Liposuction Technique Research Articles

Autologous Stromal Vascular Fraction in the Intravenous Treatment of End-Stage Chronic Obstructive Pulmonary Disease: A Phase I Trial of Safety and Tolerability.

BackgroundChronic obstructive pulmonary disease (COPD) is a consistently progressive, ultimately fatal disease for which no treatment exists capable of either reversing or even interrupting its course. It afflicts more than 5% of the population in many countries, and it accordingly represents the third most frequent cause of death in the US, where it accounts for more than 600 billion in health care costs, morbidity, and mortality. Adipose tissue contains within its stromal compartment a high abundance of adipose stem/stromal cells (ASCs), which can be readily separated from the adipocyte population by methods which require less than 2 h of processing time and yield a concentrated cellular preparation termed the stromal vascular fraction (SVF). The SVF contains all cellular elements of fat, excluding adipocytes. Recent clinical studies have begun to explore the feasibility and safety of the local injection or intravascular delivery of SVF or more purified populations of ASCs derived by culture protocols. Several pre-clinical studies have demonstrated a remarkable ability of ASC to nearly fully ameliorate the progress of emphysema due to cigarette smoke exposure as well as other causes. However, no prior clinical studies have evaluated the safety of administration of either ASC or SVF in subjects with COPD. We hypothesized that harvest, isolation, and immediate intravenous infusion of autologous SVF would be feasible and safe in subjects with COPD; and that such an approach, if ultimately determined to be efficacious as well as safe, would provide a highly practical method for treatment of COPD.MethodsIn this study, an initial phase I trial evaluating the early and delayed safety of SVF infusion was performed. Twelve subjects were enrolled in the study, in which adipose tissue was harvested using standard liposuction techniques, followed by SVF isolation and intravenous infusion of 150 - 300 million cells. Standardized questionnaires were administered to study feasibility as well as immediate and delayed outcomes and adverse events as primary endpoints. Secondary endpoints included subjective wellness and attitudes towards the procedure, as well as willingness to undergo the procedure a second time. The follow-up time ranged from 3 to 12 months, averaging 12 months.ResultsOf the 12 subjects, only one experienced an immediate adverse event, related to bruising from the liposuction. No observed pulmonary or cardiac issues were observed as related to the procedure. There were no deaths over the 12-month study period, and none identified in the subsequent telephonic follow-up. Attitudes toward the procedure were predominantly positive, and 92% of the study subjects expressed a desire to undergo the procedure a second time.ConclusionsThis study is the first to demonstrate safety of SVF infusion in humans with serious pulmonary disease. Specifically, the use of intravenous infusion as a route to achieve pulmonary cellular targeting did not lead to clinical pulmonary compromise. The intravenous administration of SVF should be further explored as a potentially feasible and safe method for delivery leading to possible therapeutic benefit.

Madelung's Disease: Revision of 59 Surgical Cases.

Madelung's disease (MD) is a rare disease, more common in Mediterranean countries and associated with alcohol abuse. However, MD etiology remains not completely understood. The aim of this study was to investigate clinical features, treatment options and outcomes in patients with MD treated in our plastic surgery department. We retrospectively reviewed 59 cases of MD operated on between 2004 and 2013. Demographic information, location of the deposits, associated pathology and habits, number and type of surgeries performed, surgical complications and disease evolution were analyzed. Ninety percent of the patients were males. Active or past history of alcohol abuse was reported by 86%. The main affected areas were anterior and posterior neck. A total of 230 surgical procedures were performed. Open surgery was used on 192 occasions (83.5%), liposuction alone on 30 procedures (13%) and lipectomy combined with liposuction on 8 interventions (3.5%). Surgical complications were found in 41 procedures (17.8%). Twenty-three patients (39%) were identified as having disease recurrence of the operated site in a mean time of 3.8years. Alcohol consumption was not clearly associated with disease recurrence. Demographic characteristics of the studied cohort stand for published data. It is our opinion that lipectomy/dermolipectomy provides better aesthetic and functional results. Lipectomy procedures allow a thorough excision, correct identification of noble structures and careful hemostasis. Liposuction techniques, even ultrasound-assisted ones, had limited efficacy for the treatment of large masses. A long follow-up period is recommended considering the high propensity and mean time to recurrence. 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 .

