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Zhang J, Chen A, Liu Y, Herrler T, Yu B, Fang L, Zhu F, Li X, Dai C, Wei J. Lateral Osteotomy for the Surgical Treatment of the Asian Wide Nose. J Craniofac Surg 2023; 34:2475-2478. [PMID: 37639666 DOI: 10.1097/scs.0000000000009615] [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] [Received: 08/01/2022] [Accepted: 05/20/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Narrowing of the nasal dorsum allows for a more pleasing moderate width. We here introduce a lateral osteotomy technique that is less traumatic and easier to perform than commonly used procedures in Asian and share our experiences in the application. METHODS After a blunt dissection of the periosteum at the mucosal side of the nasal bone, all patients who underwent treatment using nasal osteotomy at the level of the maxillary nasal process were retrospectively analyzed. The bony nasal width, height, and the nasal lateral wall slope of bone before and after surgery were measured. The postoperative outcomes, complications, and patient satisfaction were analyzed and evaluated. RESULTS From January 2008 to January 2018, nasal dorsum narrowing was implemented in 106 patients. On average, nasal width was significantly decreased and no change in nose height after the nasal osteotomy. The nasal width was significantly reduced by 8.51 ± 2.16 mm compared with before surgery. The slope of the nasal lateral wall was reduced from the mean of 155.0 ± 7.63-degree preoperation to the mean of 135.25 ± 7.50-degree postoperation. The follow-up period ranged from 6 months to 4 years, with an average of 10.3 months. CONCLUSIONS This type of nasal bone base osteotomy is a simple and feasible method for the treatment of wide Asian noses with a high patient acceptance and stable postoperative results. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jinsong Zhang
- Department of Plastic Surgery, the Ninth Hospital of Shanghai Jiaotong, University School of Medicine, Shanghai, China
- Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China
| | - Aihong Chen
- Department of Plastic Surgery, the Ninth Hospital of Shanghai Jiaotong, University School of Medicine, Shanghai, China
| | - Ye Liu
- Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China
| | - Tanja Herrler
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Baofu Yu
- Department of Plastic Surgery, the Ninth Hospital of Shanghai Jiaotong, University School of Medicine, Shanghai, China
| | - Linsen Fang
- Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China
| | - Fei Zhu
- Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China
| | - Xiaojing Li
- Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China
| | - Chuanchang Dai
- Department of Plastic Surgery, the Ninth Hospital of Shanghai Jiaotong, University School of Medicine, Shanghai, China
| | - Jiao Wei
- Department of Plastic Surgery, the Ninth Hospital of Shanghai Jiaotong, University School of Medicine, Shanghai, China
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Wei J, Baptista-Hon DT, Wang Z, Li G, Herrler T, Dai C, Liu K, Yu B, Chen X, Yang M, Han D, Gao Y, Huang RL, Guo L, Zhang K, Li Q. Bioengineered human tissue regeneration and repair using endogenous stem cells. Cell Rep Med 2023; 4:101156. [PMID: 37586324 PMCID: PMC10439273 DOI: 10.1016/j.xcrm.2023.101156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/18/2022] [Revised: 04/30/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
We describe a general approach to produce bone and cartilaginous structures utilizing the self-regenerative capacity of the intercostal rib space to treat a deformed metacarpophalangeal joint and microtia. Anatomically precise 3D molds were positioned on the perichondro-periosteal or perichondral flap of the intercostal rib without any other exogenous elements. We find anatomically precise metacarpal head and auricle constructs within the implanted molds after 6 months. The regenerated metacarpal head was used successfully to surgically repair the deformed metacarpophalangeal joint. Auricle reconstructive surgery in five unilateral microtia patients yielded good aesthetic and functional results. Long-term follow-up revealed the auricle constructs were safe and stable. Single-cell RNA sequencing analysis reveal early infiltration of a cell population consistent with mesenchymal stem cells, followed by IL-8-stimulated differentiation into chondrocytes. Our results demonstrate the repair and regeneration of tissues using only endogenous factors and a viable treatment strategy for bone and tissue structural defects.
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Affiliation(s)
- Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Daniel T Baptista-Hon
- University Hospital and Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology, Taipa 999078, Macau, China; Zhuhai International Eye Center, Zhuhai People's Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Technology, Zhuhai, Guangdong, China; Department of Bioinformatics and AI, Guangzhou Laboratory, Guangzhou, China; School of Medicine, University of Dundee, Dundee, UK
| | - Zi Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Gen Li
- Department of Bioinformatics and AI, Guangzhou Laboratory, Guangzhou, China; Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tanja Herrler
- Department of Hand Surgery, Trauma Center Murnau, 82418 Murnau, Germany
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Baofu Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiaoxue Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Mei Yang
- Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yuanxu Gao
- University Hospital and Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lifei Guo
- Division of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, VT 01808, USA.
| | - Kang Zhang
- University Hospital and Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology, Taipa 999078, Macau, China; Zhuhai International Eye Center, Zhuhai People's Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Technology, Zhuhai, Guangdong, China; Department of Bioinformatics and AI, Guangzhou Laboratory, Guangzhou, China.
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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Wei J, Herrler T, Yu B, Chen X, Wang Z, Dong L, Chen A, Chen Q, Li Q, Dai C. Reconstruction of the shortened columella in mild bifid nose using a propeller flap based on the nasal columella artery. J Plast Reconstr Aesthet Surg 2023; 82:152-158. [PMID: 37167716 DOI: 10.1016/j.bjps.2023.02.011] [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: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Bifid nose generally appears short columellar and lacks the nasal tip. Here, we describe a surgical correction technique for correcting the short columellar and nasal tip of bifid nose using a local flap to discuss outcomes, patient selection, and complications based on 11 years of experience. Thirty-two patients with mild wide bifid nose and shortened columella were included in this retrospective study. All patients underwent nasal rhinoplasty using a propeller flap based on the nasal columella artery. Nasal columella length, horizontal distance of tip-defining point, and angle of facial convexity were evaluated based on three-dimensional simulation technology. Complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey. Nasal esthetics and function were considerably improved. Follow-up examinations during a period of 9 months on average demonstrated stable results. The columella length was 9.7 ± 4.6 mm preoperatively and 19.9 ± 3.2 mm postoperatively (P < 0.05). The horizontal distance of tip-defining point (mm) decreased to 18.9 ± 5.5 mm postoperatively from a preoperative 23.3 ± 5.4 mm (P < 0.05). There were no severe postoperative complications. Complications were scar, temporary hematoma, and mild infection of nasal skin. The majority of patients (97%) rated their outcome as improved and much improved. Surgical correction using a nasal columella artery propeller flap is an effective therapeutic approach for patients with mild bifid nose. The use of a local flap along with minimal donor-site morbidity and reliable outcomes contributes to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.
