decrease. The StO(2) values decreased 27.3% ± 7.1% after arterial occlusion and 28.4% ± 19.1% after venous occlusion at 30 min after pedicle vessel clamping (P > 0.05). The StO(2) values were 0.4% ± 5.8% lower than baseline 30 min after arterial release (P > 0.05), while 18.9% ± 11.3% lower than baseline 30 min after venous release (P < 0.01). CONCLUSION NIRS can be used to indicate StO(2) changes in flaps with the pedicle vessel occlusion and differentiate between pedicle artery and vein occlusion. Further investigations are needed to obtain definitive evidence associated with predicting the degree of flap viability and determine the practical use of this technique.
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Erratum to: Bimatoprost for Eyelash Growth in Japanese Subjects: Two Multicenter Controlled Studies. Aesthetic Plast Surg 2014. [PMCID: PMC4643599 DOI: 10.1007/s00266-014-0390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bimatoprost for eyelash growth in Japanese subjects: two multicenter controlled studies. Aesthetic Plast Surg 2014; 38:451-60. [PMID: 24643895 PMCID: PMC4003339 DOI: 10.1007/s00266-014-0293-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bimatoprost 0.03% has enhanced eyelash prominence in clinical trials enrolling mostly Caucasian subjects. The studies described in this report evaluated the efficacy and safety of bimatoprost in Japanese subjects with idiopathic and chemotherapy-induced eyelash hypotrichosis. METHODS In two multicenter, double-masked, randomized, parallel-group studies (study 1: n=173 [idiopathic]; study 2: n=36 [chemotherapy-induced]), subjects received bimatoprost 0.03% or vehicle applied once daily to the upper eyelid margins. The primary efficacy measure was eyelash prominence measured by Global Eyelash Assessment (GEA) scores. Additional measures were eyelash length, thickness, and darkness, assessed by digital image analysis, and patient satisfaction (Eyelash Satisfaction Questionnaire-9). Safety assessments included adverse-event monitoring and ophthalmic examinations. RESULTS Significantly more bimatoprost-treated subjects had at least a one-grade improvement in GEA score from baseline to month 4 compared with vehicle in study 1 (77.3 vs 17.6%; P<0.001) and study 2 (88.9 vs 27.8%; P<0.001). Bimatoprost-treated subjects had significantly greater increases in eyelash length, thickness, and darkness at the primary time point (month 4 in both studies; all P<0.001, study 1; P≤0.04, study 2). The bimatoprost group showed greater subject satisfaction in both studies. The incidence of adverse events was similar in the two groups. Ophthalmic examination showed slightly greater mean reductions in intraocular pressure (IOP) with bimatoprost than with vehicle, and the reductions were within the normal range for daily IOP fluctuations. CONCLUSION Bimatoprost 0.03% was shown to be effective and safe in these studies of Japanese subjects with eyelash hypotrichosis. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Reinnervation of segmented latissimus dorsi muscle with the distal stump of the thoracodorsal nerve: A preliminary experimental study in rats. Microsurgery 2013; 33:545-50. [PMID: 24038515 DOI: 10.1002/micr.22164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/25/2013] [Accepted: 07/08/2013] [Indexed: 11/10/2022]
Abstract
To date, nerve stumps have been dissected at the proximal side of the donor muscle for reinnervation of the muscle in free neurovascular muscle transfer. Herein, we examined the use of the distal thoracodorsal nerve, dissected from the muscle belly at the distal side of the latissimus dorsi muscle, for the reinnervation of muscle. The rat right latissimus dorsi muscle was employed as the model for our study. Twenty Wistar rats were used in this study. A rectangular muscle segment was dissected with the distal stump of dominant thoracodorsal nerve. After rotation of muscle, the distal nerve stump was sutured to a severed proximal recipient thoracodorsal nerve (n = 5). The degree of reinnervation through the distal nerve stump was compared with control groups that received proximal-to-proximal nerve sutures (n = 5), nerves that were not severed (n = 5), and severed nerves that were not sutured (n = 5) using electrophysiological, histological, and muscular volume assessments. Reinnervation of the distal nerve stump was confirmed by the contraction of the muscle following electrical stimulation and electromyography. Crossing of axons into motor endplates was confirmed by histology. Results of these assays were similar to that of the proximal nerve suture group. The volume of muscle in the distal nerve suture group was not significant different from that of the proximal nerve suture group (P = 0.63). It was demonstrated that the distal stump of the thoracodorsal nerve can be used to innervate segmented latissimus dorsi muscle. This novel procedure for the reinnervation of transplanted muscle deserves further investigations.
