Problem In Reconstructive Surgery Research Articles

Application experience and research progress of different emerging technologies in plastic surgery.

In the diagnosis and treatment of plastic surgery, there are structural processing problems, such as positioning, moving, and reconstructing complex three-dimensional structures. Doctors operate according to their own experience, and the inability to accurately locate these structures is an important problem in plastic surgery. Emerging digital technologies such as virtual reality, augmented reality, and three-dimensional printing are widely used in the medical field, particularly in plastic surgery. This article reviews the development of these three technical concepts, introduces the technical elements and specific applications required in plastic surgery, summarizes the application status of the three technologies in plastic surgery, and summarizes prospects for future development.

Overexpression of fibroblast growth factor receptor 2 in bone marrow mesenchymal stem cells enhances osteogenesis and promotes critical cranial bone defect regeneration.

Background: Reconstruction of cranial bone defects is one of the most challenging problems in reconstructive surgery, and several biological tissue engineering methods have been used to promote bone repair, such as genetic engineering of bone marrow mesenchymal stem cells (BMSCs). Fibroblast growth factor receptor 2 (Fgfr2) is an important regulator of bone construction and can be used as a potential gene editing site. However, its role in the osteogenesis process of BMSCs remains unclear. This article clarifies the function of Fgfr2 in BMSCs and explores the role of Fgfr2-overexpressed BMSCs carried by light-induced porous hydrogel (GelMA) in the repair of cranial bone defects. Methods: Lenti-virus was used to overexpress Fgfr2 in BMSCs, and cell counting kit-8, transwell, and flow cytometry assays were conducted to investigate the proliferation, migration, and characteristics. After 0, 3, 7, and 10 days of osteogenic or chondrogenic induction, the changes in osteogenic and chondrogenic ability were detected by real-time PCR, western blot, alkaline phosphatase staining, alizarin Red staining, and alcian blue staining. To investigate the viability of BMSCs carried by GelMA, calcein and propyl iodide staining were carried out as well. Finally, a critical cranial bone defect model was established in 6-week-old male mice and micro-computerized tomography, masson staining, and immunohistochemistry of OCN were conducted to test the bone regeneration properties of implanting Fgfr2-overexpressed BMSCs with GelMA in cranial bone defects over 6 weeks. Results: Overexpression of Fgfr2 in BMSCs significantly promoted cell proliferation and migration and increased the percentage of CD200+CD105+ cells. After osteogenic and chondrogenic induction, Fgfr2 overexpression enhanced both osteogenic and chondrogenic ability. Furthermore, in cranial bone defect regeneration, BMSCs carried by light-induced GelMA showed favorable biocompatibility, and Fgfr2-overexpressed BMSCs induced superior cranial bone regeneration compared to a normal BMSCs group and an untreated blank group. Conclusion: In vitro, Fgfr2 enhanced the proliferation, migration, and stemness of BMSCs and promoted osteogenesis and chondrogenesis after parallel induction. In vivo, BMSCs with Fgfr2 overexpression carried by GelMA showed favorable performance in treating critical cranial bone defects. This study clarifies the multiple functions of Fgfr2 in BMSCs and provides a new method for future tissue engineering.

Hypoxia Differentially Affects Chondrogenic Differentiation of Progenitor Cells from Different Origins.

Ear cartilage malformations are commonly encountered problems in reconstructive surgery, since cartilage has low self-regenerating capacity. Malformations that impose psychological and social burden on one's life are currently treated using ear prosthesis, synthetic implants or autologous flaps from rib cartilage. These approaches are challenging because not only they request high surgical expertise, but also they lack flexibility and induce severe donor-site morbidity. Through the last decade, tissue engineering gained attention where it aims at regenerating human tissues or organs in order to restore normal functions. This technique consists of three main elements, cells, growth factors, and above all, a scaffold that supports cells and guides their behavior. Several studies have investigated different scaffolds prepared from both synthetic or natural materials and their effects on cellular differentiation and behavior. In this study, we investigated a natural scaffold (alginate) as tridimensional hydrogel seeded with progenitors from different origins such as bone marrow, perichondrium and dental pulp. In contact with the scaffold, these cells remained viable and were able to differentiate into chondrocytes when cultured in vitro. Quantitative and qualitative results show the presence of different chondrogenic markers as well as elastic ones for the purpose of ear cartilage, upon different culture conditions. We confirmed that auricular perichondrial cells outperform other cells to produce chondrogenic tissue in normal oxygen levels and we report for the first time the effect of hypoxia on these cells. Our results provide updates for cartilage engineering for future clinical applications.

