Transplantation Of Fascia Research Articles

Critical Considerations for Expanding Indications for Nonvascularized Rectus Fascia Transplantation: Clarifying Definitions, Techniques, and Immunogenicity.

Critical Considerations for Expanding Indications for Nonvascularized Rectus Fascia Transplantation: Clarifying Definitions, Techniques, and Immunogenicity.

Allogeneic abdominal non-vascularized rectus fascia transplantation without immunosuppression equals syngeneic transplantation in a rabbit model at short-term follow-up

Complex abdominal wall repair remains a major surgical challenge. In transplant patients, non-vascularized rectus fascia (NVRF) is successfully used to bridge the defect. To extrapolate this to non-transplant patients, we developed a rabbit model of NVRF-transplantation without immunosuppression comparing syngeneic versus allogeneic transplants. Short-term outcome (4 weeks) was evaluated macroscopically (ingrowth, seroma/hematoma, herniation, and infection), histologically at the graft interface and center (inflammation, neovascularization, and collagen deposition) and by mechanical testing. In both groups a similar macroscopic ingrowth of the NVRF was observed. In the syn-group, one seroma and one hematoma was seen. Two small herniations were detected at the suture line in the allo-group. No surgical site infections were observed. Histologically, graft neovascularization was observed in all animals. Infiltration of T-lymphocytes was seen at the graft interface in both groups, but more in the allo-group (p < 0.0001). Deposition of collagen was not different between groups. Macrophages were present in both groups around sutures and in the center more abundantly in the allo-group (p = 0.0001). Graft stiffness and strength were similar for both groups. With this model, we showed that allogeneic transplantation without immunosuppression results in favorable short-term inflammatory and mechanical outcomes. Long-term experiments are needed to further evaluate the effect on graft integration and hernia development.

Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation.

Failure to close the abdominal wall after intestinal transplantation (ITx) or multivisceral Tx remains a surgical challenge. An attractive method is the use of nonvascularized rectus fascia (NVRF) in which both layers of the donor abdominal rectus fascia are used as an inlay patch without vascular anastomosis. How this graft integrates over time remains unknown. The study aims to provide a multilevel analysis of the neovascularization and integration process of the NVRF. Three NVRF-Tx were performed after ITx. Clinical, radiological, histological, and immunological data were analyzed to get insights into the neovascularization and integration process of the NVRF. Moreover, cryogenic contrast-enhanced microfocus computed tomography (microCT) analysis was used for detailed reconstruction of the vasculature in and around the NVRF (3-dimensional histology). Two men (31- and 51-y-old) and 1 woman (49-y-old) underwent 2 multivisceral Tx and 1 combined liver-ITx, respectively. A CT scan showed contrast enhancement around the fascia graft at 5 days post-Tx. At 6 weeks, newly formed blood vessels were visualized around the graft with Doppler ultrasound. Biopsies at 2 weeks post-Tx revealed inflammation around the NVRF and early fibrosis. At 6 months, classical 2-dimensional histological analysis of a biopsy confirmed integration of the fascia graft with strong fibrotic reaction without signs of rejection. A cryogenic contrast-enhanced microCT scan of the same biopsy revealed the presence of microvasculature, enveloping and penetrating the donor fascia. We showed clinical, histological, and microCT evidence of the neovascularization and integration process of the NVRF after Tx.

Treatment of Cicatricial Lower Eyelid Ectropion with Suture of Horner Muscle Combined with Fascia Transplantation.

This case series aimed to describe a new technique for correcting contractures and deformities that reliably addresses lacrimal punctum deviation and severe cicatricial lower eyelid ectropion. This was a technical description and a retrospective interventional case series. Eyelid ectropion and lacrimal punctum deviation were treated surgically by grafting the fascia lata and suturing the tarsus-Horner muscle. In total, three patients underwent this surgery: one for burns, one for lower eyelid tumor resection, and the other for an orbital floor fracture following a motorcycle accident, all resulting in ectropion. All patients previously had failed ectropion correction procedures, including scar revision, skin grafting, auricular cartilage grafting, and lateral tarsal strips. The mean follow-up was 15.8 (12.5-18.5) months. Furthermore, all patients showed resolution of lower eyelid ectropion and significant improvement in lower eyelid contracture, with a mean increase of 4.0 (2.5-5) mm. No severe complications were observed, and they reported a significant improvement in ocular surface symptoms. Our study shows that tacking of the tarsus and Horner muscles in combination with fascia lata grafting is effective in correcting refractory cicatricial lower eyelid ectropion with deviation of the tear punctum.