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Unidirectional spin-wave heat conveyer. NATURE MATERIALS 2013; 12:549-553. [PMID: 23603850 DOI: 10.1038/nmat3628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/12/2013] [Indexed: 06/02/2023]
Abstract
When energy is introduced into a region of matter, it heats up and the local temperature increases. This energy spontaneously diffuses away from the heated region. In general, heat should flow from warmer to cooler regions and it is not possible to externally change the direction of heat conduction. Here we show a magnetically controllable heat flow caused by a spin-wave current. The direction of the flow can be switched by applying a magnetic field. When microwave energy is applied to a region of ferrimagnetic Y3Fe5O12, an end of the magnet far from this region is found to be heated in a controlled manner and a negative temperature gradient towards it is formed. This is due to unidirectional energy transfer by the excitation of spin-wave modes without time-reversal symmetry and to the conversion of spin waves into heat. When a Y3Fe5O12 film with low damping coefficients is used, spin waves are observed to emit heat at the sample end up to 10 mm away from the excitation source. The magnetically controlled remote heating we observe is directly applicable to the fabrication of a heat-flow controller.
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Silicone sheet containing all-trans retinoic acid and hydroquinone for the treatment of epidermal melanosis. Dermatol Surg 2013; 39:1237-42. [PMID: 23577722 DOI: 10.1111/dsu.12206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although bleaching treatment using all-trans retinoic acid (RA) and hydroquinone (HQ) improves epidermal melanosis, the application of two medications and the irritant dermatitis induced by RA inconvenience patients. To overcome these problems, we developed a silicone sheet containing RA and HQ. OBJECTIVE To compare the efficacy of a silicone sheet containing RA and HQ with that of conventional bleaching treatment. METHOD Silicone sheets containing 1% RA and 5% HQ were applied at night during the bleaching phase of 4 weeks, followed by application of sheets containing 5% HQ during the healing phase of 4 weeks. Hemifacial epidermal melanosis, for which the sheets were applied, was compared with a contralateral face which was treated conventionally using RA and HQ. Twenty-four Japanese women who were enrolled in this study and followed up for more than 6 months were analyzed. RESULTS RA/HQ sheets improved epidermal melanosis, as did the conventional bleaching method, but irritant dermatitis occurred less in patients treated using silicone sheets. CONCLUSION RA/HQ sheets, which are easily applied to face skin, can improve epidermal melanosis to the same extent as conventional bleaching.
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Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis. J Plast Reconstr Aesthet Surg 2013; 66:991-5. [PMID: 23283482 DOI: 10.1016/j.bjps.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/20/2012] [Accepted: 12/06/2012] [Indexed: 11/25/2022]
Abstract
We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow. To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.