Early reinnervation of facial muscles after removal of large and giant vestibular schwannomas

Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).

Scar-centered dilation in the treatment of large keloids.

BACKGROUNDHypertrophic scars and keloid treatment is a major problem in plastic surgery. While small keloids can be treated with resection followed by radiotherapy, large keloids require treatment with a tissue expander. Conventional methods increase the need for auxiliary incisions, causing new scar hyperplasia. AIMTo introduce a new method for the treatment of keloids with an expander. METHODSBetween 2018 and 2021, we performed surgeries to treat large keloids in nine patients with a two-stage approach. In the first stage, an intrascar incision was made in the keloid, and a customized expander was implanted under the keloid and the surrounding normal skin. A period of 3-6 mo was allowed for skin expansion. In the second stage, after the initial incision healed, a follow-up surgery was performed to remove the expander, resect the keloid, and repair the expanded skin flap. To accomplish this, an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars. Superficial radiotherapy was then performed postoperatively.RESULTSTwo patients had anterior chest keloids. After treatment, the anterior chest incision was broken repeatedly and then sutured again after debridement. It healed smoothly without scar hyperplasia. Keloids were successfully removed in 7 patients without recurrence.CONCLUSIONThis method was performed through a keloid incision and with a custom expander embedded. After full expansion, the keloid was directly resected using a linear suture, which avoids new surgical incisions and scars and can successfully remove large-area keloids. The treatment is effective, providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.

Insights Into Vascular Anomalies, Cancer, and Fibroproliferative Conditions: The Role of Stem Cells and the Renin-Angiotensin System

Cells exhibiting embryonic stem cell (ESC) characteristics have been demonstrated in vascular anomalies (VAs), cancer, and fibroproliferative conditions, which are commonly managed by plastic surgeons and remain largely unsolved. The efficacy of the mTOR inhibitor sirolimus, and targeted therapies that block the Ras/BRAF/MEK/ERK1/2 and PI3KCA/AKT/mTOR pathways in many types of cancer and VAs, further supports the critical role of ESC-like cells in the pathogenesis of these conditions. ESC-like cells in VAs, cancer, and fibroproliferative conditions express components of the renin-angiotensin system (RAS) – a homeostatic endocrine signaling cascade that regulates cells with ESC characteristics. ESC-like cells are influenced by the Ras/BRAF/MEK/ERK1/2 and PI3KCA/AKT/mTOR pathways, which directly regulate cellular proliferation and stemness, and interact with the RAS at multiple points. Gain-of-function mutations affecting these pathways have been identified in many types of cancer and VAs, that have been treated with targeted therapies with some success. In cancer, the RAS promotes tumor progression, treatment resistance, recurrence, and metastasis. The RAS modulates cellular invasion, migration, proliferation, and angiogenesis. It also indirectly regulates ESC-like cells via its direct influence on the tissue microenvironment and by its interaction with the immune system. In vitro studies show that RAS inhibition suppresses the hallmarks of cancer in different experimental models. Numerous epidemiological studies show a reduced incidence of cancer and improved survival outcomes in patients taking RAS inhibitors, although some studies have shown no such effect. The discovery of ESC-like cells that express RAS components in infantile hemangioma (IH) underscores the paradigm shift in the understanding of its programmed biologic behavior and accelerated involution induced by β-blockers and angiotensin-converting enzyme inhibitors. The findings of SOX18 inhibition by R-propranolol suggests the possibility of targeting ESC-like cells in IH without β-adrenergic blockade, and its associated side effects. This article provides an overview of the current knowledge of ESC-like cells and the RAS in VAs, cancer, and fibroproliferative conditions. It also highlights new lines of research and potential novel therapeutic approaches for these unsolved problems in plastic surgery, by targeting the ESC-like cells through manipulation of the RAS, its bypass loops and converging signaling pathways using existing low-cost, commonly available, and safe oral medications.