Liposuction Technique Used as a Treatment Modality for Suicide Attempt by Injection of Mercury.

Elemental mercury poisoning commonly occurs through vapour inhalation as it is well absorbed through the lungs. Administering subcutaneous and intravenous elemental mercury is very uncommon with only a few isolated case reports in literature. We present a case of attempted suicide by subcutaneous injection of elemental mercury, an unusual substance used for suicide. As the attempt at self-injury was not confessed by the patient, diagnosis was challenging. Patient was treated with an initial diagnosis of cellulitis, but with repeated and persistent questioning, a history of self-injection of mercury into the arm was revealed. On confirmation, mercury was aspirated from subcutaneous space similar to liposuction technique under X-ray guidance. Management of subcutaneous injection of elemental mercury with particular emphasis on the need for surgical removal of all available mercury is discussed.

Outcomes of Autologous Fat Injection Laryngoplasty in Unilateral Vocal Cord Paralysis.

Unilateral vocal cord paralysis (UVCP) is not an uncommon finding. Several procedures are available to manage glottal insufficiency. We conducted a clinical trial to evaluate the outcome of fat injection laryngoplasty. Liposuctioned lower abdomen fat was injected for augmentation of paralyzed vocal cord in 20 patients with UVCP. Autologous fat was harvested with an 18G needle and a 20-ml disposable syringe using a liposuction technique. Clinical follow-up after the injection was carried out from 1 to 6-21 months. Voice and glottal protective function were significantly improved after the surgery. Vocal elements were immediately improved after the surgery, and after 1 year of follow-up. Fat injection laryngoplasty by liposuction is simple, safe, effective and has a low cost for patients with UVCP with aspiration and breathy voice dysphonia.

Cytokine-Rich Adipose Tissue Extract Production from Water-Assisted Lipoaspirate: Methodology for Clinical Use

Proper functioning wound healing strategies are sparse. Adequate vascular formation to the injured area, as well as replacement of the volume loss, is fundamental in soft tissue repair. Tissue engineering strategies have been proposed for the treatment of these injury sites. Novel cell-free substance, human adipose tissue extract (ATE), has been previously shown to induce in vitro angiogenesis and adipogenesis and in vivo soft tissue formation. This study reports the translation of ATE preparation from laboratory to the operating room (OR). ATE samples for this study were derived from adipose tissue obtained with the water-jet assisted liposuction technique from 27 healthy patients. The variables studied included incubation time (15, 30, and 45 min), temperature (room temperature vs. 37°C), and filter type to determine the optimal method yielding the most consistent total protein content, as well as consistent and high expression of adipose-derived growth factors and cytokines, including: vascular endothelial growth factor, basic fibroblast growth factor, interleukin-6, adiponectin, leptin, and insulin-like growth factor. Following the optimization, samples were produced in the OR and tested for their sterility. No significant differences were observed when comparing extract incubation time points or incubation temperature. Nonetheless, when studying the different filter types used, a syringe filter with PES membrane with larger filter area showed significantly higher protein concentration (p ≤ 0.018). When studying the different growth factor concentrations, ELISA results showed less variation in cytokine concentrations in the OR samples with the optimized protocol. All of the OR samples were tested sterile. The devised protocol is an easy and reproducible OR-ready method for ATE generation. As an attractive source of growth factors, ATE is a promising alternative in the vast field of tissue engineering. Its clinical applications include volume replacement as a complement to fillers and improvement of the permanence of fat grafts and wound healing, among other bioactive functions.

Abdominoplasty with Scarpa's Fascia Advancement Flap to Enhance the Waistline.