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Recent advances in reconstructive surgery: head and neck reconstruction. Int J Clin Oncol 2012; 18:561-5. [DOI: 10.1007/s10147-012-0513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Indexed: 10/27/2022]
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Abstract
Clinically, wounds on the face tend to heal with less scarring than those on the trunk, but the causes of this difference have not been clarified. Fibroblasts obtained from different parts of the body are known to show different properties. To investigate whether the characteristic properties of facial and trunk wound healing are caused by differences in local fibroblasts, we comparatively analyzed the functional properties of superficial and deep dermal fibroblasts obtained from the facial and trunk skin of seven individuals, with an emphasis on tendency for fibrosis. Proliferation kinetics and mRNA and protein expression of 11 fibrosis-associated factors were investigated. The proliferation kinetics of facial and trunk fibroblasts were identical, but the expression and production levels of profibrotic factors, such as extracellular matrix, transforming growth factor-β1, and connective tissue growth factor mRNA, were lower in facial fibroblasts when compared with trunk fibroblasts, while the expression of antifibrotic factors, such as collagenase, basic fibroblast growth factor, and hepatocyte growth factor, showed no clear trends. The differences in functional properties of facial and trunk dermal fibroblasts were consistent with the clinical tendencies of healing of facial and trunk wounds. Thus, the differences between facial and trunk scarring are at least partly related to the intrinsic nature of the local dermal fibroblasts.
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Fifteen-year survey of one-stage latissimus dorsi muscle transfer for treatment of longstanding facial paralysis. J Plast Reconstr Aesthet Surg 2012; 66:29-36. [PMID: 22960057 DOI: 10.1016/j.bjps.2012.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurovascular free muscle transfer is one of the main reconstructive options for established or long-standing facial paralysis. The two-stage gracilis muscle transfer combined with the cross-face nerve graft (two-stage method) has been supplanted by one-stage reconstruction using the latissimus dorsi muscle (LD) at our institution. This study retrospectively evaluated the results of one-stage LD transfer. METHODS Between September 1993 and December 2008, 344 patients (133 males, 211 females; age range, 5-75 years) with unilateral facial paralysis underwent 351 one-stage LD transfers. Patients were evaluated with a custom grading scale. Differences in grading scale score were compared according to age, past surgical history and the duration from operation to neuromuscular recovery. RESULTS Contraction of the transferred muscle was recognised in 305 (87.0%) transfers. The duration until neuromuscular recovery ranged from 3 to 16 months (average ± standard deviation: 6.48 ± 1.92 months). The grading scale was significantly lower in middle-age group than in younger and elder groups (P < 0.01). Duration until neuromuscular recovery was significantly different when comparing the younger group and the oldest group. There was no difference in grading scale score or in duration until neuromuscular recovery when comparing the patients with a past surgical history and those without. The grading scale negatively correlated with the duration until neuromuscular recovery. CONCLUSIONS The results are consistent and statistical analysis revealed the versatility of the one-stage LD transfer. Although we believe the two-stage method is still a good option for facial reanimation, the one-stage method is advantageous regarding the shorter period of recovery and little donor-site morbidity.
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[Surgical treatment and topical wound management for diabetic foot]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2012; 70 Suppl 5:476-480. [PMID: 23156442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Detrimental influences of intraluminally-administered sclerotic agents on surrounding tissues and peripheral nerves: an experimental study. J Plast Surg Hand Surg 2012; 46:145-51. [PMID: 22686430 PMCID: PMC3469215 DOI: 10.3109/2000656x.2012.675881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The minimally-invasive nature of sclerotherapy makes it one of the first treatment options for venous malformations, although treatment-related complications, such as peripheral nerve paralysis, have been reported in some clinical cases. However, no studies of the aetiology of the detrimental effects of intraluminally-administered sclerotic agents on the surrounding tissues, including the peripheral nerves, have yet been published. This study therefore investigated the influences of intraluminally-administered sclerotic agents on the tissues surrounding the injection site using a newly-developed rat femoral vein model. Using this model, the effects of absolute ethanol, 5% ethanolamine oleate, and 1% polidocanol were compared histologically with those of normal saline controls. Fluorescein isothiocyanate-conjugated agents were administered and the leakage of sclerotic agents through the venous wall was evaluated by fluorescence microscopy. Damage to the adjacent femoral nerve was quantitatively evaluated by counting the numbers of axons in cross-sections. All the sclerotic agents caused vascular wall injuries and leakage into the surrounding tissues. The number of axons in the femoral nerve was significantly reduced following administration of absolute ethanol or 5% ethanolamine oleate, compared with normal saline. The results of this study suggest that sclerotic agents commonly leak out the vascular lumen, and some agents can cause adjacent nerve injury. It is important to be aware of this type of complication of sclerotherapy for venous malformations when selecting appropriate therapeutic interventions.