Influence of Covid-19 on Surgical Practice: An update is a need

Aim: To evaluate existing practice recommendations in the event of a COVID-19 pandemic and to develop future pandemic strategies. Methods: In the context of COVID-19, a review of surgical societies' and government agencies' websites, as well as current literature, was done to discover recommendations for plastic surgery operations. Our plastic surgery problems have been divided into four areas, with guidelines developed for each. Results: This pandemic demands modification in clinical practice and transformations are recommended in outpatients and peri-operative settings to minimize the potential risk of disease transmission. Prioritization methods, operating room atmosphere, health care personnel safety, and preoperative patient evaluation are all covered by consensus standards for Plastic and Reconstructive Surgery. Operation theatre should be modified to minimize the disease transmission. PPE use is marked critical for all health care personals working in emergency settings. Preoperative assessment should be a critical component of management strategy. Conclusion: Since COVID-19 is predicted to resurface, doctors must weigh the risks and benefits of each operation in relation to essential patient care, COVID-19 spread reduction, and health-care worker safety. The plastic surgeon will be guided by scientific evidence-based standards that include conscious decision-making in emergency and non-urgent patients, OR changes, PPE usage, and preoperative screening tools. Keywords: Safety guidelines, plastic surgical procedures, COVID-19

Averaged Body Contours: Redefining the Breast Surgery Outcomes Presentation.

An essential part of aesthetic and reconstructive breast surgery is a meticulous analysis of the outcomes. However, the reliable evaluation of breast attractiveness, the primary determinant of treatment, is challenging.1,2 Over the years, many methods of breast aesthetics evaluation have been proposed. Most of the studies are based on subjective analysis, utilizing either various scales or questionnaires.1–3 The quantitative evaluation mainly includes indirect anthropometric analysis of breast photographs.2,4 Unfortunately, the numeric measurements cannot be clearly translated into clinical conclusions, especially the breast shape and contour definition.1 There are two significant limitations of publications on breast surgery outcomes. First, they contain numeric data tables, which poorly represent the aesthetic value and underrepresent the shape.1,4 Second, publications show photographs of only a few patients at most.1–4 The inability to visually present all evaluated individuals’ outcomes is a common problem in plastic surgery in general. To overcome these limitations, we created a new evaluation technique called Averaged Body Contours, or ABC, which summarizes quantitative morphometric data and shapes of numerous breasts in the form of a single figure (Fig. 1).Fig. 1.: The graphical summarization of 20 female individuals’ breast analysis in the frontal view as an Averaged Body Contours parameter.The whole process is integrated with our Analyze It Doc software (A.I.D.; Pietruski & Majak, Warsaw, Poland) and consists of two steps.5 First, photogrammetric analysis of breast photographs in frontal and lateral views is performed. The semiautomatization of this process makes it easy and time efficient, taking fewer than 4 minutes per individual. The surgeon’s role is to label specific landmarks and contours according to the system’s instructions. The process requires metric calibration by marking the known distance on the photograph. For this purpose, we use an adhesive skin marker, but any measurement, such as intramammary distance, can be used. The second step is fully automated. The software algorithm instantly generates a set of hundreds of linear, angular, and surface area measurements as well as an averaged body contour. The latter is a graphical summarization of averaged values of obtained numeric parameters, which can be subdivided into specific contours if needed (Fig. 2).Fig. 2.: A view of the A.I.D. software generator with exemplary averaged body contours of 20 females’ breasts in lateral projection. Display of various breast contours, landmarks, reference lines, and standard deviations is possible.The conducted validation study confirmed our novel method’s effectiveness and reliability. The Averaged Body Contours technique generates an average shape and morphometry of multiple individuals’ breasts that complies with their quantitative anthropometric analysis results. In other words, the Averaged Body Contours technique translates numeric data into shape, something that, according to our knowledge, was not possible for photogrammetric-based outcomes evaluation, until now. Due to the deep analytic insight it provides, the Averaged Body Contours parameter has vast potential in breast surgery. Its application may redefine the form of aesthetic results presentation. Graphical summarization of entire group contours increases the comprehension of numeric measurements and reduces the tables’ role to supplementary material. Our analytic tool enables clear visualization of the shapes and tracking of their changes with time, enhancing both research and young surgeon development. The Averaged Body Contours technique may also be used to create the breast’s populational normative data for a specific age or ethnicity group, thus providing a visual aesthetic template that could improve preoperative consultations. We encourage all interested researchers and clinicians to test our analytic tool, which is distributed free of charge, and provide the feedback needed for further improvements. ACKNOWLEDGMENTS The development of the A.I.D. system is a private, nonprofit initiative of both authors. Their goal is to provide a free analytic tool for plastic surgery researchers and clinicians. The software, when ready, will be distributed free of charge (apply at http://analyzeitdoc.com). DISCLOSURE Neither author has a financial interest in any of the products or devices mentioned in this article. No funding was received for this article. The A.I.D. software discussed in this article, which both authors developed, is distributed free of charge.