Abdominoplasty for body contouring has evolved from focusing primarily on modification of the skin flap and underlying rectus diastasis repair, to the association of liposuction and limited undermining techniques. While plication of the midline diastasis reliably improves anterior posterior dimensions, it has a more limited effect on the waist contour. Nahas suggested that increasing the width of the plication of the anterior rectus sheath may be responsible for displacement of the contours of the abdomen, yielding unnatural results.1 In an attempt to achieve reliable waist modification, different techniques have been published. L-shaped external oblique muscle plication, multidirectional abdominal wall plication, and advancement of the external oblique muscle flaps have been described.2 Plication of the external obliques demonstrates limited mobility and the creation of widely undermined external oblique flaps is typically beyond the scope of the standard outpatient procedure. It has been suggested that the preservation of Scarpa's fascia during abdominoplasty may lead to a decrease in postoperative complications.3,4 Friedman et al suggested that up to 17% of the lymphatic drainage of the abdominal wall is maintained if dissection is performed above Scarpa's fascia.5 The use of Scarpa's fascia to enhance the waist line definition during abdominoplasty has been limited. Mossaad et al used a medial directional pull on Scarpa's fascia in an effort to define the waistline as a modification of the lipoabdominoplasty technique described by Saldanha et al.6-9 Mossaad's technique removes a full thickness midline strip of subcutaneous tissue below the umbilicus down to the rectus sheath, extending approximately 4 cm lateral to the midline on each side. Tissue advancement was achieved only through lipo-mobilization using standard liposuction techniques with o undermining above the umbilicus other than the midline. Mallucci presented a refinement to traditional abdominoplasty using a superficial fascial …

Evolving Trends in Breast Surgery: Oncoplastic to Onco-Aesthetic Surgery.

The term oncoplastic surgery was first coined by Gabka and Bohmert [1], reflecting a recognition that the cosmetic outcome of breast surgery is an important part of patient outcomes. With the publication of practice guidelines, the principles of oncoplastic surgery were embedded in the management of breast cancer [2,3,4,5,6]. The evidence that poor aesthetic outcomes after breast surgery adversely impacted the quality of life led surgeons to seek out and refine surgical techniques that would preserve the size, volume, shape, and cosmetic appearance of breasts treated for breast cancer [7]. This led to the evolution of surgical procedures that utilize fibroglandular flap advancement to fill the surgical defect left after the excision of the breast, and therapeutic mammoplasty to excise large tumours or tumours located at cosmetically unforgiving sites on the breast such as the lower and medial quadrants of the breast [8,9]. Various techniques have been described for reconstructing large-volume breast excisions [10,11,12]. Increased awareness regarding the availability of these techniques has led women of today to be well informed and to expect an aesthetically acceptable breast form after the conservative treatment of breast cancer. Advancements in reconstruction techniques after mastectomy using latissimus dorsi flaps, transverse rectus abdominus muscle flaps, and deep inferior epigastric perforator flaps, as well as improvements in implant-based reconstruction, contributed to an increase in the demand for and uptake of post-mastectomy reconstruction; moreover, the safety of nipple sparing mastectomy has been demonstrated in large-scale cohort studies [13,14]. The evidence that post-mastectomy radiotherapy can contribute to patient survival compelled breast surgeons to revise the reconstruction options offered to women after mastectomy. Delayed reconstruction with autologous flaps or two-staged reconstruction deploying a tissue expander during radiotherapy, followed by a fixed-volume implant or autologous flap reconstruction, became the reconstruction of choice for patients who were likely to need chest wall radiotherapy after mastectomy [14]. The literature regarding potential comorbidities associated with silicone-based breast implants led to declining patient acceptance of silicone-based implants. After safety statements by the Food and Drug Administration, the uptake of silicone-based resumed in North America, and silicone and saline-based implants are more commonly used implants [15]. The advent of acellular dermal matrix (ADM) dramatically increased the number of options and techniques available for breast reconstruction, and the increasing use of ADM diminished the surgical challenge of donor site morbidity, enhancing patient acceptance. Guidelines for the optimal use of ADM are still evolving and are the focus of intense research and training [16]. Advancements in liposuction techniques that yield a high success rate after autologous fat transplant have led to the development of lipo-modelling techniques as an adjunct in restoring cosmetic defects after breast-conserving surgery and enhancing the cosmetic appearance of a reconstructed breast [17,18,19]. Oncoplastic breast surgery has come of age: the technical skills of surgeons have advanced, the technology of reconstructive mechanical adjuncts has improved, and a better scientific understanding of restorative and reconstructive breast surgery has been achieved. The new frontiers of aesthetic enhancement after breast cancer surgery in terms of restoring normal anatomical appearance and symmetry have been reached by breast surgeons. Indeed, most modern oncoplastic-trained surgeons are able and willing to undertake surgery on the contralateral side to enhance the aesthetics and cosmetic appearance of the breast treated for cancer. One could perhaps argue that surgical treatment that involves the techniques of flap formation, reconstruction with pedicled grafts, liposuction, lipo-modelling, and the use of ADM now deserves to be called onco-aesthetic surgery, which is a significant and rewarding step forward from oncoplastic surgery!

