Dermal Graft Research Articles

Complete Urethral Duplication With Epispadias in a Young Man: A Case Report

A 25 year male patient presented with the complaints of passage of urine through two openings on his penis, with deformities of penis since birth. After birth his parents noticed, when he micturates, urine comes through an opening on the proximal part of dorsal surface of penis in addition to the opening on the tip of glans penis. The penis is also a bit deformed and dorsal part of corona glandis is bifid. No treatment for the anomaly was taken. At puberty his testes, scrotum and other secondary sexual characteristics developed normally. He feels sexual attractions to opposite sex and experiences nocturnal emissions periodically. His penis erects on sexual stimulations, but bends upwards and at the peak of excitement orgasm also occurs and semen comes through the ventral orthotopic opening only. General physical examination was unremarkable, but external genitalial examination, shows, two external urethral meatus – one small pit like opening at the normal orthotopic position on the tip of glans penis and another on the dorsal surface of proximal penile shaft with epispadias and exposed urethral plate distal to this.. He had also dorsal chordee and ventral hooding with dorsal bifid glans penis. He had normally developed scrotum with normal both testes . Corpora cavernosa are developed but separated proximally. Spongiosa also developed and orthotopic anterior urethra can be palpated. Other systemic examinations revealed no abnormalities. Routine investigations like urine R/E, C/S, S.creatinine, blood sugar, CBC were normal. X-ray KUB revealed small separation of pubic symphysiis. USG of whole abdomen with KUB revealed significant PVR (77cc) with features of cystitis (sediments in bladder) with no other abnormality. RGU and MCU revealed duplicated urethra –with an accessory urethra arising from bladder neck, runs above the orthotopic one along the shaft terminating at the proximal part of dorsal penile shaft. The lower orthotopic urethra is normal with no stricture or abnormality except narrowing of the distal anterior urethra and external opening. Cystogram shows normal bladder with no VUR or divarticula except thickend wall. Urethrocystopic examination after dilatation of stenosed EUM of orthotopic (ventral) urethra showed normal anterior and posterior urethra containing sphincter and verumotanum and prostatic urethra opening into the bladder neck. Then cystoscope passed through the dorsal epispadiac urethra , which showed a less developed urethra, opening into the protruding bladder neck. Urinary bladder and ureteric orifices were normal . Then excision of accessory epispadiac urethra and the urethral plate done as high as possible near to bladder neck, followed by correction of chordee by ventral plication and repair of bifid corona glandis. He had an uneventful recovery ,though having a residual dorsal chordee, which was corrected by a second operation after 18 months, when excision of residual stump of accessory dorsal urethra followed by dermal graft repair of dorsal corporal body done. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.48-51

Long‐term outcomes after plaque incision and grafting for Peyronie’s disease: comparison of porcine dermal and bovine pericardium grafts

Plaque incision and grafting (PEG) is one of the mainstays in surgical therapy for severe penile curvature in Peyronie's disease (PD). Different kinds of grafts are available for covering albugineal defects during PEG, both allografts and xenografts. However, to date, none of these proved superior to others. To compare two different types of xenograft, porcine dermal matrix and bovine pericardium matrix in PEG for PD. From 2010 to 2019, 63 patients with PD underwent PEG, using porcine dermal (n=25; Group 1) and bovine pericardium (n=38; Group 2) grafts. Long-term outcomes were evaluated through multi-disciplinary questionnaires administration by phone interview. The following items were considered: correction of penile bending, quality of erection, intercourse ability, penile shortening, and sensitiveness. Overall satisfaction and impact of surgery on sexual activity and quality of life were also investigated. Plaque median (IQR) size was 29 (22-33) mm and was smaller in Group 1 (27.5 vs. 31mm; P=.03). Complete follow-up data were available for 53 patients (84%). Considering post-operative outcomes, no differences were found when considering ED rates, penile shortening, sensitiveness, complications, and penile straightening (all P>.1). Patients in Group 2 were more likely to have palpable penile nodules at follow-up (20.6 vs. 0%; P=.03). However, patient's post-operative sexual life satisfaction was consistent between the two groups, with just 1 (5.3) and 8 (23.5) patients in Group 1 and 2 respectively referring a worsening in sexual life satisfaction (P=0.2). At follow-up, 84.9% of patients that would still undergo surgery for PD, with no statistical difference between the two groups (P=.4). Corporoplasty with PEG is an effective treatment for men with PD. Porcine dermal and bovine pericardium xenografts seem to have similar long-term outcomes.