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Affiliation(s)
- Jiao Wei
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Tanja Herrler
- Department of Hand Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Baofu Yu
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Xiaoxue Chen
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Zi Wang
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Liping Dong
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Aihong Chen
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Qinghua Chen
- Study in the Universitas Prima Indonesia, Indonesia
| | - Qingfeng Li
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China
| | - Chuanchang Dai
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, PR China.
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Wei J, Herrler T, Yu B, Chen X, Dai C. Correction of severe bifid nose deformity using an open W-shaped incision. J Plast Reconstr Aesthet Surg 2022; 75:3457-3461. [DOI: 10.1016/j.bjps.2022.06.060] [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] [Received: 01/19/2022] [Revised: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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Cheng C, Fang B, Xie Y, Zhao PJ, Huang RL, Zhou SB, Gu B, Herrler T, Liu K, Li QF. Autologous fat transfer rescues expanded skin from expansion failure: A retrospective cohort study in Asians. J Plast Reconstr Aesthet Surg 2021; 75:1094-1099. [PMID: 34903491 DOI: 10.1016/j.bjps.2021.11.055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/22/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Soft tissue expansion is a common technique for the regeneration of extra skin to repair skin defects. However, some warning signs like skin thinning and telangiectasia are often found during the expansion process, which indicates the skin flaps cannot be further expanded. These signs may result in the suspension of expansion or ultimately jeopardize the final outcome. Fat grafting is used to treat these potential complications and enable the continuation of the expansion procedure in some cases. In this study, we aimed to investigate the efficiency and safety of fat grafting in this process. METHODS The study was conducted on patients from January 2012 to December 2017 with warning signs of expansion treated with fat grafting (treatment group) or pause expansion (control group). Follow-up data, such as expansion status, dermal thickness, telangiectasia, skin texture using volume assessment, B-mode ultrasound, and semiquantitative scoring, were collected. RESULTS A total of 67 expanded skin regions with warning signs were enrolled. The expansion fold increased 2.14-fold at 12 weeks after treatment compared with 0.74-fold in control (P=0.02). The semiquantitative score was significant improved at 4 weeks (9.03 ± 0.73 vs. 7.45 ± 0.55; p=0.033). Meanwhile, the skin thickness in the experimental group did not show decreasing trend even in the continued expansion process. CONCLUSIONS Autologous fat grafting represents an effective and safe method to rescue expanded skin from limited skin regeneration. This technique also represents a valuable tool to increase the chances for further expansion.
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Affiliation(s)
- Chen Cheng
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Fang
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Pei-Juan Zhao
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ru-Lin Huang
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang-Bai Zhou
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Gu
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tanja Herrler
- Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Kai Liu
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Feng Li
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wei J, Deng N, Herrler T, Zhang Y, Li Q, Hua C, Dai C. Short term results of philtrum reconstruction with an orbicularis oris muscle flap in cleft patients. J Craniomaxillofac Surg 2020; 48:569-573. [PMID: 32340907 DOI: 10.1016/j.jcms.2020.03.008] [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: 06/19/2019] [Revised: 01/15/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In the treatment of philtral ridge deficiency in cleft lip patients, optimal results are difficult to obtain due to visible scarring following surgery. The purpose of this article is to introduce a novel strategy for philtrum reconstruction along with an evaluation of postoperative outcomes of this technique. METHOD All patients with a deficiency of the philtrum underwent reconstruction of the philtral ridge and upper lip using an orbicularis oris muscle flap with a specific re-suturing technique in our study. The convexity of the philtral ridge was evaluated pre- and postoperatively at rest and while puckering using patient photography as well as three-dimensional simulation technology. Postoperative outcomes and complications were assessed during follow-up, including a patient satisfaction survey. RESULTS Thirty cleft lip patients underwent treatment in this study using a specific orbicularis oris muscle re-suturing technique. The average age of the 13 male and 17 female patients was 31.5 years. The follow-up period ranged from 6 months to 3.5 years with an average of 10.3 months. Postoperative results showed an aesthetic reconstructed philtral ridge with stable outcome. Complications included acute infection (1 case) and temporary stiffness of smile (3 cases). No systemic complications occurred. All patients were satisfied with their results, and none required further surgery. CONCLUSION We propose a simple, effective, and reproducible technique involving an orbicularis oris muscle flap for the creation of the philtral column in secondary cleft lip deformity. Our approach allowed aesthetically pleasing and stable outcomes. Although the short-term results of the philtrum reconstruction seem to be adequate there is no information on the long-term situation, and therefore no general recommendation to adopt this method can be given.
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Affiliation(s)
- Jiao Wei
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Ning Deng
- Department of Breast Surgery, LiaoNing Cancer Hospital & Institute, PR China
| | - Tanja Herrler
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Yi Zhang
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Qingfeng Li
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Chenqing Hua
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Chuanchang Dai
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China.
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Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Müller MA, Drosten C, Pöhlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020. [PMID: 32142651 DOI: 10.1016/j.cell.2020.02.052,] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
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Affiliation(s)
- Markus Hoffmann
- Infection Biology Unit, German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany.
| | - Hannah Kleine-Weber
- Infection Biology Unit, German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany; Faculty of Biology and Psychology, University Göttingen, Göttingen, Germany
| | - Simon Schroeder
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany
| | - Nadine Krüger
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany; Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Sandra Erichsen
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tobias S Schiergens
- Biobank of the Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Georg Herrler
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Nai-Huei Wu
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andreas Nitsche
- Robert Koch Institute, ZBS 1 Highly Pathogenic Viruses, WHO Collaborating Centre for Emerging Infections and Biological Threats, Berlin, Germany
| | - Marcel A Müller
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany; Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, Moscow, Russia
| | - Christian Drosten
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany
| | - Stefan Pöhlmann
- Infection Biology Unit, German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany; Faculty of Biology and Psychology, University Göttingen, Göttingen, Germany.