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Abstract
Dermal fibroblasts (DF) obtained from the superficial dermal layer and those from the deep dermal layer have different cellular functions. These differences are often associated with excessive scarring; they also influence early wound healing. We therefore investigated the differences between superficial and deep dermal fibroblasts with special emphasis on their contractile properties, and ability to produce connective tissue. We investigated their proliferation kinetics, ability to contract collagen lattices, and chronological mRNA expression of eight genes associated with wound healing. To estimate the changes in the differences between them during the early phase of wound healing, we investigated mRNA expression in bFGF supplemented medium because bFGF is a representative cytokine that is familiar to clinicians. Superficial DF proliferate faster than deep DF in culture, whereas deep DF are better at contracting collagen lattices than superficial ones. In realtime analysis of polymerase chain reaction, the expression of type I and III collagen, fibronectin, TGF β1 and β3, and connective tissue growth factor were higher in deep DF than in superficial DF, while the expression of TGF β2 was higher in superficial DF. After bFGF supplementation, the relative dominance of mRNA expression between superficial and deep DF remained constant except for the expression of collagenase. According to our analysis, deep DF are superior to superficial DF at promoting wound healing (particularly contraction and production of connective tissue). The intradermal distribution of DF is appropriate for efficient wound healing.
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Extravascular injection of sclerotic agents does not affect vessels in the rat: experimental implications for percutaneous sclerotherapy of arteriovenous malformations. Eur J Vasc Endovasc Surg 2012; 44:73-6. [PMID: 22546640 DOI: 10.1016/j.ejvs.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Sclerotherapy is useful for the treatment of arteriovenous vascular malformations. However, intravascular administration of sclerotic agents into small arteriovenous niduses is often difficult. Extravascular administration of sclerotic agents causes reduction of vascular flow on Doppler echo during clinical sclerotherapy. Therefore, we aimed to investigate whether the extravascular injection of sclerotic agents affects tiny vessels. DESIGN Animal study. MATERIALS The effect of extravascular injection of sclerotic agents on vessels was investigated using rat femoral and superficial inferior epigastric vessels. METHODS After surgical exposure of vessels, absolute ethanol, 5% ethanolamine oleate and 3% polidocanol were injected into perivascular surrounding tissues, and their effect on vessels was evaluated after 14 days using histology and coloured silicone rubber injection. RESULTS The integrity of the vascular lumen, endothelial cells and vascular patency were not affected by injection of sclerotic agents. CONCLUSIONS Attenuation of vascular flow of an arteriovenous shunt after extravascular injection of sclerotic agents is transient and/or trivial and does not cause disruption of vessels. Therefore, sclerotic agents should be delivered to obtain sufficient destruction of arteriovenous malformation lesions and blood flow.
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Continuous generation of spinmotive force in a patterned ferromagnetic film. PHYSICAL REVIEW LETTERS 2011; 107:236602. [PMID: 22182112 DOI: 10.1103/physrevlett.107.236602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Indexed: 05/31/2023]
Abstract
We study, both experimentally and theoretically, the generation of a dc spinmotive force. By exciting a ferromagnetic resonance of a comb-shaped ferromagnetic thin film, a continuous spinmotive force is generated. Experimental results are well reproduced by theoretical calculations, offering a quantitative and microscopic understanding of this spinmotive force.