Biomechanical Comparison of Augmentation of Engineered Tendon-Fibrocartilage-Bone Composite With Acellular Dermal Graft Using Double Rip-Stop Technique for Canine Rotator Cuff Repair.

Background:The retear rate after rotator cuff repair remains unacceptably high. Various biological engineered scaffolds have been proposed to reduce the retear rate. We have developed a double rip-stop repair with medial row knot (DRSK) technique to enhance suture-tendon strength and a novel engineered tendon-fibrocartilage-bone composite (TFBC) for rotator cuff repair.Hypothesis:DRSK rotator cuff repair augmented with TFBC will have better biomechanical properties than that of DRSK repair with an acellular dermal graft (DG).Study Design:Controlled laboratory study.Methods:Fresh-frozen canine shoulders (n = 30) and knees (n = 10) were used. TFBCs were harvested from the patellar tendon–tibia complex and prepared for rotator cuff repair. The infraspinatus tendon was sharply detached from its bony attachment and randomly assigned to the (1) control group: DRSK repair alone, (2) TFBC group: DRSK repair with TFBC, and (3) DG group: DRSK repair with DG. All specimens were tested to failure, and videos were recorded. The footprint area, tendon thickness, load to create 3-mm gap formation, failure load, failure modes, and stiffness were recorded and compared. Data were recorded as mean ± SD.Results:The mean load to create a 3-mm gap in both the control group (206.8 ± 55.7 N) and TFBC group (208.9 ± 39.1 N) was significantly higher than that in the DG group (157.7 ± 52.3 N) (P < .05 for all). The failure load of the control group (275.7 ± 75.0 N) and TFBC group (275.2 ± 52.5 N) was significantly higher compared with the DG group (201.5 ± 49.7 N) (P < .05 for both comparisons). The stiffness of the control group (26.4 ± 4.7 N/mm) was significantly higher than of the TFBC group (20.4 ± 4.4 N/mm) and the DG group (21.1 ± 4.8 N/mm) (P < .05 for both comparisons).Conclusion:TFBC augmentation showed superior biomechanical performance to DG augmentation in rotator cuff tears repaired using the DRSK technique, while there was no difference between the TFBC and control groups.Clinical Relevance:TFBC may help to reduce retear or gap formation after rotator cuff repair using the DRSK technique.

Using Dermal Fat Graft to Release Complex Syndactyly: A New Method.

Using Dermal Fat Graft to Release Complex Syndactyly: A New Method.

Innovative Bioactive Glass Fiber Technology Accelerates Wound Healing and Minimizes Costs: A Case Series.

To evaluate the efficacy and value of a novel borate-based bioactive glass fiber (BBGF) advanced wound matrix in the treatment of chronic wounds. Four patients with chronic wounds that had failed multiple prior treatments were identified and treated with the BBGF technology. Patient demographics, wound characteristics, and prior treatment history were obtained. Costs associated with prior treatments were estimated and recorded using available cost data. The average wound duration prior to initiation of BBGF treatment was 391 days. All of the patients had a history of multiple failed interventions, including operative procedures, negative-pressure wound therapy, cellular and/or tissue-based products, dermal grafts, and synthetic wound matrices. Prior interventions resulted in an average estimated cost of $87,750 per patient. All of the patients achieved complete wound closure in an average of 55 days using BBGF treatment. Patients were treated with 3.3 applications of the BBGF product on average, with an average cost of $3,564. The use of the BBGF advanced wound matrix on initial presentation could have saved the healthcare system an average of $84,186 per patient and reduced wound duration by an average of 336 days. The BBGF advanced wound matrix resulted in the healing of chronic wounds that had failed multiple prior interventions. In this series of challenging cases, BBGF accelerated healing while minimizing costs and improving patient outcomes. By offering an effective therapy at a low cost, BBGF has the potential to add significant value for both the healthcare system and the patient.