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Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Müller MA, Drosten C, Pöhlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020. [DOI: '10.1016/j.cell.2020.02.052] [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: 10/31/2022]
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Wei J, Chen Q, Herrler T, Xu H, Li Q, He J, Dai C. Supermicrosurgical reconstruction of nasal tip defects using the preauricular reversed superficial temporal artery flap. J Plast Reconstr Aesthet Surg 2019; 73:58-64. [PMID: 31466909 DOI: 10.1016/j.bjps.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/21/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Microsurgical reconstruction of nasal tip defects is difficult to achieve. The free composite auricular flap allows for repair in a one-stage procedure. However, anastomosis to the recipient facial artery is often complicated because of its variable anatomy and the need for a vessel graft. In this study, we describe our experience using the alar artery and angular vein as recipient vessels for direct super microsurgical anastomosis. METHOD From February 2004 to December 2015, thirty-two patients with different degrees of full-thickness multi-subunit nasal tip defects were included in this study. The superficial temporal vessels, alar artery, and angular vein were marked preoperatively by ultrasound detection. The preauricular reversed superficial temporal artery flap was harvested and transferred to the nasal tip defect region as a free flap using a supermicrosurgical technique. Patient pictures were taken before surgery and at 1, 3, and 6 months of follow-up. Outcomes and complications were recorded and analyzed. Moreover, a postoperative patient satisfaction survey was performed. RESULTS The reversed superficial temporal artery flap was used in a total of 32 patients for the reconstruction of nasal tip defects in a one-stage procedure. In all cases, the alar artery and angular vein showed no anatomical variations and were used as recipient vessels. The size of the harvested preauricular flap size was 2.5 × 2.0 to 4.0 × 3.6 cm2, and the average flap size was 3.6 × 2.7 cm2. The length of the arterial pedicle was 4.0 to 6.7 cm, 5.58 cm on average. The length of the venous pedicle was 5.0 to 6.8 cm, 6.21 cm on average. Direct anastomosis was achieved in all patients, and in none of the cases, a vascular graft was needed. Donor sites were all closed primarily. Flap survival was complete, except for one case of vascular thrombosis, resulting in a 10% flap necrosis. Temporary hematoma was noted in one patient. The postoperative outcome showed excellent functional coverage and improved esthetic appearance. The average follow-up period was 12 months. The majority of patients (98.5%) rated their postoperative outcome as highly improved and improved. No late recurrence or other complications were seen in any of the patients. Twenty-two patients underwent a secondary debulking procedure of the flap for fine adjustment. CONCLUSION Our results demonstrate that the alar artery and angular vein are suitable recipient vessels for the super microsurgical reconstruction of nasal tip defects. Surgical planning and procedure are facilitated by their reliable anatomy without the need for a vessel graft. This technique may offer wider applications by extension to other facial cutaneous defects.
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Affiliation(s)
- Jiao Wei
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
| | - Qinghua Chen
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
| | - Tanja Herrler
- Department of Hand Surgery, Trauma Center Murnau, Murnau, Germany.
| | - Hua Xu
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
| | - Qingfeng Li
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
| | - Jinguang He
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
| | - Chuanchang Dai
- Department of Plastic & Reconstructive Surgery, The Ninth affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd., Shanghai 200011, P. R. China.
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Wei J, Herrler T, Gu B, Yang M, Li Q, Dai C, Xie F. Large-Scale Skin Resurfacing of the Upper Extremity in Pediatric Patients Using a Pre-Expanded Intercostal Artery Perforator Flap. J Craniofac Surg 2018; 29:562-565. [DOI: 10.1097/scs.0000000000004402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhou J, Xie Y, Wang WJ, Herrler T, Hang RL, Zhao PJ, Zhou SZ, Li QF. Hand Rejuvenation by Targeted Volume Restoration of the Dorsal Fat Compartments. Aesthet Surg J 2017; 38:92-100. [PMID: 29117295 DOI: 10.1093/asj/sjx091] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/15/2022] Open
Abstract
BACKGROUND Recent anatomic findings suggest aging-related changes of the complex fat distribution in the hand. OBJECTIVES To rejuvenate the aging hand, we developed a targeted fat grafting technique based on the physiologic fat distribution of the hand. METHODS The dorsum of both hands was examined in 30 healthy volunteers of different age utilizing B-mode ultrasound to determine physiological changes of the aging hand. Additional anatomic dissection was performed in 10 hands of five fresh cadavers to establish the anatomic basis for the targeted restoration technique. A total of 17 patients were treated for hand rejuvenation utilizing this technique and followed up for at least 6 months. The posttreatment outcome was assessed through B-mode ultrasound, 3-dimensional (3D) topography scanning, and a patient satisfaction survey. RESULTS According to the fat distribution of the dorsum, hand aging was divided into three grades: (1) mild atrophy with rhytides; (2) moderate atrophy with exposed veins; and (3) serious atrophy with exposed tendons. Anatomic findings showed the existence of distinct superficial and deep fat compartments. The average fat grafting volume was 25.5 ml per hand dorsum administered in one or two procedures. Patients were monitored for 8.3 ± 2.6 months. After 6 months, a volume gain was found in all patients. The degree of aging was significantly reduced. The majority of patients (94.1%) were satisfied with their results. CONCLUSIONS This study provides the anatomic and clinical basis for targeted restoration of the physiological fat volume in the hand dorsum with high satisfaction rates. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Wen-Jin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Tanja Herrler
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Ru-Lin Hang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Pei-Juan Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Si-Zheng Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, Shanghai, China; and the Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
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Huang RL, Xie Y, Wang W, Herrler T, Zhou J, Zhao P, Pu LLQ, Li Q. Anatomical Study of Temporal Fat Compartments and its Clinical Application for Temporal Fat Grafting. Aesthet Surg J 2017; 37:855-862. [PMID: 28520850 PMCID: PMC5846703 DOI: 10.1093/asj/sjw257] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low satisfaction rates and severe complications are two major limitations for temporal hollowing augmentation using autologous fat grafting. Despite fat compartments in temporal region have been reported, its clinical applied anatomy for fat grafting have not been the subject of studies that show its benefits objectively and statistically. OBJECTIVES To investigate temporal fat compartments and relative neurovascular structures in cadavers, developing a safe and effective fat grafting technique for temporal hollowing augmentation. METHODS The study was conducted on 8 cadavers (16 temples). The tissue layers, fat compartments, ligaments, and neurovascular structures in the temporal region were analysed. The variables were the number and location of sentinel veins, perforator vessels of the middle temporal vein. Measurements were taken with a digital calliper. RESULTS Two separate fat compartments, the lateral temporal-cheek fat compartment and lateral orbital fat compartment, were found in the subcutaneous layer, and two separate septum compartments, the upper and lower temporal compartment, were found in the loose areolar tissue layer. One sentinel vein and 1 to 6 perforator vessels were found to travel through the subcutaneous tissue layer, traverse the overlapping tissue layers in the lower temporal septum region, and finally join in the middle temporal vein. CONCLUSIONS The four fat compartments in the temporal region are ideal receipt sites for fat grafting. The medial border of the junction of the hairline and temporal line is a safe and effective cannula entry site for temporal fat grafting. The anterior half of the lower temporal compartment is a "zone of caution" for temporal fat grafting.