Human Adipose-Derived Mesenchymal Stem Cells Cryopreservation and Thawing Decrease α4-Integrin Expression.

Aim. The effects of cryopreservation on adipose tissue-derived mesenchymal stem cells are not clearly documented, as there is a growing body of evidence about the importance of adipose-derived mesenchymal stem cells for regenerative therapies. The aim of this study was to analyze human adipose tissue-derived mesenchymal stem cells phenotypic expression (CD34, CD45, CD73, CD90, CD105, and CD49d), colony forming unit ability, viability, and differentiation potential before and after cryopreservation. Materials and Methods. 12 samples of the adipose tissue were collected from a healthy donor using the liposuction technique. The cell isolation was performed by enzymatic digestion and then the cells were cultured up to passage 2. Before and after cryopreservation the immunophenotype, cellular viability analysis by flow cytometer, colony forming units ability, differentiation potential into adipocytes and osteoblasts as demonstrated by Oil Red O and Alizarin Red staining, respectively. Results. The immunophenotypic markers expression was largely preserved, and their multipotency was maintained. However, after cryopreservation, the cells decreased α4-integrin expression (CD49d), cell viability, and number of colony forming units. Conclusions. These findings suggest that ADMSC transplanted after cryopreservation might compromise the retention of transplanted cells in the host tissue. Therefore, further studies are warranted to standardize protocols related to cryopreservation to attain full benefits of stem cell therapy.

Roll, Spin, Wash, or Filter? Processing of Lipoaspirate for Autologous Fat Grafting: An Updated, Evidence-Based Review of the Literature.

The use of autologous adipose tissue harvested through liposuction techniques for soft-tissue augmentation has become commonplace among cosmetic and reconstructive surgeons alike. Despite its longstanding use in the plastic surgery community, substantial controversy remains regarding the optimal method of processing harvested lipoaspirate before grafting. This evidence-based review builds on prior examinations of the literature to evaluate both established and novel methods for lipoaspirate processing. A comprehensive, systematic review of the literature was conducted using Ovid MEDLINE in January of 2015 to identify all relevant publications subsequent to the most recent review on this topic. Randomized controlled trials, clinical trials, and comparative studies comparing at least two of the following techniques were included: decanting, cotton gauze (Telfa) rolling, centrifugation, washing, filtration, and stromal vascular fraction isolation. Nine articles comparing various methods of processing human fat for autologous grafting were selected based on inclusion and exclusion criteria. Five compared established processing techniques (i.e., decanting, cotton gauze rolling, centrifugation, and washing) and four publications evaluated newer proprietary technologies, including washing, filtration, and/or methods to isolate stromal vascular fraction. The authors failed to find compelling evidence to advocate a single technique as the superior method for processing lipoaspirate in preparation for autologous fat grafting. A paucity of high-quality data continues to limit the clinician's ability to determine the optimal method for purifying harvested adipose tissue. Novel automated technologies hold promise, particularly for large-volume fat grafting; however, extensive additional research is required to understand their true utility and efficiency in clinical settings.