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Standing nail deformity of the great toes with multiple brachymetacarpia and brachyphalangia of the hand. J Plast Surg Hand Surg 2011; 44:260-4. [PMID: 21446825 DOI: 10.3109/02844311003679646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the surgical treatment of two patients who had rare complex anomalies of the foot and hand. The nails of their great toes curved dorsally as if they were standing on the nail matrix. They had difficulty in flexing the interphalangeal joint of the great toe. Their hands showed multiple and sporadic brachymetacarpia and brachyphalangia.
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Cyclic stretch induces upregulation of endothelin-1 with keratinocytes in vitro: Possible role in mechanical stress-induced hyperpigmentation. Biochem Biophys Res Commun 2011; 409:103-7. [DOI: 10.1016/j.bbrc.2011.04.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 04/24/2011] [Indexed: 11/28/2022]
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Latissimus dorsi flaps oriented on the lateral intercostal artery perforators: anatomical study and application in autologous breast reconstruction. J Plast Surg Hand Surg 2011; 45:58-65. [PMID: 21504274 DOI: 10.3109/2000656x.2011.569188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous breast reconstruction with the latissimus dorsi (LD) musculocutaneous flap has several problems including scarcity of tissue and postoperative atrophy of muscles. We report a modification of the flap based on a re-evaluation of the intramuscular and perforating vascular anatomy focused on the intercostal vascular system. Our anatomical study confirmed the following technical improvements: splitting of the muscle oriented along the 10(th) posterior intercostal artery; siting the axis of the flap on the centre of the 10(th) lateral intercostal artery perforator to obtain ample subcutaneous fat cranial to the iliac crest; and enclosing the dermoadipofascial flap around the split muscular pedicle. These flaps were used in 12 patients who required reconstruction without implants. The results showed a consistent volume of tissue and shape, and less donor site morbidity. Our modifications can be used to improve the three-dimensional potential of the LD flap in autologous breast reconstruction.
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Usefulness of microscope-based ICG videoangiography for detection of the dominant drainage vein in fingertip replantation. J Plast Reconstr Aesthet Surg 2010; 63:2200-1. [DOI: 10.1016/j.bjps.2010.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 03/29/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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Ileal patch graft used to repair a bladder injured during repair of an abdominal wall hernia. J Plast Surg Hand Surg 2010; 44:66-8. [DOI: 10.3109/02844310801939926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: Clinical and experimental studies. J Plast Surg Hand Surg 2010; 44:75-87. [DOI: 10.3109/02844310903569725] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg 2010; 63:1196-201. [DOI: 10.1016/j.bjps.2009.05.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 05/01/2009] [Accepted: 05/27/2009] [Indexed: 11/15/2022]
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Reply to discussion by Dr. M. Kane. Aesthetic Plast Surg 2010; 34:401-3. [PMID: 20186416 DOI: 10.1007/s00266-009-9400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
We report the cases of two patients who had pronounced stenosis of the lower part of the vagina after vaginal reconstruction for congenital vaginal aplasia and hypoplasia. Bilateral pudendal thigh flaps were used for secondary reconstruction, and gave satisfactory results with no signs of recurrence or severe scarring at the donor site.
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Validity of the orthopedic POSSUM scoring system for the assessment of postoperative mortality in patients with pressure ulcers. Wound Repair Regen 2009; 17:312-7. [PMID: 19660038 DOI: 10.1111/j.1524-475x.2009.00486.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O-POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness-of-fitness testing with the Hosmer-Lemeshow chi(2) test for logistic regression modeling. POSSUM and O-POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O-POSSUM was also confirmed. O-POSSUM was superior to POSSUM in both analyses. O-POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O-POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.