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Affiliation(s)
- Ru-Lin Huang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Yun Xie
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Wenjin Wang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Tanja Herrler
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Jia Zhou
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Peijuan Zhao
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee LQ Pu
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Qingfeng Li
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
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Wei J, Luo J, Herrler T, Xu H, Deng N, Li Q, Dai C. A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants. J Plast Reconstr Aesthet Surg 2017; 70:1292-1297. [PMID: 28705589 DOI: 10.1016/j.bjps.2017.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/09/2016] [Revised: 06/11/2017] [Accepted: 06/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The treatment of maxillonasal dysplasia in Binder's syndrome using autologous costal bone and cartilage is well established, but postoperative results may be compromised by scarring, unpredictable absorption of transferred autologous tissue, and donor site morbidity. Here, we propose a simple surgical technique to improve maxillonasal dysplasia using an expanded polytetrafluoroethylene (ePTFE) implant. MATERIALS AND METHODS From February 1999 to May 2014, fifty-eight patients affected by maxillonasal dysplasia with different degrees of flattened nose and midfacial depression underwent surgical correction by augmentation of the nasal dorsum using an "L"-shaped ePTFE and subperiosteal implantation of an inverted "m"-shaped ePTFE at the base of the piriform aperture. The outcome was evaluated based on preoperative and postoperative patient pictures, 3D imaging technology for the assessment of nasolabial angle and facial convexity angle, and a postoperative patient satisfaction survey. RESULTS Postoperative results showed improved facial aesthetics with a significantly increased nasolabial angle from initially 74.1° ± 8.9° to 93.7° ± 6.1° at 6 months postoperatively (p < 0.05). Temporary discomfort involving upper lip numbness, foreign body sensation, and stiff smiling expression were complained during the first 3 months postoperatively, but spontaneously resolved within 6 months. Complications included infection (2 cases), implant migration (2 cases), and implant exposure (1 case). The vast majority of patients (95.7%) rated their postoperative outcome as highly improved and improved. CONCLUSION The present therapeutic strategy provides a simple and effective treatment for the correction of maxillonasal dysplasia with high patient acceptance in a single step approach. Further research is required to determine long-term outcomes.
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Affiliation(s)
- Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, China
| | - Jiawen Luo
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tanja Herrler
- Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Hua Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, China
| | - Ning Deng
- Student of China Medical University, Shenyang, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, China
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, China.
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Wei J, Herrler T, Liu K, Han D, Yang M, Dai C, Li Q. The Role of Cell Seeding, Bioscaffolds, and the In Vivo Microenvironment in the Guided Generation of Osteochondral Composite Tissue. Tissue Eng Part A 2016; 22:1337-1347. [PMID: 27806676 DOI: 10.1089/ten.tea.2016.0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, China
| | - Tanja Herrler
- Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, China
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, China
| | - Mei Yang
- Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, China
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Wei J, Herrler T, Han D, Liu K, Huang R, Guba M, Dai C, Li Q. Autologous temporomandibular joint reconstruction independent of exogenous additives: a proof-of-concept study for guided self-generation. Sci Rep 2016; 6:37904. [PMID: 27892493 PMCID: PMC5124955 DOI: 10.1038/srep37904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 06/21/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022] Open
Abstract
Joint defects are complex and difficult to reconstruct. By exploiting the body’s own regenerative capacity, we aimed to individually generate anatomically precise neo-tissue constructs for autologous joint reconstruction without using any exogenous additives. In a goat model, CT scans of the mandibular condyle including articular surface and a large portion of the ascending ramus were processed using computer-aided design and manufacturing. A corresponding hydroxylapatite negative mold was printed in 3D and temporarily embedded into the transition zone of costal periosteum and perichondrium. A demineralized bone matrix scaffold implanted on the contralateral side served as control. Neo-tissue constructs obtained by guided self-generation exhibited accurate configuration, robust vascularization, biomechanical stability, and function. After autologous replacement surgery, the constructs showed stable results with similar anatomical, histological, and functional findings compared to native controls. Further studies are required to assess long-term outcome and possible extensions to other further applications. The absence of exogenous cells, growth factors, and scaffolds may facilitate clinical translation of this approach.
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Affiliation(s)
- Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tanja Herrler
- Plastic Surgery and Burn Center, Trauma Center Murnau, Munich, Germany
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rulin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Markus Guba
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zan T, Jin R, Li H, Herrler T, Meng X, Huang X, Li Q, Gu B. A Novel U-Flap Epicanthoplasty for Asian Patients. Aesthetic Plast Surg 2016; 40:458-65. [PMID: 27286852 DOI: 10.1007/s00266-016-0665-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The epicanthal fold is a distinct characteristic of the Asian upper eyelid, which may impair the beauty of the eyes and the outcome of double eyelid blepharoplasty. Although many surgical procedures have been reported, their main drawbacks include a conspicuous scar in the medial canthal area and an unnatural palpebral contour. We devised a novel surgical approach to correct the epicanthal fold with acceptable scarring. METHODS From June 2011 to October 2014, U-flap epicanthoplasty was performed on 118 Chinese patients in our department. The U-flap was designed on the medial canthal skin. After complete dissection of the flap from the dislocated orbicularis muscle and underlying connective tissue, the flap naturally rotated upward to a line consistent with the direction of the palpebral fold. The flap was then subcutaneously fixed to the medial part of the medial canthal ligament. Finally, the redundant skin was trimmed off and the incision was sutured without tension. Patients were evaluated before and 12 months after surgery. RESULTS The average decrease in the intercanthal distance was 4.36 ± 0.32 mm. The general satisfaction rate was 97.5 %. Three patients showed bilateral hypertrophic scar formation on both bilateral medial canthal incisions and palpebral incisions; however, the scarring subsided after three triamcinolone acetonide injections. No epicanthal fold recurrence or other complications were observed during the 12-month follow-up period. CONCLUSION U-flap epicanthoplasty is a simple and effective method for elimination of types I-III epicanthal folds. However, its long-term effects require further study. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Wei J, Herrler T, Xu H, Li Q, Dai C. Treatment of gummy smile: Nasal septum dysplasia as etiologic factor and therapeutic target. J Plast Reconstr Aesthet Surg 2015; 68:1338-43. [PMID: 26255876 DOI: 10.1016/j.bjps.2015.06.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/12/2015] [Indexed: 12/31/2022]
Abstract
Various techniques to improve gummy smile exist. Depending on the individual etiology, previous approaches have focused on osseous, dental, and soft-tissue aspects. On the basis of the identification of nasal septum dysplasia as etiologic factor of gummy smile, we propose a novel strategy for the improvement in the treatment of excessive gingival exposure. In this prospective controlled study, 121 Asian patients with gummy smile and 150 volunteers were examined and compared with regard to the developmental status of the nasal septal cartilage reflected by the columella upward maximum movability (CUMM) as objective measurement parameter. A total of 46 patients with significantly increased CUMM underwent surgical treatment for excessive gingival exposure by septum cartilage reinforcement and, where required, additional extension using an autologous cartilage graft or an expanded polytetrafluoroethylene (ePTFE) implant. Gingival exposure at the fullest smile was photographed, measured, and analyzed before and 1, 3, and 6 months after surgery, and all possible complications were recorded. The results were evaluated in a patient satisfaction survey. CUMM showed a significant statistical difference between the patients desiring treatment for gummy smile (5.6 ± 0.92 mm) and volunteers (3.1 ± 0.76 mm), (p < 0.05). In the 46 patients who underwent surgical correction of gummy smile, the measured maximum gingival exposure at the fullest smile was 4.52 ± 1.7 mm preoperatively and significantly decreased to 1.79 ± 0.26 mm at 6 months postoperatively (p < 0.05). The overall complication rate was low, including transient stiffness of smile, implant deformation, and acute infection. The postoperative results were highly satisfactory in terms of aesthetic smile. This study proposes a novel strategy of reinforcement and extension of the nasal septum cartilage for the improvement of gummy smile confirming septal cartilage dysplasia as the etiologic factor.