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study.

while reconstruction of complex wounds with severe tissue defects has been a significant problem in plastic surgery, free flap microsurgical procedures could solve many of these problems. In Yemen, data regarding free flap microsurgery for complex wounds are scarce. This study aimed to share our microsurgery experiences in repairing complex wounds using different free flaps in a resource-limited setting. a retrospective cross-sectional study between April 2019 and June 2022 conducted at 21 University-affiliated hospitals included 30 patients with complex wound defects that were not amenable for regional, pedicle procedures, or skin grafts and underwent microsurgical reconstructions with deferent free flap tissue transfer. The primary outcome was flap survival or failure, while the secondary outcome was postoperative complications. the main age was 34.76 ± 16.88 years, with 24 (80%) males and 6 (20%) females. Replacing extensive tissue loss caused by road traffic accidents was the most common indication (36.6%). The mean defects required to be reconstructed were 84.9 ± 44.70 cm2. The lower extremities accounted for the majority of reconstructed defects (50%), and mostly (23.3%) involved the leg. Only 10 (33.3%) flaps were performed immediately within 48 hours of trauma. The fibulae osteo-cutaneous free flap (30.0%), radial forearms free flap (23.3%), and anterolateral thigh flap (23.3%) were used most commonly. All flaps were harvested and repaired under loupe magnification or operative microscope by a single surgeon. The overall flap success rate was 83.3%. The total complication rate was 23.3%, and postoperative infection and partial flap necrosis occurred in 3 (10.0%) and 2 (6.6%) patients, respectively. A total flap loss occurred in 5 (16.7%) patients. reconstruction of complex wounds with microsurgical free flaps is a viable option even in a resource-limited setting. In our study, microsurgery with fibulae osteo-cutaneous free flap was the most commonly used. Despite many limitations, microsurgical free flaps were effective in treating individuals operated on in our setup with a limb salvage rate of 83.3%.

Reading Man Flap: A Nasal Reconstruction Technique.

Closure of the nasal skin defects that resulted from excision of the skin neoplasms represents a challenging problem in reconstructive surgery. Here, the use of the reading man procedure as a new alternative in reconstruction of the skin defects of the nose is presented. In this procedure, 2 local flaps designed in an unequal Z-plasty manner are used. Defect coverage is achieved by transposing the first flap to the defect area, whereas the second flap is used for closure of the first flap's donor site. In last 10 years, this technique has been used for closure of the nasal skin defects that resulted from removal of skin cancers in 28 patients (15 men and 13 women) aged from 45 to 98 years. The defects were ranging between 1.5 and 3.1 cm in diameter. In all patients, a tension-free 1-stage closure was obtained. There was no patient with dog ear formation and/or distortion of the mobile anatomical structures, such as nasal tip, alar lobules, and nostrils. All patients healed without complications. A mean follow-up of 52 months (8 months to 6.5 years) revealed satisfactory cosmetic results in all patients. No tumor recurrence was observed. Using the advantage of extra tissue relaxation provided by an unequal Z-plasty, the reading man procedure seems to be a useful alternative for the closure of nasal defects with alike local skin. As a critical achievement, this procedure does not require excision of additional healthy tissue. Borrowing tissue from multiple directions, it avoids dog ear formation and distortion of the mobile anatomic structures.