67: Long-term outcome after non-vascularized rectus fascia transplantation in solid organ transplantation: A global multi-center IRTA survey.

67: Long-term outcome after non-vascularized rectus fascia transplantation in solid organ transplantation: A global multi-center IRTA survey.

V-053 USE OF ABDOMINAL FASCIA TRANSPLANTATION FOR COMPLEX GIANT INCISIONAL HERNIA AFTER LIVER TRANSPLANT

Abstract Incisional hernias are a well-known complicationafter liver transplantation, with an incidence of up to 15%. Conventional closure techniques such as synthetic or biological meshes do not have proper results, probably due to a variety of factors including tension in a definitive wall closure and the use of immunosuppressive drugs that can cause necrosis and wound infection. Alternative techniques such as a complete abdominal fascia transplantation can sometimes be needed. We present the case of a 57-year-old man with a history of liver transplantation due to HCV Cirrhosis, Portal Thrombosis and Pulmonary Hypertension. The patient developed a hernia of the Mercedes scar with a large fascial defect that caused him pain and obstructive symptoms. Surgical intervention was performed for hernia repair. During surgery, a large aponeurotic defect was identified with a ring of 25×15cm associated with an adhesion syndrome within the hernial sac. During surgery, the hernial sac was released, followed by release of the anterior aponeurosis and peritoneal closure. An abdominal wall transplant was performed from a 56-year-old donor after the graft had been preserved for 10 days in Celsior® at 4°. The fascial graft was placed to cover the abdominal wall defect and sutured to the edges of the recipient's fascia, using 4 interrupted 2-0 polypropylene non absorbable stitches. This patient's loss of domain of the abdominal cavity, associated with the existing vascular complications, were more than sufficient reasons to choose this technique. The patient's postoperative course was uneventful, but developed bulging during follow-up, without any additional complications.

Extensive Cutaneous Necrosis of Hand and Forearm Due to Extravasation of Norepinephrine Requiring Fascia Transplantation and Anterolateral Thigh Flap -A Case Report

Extensive Cutaneous Necrosis of Hand and Forearm Due to Extravasation of Norepinephrine Requiring Fascia Transplantation and Anterolateral Thigh Flap -A Case Report

Combined autologous fascia transplantation with autologous fascia and fat injection into the vocal fold for sulcus vocalis

Objective: To assess voice outcomes after surgical technique for typeⅡ and type Ⅲ sulcus vocalis. Methods: The data of 39 cases of bilateral type Ⅱ-Ⅲ sulcus vocalis were collected and analyzed retrospectively. There were 29 patients with bilateral type Ⅲ sulcus vocalis, and 10 patients with type Ⅲ on one side and typeⅡon the contralateral vocal cord. All of vocal cords were applied autologous anterior rectus sheath fascia transplant, and 68 sides of vocal cords with type Ⅲ sulcus vocalis were also applied autologous fascia and fat injection. Two male patients, whose results from transplant and injection were not satisfied, were carried out cricothyroid myotomy one year after surgery. Subjective and objective voice evaluations were performed before and after operation. Results: One patient was found mild adhesion on the middle part of vocal cords, and all the other 38 patients recovered well and there were no complications. During 5-6 weeks after surgery, breathy voice was the feather. Then vocal quality and glottal closure were gradually improved and became steady in 12 months. It showed that all the subjective and objective parameters, except for fundamental frequency, were significantly improved (P<0.05), and obvious improvement was achieved in glottal closures and mucosal waves in 35 patients. Three patients obtained no significant vocal quality improvement after transplant and injection surgery, and two male patients of them achieved improvement in mucosal waves and MPT after bilateral cricothyroid muscle amputations. One patient, who was revealed with mild adhesion, achieved a satisfied result after adhesion separation and suture. All the patients who originally had feelings of fatigue and voice discontinuity during phonation gained significant improvement postoperatively. Steady function with no complications was observed during the 36 months (up to 5 years in 20 patients) follow-up period. Conclusions: Autologous fascia transplantation combined fascia and fat injcetion can lead to excellent long-term results, and it is a good treatment option for pathologic sulcus vocalis. Cricothyroid muscle amputations can reduce the tension, and may improve vibration property of the vocal fold in patients with pathological sulcus vocalis.