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Affiliation(s)
- Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, People's Republic of China
| | - Tanja Herrler
- Department of General, Trauma, Hand and Plastic Surgery, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Hua Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, People's Republic of China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, People's Republic of China
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University Medical School, Ninth People's Hospital, Shanghai, People's Republic of China.
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Li H, Zhou Y, Du Z, Gu B, Liu K, Xie F, Xie Y, Herrler T, Li Q, Zan T. Strategies for customized neck reconstruction based on the pre-expanded superficial cervical artery flap. J Plast Reconstr Aesthet Surg 2015; 68:1064-71. [PMID: 25964230 DOI: 10.1016/j.bjps.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/23/2014] [Revised: 03/19/2015] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is still highly challenging to restore the esthetic neck contour for postburn deformities. In many patients with burns, the back skin remains intact, which is a useful donor site for extensive contracture release. As the main technique, the refinement of the pre-expanded superficial cervical artery (SCA) flaps may improve its application in diverse neck contractures. METHODS This study reviewed the cases of three types of neck contractures that were reconstructed with pre-expanded SCA flaps: (1) for unilateral neck contractures, the flaps were harvested as pedicled perforator flaps including a small amount of muscle; (2) for lateral and anterior neck contractures, vascular augmentation with circumflex scapular vessels was used to increase the flap size; (3) for contractures of the entire neck, maximal flap release with pedicle dissection toward the origin of the superficial cervical vessels allowed for reaching contralateral defects. RESULTS From March 2010 to September 2012, pre-expanded SCA flaps were recommended in 15 patients with severe neck contracture. Tip necrosis occurred in one patient. The donor sites were closed primarily in all cases. One patient had donor-site wound dehiscence that healed within 2 weeks by conservative management. All patients had restored neck extension to a near-normal position without the sense of restricted neck flexion or rotation. CONCLUSIONS Pre-expanded SCA flaps are practical and flexible for the reconstruction of diverse scar contractures ranging from unilateral to total neck lesions. Considering the reconstructive efficiency and the reduced donor-site morbidity, this flap may be an ideal option for the reconstruction of severe neck scar contractures.
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Affiliation(s)
- Haizhou Li
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Yiwen Zhou
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Zijing Du
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Bin Gu
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Tanja Herrler
- Hand, Plastic, and Aesthetic Surgery, Department of General, Trauma, Hand, and Plastic Surgery, University of Munich, Munich, Germany
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
| | - Tao Zan
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
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Lehner S, Todica A, Vanchev Y, Uebleis C, Wang H, Herrler T, Wängler C, Cumming P, Böning G, Franz WM, Bartenstein P, Hacker M, Brunner S. In vivo monitoring of parathyroid hormone treatment after myocardial infarction in mice with [68Ga]annexin A5 and [18F]fluorodeoxyglucose positron emission tomography. Mol Imaging 2015; 13. [PMID: 25249170 DOI: 10.2310/7290.2014.00035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[68Ga]Annexin A5 positron emission tomography (PET) reveals the externalization of phosphatidylserine as a surrogate marker for apoptosis. We tested this technique for therapy monitoring in a murine model of myocardial infarction (MI) including parathyroid hormone (PTH) treatment. MI was induced in mice, and they were assigned to the saline or the PTH group. On day 2, they received [68Ga]annexin A5 PET or histofluorescence TUNEL staining. Mice had 2-deoxy-2-[18F]fluoro-d-glucose (FDG)-PET examinations on days 6 and 30 for calculation of the left ventricular ejection fraction and infarct area. [68Ga]Annexin A5 uptake was 7.4 ± 1.3 %ID/g within the infarction for the controls and 4.5 ± 1.9 %ID/g for the PTH group (p = .013). TUNEL staining revealed significantly more apoptotic cells in the infarct area on day 2 in the controls (64 ± 9%) compared to the treatment group (52 ± 4%; p = .045). FDG-PET revealed a significant decrease in infarct size in the treatment group and an increase in the controls. Examinations of left ventricular ejection fraction on days 6 and 30 did not reveal treatment effects. [68Ga]Annexin A5 PET can detect the effects of PTH treatment as a marker of apoptosis 2 days after MI; ex vivo examination confirmed significant rescue of myocardiocytes. FDG-PET showed a small but significant reduction in infarct size but no functional improvement.