Use of blood-supplied fibula grafts with a functioning growth zone for the reconstruction of limb bone defects in pediatric patients: A literature review

BACKGROUND: Restoration of significant anatomical and functional bone defects is one of the most urgent problems of reconstructive surgery in children. Various options for plastic surgery of bone defects are considered. However, some publications present both positive and negative aspects of using vascularized bone autotransplants.
 AIM: This study aimed to conduct a systematic analysis of foreign literature data on the use of blood-supplied fibular grafts with a functioning growth zone.
 MATERIAL AND METHODS: A systematic literature search was performed in the PubMed information data base and Google Scholar from 1988 to February 7, 2021. Based on the criteria for the selection of literature sources, 21 literary sources were identified. In the analysis, special attention was paid to the age of patients at the time of reconstructive surgery, type of vascularized bone graft used with vessels that are part of the feeding leg, follow-up period, complications in the area of the surgical intervention, as well as the functional result and functioning of the graft growth zone.
 RESULTS: In this study, 21 articles comprised the sample, of which 14 were descriptions of clinical observation and seven were descriptions of clinical series. These publications include information on the follow-up of 54 patients with an average age of 6.86 years (minmax, 115 years). The average duration of postoperative follow-up was 56 months (minmax, 622 years). Indications for surgical interventions were extensive bone defects formed as a result of the tumor process (n = 44), trauma (n = 4), infectious process (n = 1), and birth defects (n = 5).
 CONCLUSIONS: In pediatric orthopedics, bone-vascularized fibular grafts with a functioning growth zone are used for the reconstruction of extensive bone defects in complex clinical situations if standard bone auto-/alloplasties are impossible. According to the literature, this technique allows us to achieve satisfactory functional results in most cases. Despite the positive functional results, postoperative complications are quite common in patients.

Silver Ion Hydrocolloid Gauze and Self-Adhesive Polyurethane Foam Dressing Combination Therapy Can Better Promote Healing of Skin Graft Donor Area Than Traditional Therapy: A Case Control Study

The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician. With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites. Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the experience of their own doctor. Donor sites were covered with silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group, n = 23]) or petrolatum gauze, sterile gauze, and compression bandage (control group, n = 25]). Wounds healed faster (mean, 12.7 days ± 2.4 standard deviation vs 22.0 days ± 5.8; P < .001), with fewer dressing changes (median [interquartile range, IQR], 2 [IQR, 2-3] vs 4 [IQR, 2.5-5]; P = .002), and with reduced pain on first dressing change (median visual analog scale score, 5 [4-6] vs 7 [6-7.5]; P < .001) in the AG+foam group compared with the control group. The Patient and Observer Scar Assessment Scales and overall scar ratings were better in the AG+foam group than in the control group (P < .001 for all). The AG+foam group had no infections; 2 infections occurred in the control group. Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.

Liraglutide, a TFEB-Mediated Autophagy Agonist, Promotes the Viability of Random-Pattern Skin Flaps.