Application of water jet-assisted liposuction in augmentation mammoplasty with autologous fat graft

Objective To investigate the clinical value of breast augmentation with autologous fat graft using water jet-assisted liposuction (WAL) technique. Methods From October 2010 to December 2012, 20 patients underwent Water Jet-Assisted Lipoplasty and breast augmentation with autologous fat tissue (average, 210 ml volume injected per breast). Pretreatment and posttreatment TN, bilateral SN and MP were measured, and the outcomes were statistically analysed using paired t test, combined with photos of pretreatment and posttreatment. Follow-up ranged from 3 months to 2 years. Results The results were satisfactory. All the patients got good shape of breasts. There was no infection in all the patients. TN and SN were signifigantly increased at 3 month after operation [(88.7±2.9) cm vs. (87.2±4.2) cm, P<0.01], [left (20.1±1.5) cm, right (20.1±1.5) cm, vs left (19.5±1.5) cm, right (19.5±1.6) cm, P<0.01]. MP was also increased compared with measurement of pre-operation [(4.6±0.4) cm vs. (4.2±0.9) cm, P<0.05]. Conclusions It is a good option to use water jet-assisted liposuction technique in the treatment of breast augmentation with autologous fat graft. Key words: Augmentation mammoplasty; Liposuction; Fat transfer, Autologous

Enriched autologous facial fat grafts in aesthetic surgery: 3D volumetric results.

Improved results with aesthetic fat augmentation of the face have been recently described by the concomitant use of autologous stem cells from the stromal vascular fraction (SVF). There are no studies in the literature regarding facial fat augmentation results with the use of SVF using 3D computer volumetric analyses. This prospective study was thus undertaken to answer this question. Fat was harvested by a standard liposuction technique for reinjection. A 50 cc aliquot of fat was also processed to obtain the SVF using a standard collagenase technique. A cell count was done using a cytometer, and the amount of injected fat and cells were recorded. The Vultus 3D photogrammetric scanning system was used to scan the face pre- and posttreatment and long-term, and volume changes were then calculated at the different time intervals. The data was then correlated to the variables. Ten subjects were included in the study, with an average follow-up of 12.6 months. The average amount of fat injected was 18.4 cc, of which 68% was retained. The average cell count of the SVF was 4.8 × 105. The amount of retained fat by volume was found to be positively correlated to the number of cells in the SVF. There was no correlation between the age and number of cells in the SVF. There is a correlation between the number of cells in the SVF and the amount of fat retained. 3 Therapeutic.

Functional and Therapeutic Indications of Liposuction: Personal Experience and Review of the Literature.

Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.

Adipocyte and preadipocyte viability in autologous fat grafts: comparing the water jet-assisted liposuction (WAL) and Coleman techniques

Background Autologous fat transplantation is a promising technique for soft tissue augmentation. However, the long-term maintenance of fat grafts remains unpredictable. Based on Peer’s cell theory, techniques that cause less cellular damage will optimize graft integration. Water jet-assisted liposuction (WAL) was introduced as a gentle and efficient technique for harvesting a large volume of fat in a short period of time. In this study, we evaluated the viability and function of adipocytes and preadipocytes harvested using WAL and compared this with the Coleman technique.

Liposuction for chronic medical diseases and noncosmetic conditions: review of the literature

The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction. Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation. An online search of the Cochrane Library, MEDLINE, Embase, and SciELO were conducted. Forty-seven original articles reported from 1982 to February 2014 were included in this review. The articles reported on the use as well as the limitations of liposuction for treatment of noncosmetic and disabling medical conditions. The criteria used for selection of articles were: large sample size and originality. The case reports were excluded. There was a broad agreement about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions, such as multiple systemic lipomatosis, dercum's disease, chronic lymphedema, and axillary hyperhidrosis. Literatures review confirmed that Liposuction technique has provided significant and stable cure for these chronic medical conditions. Liposuction is the most frequent esthetic procedure for adipose tissue reduction and treatment of lipedema worldwide. Apart from esthetic indications, liposuction can also be used to treat chronic medical diseases and noncosmetic conditions.

Does water-jet force make a difference in fat grafting? In vitro and in vivo evidence of improved lipoaspirate viability and fat graft survival.

