Restoration Of Volume Research Articles

Customized in-vivo tissue engineering for bone grafting

Relevance. Jaw bone volume restoration during dental implantation and reconstructive oral surgery is a relevant problem in modern dentistry. In recent years, the needs of daily dental practice determined the search for new osteoplastic materials with desired properties, including cellular technologies, to stimulate bone regeneration and accelerate bone repair processes.Materials and methods. The study used third molar area gingival specimens to create tissue-engineered constructs for bone matrix colonization, subject to in vitro expansion. Octacalcium-phosphate-based materials (OCP), used as the carrier matrix, were characterized by a larger particle surface area for a more developed microrelief, a bioresorption rate, and a hydrophilic surface. The finished tissue-engineered construct, consisting of multipotent mesenchymal stromal cells colonized on the matrix, was implanted into an artificially created tibial defect in 8 Chinchilla male rabbits. Animal experiments were conducted according to ethical standards. Rabbits were sacrificed on days 8 and 12 for histological testing.Results. In the early follow-up period (8 weeks), there were areas of mature bone with incorporated osteoblasts. Besides, there were areas of primary bone with adhesion lines. Later (12 weeks), such granules fully integrated into the diaphysis cortical part. The results showed the preservation of the low-mineralized bone girdle, osteoid - a bone substance formation precursor, between the octacalcium phosphate granule and the bone.Conclusion. The results of the experimental study allow us to conclude that the customized tissue-engineered construct developed by us contributes to bone grafting.

Surgical wound healing quantitative assessment method: the case of dental implant placement using a modified guided bone regeneration technique. Part II

Relevance. The guided bone regeneration (GBR) technique during dental implant treatment, if alveolar bone/part of the jaws is lost, stands out for its effective potential, the main factor of which is the possibility of the necessary bone volume restoration having morphofunctional signs of organotypicity. The prognosis effectiveness of such reconstruction outcome directly depends on the wound process characteristics. The variability of the latter, subject to an unbiased quantitative assessment, can be essential for predictive analysis and prognosis.Aim. The study aimed to develop a technique for quantitative assessment of surgical wound healing (exemplified with an extracted tooth socket), described in the first part of the publication.Materials and methods. The clinical study involved 20 patients of both sexes diagnosed with the condition after dental implantation and reconstruction of the alveolar bone volume using the GBR technique modified by the formation of a situational vicryl framework (SVF). We determined the following parameters: independent and dependent variables, with their indirect mutually dependent influence on a favourable, compromised or unfavourable treatment outcome, based on the wound healing process follow-up and assessment of immediate results in the early, middle and late postoperative period − up to 1 month, and the analysis of delayed – from 1 month to 1 year, and long-term – over one year. These variables are characterized as quantitative indicators – biomarkers, processed by the correlation and regression analysis using the Gretl statistical package.Results. The study revealed a direct correlation regarding all parameters as independent (factor) and dependent (effect) variables necessary for quantifying the wound healing process variability. The created linear regression model confirmed the empirically observed and theoretically substantiated idea of the reciprocal influence of normal and pathological variations of wound healing process on an outcome of dental implantation in the reconstruction of the alveolar bone defect. The correlation and regression analysis for an unbiased quantitative assessment of surgical wound healing demonstrated the statistically explicable behaviour of dependent variables at a 95% le vel.Conclusion. The correlation and regression analysis performed using the presented data indicates a direct correlation between the parameters of a favourable, compromised and unfavourable outcome of dental implantation during the reconstruction of the alveolar bone volume using the GBR technique modified by the formation of SVF and variables expressed by biomarkers, such as the initial complexity of clinical conditions, duration of surgery, mechanical load of the wound, bio-reactive properties of the additional materials required in the w ound.

Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life.

An increasing number of patients are undergoing explantation to alleviate symptoms attributed to the presence of a prothesis or dissatisfaction with the appearance of their breasts. The authors aim to evaluate the clinical effectiveness and quality of life (QoL) of simultaneous explantation, capsulectomy, and mastopexy for patients requesting implant removal. Two hundred sixty-two simultaneous explantation, capsulectomy, and mastopexy (ECM) procedures were performed in 131 patients from 2009 to 2019. Prospective QoL assessment was administered for all patients. Inclusion criteria included a minimum postoperative follow-up of 6 months and completion of a practice-generated patient reported outcomes (PRO) questionnaire. Wilcoxon signed-rank test was performed to compare changes in QoL scores. Mean follow-up and BMI were 23 months (6 months to 8 years) and 24.8 kg/m2 (18-34 kg/m2), respectively. Mean age was 48.3 years (26-75 years). Autologous fat grafting was performed simultaneously in patients 47.3% (n = 62). The complication rate was 3.8% (n = 10 breasts) in 9 patients (6.9%). The overall reoperation rate was 7.3% of procedures (n = 19 breasts) and 9.2% of patients (n = 12), including secondary autologous fat grafting (11.3%, n = 7). PRO results demonstrated a significant improvement in all QoL domains, including physical well-being (P < .005), psychological well-being (P < .005), sexual well-being (P < .005), breast shape (P < .005), and breast appearance (P < .005). With respect to breast implant illness symptoms, 59 patients (88.1%) noted reduced pain, myalgias/arthralgias, and fatigue after ECM. This study presents an effective paradigm to manage implant removal through simultaneous explantation, capsulectomy, and mastopexy with acceptable clinical outcomes and a significant improvement in QoL and breast aesthetics.