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Abstract
Breast enhancement with artificial implants is one of the most frequently performed cosmetic surgeries but is associated with various complications, such as capsular contracture, that lead to implant removal or replacement at a relatively high rate. For replacement, we used transplantation of progenitor-supplemented adipose tissue (cell-assisted lipotransfer; CAL) in 15 patients. The stromal vascular fraction containing adipose tissue progenitor cells obtained from liposuction aspirates was used to enrich for progenitor cells in the graft. Overall, clinical results were very satisfactory, and no major abnormalities were seen on magnetic resonance imaging or mammogram after 12 months. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Surviving fat volume at 12 months was 155 +/- 50 mL (Right; mean +/- SD) and 143 +/- 80 mL (Left) following lipoinjection from an initial mean of 264 mL. These preliminary results suggest that CAL is a suitable methodology for the replacement of breast implants.
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An open-label, randomized, 64-week study repeating 10- and 20-U doses of botulinum toxin type A for treatment of glabellar lines in Japanese subjects. Int J Dermatol 2009; 48:768-76. [PMID: 19490208 DOI: 10.1111/j.1365-4632.2009.04071.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeated botulinum toxin type A (BoNTA) treatment typifies clinical practice. The long-term safety and efficacy should be demonstrated in diverse populations. OBJECTIVE To evaluate the long-term efficacy and safety of repeated BoNTA treatments of glabellar lines in Japanese subjects. METHODS This randomized, multicenter, 64-week, open-label study of 363 subjects compared 10-U and 20-U of BoNTA for up to five treatments. The endpoints were the physician ratings of line severity and duration of efficacy, and subject ratings of line improvement and satisfaction. Safety assessments included adverse events, laboratory tests, and vital signs. Tests for neutralizing antibodies were conducted. RESULTS Peak response rates (> 90%, maximal contraction) were observed at week 1 (treatment 1) and week 4 (treatments 2-5). The duration did not change with repeated treatments and was longer in the 20-U than in the 10-U group (17.1 +/- 6.58 weeks vs. 14.8 +/- 5.38 weeks; P < 0.001). Subject-assessed improvement ratings, 4 weeks' post-treatment, were significantly higher ( P < or = 0.05) in the 20-U group. Overall satisfaction ratings were significantly higher in the 20-U group ( P < 0.001). No serious adverse events occurred. Neutralizing antibodies were not detected. CONCLUSION Repeated treatments of glabellar lines with 10 or 20 U of BoNTA provided long-term safety and efficacy in Japanese subjects. The 20-U dose provided longer duration, greater subject satisfaction, and greater subject-rated improvement. The 20-U dose was identified as optimal for improving glabellar lines in Japanese subjects. These results apply only to the formulation of BoNTA used in this study.
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Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos. J Plast Reconstr Aesthet Surg 2009; 62:1187-95. [DOI: 10.1016/j.bjps.2007.12.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 10/26/2007] [Accepted: 12/18/2007] [Indexed: 11/30/2022]
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Clinical evaluation and morbidity of 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984–2003. ACTA ACUST UNITED AC 2009; 40:148-52. [PMID: 16687334 DOI: 10.1080/02844310600652894] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated 192 patients who had 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984-2003. The main postoperative complications were thrombosis, leaks, and stenosis. In this series, the rate of thrombosis was 7/201 (3.5%), that of leaks was 17/201 (8.5%), and that of stenosis was 25/201 (13.0%). When we assessed the relation between pre-existing conditions, surgical techniques, and these complications, we found only one significant difference: a history of alcohol misuse was associated with a reduction in the incidence of thrombosis. The surgical techniques did not affect the development of leaks or stenosis, which means that a complicated surgical technique is unnecessary.
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Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck. ACTA ACUST UNITED AC 2009; 43:126-36. [DOI: 10.1080/02844310902840296] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thermal effect of illumination on microsurgical transfer of free flaps: Experimental study and clinical implications. ACTA ACUST UNITED AC 2009; 42:58-66. [DOI: 10.1080/02844310801924266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
A distally-based sural flap was used in four patients with soft-tissue defects in the lower leg and foot. All flaps survived completely without venous congestion. To make safe use of this flap it is important to include both the sural nerve and the lesser saphenous vein in the flap. It also seems to be important to include the surrounding fatty tissues in the pedicle and to avoid compression at the point of its angulation. This flap has the advantages that it is quick and easy to raise, and the reconstruction can be done in a single operation. It is unnecessary to sacrifice the major arteries in the leg, although the sural nerve must be sacrificed. In general this type of reconstruction of the lower leg and foot is beneficial in cases similar to those presented here.