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Wang J, Zhang Y, Zhang N, Wang C, Herrler T, Li Q. An updated review of mechanotransduction in skin disorders: transcriptional regulators, ion channels, and microRNAs. Cell Mol Life Sci 2015; 72:2091-106. [DOI: 10.1007/s00018-015-1853-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/22/2015] [Accepted: 02/09/2015] [Indexed: 12/13/2022]
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Velroyen A, Bech M, Zanette I, Schwarz J, Rack A, Tympner C, Herrler T, Staab-Weijnitz C, Braunagel M, Reiser M, Bamberg F, Pfeiffer F, Notohamiprodjo M. X-ray phase-contrast tomography of renal ischemia-reperfusion damage. PLoS One 2014; 9:e109562. [PMID: 25299243 PMCID: PMC4192129 DOI: 10.1371/journal.pone.0109562] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/02/2014] [Indexed: 01/28/2023] Open
Abstract
Purpose The aim of the study was to investigate microstructural changes occurring in unilateral renal ischemia-reperfusion injury in a murine animal model using synchrotron radiation. Material and Methods The effects of renal ischemia-reperfusion were investigated in a murine animal model of unilateral ischemia. Kidney samples were harvested on day 18. Grating-Based Phase-Contrast Imaging (GB-PCI) of the paraffin-embedded kidney samples was performed at a Synchrotron Radiation Facility (beam energy of 19 keV). To obtain phase information, a two-grating Talbot interferometer was used applying the phase stepping technique. The imaging system provided an effective pixel size of 7.5 µm. The resulting attenuation and differential phase projections were tomographically reconstructed using filtered back-projection. Semi-automated segmentation and volumetry and correlation to histopathology were performed. Results GB-PCI provided good discrimination of the cortex, outer and inner medulla in non-ischemic control kidneys. Post-ischemic kidneys showed a reduced compartmental differentiation, particularly of the outer stripe of the outer medulla, which could not be differentiated from the inner stripe. Compared to the contralateral kidney, after ischemia a volume loss was detected, while the inner medulla mainly retained its volume (ratio 0.94). Post-ischemic kidneys exhibited severe tissue damage as evidenced by tubular atrophy and dilatation, moderate inflammatory infiltration, loss of brush borders and tubular protein cylinders. Conclusion In conclusion GB-PCI with synchrotron radiation allows for non-destructive microstructural assessment of parenchymal kidney disease and vessel architecture. If translation to lab-based approaches generates sufficient density resolution, and with a time-optimized image analysis protocol, GB-PCI may ultimately serve as a non-invasive, non-enhanced alternative for imaging of pathological changes of the kidney.
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Affiliation(s)
- Astrid Velroyen
- Chair of Biomedical Physics, Department of Physics (E17), Munich, Bavaria, Germany
| | - Martin Bech
- Chair of Biomedical Physics, Department of Physics (E17), Munich, Bavaria, Germany
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Irene Zanette
- Chair of Biomedical Physics, Department of Physics (E17), Munich, Bavaria, Germany
| | - Jolanda Schwarz
- Chair of Biomedical Physics, Department of Physics (E17), Munich, Bavaria, Germany
| | - Alexander Rack
- European Synchrotron Radiation Facility, Grenoble, France
| | - Christiane Tympner
- Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tanja Herrler
- Department of General, Trauma, Hand, and Plastic Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Claudia Staab-Weijnitz
- Institute for Clinical Radiology, University Hospitals Munich, Munich, Germany
- Comprehensive Pneumology Center, University Hospital, Ludwig-Maximilians-University and Helmholtz Zentrum Munich, Munich, Germany
| | - Margarita Braunagel
- Institute for Clinical Radiology, University Hospitals Munich, Munich, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, University Hospitals Munich, Munich, Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, University Hospitals Munich, Munich, Germany
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics (E17), Munich, Bavaria, Germany
| | - Mike Notohamiprodjo
- Institute for Clinical Radiology, University Hospitals Munich, Munich, Germany
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
- * E-mail:
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Zhou J, Huang X, Zheng D, Li H, Herrler T, Li Q. Oriental nose elongation using an L-shaped polyethylene sheet implant for combined septal spreading and extension. Aesthetic Plast Surg 2014; 38:295-302. [PMID: 24627142 DOI: 10.1007/s00266-014-0299-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The currently recommended strategies for short nose elongation were designed primarily for the Caucasian nasal framework. For Oriental patients, more elongation often is required because a hypoplastic septal cartilage requires more elongation, resulting in a higher risk of complications. This report proposes a modified technique for Oriental nose elongation, which adjusts the pressure points after nasal elongation using an L-shaped implant. METHODS Between January 2007 and December 2009, 58 patients underwent Oriental nose elongation using an L-shaped, porous, high-density polyethylene sheet implant. Augmentation rhinoplasty and conchal cartilage shield grafts were performed depending on the nasal shape. Pre- and postoperative nasal length, height, and projection as well as columella-labial angle, columella-lobular angle, and nasal tip angle were measured and compared. A patient satisfaction survey was performed postoperatively. All occurring complications were recorded. RESULTS The postoperative nasal length was significantly elongated from 47.0±10.4 mm to 49.3±10.1 mm (p=0.003), and the nasal height increased significantly from 48.5±9.1 mm to 50.4±8.5 mm (p=0.011). The initially obtuse columella-labial angle improved significantly from 100.8°±12.1° to 92.5°±15.5° (p=0.014). No significant changes were found regarding nasal projection, nasal tip angle, or columella-lobular angle. The majority of the patients (91.3%) were highly satisfied or satisfied with the aesthetic results. A major complication in terms of implant exposure was observed in one case. The minor complications included stiffness of the nasal tip (3 patients) and tip redness (1 patient). CONCLUSIONS In Oriental nose elongation, the use of an L-shaped graft is a feasible and safe treatment option that allows for an excellent aesthetic outcome and reduces the incidence of complications. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Herrler T, Wang H, Tischer A, Schupp N, Lehner S, Meyer A, Wallmichrath J, Habicht A, Mfarrej B, Anders HJ, Bartenstein P, Jauch KW, Hacker M, Guba M. Decompression of Inflammatory Edema along with Endothelial Cell Therapy Expedites Regeneration after Renal Ischemia-Reperfusion Injury. Cell Transplant 2013; 22:2091-103. [DOI: 10.3727/096368912x658700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Increased pressure due to postischemic edema aggravates renal ischemia-reperfusion injury (IRI). Prophylactic surgical decompression using microcapsulotomy improves kidney dysfunction after IRI. Supportive cell therapy in combination with microcapsulotomy might act synergistically protecting kidney function against IRI. The effects of therapeutic endothelial cell application alone and in combination with microcapsulotomy were investigated in a xenogenic murine model of 45-min warm renal ischemia. Renal function and perfusion were determined before as well as 2 and 18 days postischemia by 99mTc-MAG3 imaging and laser Doppler. Histological analysis included H&E stains and immunohistology for endothelial marker MECA-32, cell proliferation marker Ki-67, and macrophage marker F4/80. Histomorphological changes were quantified using a tubular injury score. Ischemia of 45 min led to severe tissue damage and a significant decrease in renal function and perfusion. Microcapsulotomy and cell therapy alone had no significant effect on renal function, while only surgical decompression significantly increased blood flow in ischemic kidneys. However, the combination of both microcapsulotomy and cell therapy significantly improved kidney function and perfusion. Combination therapy significantly reduced morphological injury of ischemic kidneys as determined by a tubular injury score and MECA-32 staining. Macrophage infiltration evidenced by F4/80 staining was significantly reduced. The Ki-67 proliferation index was increased, suggesting a regenerative environment. While microcapsulotomy and cell therapy alone have limited effect on renal recovery after IRI, combination therapy showed synergistic improvement of renal function, perfusion, and structural damage. Microcapsulotomy may create a permissive environment for cell therapy to work.