Adipose Tissue-Derived Components: From Cells to Tissue Glue to Treat Dermal Damage.

In recent decades, adipose tissue transplantation has become an essential treatment modality for tissue (volume) restoration and regeneration. The regenerative application of adipose tissue has only recently proven its usefulness; for example, the method is useful in reducing dermal scarring and accelerating skin-wound healing. The therapeutic effect is ascribed to the tissue stromal vascular fraction (tSVF) in adipose tissue. This consists of stromal cells, the trophic factors they secrete and the extracellular matrix (ECM), which have immune-modulating, pro-angiogenic and anti-fibrotic properties. This concise review focused on dermal regeneration using the following adipose-tissue components: adipose-tissue-derived stromal cells (ASCs), their secreted trophic factors (ASCs secretome), and the ECM. The opportunities of using a therapeutically functional scaffold, composed of a decellularized ECM hydrogel loaded with trophic factors of ASCs, to enhance wound healing are explored as well. An ECM-based hydrogel loaded with trophic factors combines all regenerative components of adipose tissue, while averting the possible disadvantages of the therapeutic use of adipose tissue, e.g., the necessity of liposuction procedures with a (small) risk of complications, the impossibility of interpatient use, and the limited storage options.

Saved by point of care echo.

A 40-year-old black male with a past medical history of sickle cell disease, cardiomyopathy, and pulmonary hypertension presents as a transfer from an outside facility to a tertiary care hospital for evaluation after a formal echocardiogram reported “biatrial enlargement and small cystic structure adjacent to the right atrium.” The patient arrived at the receiving hospital in acute severe distress with altered mental status, tachycardia, tachypnea, hypoxia, and hypotension with near agonal respirations on bilevel positive airway pressure. He was also noted to have bilateral jugular venous distention to the angle of mandibles and bilateral lower extremity edema. Given the acuity of the patient's condition, a bedside point-of-care (POC) ultrasound was done using the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol. Bilateral lung slide was present with a bilateral A-line profile. Inferior vena cava (IVC) interrogation showed a markedly dilated non-distensible IVC. In the apical 4-chamber cardiac view, with color Doppler, it became obvious that there was a very large extracardiac cystic mass nearly completely compressing the right atrium (Video 1). Mitral valve inflow velocity was assessed via pulse wave Doppler and was found to demonstrate echocardiographic pulsus paradoxus (Figure 1). The emergency physician made the diagnosis of an extracardiac cystic mass compressing the right atrium causing pericardial tamponade rapidly at the bedside. A multidisciplinary team was mobilized by the emergency physician and the epicardial cyst was drained under ultrasound guidance in the emergency department resulting in 1300 cc of serous fluid with the restoration of the right atrium volume, normalization of the patient's vital signs, and return to his normal mental status. Pericardial tamponade occurs when there is an impairment of ventricular filling due to atrial compression by pericardial fluid or blood.1 Far more rarely, cardiac tamponade can be caused by extrinsic compression.2 Traumatic pericardial effusions typically occur rapidly and present as acute hemodynamic compromise in the setting of trauma. Medical causes of tamponade can be much more insidious given the usually slower accumulation of pericardial fluid. Pericardial tamponade presents typically as either cardiogenic or obstructive shock. Although physical exam findings such as Beck's triad, are often cited, echocardiography provides an invaluable tool in the detection of tamponade.3 In one case series, the sensitivity of the presence of all 3 components of Becks Triad was 0%, whereas any single element had a sensitivity 50%.4 Emergency physicians can rapidly diagnose pericardial tamponade with POC ultrasound and thus render lifesaving treatment, as in this case.

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume.