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Reconstruction of maxillectomy defects with free flaps - comparison of immediate and delayed reconstruction: A retrospective analysis of 51 cases. ACTA ACUST UNITED AC 2009; 41:14-21. [PMID: 17484180 DOI: 10.1080/02844310601088262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To establish a standard reconstructive material we compared outcomes after immediate and delayed reconstruction. Of the 21 patients who had immediate reconstruction, six patients had upper horizontal plane reconstruction. All bone grafts survived without infection or absorption. Of the 30 patients who had delayed reconstruction, 22 patients had upper horizontal plane reconstruction, with vascularised bone in 14 patients, non-vascularised bone or cartilage in five patients, and hydroxyapatite bone block in three. Postoperative infections developed in three of four patients for whom costal cartilage was used, and in all three patients for whom hydroxyapatite blocks were used. Non-vascularised bone or cartilage grafts are preferable for immediate reconstruction because of their technical simplicity. Vascularised bone grafts or osteocutaneous flaps are preferable for delayed reconstruction, however, as in most cases the operating field is contaminated by bacterial.
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Orthopaedic POSSUM scoring system: An assessment of the risk of debridement in patients with pressure sores. ACTA ACUST UNITED AC 2009; 40:214-8. [PMID: 16911994 DOI: 10.1080/02844310600759665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We hypothesised that the implementation of a validated method of audit, the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM), would be useful in the evaluation of the risks of debridement in bedridden patients with pressure ulcers. With the orthopaedic version of POSSUM (O-POSSUM), physiological data and an operative profile are scored to predict mortality for 30 days postoperatively. Fourteen cases were analysed retrospectively. The difference in predicted mortality was compared with those who died and those who survived. The mean (SD) predicted mortality among those who died was 47 (16)%, and among those who lived was 18 (14)%. Those who died were classified as a relatively high risk group, and the values differed significantly (p=0.01). O-POSSUM may be helpful in audit.
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Effectiveness of short-contact topical tretinoin in promoting wound healing in db/db mice. ACTA ACUST UNITED AC 2009; 40:329-34. [PMID: 17118897 DOI: 10.1080/02844310601012007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We have investigated the effects of short-contact topical application of tretinoin using 16 male db/db mice by creating two full-thickness wounds on the skin of the back. A 0.1% tretinoin aqueous gel was applied to one wound for five minutes daily for five successive days while only aqueous gel was applied to the other (control). The mean (SD) percentage surface area unhealed before and after treatment were 0.88 (0.3) and 0.64 (0.15). In tretinoin-treated mice and non-treated mice (controls), the mean (SD) thicknesses of granulation were 1.383 (697) micro m and 683 (413) micro m, the density of capillary vessels in granulation was 12.2 (5.5)% and 5.7 (3.9)%, respectively. Differences between the two groups were significant for each variable. Wound healing was accelerated with short-contact topical application of tretinoin in db/db mice.
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Abstract
Vasodilating effects of topically applied lignocaine, papaverine, and chlorpromazine were compared in rats, using a PO2 tissue perfusion monitor and histological analysis. The period of vasospasm was significantly shorter with the use of either 10% lignocaine, 2% papaverine, or 0.25% chlorpromazine than with the use of 2% lignocaine. Although our study found that no particular vasodilating agent was more effective than the others, we did find that although lignocaine 2% and 5% might not be able to fully relieve vasospasm, 10% lignocaine, 2% papaverine, or 0.25% chlorpromazine are recommended to relieve vasospasm clinically as they do not injure the arterial wall.
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