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Affiliation(s)
- Tanja Herrler
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
| | - Hao Wang
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Anne Tischer
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
| | - Nina Schupp
- Transplantation Center, University of Munich, Munich, Germany
| | - Sebastian Lehner
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Andreas Meyer
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
| | - Jens Wallmichrath
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
| | - Antje Habicht
- Transplantation Center, University of Munich, Munich, Germany
| | - Bechara Mfarrej
- Transplantation Center, University of Munich, Munich, Germany
| | - Hans-Joachim Anders
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Universität München, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Karl-Walter Jauch
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
| | - Marcus Hacker
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Markus Guba
- Department of Surgery, Campus Großhadern, University of Munich, Munich, Germany
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Herrler T, Giunta R, Engelhardt TO. [Clinically important differential diagnosis of chronic wounds]. MMW Fortschr Med 2013; 155:57-9. [PMID: 23614200 DOI: 10.1007/s15006-013-0229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tanja Herrler
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Universität München, Ludwig-Maximilians-Universität München.
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Lehner S, Todica A, Brunner S, Uebleis C, Wang H, Wängler C, Herbach N, Herrler T, Böning G, Laubender RP, Cumming P, Schirrmacher R, Franz W, Hacker M. Temporal Changes in Phosphatidylserine Expression and Glucose Metabolism after Myocardial Infarction: An in Vivo Imaging Study in Mice. Mol Imaging 2012. [DOI: 10.2310/7290.2012.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sebastian Lehner
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Andrei Todica
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Stefan Brunner
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Christopher Uebleis
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Hao Wang
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Carmen Wängler
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Nadja Herbach
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Tanja Herrler
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Guido Böning
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Rüdiger Paul Laubender
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Paul Cumming
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Ralf Schirrmacher
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Wolfgang Franz
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
| | - Marcus Hacker
- From the Departments of Nuclear Medicine, Cardiology, Experimental Surgery, Institute of Veterinary Pathology, Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; McConnell Brain Imaging Centre, McGill University, Montreal, PQ
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Lehner S, Todica A, Brunner S, Uebleis C, Wang H, Wängler C, Herbach N, Herrler T, Böning G, Laubender RP, Cumming P, Schirrmacher R, Franz W, Hacker M. Temporal changes in phosphatidylserine expression and glucose metabolism after myocardial infarction: an in vivo imaging study in mice. Mol Imaging 2012; 11:461-470. [PMID: 23084247] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Positron emission tomography (PET) for in vivo monitoring of phosphatidylserine externalization and glucose metabolism can potentially provide early predictors of outcome of cardioprotective therapies after myocardial infarction. We performed serial [⁶⁸Ga]annexin A5 PET (annexin-PET) and [¹⁸F]fluorodeoxyglucose PET (FDG-PET) after myocardial infarction to determine the time of peak phosphatidylserine externalization in relation to impaired glucose metabolism in infracted tissue. Annexin- and FDG-PET recordings were obtained in female (C57BL6/N) mice on days 1 to 4 after ligation of the left anterior descending (LAD) artery. [⁶⁸Ga]annexin A5 uptake (%ID/g) in the LAD artery territory increased from 1.7 ± 1.1 on day 1 to 5.0 ± 3.3 on day 2 and then declined to 2.0 ± 1.4 on day 3 (p = .047 vs day 2) and 1.6 ± 1.4 on day 4 (p = .014 vs day 2). These results matched apoptosis rates as estimated by autoradiography and fluorescein staining. FDG uptake (%ID/g) declined from 28 ± 14 on day 1 to 14 ± 3.5 on day 4 (p < .0001 vs day 1). Whereas FDG-PET revealed continuous loss of cell viability after permanent LAD artery occlusion, annexin-PET indicated peak phosphatidylserine expression at day 2, which might be the optimal time point for therapy monitoring.
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Affiliation(s)
- Sebastian Lehner
- Department of Nuclear Medicine, Institute of Veterinary Pathology, University of Munich, Munich, Germany
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Wallmichrath J, Baumeister R, Herrler T, Greiner A, Pieske O, Giunta R, Frick A. Experimental study on the microsurgical or spontaneous formation of lympho-lymphonodular anastomoses in the rat model. J Plast Reconstr Aesthet Surg 2012; 65:494-500. [DOI: 10.1016/j.bjps.2011.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/15/2011] [Accepted: 11/08/2011] [Indexed: 11/30/2022]
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Herrler T, Wang H, Tischer A, Bartenstein P, Jauch KW, Guba M, Diemling M, Nimmon C, Hacker M. 99mTc-MAG3 scintigraphy for the longitudinal follow-up of kidney function in a mouse model of renal ischemia-reperfusion injury. EJNMMI Res 2012; 2:2. [PMID: 22264389 PMCID: PMC3282629 DOI: 10.1186/2191-219x-2-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 12/12/2011] [Accepted: 01/20/2012] [Indexed: 11/11/2022] Open
Abstract
Background Experimental models are essential tools in the development and evaluation of novel treatment options, but the preclinical model of renal ischemia-reperfusion injury is limited to the retrieval of (very) early functional data, leaving the pivotal long-term outcome unknown. The present study applies technetium-99m-mercapto-acetyl-tri-glycine [99mTc-MAG3] scintigraphy for the longitudinal follow-up examination of long-term kidney function after renal ischemia-reperfusion injury. Methods Unilateral warm ischemia was induced in scid beige mice by vascular clamping of the kidney hilum for 40 min. 99mTc-MAG3 scintigraphy was performed prior to injury, 8 and 14 days post ischemia. The fractional uptake rate [FUR] was calculated from scintigraphy data as a measure of renal clearance. Results FUR demonstrated a significant functional impairment of the ischemic kidney 8 and 14 days after injury (P < 0.05 vs. baseline), while contralateral non-ischemic kidneys showed no significant changes. In histological analysis, ischemic kidneys exhibited tubular dilatation and cytoplasmic degeneration as signs of hypoxia without any evidence for necrosis. Conclusions FUR enables the detection of renal dysfunction and longitudinal long-term follow-up examination in the same individual. Our model may facilitate preclinical therapy evaluation for the identification of effective renoprotective therapies.