Superior capsular reconstruction: 2-year follow-up results

IntroductionA prerequisite for a satisfying functional result in the treatment of an irreparable rotator cuff rupture is a significant reduction of shoulder pain and better range of motion with an increase in anatomic glenohumeral joint stability.PurposeProspective study to examine the outcome after superior capsular reconstruction using a porcine extracellular matrix dermal graft. A special emphasis was primarily on the functional outcome, secondarily on radiographic shoulder changes, that superior capsular reconstruction might yield.MethodsClinical results were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a 2-year period. All patients had magnetic resonance imaging (MRI) of the injured shoulder after 1 year. Graft integration and durability were qualitatively estimated as well as any graft deterioration or resorption.ResultsThirteen patients with 13 superior capsular reconstructions were included over a 3-year period. Mean age was 61 years (range 50-70) at the time of surgery. At final follow-up (mean 24 months, range 23-32), the mean Constant score had improved from an average of 24.9-55.7 points. The mean WORC index had increased from a percentage average of 32.3%-61.9%. Eleven of 13 grafts were intact on follow-up MRI.ConclusionOur hypothesis was that successful implantation of a dermal xenograft would correlate with both better functional outcome and stabilized glenohumeral radiographic features. We saw a group of patients with variable but significant increases in functional results and in general with limited pain and with an intact xenograft on an MRI scan. We did not find a positive correlation between functional outcome scores and graft durability nor with single cuff tendon defects vs. larger rotator cuff defects.This study suggests that a superior capsular reconstruction can yield results that are comparable or superior to other known salvage treatment options in patients with large to massive rotator cuff defects without significant cuff tear arthropathy. The hypothesis that superior capsular reconstruction can be a relevant treatment method for irreparable rotator cuff tears could not be refuted despite a fairly low patient inclusion number. With these results, selected patients can be considered for a different treatment than reverse shoulder arthroplasty, débridement, or tendon transfer.

The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type I gingival recessions: A randomized, controlled clinical trial.

To assess the clinical efficacy and esthetic outcome of porcine-derived dermal collagen matrix in comparison with connective tissue graft in the treatment of multiple adjacent gingival recessions (MAGR), 6 and 12 months after the surgery. Twenty patients with bilateral type I MAGR were treated randomly with porcine-derived dermal collagen matrix (test site) or connective tissue graft (control site) in combination with a modified coronally advanced tunnel technique. The primary objectives were to evaluate the mean and complete root coverage. The secondary objectives were to assess keratinized tissue width, gingival thickness gain, and root coverage esthetic score. Six and 12 months postoperatively, both groups achieved significant improvements in all clinical parameters compared to baseline, with no statistically significant differences between the groups. Mean root coverage change (Δ12m - 6 m) was statistically significant between the groups in favor of connective tissue graft, and twice as many patients exhibited a complete coverage of all recessions in the control group than the test group. The porcine-derived dermal collagen matrix combined with a modified coronally advanced tunnel technique resulted in satisfactory clinical and esthetic outcomes, which were similar to connective tissue graft. Porcine-derived dermal collagen matrix (XDM) may be proposed as a substitute for connective tissue graft in multiple adjacent recession treatment due to successful root coverage, a significant increase of gingival thickness, and high esthetic outcomes. The clinical benefits for the use of XDM could be: (a) second surgical wound avoidance, (b) patient discomfort decrease, and (c) lower complications' rate.

Dermal Onlay Grafts: A Rescue Procedure for Secondary Inferior Periorbital Hollows.

Various procedures to efface age-related lower eyelid/cheek interface depressions, or primary periorbital hollows (POHs), have been reported in the literature. Postsurgical, or secondary, POHs are a distinct contour irregularity that have received little such attention. Dermal onlay grafts (DOGs), a site-specific term for autologous dermis fat grafts, have been used to treat secondary POHs for which less invasive measures have proved unsuccessful. The aim of this study was to describe the surgical technique and outcomes of DOGs for secondary POHs. A retrospective analysis of patients who underwent DOGs for secondary POHs over a 27-month period was performed. The surgical technique and outcomes are reviewed. Thirteen patients (10 women and 3 men; average age, 52 years; average follow-up, 9 months) were included in the study. Nine patients had bilateral surgery, and all had received previous filler or fat injection, or both, with poor outcomes. Generally, surgical complications were minor, required minimal intervention, or were self-limiting. One patient had persistent infraorbital dysesthesia which improved with oral tricyclic antidepressant treatment. Eleven of 13 patients stated satisfaction with hollow effacement and outcome, a finding verified by subjective assessment by a surgeon. DOGs yielded good results in this initial description of their utility as a rescue procedure to surgically address secondary POHs. Further quantitative volumetric studies to validate outcome would of value.

Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention.

Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. 3b Laryngoscope, 131:E124-E131, 2021.

Qualitative and Quantitative Analyses of Donor Site Morbidity Following a Graft of the Acellular Dermal Matrix Versus Primary Fascial Repair After ALT Flap Harvesting.