Recent literature has revealed that water-jet-assisted liposuction offers a new method of conventional liposuction techniques by using the gentle spray of fluid. However, there has not yet been a systematic, randomized, controlled study to demonstrate its effect on the vitality and postoperative fat survival of fresh lipoaspirates. In this study, the authors compared liposuction with or without water-jet assistance in a blinded fashion. Human lipoaspirates were obtained from healthy Chinese female volunteers for body shaping. Lipoaspirates were harvested by a single surgeon using the same material and machine; water-jet assistance was the only variance in this study. At the beginning of surgery, the authors randomly performed conventional manual liposuction without water-jet assistance for one side to obtain 50 ml of lipoaspirate (group B). At the corresponding area of the other side, the authors used water-jet-assisted liposuction to obtain another 50 ml of lipoaspirate (group A). All of the harvested lipoaspirates were used in the in vitro and in vivo experiments to evaluate the effect of water-jet force on the vitality and postoperative fat survival of fresh lipoaspirates. Fresh lipoaspirates from group A had greater viability and a higher percentage of CD34/CD45 cells than group B. Grafted lipoaspirates in group A had better weight retention, less apoptosis, and greater angiogenesis. The fate of grafted lipoaspirates was affected by water-jet force. With the assistance of water-jet force during the harvesting procedure, the authors could obtain more viable lipoaspirates and achieve better fat survival.

Retinoblastoma plus lipomatosis: an autosomal dominant syndrome.

Retinoblastoma plus lipomatosis: an autosomal dominant syndrome.

Invited Commentary

Teivelis and colleagues [1Teivelis M.P. Wolosker N. Krutman M. Milanez de Campos J.R. Kauffman P. Puech-Leão P. Compensatory hyperhidrosis: results of pharmacologic treatment with oxybutynin.Ann Thorac Surg. 2014; 98: 1797-1803Google Scholar] illuminate yet again a well-recognized but poorly understood neurophysiologic side effect of sympathetic operations—that of compensatory hyperhidrosis (CH), occurring predominantly on the truncal regions. The treatment of patients with severe, problematic compensatory sweating is difficult and somewhat limited, but can include anticholinergic agents such as oxybutynin or glycopyrrolate. Most of the 21 patients in the Teivelis and colleagues’ report showed improvement in their CH with oxybutynin treatment, but the anticholinergic side effects became very problematic for some. What needs to be emphasized in no uncertain terms is that the best treatment of CH is prevention by appropriate patient selection and judgment. This appears far more important than the specific ganglion level of the sympathetic intervention per se. Mild hand moisture is not an indication for sympathectomy. The patients happiest with sympathetic operations are those with massive, dripping, debilitating palmar hyperhidrosis, usually exhibiting the classic palmoplantar hyperhidrosis pattern. It is these patients who complain the least about their CH. The complaints of CH are consistently worse for patients with axillary hyperhidrosis or mild palmar hyperhidrosis than for the appropriate, classic cases of typical palmoplantar hyperhidrosis. Is this because of truly quantitatively less compensatory sweating in severe palmar cases, or simply that the resulting CH is so much less disabling than the original palmar hyperhidrosis? The answer is not known. What is known is that it is a rare patient indeed who regrets the cure of his or her massive dripping palmar sweating because of seemingly debilitating truncal CH. Did the patients with severe CH in Teivelis and colleagues’ study really need the sympathetic intervention in the first place? In 6 of the 21 patients, the original sympathetic intervention was done for axillary hyperhidrosis; perhaps these axillary patients (and perhaps all 21 patients) might not have undergone the operation if a rigid selection criteria had been used. Topical aluminum chloride and botulinum toxin works much better for axillary hyperhidrosis than palmar hyperhidrosis, and one or both should be tried before resorting to sympathetic intervention for the axilla. Even local axillary sweat gland resection or liposuction techniques are likely preferable to sympathectomy. Sympathectomy as a first-line treatment is preferred to medical treatment for unmistakably classic dripping palmoplantar cases. But if there is any question, medical treatment should always be used first and surgical intervention only used with trepidation as a last resort. It is telling that none of the patients in the Teivelis and colleagues’ study had ever had prior treatment with oxybutynin. Did they have any medical treatment at all? Interventions have consequences, and mild hand moisture, underarm sweating, stinky feet, or patient desire alone do not warrant surgical sympathectomy as a primary treatment. Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With OxybutyninThe Annals of Thoracic SurgeryVol. 98Issue 5PreviewHyperhidrosis may affect nearly 3% of the population, and thoracic/lumbar sympathectomy has been highly effective. Compensatory hyperhidrosis is a risk associated with surgical procedures, and its treatment is both complex and not well defined. Treatment of primary hyperhidrosis with oxybutynin has yielded positive results; however, its use in compensatory hyperhidrosis (CH) has not been described. Full-Text PDF