Random skin flaps are commonly used in reconstruction surgery. However, distal necrosis of the skin flap remains a difficult problem in plastic surgery. Many studies have shown that activation of autophagy is an important means of maintaining cell homeostasis and can improve the survival rate of flaps. In the current study, we investigated whether liraglutide can promote the survival of random flaps by stimulating autophagy. Our results show that liraglutide can significantly improve flap viability, increase blood flow, and reduce tissue oedema. In addition, we demonstrated that liraglutide can stimulate angiogenesis and reduce pyroptosis and oxidative stress. Through immunohistochemistry analysis and Western blotting, we verified that liraglutide can enhance autophagy, while the 3-methylladenine- (3MA-) mediated inhibition of autophagy enhancement can significantly reduce the benefits of liraglutide described above. Mechanistically, we showed that the ability of liraglutide to enhance autophagy is mediated by the activation of transcription factor EB (TFEB) and its subsequent entry into the nucleus to activate autophagy genes, a phenomenon that may result from AMPK-MCOLN1-calcineurin signalling pathway activation. Taken together, our results show that liraglutide is an effective drug that can significantly improve the survival rate of random flaps by enhancing autophagy, inhibiting oxidative stress in tissues, reducing pyroptosis, and promoting angiogenesis, which may be due to the activation of TFEB via the AMPK-MCOLN1-calcineurin signalling pathway.

The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration.

The reconstruction of large-volume soft tissue defects is a major problem in plastic surgery. Many plastic surgeons have focused on external volume expansion (EVE) because of its capacity to promote regeneration of soft tissues, including breast, subcutaneous fat, and skin. EVE is a minimally invasive and less costly tissue engineering approach that has shown great clinical potential. However, many challenges still need to be addressed before such technology can become a common clinical practice. Basic in vivo and in vitro studies have been performed to determine the possible mechanisms by which EVE promotes tissue regeneration and to design optimized animal models. EVE application was found to facilitate cell proliferation and migration, enhance adipogenesis, improve angiogenesis, and provide available space for soft tissue growth. Understanding the mechanical and chemical signals associated with EVE during tissue regeneration may enable the clinical adaptation of this technology. This article reviews the clinical application of EVE techniques, describes preclinical animal models, and evaluates the possible mechanisms by which EVE induces tissue regeneration. Impact statement The reconstruction of large-volume soft tissue defects is a major problem in plastic surgery. External volume expansion (EVE) is a minimally invasive and less costly tissue engineering approach that has shown promise in clinical applications. This article reviews the clinical application of EVE techniques, describes preclinical animal models, and evaluates the possible mechanisms by which EVE induces tissue regeneration.

Encapsulation of troglitazone and AVE0991 by gelation microspheres promotes epithelial transformation of adipose-derived stem cells

Deformities in human soft tissue caused by trauma or burn present a difficult problem in plastic surgery. In this study, we encapsulated troglitazone and angiotensin 1-7 mimetic AVE0991 in gelation microspheres with the goal of inducing epithelial transformation for potential applications in tissue reconstruction. After troglitazone or AVE0991 were encapsulated to gelation microspheres, their release kinetics and bioactivity were examined. Surface morphology and diameter of the gelation microspheres were evaluated using light microscopy. The release of the drugs was assessed in the presence of human adipose-derived stem cells (ADSCs). Treatment with troglitazone microspheres increased cell viability and activated the β-catenin in ADSCs. Moreover, the AVE0991 microspheres also increased cell viability and C-myc expression of ADSCs. These results showed that troglitazone and AVE0991 microspheres promoted the activity of ADSCs. Furthermore, ADSCs were co-treated with troglitazone and AVE0991 microspheres. Western blot and immunofluorescent staining showed that co-treatment with troglitazone and AVE0991 microspheres elevated the expression of epithelialization associated protein CK14 in ADSCs. In conclusion, our findings indicate that microspheres with troglitazone and AVE0991 can significantly improve the viability and epithelialization of ADSCs, which provides a new approach for the construction of tissue-engineered skin.

Curcumin nanoparticles incorporated in PVA/collagen composite films promote wound healing

Skin repair remains a common problem in plastic surgery. Wound dressing plays an important role in promoting local skin healing and has been widely studied. This study aimed to manufacture a composite film (CPCF) containing curcumin nanoparticles, collagen, and polyvinyl alcohol (PVA) to effectively promote the healing of skin wounds. Sustained drug release from the composite film provides long-term protection and treatment for skin wounds. Both antibacterial property and good histocompatibility of the CPCF were examined by analyzing antibacterial activity and cytotoxicity to validate its applicability for wound management. Moreover, in vivo studies proved that the CPCF had a rapid healing rate of 98.03%±0.79% and mature epithelialization on day 15 after surgery. Obvious hair follicles and earlier re-epithelialization was also noticed in the CPCF group using H&E staining. The result of Masson’s trichrome staining confirmed that CPCF could promote the formation of collagen fibers. In summary, CPCF may be promising as a wound dressing agent in wound management owing to its rapid wound-healing effects.