The anterolateral thigh (ALT) flap is one of the most useful flaps in reconstruction because of its reliability, large skin flap territory, and versatility. The relatively small number of side effects is a common reason for preferring this flap. Primary repair is usually performed at the donor site closure; however, this requires substantial tension and causes many donor site morbidities, including pain. We attempted to use acellular dermal matrix graft to overcome these problems. We analyzed a total of 41 cases (41 flaps) in this study. Among these flaps, we conducted donor fascia suture with artificial dermis in 20 cases (study group) and primary fascial suture in 21cases (control group). Post-operative ambulation recovery times, pain scores, drainage removals, and wound problems of the donor site were recorded. There were no serious complications, including infection, at the donor sites of all 41 cases. Of 20 cases using the acellular dermal matrix, seroma occurred in 2 cases and partial skin necrosis occurred in 2 cases. In 1 case of skin necrosis, the acellular dermal matrix was removed. However, in comparison to the control group, the group using the artificial dermis recovered ambulatory ability 3.9 days earlier and had a 1.8-point lower visual analogue scale score 5 days post-operatively. Our study suggested that, if used selectively, the acellular dermal matrix may play an effective role in donor site closure in cases with procedures involving the ALT flap.

Autologous dermis graft versus conchal cartilage graft for managing lower eyelid retraction: A comparative study.

Lower eyelid management is challenging. The conchal cartilage is often considered a spacer of choice for treating lower eyelid retraction. However, dermis graft has also recently been shown to be a viable spacer. The aim of this study was to compare the efficacy of dermis graft to that of conchal cartilage graft in this indication. A retrospective comparative study was conducted in patients who underwent lower eyelid lengthening with autologous dermis graft (group 1) or autologous conchal cartilage graft (group 2). The main outcome measure was the reduction in inferior scleral show (ISS) assessed by three independent masked surgeons. Secondary outcome measures was the assessment of lagophthalmos and corneal keratitis. Complications were also recorded. Twenty-five eyelids of 23 patients were included: 11 and 14 eyelids, respectively in group 1 (dermis graft) and group 2 (conchal cartilage graft). Patient mean follow-up was 12.3 (±12.5) and 7.1 (±7.7) months, respectively. No statistical differences in postoperative ISS reduction, lagophthalmos and exposure keratitis was observed (p = 0.540, p = 0.946, p = 0.934, respectively). Three patients experienced a grade I Clavien-Dindo complication in group 1 and one patient experienced a grade II complication in group 2 (p = 0.540). Autologous dermis grafts and conchal cartilage grafts provide favorable outcomes without major complications.

Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat.

The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. We eliminate the first surgical step by using a decellularized dermal skin graft (Epiflex®) populated with bone marrow mononuclear cells (BMC), as a replacement for the induced membrane. The aim of this study was to demonstrate the feasibility of this technology and provide evidence of equivalent bone healing in comparison to the induced membrane-technique. Therefore, 112 male Sprague–Dawley rats were allocated in six groups and received a 10 mm femoral defect. Defects were treated with either the induced membrane or decellularized dermis, with or without the addition of BMC. Defects were then filled with a scaffold (β-TCP), with or without BMC. After a healing time of eight weeks, femurs were taken for histological, radiological and biomechanical analysis. Defects treated with Epiflex® showed increased mineralization and bone formation predominantly in the transplanted dermis surrounding the defect. No significant decrease of biomechanical properties was found. Vascularization of the defect could be enhanced by addition of BMC. Considering the dramatic reduction of a patient’s burden by the reduced surgical stress and shortened time of treatment, this technique could have a great impact on clinical practice.

Human Acellular Dermal Matrix Augmentation Phalloplasty Surgery

Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard. To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique. From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck's fascia was made. Then separate the dartos fascia from the Buck's fascia. The prepared graft was then placed on top of the Buck's fascia, with the blood-remained side facing the Buck's fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck's fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently. The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm (P < .05), while the mean erect girth increased to 12.79 ± 1.23 cm (P < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation. Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.

Skin seeding technique with 0.5-mm micropunch grafting for vitiligo irrespective of the epidermal-dermal orientation: Animal and clinical studies.