NEW TECHNIQUE FOR ABDOMINAL WALL RETRIEVAL: OUR INITIAL OUTCOMES WITH THE NEW TECHNIQUE IN NON-VASCULARIZED FASCIA

Introduction: Abdominal wall transplantation is a rarely used surgical technique indicated in the context of intestinal and multivisceral transplantation or in liver transplant candidates with abdominal wall problems. The two techniques described so far include the extraction of only non-vascularized fascia proposed by Favaloro –which minimizes the aesthetic damage to the donor’s body– and the full-thickness abdominal wall extraction technique proposed by Miami, with graft bank perfusion. Both techniques have less than 35% complication rates. Methods: Since March 2018, we have performed six transplants of non-vascularized fascia with the following technique: The donor is opened by means of a cutaneous “home” flap, followed by the identification of the inferior epigastric vessels. Before perfusion of the abdominal viscera to be extracted, both common iliac arteries are cannulated up to the level of the external iliac artery, bypassing the internal iliac artery, with ligation of the external iliac artery distal to the exit of the inferior epigastric artery. No venous cannulation is performed. Synchronously with the grafts, perfusion of 1 liter of Celsior is performed for each iliac and the wall flap is covered with cold compresses. After graft removal and depending on the local conditions of the recipient, a full-thickness transplant or non-vascularized fascia transplant is decided. Results: 6 non-vascularized fascia transplants have been performed between 14-63 years-old: 3 in intestinal transplantation, 1 in multivisceral and 2 in liver, resulting in the loss of a single wall transplant due to persistent enterocutaneous fistula. In the remaining 5 cases, the graft was maintained until the present time or loss of follow-up; a period between 3-21 months. The covered defects ranged from 17x7 cm to 25x20 cm. The main indication was the impossibility of primary closure in 4 cases, use of full graft instead of reduced in one case, and abdominal wall closure after compartment syndrome in the last one. The transplants were performed synchronously to the abdominal organ except in a case that required a second donor. Conclusions: Our wall transplant technique is associated with a lower complication rate after wall transplantation, being a valid alternative to conventional techniques.

Use of Nonvascularized Fascia in Liver Transplantation

Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. Case 1A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Uneventful liver transplant, with a graft procured from a 14-year-old donor. At the time of wall closure it was decided to implant a nonvascularized fascia graft to supplement the right side of the transverse incision, with a 17 x 7 cm defect. This required reintervention after 4 months for biliary stricture. At that point, the wall graft was almost completely integrated into the native tissue. Case 2A 63-year-old man, transplanted for hepatitis C virus+ hepatocellular carcinoma+ nonocclusive portal thrombosis. Thirty-six hours after transplant the patient developed portal thrombosis. Thrombectomy and closure with biological mesh were performed. After 24 hours he was reoperated on for abdominal compartment syndrome and temporary closure with a Bogotá bag. Six days later he underwent omentectomy, intestinal decompression, and left components separation, identifying a 25 x 20 cm defect. For definitive closure, a nonvascularized fascia graft procured from a different donor was used, accomplishing a reduction in intra-abdominal pressure.Nonvascularized fascia transplantation is an interesting alternative in liver transplant recipients with abdominal wall closure difficulties.

P4.12: Immune response in an experimental model of pig to rabbit abdominal fascia transplantation.

P4.12: Immune response in an experimental model of pig to rabbit abdominal fascia transplantation.

Abdominal Wall Transplantation in Organ Transplantation: Our Experience

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. We report two cases of non-vascularized fascia transplantation in intestinal and multivisceral transplants, respectively. Both donors were young (23 and 18 years old). Both recipients had endured multiple previous surgeries, and no surgical alternatives for primary wall repair could be offered. In both cases, a complete abdominal wall flap was retrieved from the donor, however, due to the characteristics of the recipient's abdominal wall defect, only non-vascularized fascia was used after removing skin and subcutaneous cellular tissue from the graft. Abdominal wall transplantation is an option to consider for abdominal wall closure in patients with multiple previous surgeries and no alternatives for primary wall repair.