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Affiliation(s)
- Tanja Herrler
- Department of Nuclear Medicine, University of Munich, Munich, 81377, Germany.
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Herrler T, Leicht SF, Huber S, Hermann PC, Schwarz TM, Kopp R, Heeschen C. Prostaglandin E positively modulates endothelial progenitor cell homeostasis: an advanced treatment modality for autologous cell therapy. J Vasc Res 2009; 46:333-46. [PMID: 19142013 DOI: 10.1159/000189794] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 07/29/2008] [Indexed: 11/19/2022] Open
Abstract
AIMS The mobilization of endothelial progenitor cells (EPC) and their functioning in postnatal neovascularization are tightly regulated. To identify new modulators of EPC homeostasis, we screened biologically active prostaglandin E compounds for their effects on EPC production, trafficking and function. METHODS AND RESULTS We found that EPC are a rich source for prostaglandin E(2) (PGE(2)), stimulating their number and function in an auto- and paracrine manner. In vivo blockade of PGE(2) production by selective cyclooxygenase-2 inhibition virtually abrogated ischemia-induced EPC mobilization demonstrating its crucial role in EPC homeostasis following tissue ischemia. Conversely, ex vivo treatment of isolated EPC with the clinically approved PGE(1) analogue alprostadil enhanced EPC number and function. These effects were mediated by increased expression of the chemokine receptor CXCR4 and were dependent on nitric oxide synthase activity. Most importantly, ex vivo PGE(1) pretreatment of isolated EPC significantly enhanced their neovascularization capacity in a murine model of hind limb ischemia as assessed by laser Doppler analysis, exercise stress test and immunohistochemistry. CONCLUSIONS The conserved role for PGE in the regulation of EPC homeostasis suggests that ex vivo modulation of the prostaglandin pathway in isolated progenitor cells may represent a novel and safe strategy to facilitate cell-based therapies.
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Affiliation(s)
- Tanja Herrler
- Department of Surgery, Experimental Medicine, Ludwig Maximilian University, Munich, Germany
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Hermann PC, Huber SL, Herrler T, von Hesler C, Andrassy J, Kevy SV, Jacobson MS, Heeschen C. Concentration of bone marrow total nucleated cells by a point-of-care device provides a high yield and preserves their functional activity. Cell Transplant 2008; 16:1059-1069. [PMID: 18351022 DOI: 10.3727/000000007783472363] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Stem and progenitor cell therapy is a novel strategy to enhance cardiovascular regeneration. Cell isolation procedures are crucial for the functional activity of the administered cellular product. Therefore, new isolation techniques have to be evaluated in comparison to the Ficoll isolation procedure as the current gold standard. Here we prospectively evaluated a novel point-of-care device (Harvest BMAC System) for the concentration of bone marrow total nucleated cells (TNC) in comparison to the Ficoll isolation procedure for bone marrow mononucleated cells (MNC). The yield in total numbers of TNC was 2.4-fold higher for Harvest compared to Ficoll. Despite significant differences in their cellular compositions, the colony-forming capacity was similar for both products. Intriguingly, the migratory capacity was significantly higher for the Harvest TNC (164 +/- 66%; p = 0.007). In a mouse model of hind limb ischemia, the increase in blood flow recovery was similar between Harvest BM-TNC and Ficoll BM-MNC (0.53 +/- 0.20 vs. 0.46 +/- 0.15; p = 0.88). However, adjustment of the injected cell number based on the higher yield of Harvest TNC resulted in a significant better recovery (0.64 +/- 0.16 vs. 0.46 +/- 0.15; p = 0.003). Cells concentrated by the Harvest point-of-care device show similar or greater functional activity compared to Ficoll isolation. However, the greater yield of cells and the wider range of cell types for the Harvest device may translate into an even greater therapeutic effect.
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Affiliation(s)
- Patrick C Hermann
- Department of Surgery, Ludwig-Maximilians-University, 81377 Munich, Germany
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Hermann PC, Huber SL, Herrler T, Aicher A, Ellwart JW, Guba M, Bruns CJ, Heeschen C. Distinct populations of cancer stem cells determine tumor growth and metastatic activity in human pancreatic cancer. Cell Stem Cell 2008. [PMID: 18371365 DOI: 10.1016/j.stem] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pancreatic adenocarcinoma is currently the fourth leading cause for cancer-related mortality. Stem cells have been implicated in pancreatic tumor growth, but the specific role of these cancer stem cells in tumor biology, including metastasis, is still uncertain. We found that human pancreatic cancer tissue contains cancer stem cells defined by CD133 expression that are exclusively tumorigenic and highly resistant to standard chemotherapy. In the invasive front of pancreatic tumors, a distinct subpopulation of CD133(+) CXCR4(+) cancer stem cells was identified that determines the metastatic phenotype of the individual tumor. Depletion of the cancer stem cell pool for these migrating cancer stem cells virtually abrogated the metastatic phenotype of pancreatic tumors without affecting their tumorigenic potential. In conclusion, we demonstrate that a subpopulation of migrating CD133(+) CXCR4(+) cancer stem cells is essential for tumor metastasis. Strategies aimed at modulating the SDF-1/CXCR4 axis may have important clinical applications to inhibit metastasis of cancer stem cells.
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Affiliation(s)
- Patrick C Hermann
- Department of Surgery, Ludwig-Maximilians-University, 81377 Munich, Germany
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Hermann PC, Huber SL, Herrler T, Aicher A, Ellwart JW, Guba M, Bruns CJ, Heeschen C. Distinct Populations of Cancer Stem Cells Determine Tumor Growth and Metastatic Activity in Human Pancreatic Cancer. Cell Stem Cell 2007. [DOI: 78495111110.1016/j.stem.2007.06.002' target='_blank'>'"<>78495111110.1016/j.stem.2007.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1016/j.stem.2007.06.002','', 'Tanja Herrler')">Reference Citation Analysis] [78495111110.1016/j.stem.2007.06.002', 33)">What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
78495111110.1016/j.stem.2007.06.002" />
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Hermann PC, Huber SL, Herrler T, Aicher A, Ellwart JW, Guba M, Bruns CJ, Heeschen C. Distinct Populations of Cancer Stem Cells Determine Tumor Growth and Metastatic Activity in Human Pancreatic Cancer. Cell Stem Cell 2007; 1:313-23. [DOI: 10.1016/j.stem.2007.06.002] [Citation(s) in RCA: 1789] [Impact Index Per Article: 105.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/11/2007] [Accepted: 06/12/2007] [Indexed: 02/06/2023]
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