Micropunch grafting is the simplest surgical intervention for refractory vitiligo but is tedious and time-consuming. Therefore, we aimed to verify the efficacy and safety of dermal orientation grafting using motorized 0.5-mm micropunch grafting for vitiligo. In a preliminary animal study, 12-week-old rats were used to observe the healing process after the transplantation of dermal orientation grafts with various punch sizes. In a clinical trial, a total of 100 vitiligo patches in 50 patients with stable vitiligo were randomly allocated to motorized 0.5-mm micropunch grafting in epidermal and dermal orientations, respectively. The grafts were implanted at intervals of 5mm at the recipient site. Treatment success was defined as greater than 75% repigmentation. In the animal study, all grafts were shown to be well integrated into the recipient site within 3weeks. In the clinical trial, treatment success was achieved in 72% and 76% of the epidermal and dermal orientation groups, respectively; a cobblestone appearance was observed in 4% and 2%, respectively. In conclusion, we demonstrated that this new grafting method irrespective of epidermal-dermal orientation using motorized 0.5-mm micropunch grafting was effective and safe. We have named this the "skin seeding technique" and it differs from traditional punch grafting in that it can be performed regardless of the graft orientation.

Root coverage of gingival recessions with non-carious cervical lesions: a controlled clinical trial.

The non-carious cervical lesion (NCCL) is commonly produced by improper toothbrushing techniques, occlusion trauma, anatomic mal-positioned teeth, and acid erosion, thus sharing the same etiology of gingival recession (GR). The association of a graft to the coronally advanced flap had demonstrated the best long-term outcome for root coverage (RC). However, substitutes for the autogenous graft must be studied. This split-mouth clinical trial investigates the RC and the increase in keratinized tissue (KT) when comparing RC of NCCLs associated with GR with intact roots using an extended coronally advanced flap (ECAF) associated with the acellular dermal matrix graft (ADMG), a connective tissue replacement graft. Seventeen individuals with bilateral GR were included in the study. One side had a NCCL (TG) and the opposite root was intact (CG). All patients were treated with the ECDF associated with ADMG. All clinical parameters were assessed at baseline and 6 months postoperative. Root coverage means (CG, 69.5 ± 19 and TG. 72.2 ± 16.5; p value = 0.849570) were not significantly different between control and test groups. In addition, the KT had an increase in the follow-up period for both groups. GR associated with NCCLs can be successfully treated with the ECDF and ADMG. Patients frequently search for GR treatment due to cervical wear, root sensitivity, and compromising aesthetics. The NCCL participates with the same issues. The present study contributes to the literature that GR associated with NCCLs can be successfully treated with the ECAF and the ADMG.

Cellular Response to Vitamin C-Enriched Chitosan/Agarose Film with Potential Application as Artificial Skin Substitute for Chronic Wound Treatment.

The treatment of chronic wounds is still a meaningful challenge to physicians. The aim of this work was to produce vitamin C-enriched chitosan/agarose (CHN/A) film that could serve as potential artificial skin substitute for chronic wound treatment. The biomaterial was fabricated by a newly developed and simplified method via mixing acidic chitosan solution with alkaline agarose solution that allowed to obtain slightly acidic pH (5.97) of the resultant material, which is known to support skin regeneration. Vitamin C was immobilized within the matrix of the film by entrapment method during production process. Produced films (CHN/A and CHN/A + vit C) were subjected to comprehensive evaluation of cellular response with the use of human skin fibroblasts, epidermal keratinocytes, and macrophages. It was demonstrated that novel biomaterials support adhesion and growth of human skin fibroblasts and keratinocytes, have ability to slightly reduce transforming growth factor-beta 1 (TGF-β1) (known to be present at augmented levels in the epidermis of chronic wounds), and increase platelet-derived growth factor-BB (PDGF-BB) secretion by the cells. Nevertheless, addition of vitamin C to the biomaterial formulation does not significantly improve its biological properties due to burst vitamin release profile. Obtained results clearly demonstrated that produced CHN/A film has great potential to be used as cellular dermal, epidermal, or dermo-epidermal graft pre-seeded with human skin cells for chronic wound treatment.

Pivot Superior Capsular Reconstruction of the Shoulder

Massive rotator cuff tears involving the posterosuperior rotator cuff remain difficult to treat, particularly in the younger population. Fatty infiltration of the muscle, excessive chronic tendon retraction, and degeneration are the main irreversible factors predisposing to high failure rates of direct repair. Many techniques exist for superior capsular reconstruction (SCR), mainly using allograft. However, the higher costs of dermal grafts and morbidity of fascia lata autograft led us to find another option for SCR of the shoulder using the semitendinosus autograft as a pivot in a better biomechanical configuration. The pivot SCR technique has shown good functional and biomechanical results. We have found this technique to be a reliable and less expensive option for irreparable lesions of the rotator cuff.