Utilidad del trasplante de la pared abdominal en el trasplante de órganos. Nuestra experiencia inicial

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. We report two cases of non-vascularized fascia transplantation in intestinal and multivisceral transplants, respectively. Both donors were young (23 and 18 years old). Both recipients had endured multiple previous surgeries, and no surgical alternatives for primary wall repair could be offered. In both cases, a complete abdominal wall flap was retrieved from the donor, however, due to the characteristics of the recipient's abdominal wall defect, only non-vascularized fascia was used after removing skin and subcutaneous cellular tissue from the graft. Abdominal wall transplantation is an option to consider for abdominal wall closure in patients with multiple previous surgeries and no alternatives for primary wall repair.

Nasal septum perforation – new treatment methods

Perforation is a defect of nasal septum manifested by the disruption of mucosa in the cartillaginous or bone part of nasal septum or in both of the parts at the same time.As a result, disruption of air transport through the nose and impaired nasal physiology occur. Crusting, epistaxis, and wheezing arise. Perforations are classified according to their size, type, and localization. There are many causes for nasal septum perforation: trauma, surgery, tumors, coexistence of inflammatory, infectious, degenerative, and autoimmune diseases, and cocaine abuse. The assessment of a patient with nasal septum perforation includes detailed medical history, physical examination, diagnostic and laboratory tests. Treating the underlying disease is of primary importance. The second step involves closing the perforation. Perforations can be treated conservatively (pharmacologically) or surgically. The choice of approach depends on the etiology, size, and location of the perforation. Surgical approach is the most effective. Surgical closure of nasal septal perforation is a difficult procedure associated with many complications. All surgical approaches are based on two main principles: creating mucosal, mucoperichondrial, and/or mucoperiosteal flaps or transplant. Prosthetic treatment is another solution. Literature data shows that highest success rate is achieved after surgical procedures with the use of mucosal flaps and temporal fascia transplants, as well as acellular human dermal allografts.

Temporalis Fascia Transplantation for Sulcus Vocalis and Vocal Fold Scar: Long-Term Outcomes.

Sulcus vocalis and vocal fold scar involve derangement of the superficial lamina propria of the vocal fold, which results in significant dysphonia. Many options exist for treatment, most of which have unsatisfactory and unpredictable outcomes. Autologous transplantation of temporalis fascia into the vocal fold (ATFV) has the potential to be a better treatment option, but long-term outcomes have not been well studied. Retrospective chart review and patient survey. Twenty-one patients diagnosed with vocal fold scar or sulcus vocalis and treated with ATFV with at least 1-year follow-up were included. Voice Handicap Index 10 (VHI-10) questionnaires were collected preoperatively and 6 months postoperatively. Patients were reached at the time of the study to complete another VHI-10 and a Likert scale survey. The mean decrease in VHI-10 scores between preoperation and 6 months postoperation was 8.35 ( P < .001). From preoperation to the time of the study (average 44 months; range, 12-72 months), the VHI decreased 13.53 ( P < .001). Eighty-eight percent of patients reported they would recommend this surgery to others with the same diagnosis. Only 1 minor self-limited complication occurred. Autologous transplantation of temporalis fascia into the vocal fold for the treatment of vocal fold scar and sulcus vocalis is a safe surgery with good long-term outcomes and high patient satisfaction.

Evaluation of Autologous Fascia Implantation With Controlled Release of Fibroblast Growth Factor for Recurrent Laryngeal Nerve Paralysis Due to Long-term Denervation.