The Impact of Liposuction Technique, Centrifugation and Freezing in Adipose Tissue Viability

BACKGROUND: The ideal technique for obtaining, processing and storing aspirated adipose tissue to use as grafts is controversial in the literature. This is due to the variety of methods available for collecting and processing fat, combined with the lack of a standardized measurement tool to allow us to compare the different techniques.1-5 OBJECTIVES: The main goal of this study was to evaluate the viability of aspirated adipose tissue and stem cell density, using variations in the suction technique. The secondary end point was to evaluate cell viability after centrifugation and freezing at 20°C without cryopreservation agents. METHODS: Ten female patients between 18 and 55 years of age were included. Adipose tissue was obtained by central suction or syringe with 3 different types of cannula (1.8 mm Coleman, Mercedes 3 and 4 mm). Five samples were centrifuged at 1200G x 3 min and 2 samples were frozen for a period of 1 to 3 months. Tissue viability was assessed by XTT assay quantifying mitochondrial activity and by conventional histology (score of tissue integrity). Stem cell density was assessed by enzymatic digestion with collagenase, set in a culture medium for 7 days and counted on a Neubauer chamber. RESULTS: The highest viability was obtained by the 4 mm cannula versus smaller diameter cannulas in XTT (Figure 1) and histological assessment (0.61 vs 0.45 p=0.03, 2.9 vs 3.7 p=0.007 respectively). The highest density of progenitor cells was also obtained with the 4 mm cannula (4.1 x 104 cells / ml vs. 1.3 x104 cells /ml, p = 0.041) (Figure 2). There was no statistically significant difference between the use of central suction o syringes suction. After centrifuging the samples obtained with the 4 mm cannula, there was an improvement in the viability evaluated by XTT (0.54 vs. 0.7 p = 0.018). No cell activity was found after freezing the samples using this methodology.Figure 1: XTT cell viability assay.Figure 2: Stem cells density.CONCLUSIONS: The use of larger diameter canullas provides better tissue viability, regardless of the type of suction. We would recommended the use of centrifugation with the proposed parameters. This study does not provide evidence for adipose tissue freezing in commercial refrigerators without cryopreservation agents.

Surgical Treatment of Gynecomastia

Gynecomastia is a benign enlargement of the male breast. Yet enlarged breasts cause anxiety, embarrassment, psychosocial discomfort, and fear of breast cancer. The aim of this study was to assess the experience of gynecomastia patients undergoing mastectomy and liposuction surgery. Seven hundred thirty-three patients were analyzed for age, chief complaint, position, grade, operation approach, biopsy, and complication between mastectomy group and liposuction group, from 1990 to 2010. Four hundred two patients (436 breasts) were treated with mastectomy and 331 patients (386 breasts) were treated with liposuction techniques. Three hundred thirty (82%) patients complained of breast lump and lump with pain in mastectomy group, and 204 (61%) patients complained of enlargement breast and enlargement with pain in liposuction group (P < 0.05). All excision specimens were performed for routine histological analysis which showed pathologic diagnosis in patients with mastectomy (100%). One hundred fifty-nine (41%) patients with liposuction acquired pathologic diagnosis through fine needle aspiration and/or core biopsy (P < 0.05). The reoperation rates in mastectomy group and liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group. The surgical treatment of gynecomastia required an individual approach, depending on symptoms (lump or enlargement) and requirements of patients. Patients who chose mastectomy were looking for reassurance that their pathologic diagnosis was benign. The increase in the number of liposuction patients was reflected in our study because it was associated with superior esthetic results and few complications.

Acute Nasal Reconstruction With Forehead Flap After Dog Bite

Acute Nasal Reconstruction With Forehead Flap After Dog Bite