Porcine dermal matrix sandwich graft for lower eyelid reconstruction

ABSTRACT Purpose: To report the clinical outcomes of porcine acellular dermal matrix implants sandwiched between skin and conjunctival flaps for lower eyelid reconstruction following Mohs surgery. Methods: A retrospective review was performed on patients with lower eyelid defects following Mohs surgery treated using a porcine acellular dermal matrix sandwich graft from 2013 to 2018. Patient demographics, defect size and characteristics, and collagen matrix implant dimensions were evaluated. Postoperative course and complications were also reviewed. Results: The dermal matrix sandwich graft was performed in 13 cases (12 patients). Average horizontal marginal defect width was 11.7 mm (range: 6–16 mm). Mean width of the implanted dermal matrix was 7.7 mm (range: 5–9 mm). There were no instances of infection or graft failure. The reconstructed lid had an excellent marginal contour in 11 cases (84.6%), while 2 had minimal irregularities. All patients had an excellent thickness of the reconstructed margin. One patient (7.7%) required cauterization of overgrown marginal conjunctiva after surgery. Two patients (15.4%) experienced symptomatic trichiasis, requiring electrolysis (n = 1) and epilation (n = 1). Conclusions: The dermal matrix sandwich graft is an effective method for marginal defect repair when the remaining conjunctiva and skin are sufficient to develop the necessary flaps. While the resolution of edema and erythema may take several months, an excellent final result is achieved in the majority of cases. Complications are mild, relatively uncommon, and similar to those encountered in other reconstructive procedures. This single-stage, tissue-sparing technique preserves the capability of performing future tarsoconjunctival flaps or lateral canthal procedures, should the need arise.

Free Dermal Fat Graft for Reconstruction of Soft Tissue Defects in the Maxillofacial Region.

Facial contour deformities are a very challenging issue for aesthetic and reconstructive surgeons. Free dermal fat graft is a composite graft used for the reconstruction of soft tissue defects in the maxillofacial region. The free dermal fat graft is easily adapted and contoured intraoperatively and provides a soft, natural, and favorable appearance after augmentation of the soft tissue defects. To assess the use of free dermal fat graft for reconstruction of soft tissue defects in the maxillofacial region in regard to graft success, percentage of overcorrection, any associated complications, and cone beam computed tomography scan linear measurements for defect's depth. This is a prospective study that included a patients were grafted with free dermal fat graft for correction of facial soft tissue defects from November 2017 to July 2019. All patients possess a depression defect and facial asymmetry due to congenital facial deformities, post-traumatic deformities, and post-ablative surgical deformities. Eleven patients (8 males and 3 females) with a mean age of 33.7 years were enrolled in this study. Five regions in the maxillofacial area were grafted in 11 patients. The mean of the postoperative follow-up was 6 months. The percentage of graft overcorrection was 15%. The mean for graft survival was 94.4% with no serious complications reported. The autologous FDFG is a versatile and less invasive method in the reconstruction of facial soft tissue defects with a very good survival rate.

Generation of niche tuned antifibrotic fibroblasts and non-viral mediated endothelial commitment using adipose stem cells for dermal graft development.

Cell-based skin substitute generation has seen considerable development. Combining synthetic scaffolds with biomimetic fibrin does direct both exogenous and endogenous stem cell differentiation, addressing needs for reliable tissue engineering. However, lack of immediate vasculature within implantable grafts remains critical for its sustenance and integration. Multipotency, high proliferation potential, ability to release multiple growth factors (GFs), and autologous availability highlight the use of human adipose derived mesenchymal stem cells (hADMSCs) in tissue-engineered dermal grafts (TEDG) construction. However, hADMSCs' insufficiency to independently establish angiogenesis within tissue constructs demands improvement of stem cell application for dermal graft survival. Approaches to harness microenvironmentally sensitive paracrine interactions could improve the angiogenic efficiency of hADMSCs within TEDG. This study conceptualized a fibrin-based niche, to direct hADMSCs toward a nonfibrotic fibroblast commitment and incorporation of bioengineered hADMSCs, specifically releasing potent angiogenic factors within TEDG. Coexistence of tuned fibroblast and endothelial lineage committed cells contributed to well-regulated extracellular matrix formation and prevascularization. Adequate cell proliferation; sustained transient release of angiogenic GFs till 20 days; directed dermal, endothelial, fibroblast, and vascular smooth muscle cell differentiation; and favored elastin and collagen deposition were achieved in vitro. In conclusion, specific niche composition and employment of bioengineered hADMSCs favor implantable TEDG construction.