Paralyzed tissue due to long-term denervation is resistant to many treatments because it induces irreversible histological changes and disorders of deglutition or phonation. We sought to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on long-term unilateral vocal fold paralysis (UVFP). Unilateral recurrent laryngeal nerve (RLN) section was performed on 20 rats. Five rats were implanted with autologous fascia only (fascia group), and 10 rats were implanted with autologous fascia and a gelatin hydrogel sheet with 1 μg (1 μg bFGF + fascia group) or 0.1 μg (0.1 μg bFGF + fascia group) of bFGF 4 months after RLN section. We evaluated the normalized glottal gap and laryngeal volume and histological changes 3 months after implantation. The normalized glottal gap was significantly reduced in the 3 fascia implantation groups. Normalized laryngeal volume, fat volume, and lateral thyroarytenoid muscle volume were significantly increased in the 2 fascia implantation with bFGF groups. The ATFV with controlled release of bFGF repaired the glottal gap and laryngeal volume after RLN section and may reduce the occurrence of aspiration and hoarseness. We speculate that this treatment improves laryngeal function in long-term RLN denervation.

Reconstruction of the external auditory canal using the random flap technique and laser Doppler evaluation.

The external auditory canal is one of the most difficult sites to reconstruct after tumor resection. In general, fascia transplantation is used to reconstruct defects of the external auditory canal, but this method is associated with scar formation and prolonged wound healing. Scar tissue might cause stenosis in the external auditory canal and hypoacusis, and wound healing is further delayed by radiation and chemotherapy. To examine the safety of a random flap for reconstruction of an external auditory canal based on blood flow evaluation using a laser Doppler system. Ten healthy volunteers were enrolled in this study to compare blood flow in the face, back, and behind the ear using a laser Doppler system. Two cases of external auditory canal reconstruction are presented. Blood flow behind the ear was abundant compared with that in the back. Blood flow in the face was higher than that behind the ear or on the back. Blood flow in the random flap was easily evaluated using the laser Doppler method. Based on our findings, we propose the random flap to reconstruct the external auditory canal after tumor resection.

Structural signs of dynamic state of synaptic contacts between neurotransplant and brain.

We studied ultrastructure of synaptic connections between long-living dentate fascia transplants and somatosensory area of the neocortex in rats. Giant synaptic terminals of granular neurons upon contact with unusual neuronal targets in the neocortex reproduced their specific constitutive morphological features. At the same time, developing synapses with signs of active structural and metabolic reorganization were revealed. This is indicative of a dynamic state and instability of functional connections between the transplant and brain despite long time after transplantation.

Temporalis fascia transplant for vocal fold scar and sulcus vocalis

To evaluate vocal outcomes in 10 patients 1 year after autologous transplantation of temporalis fascia into Reinke's space (ATFV) for vocal fold scar and sulcus vocalis. Retrospective, clinical case series. Subjective and objective evaluation was performed 12 months after surgery using laryngovideostroboscopy (LVS) in all patients, the Voice Handicap Index-10 (VHI-10) in seven patients, GRBAS (grade, roughness, breathiness, asthenia, strain) scale in nine patients, and noise-to-harmonics ratio (NHR), phonatory range (PR) and maximum phonation time (MPT) in six patients. LVS improved in all but one patient. A significant decrease was noted in the GRBAS subscales grade, roughness, asthenia, and strain (P<.05). Breathiness was almost significant, with a P value of .052. There was an average decrease in the VHI-10 of 8.14 (P=.032). NHR, MPT, and PR did not statistically improve. ATFV for vocal fold scar and sulcus vocalis results in significant subjective vocal improvement that persists at least 1 year after surgery. 4.

Fascia implantation with fibroblast growth factor on vocal fold paralysis

PurposeThe purpose of this prospective study was to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on unilateral vocal fold paralysis (UVFP) in a rat model. Materials and methodsUnilateral recurrent laryngeal nerve (RLN) section was performed on 15 rats. Ten rats received an autologous fascia implant and gelatin hydrogel with or without bFGF (1μg) to their larynxes (fascia only, “fascia group”; bFGF+fascia, “fascia+bFGF group”), while the rest underwent RLN transection (“RLN section group”). Four months later, evaluation of the laryngeal glottal gap and histological analysis were performed. ResultsThe glottal gap was significantly reduced in the fascia+bFGF group, and fat volume increased significantly relative to the RLN section. The volume of the remaining fascia in the bFGF+fascia group was significantly greater than that of the fascia group. ConclusionsATFV with controlled release of bFGF may compensate for diminished laryngeal volume in UVFP by reducing resorption of the implanted fascia and increasing fat volume. Our findings suggest that this modality may represent an attractive option for treating UVFP.