Evaluation of Pedicled Medial Thigh Perforator Flap and Its Application in Loco-Regional Soft Tissue Reconstruction

Introduction: perineoscrotal defects represent a challenging problem in reconstructive surgery. Scrotal skin loss can occur following trauma, Fournier’s gangrene, post tumor excision, burns, etc. There are many techniques described in the literature for reconstruction of defects of scrotal skin. The pedicled medial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. Objective: the purpose of this study was to describe clinical applications of the pedicled medial thigh (PMT) perforator flap for reconstruction of loco-regional soft tissue defects. Patients and Methods: between June 2018 and June 2019, an experimental cadaveric study including two cadavers with four lower limbs was done in Al-Azhar University, Faculty of Medicine, Department of Anatomy and Embryology. A prospective cross-sectional study in which ten male patients with soft tissue defects or lesions that requires excision and reconstruction in perineum and scrotum received MTP flaps. All flaps were unilateral and the flap sizes ranged from 9-12 cm to 12-26 cm. Results: all flaps survived well, with the exception of partial wound dehiscence in two patients that was managed conservatively by frequent dressings and healed by 2ry intention. Conclusion: the medial thigh fasciocutaneous perforator flap offers a good option for Perineoscrotal defects. The flap provides a single stage, stable, well vascularized soft tissue coverage with no significant major complications, short hospital stay, appropriate range of motion, faster return to normal lifestyle and accepted aesthetic appearance.

Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery

IntroductionImpaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. Material and methodsIn this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. ResultsThe use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. ConclusionThe negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.

POLYMERIC BIOMATERIALS FOR SCAFFOLD-BASED BONE REGENERATIVE ENGINEERING.

Reconstruction of large bone defects resulting from trauma, neoplasm, or infection is a challenging problem in reconstructive surgery. The need for bone grafting has been increasing steadily partly because of our enhanced capability to salvage limbs after major bone loss. Engineered bone graft substitutes can have advantages such as lack of antigenicity, high availability, and varying properties depending on the applications chosen for use. These favorable attributes have contributed to the rise of scaffold-based polymeric tissue regeneration. Critical components in the scaffold-based polymeric regenerative engineering approach often include 1. The existence of biodegradable polymeric porous structures with properties selected to promote tissue regeneration and while providing appropriate mechanical support during tissue regeneration. 2. Cellular populations that can influence and enhance regeneration. 3. The use of growth and morphogenetic factors which can influence cellular migration, differentiation and tissue regeneration in vivo. Biodegradable polymers constitute an attractive class of biomaterials for the development of scaffolds due to their flexibility in chemistry and their ability to produce biocompatible degradation products. This paper presents an overview of polymeric scaffold-based bone tissue regeneration and reviews approaches as well as the particular roles of biodegradable polymers currently in use.

Hyperbaric Oxygen Therapy in Plastic Surgery

Objective: In this review the literature aims to familiarize the reader with several of the more common plastic surgery problems and to review the appropriate use of HBO for each condition. Plastic surgery is a broad specialty encompassing a variety of areas including the treatment of traumatic soft tissue injury, burn care, hand surgery, microsurgery and limb replantation, problem wound management, flap reconstruction, cosmetic surgery, and congenital deformity. In recent years an emphasis on less anecdotal and more scientific research has provided a better understanding of the role of hyperbaric oxygen therapy (HBO) for many plastic surgical conditions. Patient selection remains the key to successful outcome. The rationale for HBO treatment of a specific plastic surgery problem should be based on scientific research if possible. If supportive research is not available or applicable to a specific case, then the decision to treat should be based on sound physiological principles.