To investigate the relationship between invasively measured stroke volume (SV) and (1) esophageal Doppler-derived indices such as stroke distance (StrokeD), flow time corrected (FTc), stroke distance variation (SDV), and peak velocity variation (PVV); and (2) arterial load (AL) variables during evaluation of fluid responsiveness (FR) in anesthetized dogs undergoing sudden hemodynamic shifts in blood volume. 6 healthy male dogs. Dogs were anesthetized with isoflurane, ventilated mechanically, and instrumented to undergo sequential, nonrandomized experimental stages. The dogs transitioned from normovolemia (NORMO-BL) to hypovolemia (30% blood loss; HYPO-30), followed by autologous blood transfusion, and then to hypervolemia (colloid bolus). During each stage, SV was quantified using pulmonary artery thermodilution and its relationship with StrokeD, FTc, SDV, and PVV; and AL variables such as effective arterial elastance (Ea), dynamic arterial elastance (Eadyn), and total arterial compliance (Ca) were established. As SV decreased significantly during HYPO-30 compared to NORMO-BL, there was a significant (P < .001) decrease in StrokeD, FTc, and Ca, with simultaneous increases in SDV, PVV, Ea, and Eadyn. Upon restoration of blood volume, these values stabilized closer to NORMO-BL. A significant (P < .001) correlation was observed between SV and StrokeD, FTc, Ea, Eadyn, and Ca. Minimally invasive StrokeD, FTc, SDV, and PVV act as SV surrogates and help assess FR during different blood volume stages in healthy dogs. During hypovolemia-induced hypotension, Ea, Eadyn, and Ca may be able to guide therapeutic decisions favoring improvement in blood pressure and SV.

Sunken Upper Eyelid Deformity Correction by Orbital Fat Pad Repositioning and Orbicularis Oculi Muscle Folding in Blepharoplasty.

Sunken upper eyelid deformity results in an aged and unnatural appearance and is common among Asians along with the single eyelid. The upper eyelid volume restoration is as important as the creation of a supratarsal fold for patients with sunken eyelids. In the present study, the combination of orbital fat pad repositioning and orbicularis oculi muscle flap folding was established to correct the upper eyelid depression during blepharoplasty. A retrospective study was conducted on patients who underwent the orbital fat pad repositioning and orbicularis oculi muscle flap folding to correct the upper eyelid depression between July 2020 and October 2021. The preoperative and postoperative sunken depths were calculated and compared, and overall patient satisfaction was performed to evaluate the operation efficiency. There were 40 patients, including 39 females and 1 male, who underwent surgery with an average age of 25.4 years. During the mean follow-up period of 12.7 months, the sunken depth improved from 3.2mm preoperatively to 1.5mm postoperatively with a statistical significance. Satisfactory results were achieved without major complication. For patients with mild to moderate sunken upper eyelids, the combination of orbital fat pad repositioning and orbicularis oculi muscle folding has been proved efficient and consistent to restore the upper eyelid volume and helpful to build esthetic double eyelids.

Efficacy and Safety of Stylage XL Lidocaine for the Restoration and/or Augmentation of Facial Volume: The Beauty Volume Study.

Hyaluronic acid (HA)-based gel fillers help correct facial volume deficits through their volumizing effect. This postmarket clinical follow-up study was a single-center prospective cohort study designed to evaluate the efficacy and safety of Stylage XL Lidocaine (Laboratoires VIVACY, Paris, France) for the augmentation and/or restoration of facial volume. Healthy patients aged between 30 and 65 years with a facial volume grade of 3 to 5 according to the facial volume loss scale (FVLS) were considered eligible. Participants were injected subcutaneously in the area of the cheekbones (essential area). If necessary, patients were also injected in the chin, the temples, and the facial oval (optional areas). Outcomes were assessed at 1, 3, 6, 12, and 18 months following the initial treatment. A touch-up was possible at 1 month following the initial injection. The primary endpoint was the variation in the mean FVLS scores at M6 compared to baseline as evaluated by an independent assessor. A total of 40 female patients (mean age of 52.5 years) were recruited between November 2019 and July 2021. There was a significant improvement in the mean FVLS score at 6 months compared to baseline (2.3 [0.6] vs 3.1 [0.6]; P < .0001). Patients were satisfied with the achieved aesthetic improvements and results were still observed at 12 and 18 months. Stylage XL Lidocaine also had a good safety profile and was well tolerated by the study cohort. The results of the 18-month Beauty Volume study confirmed the efficacy and safety of the Stylage XL Lidocaine HA-based gel filler in the augmentation and/or restoration of facial volumes.

Clinical, ultrasonic, and histopathologic evaluation of autologous fat transplantation plus platelet-rich plasma with versus without fractional carbon dioxide laser in the treatment of aging hands

Background Aging hands show soft tissue atrophy with prominent bones, tendons, and visible veins as well as pigmented changes and skin rhytids. Autologous fat grafting (AFG) combined with platelet-rich plasma (PRP) sessions can be used in hand rejuvenation for improvement of cutaneous and subcutaneous defects with long lasting results. Objective To evaluate the efficacy, tolerability, and possible side effects of AFG plus PRP with versus without fractional carbon dioxide (CO2) laser in hand rejuvenation. Patients and methods This comparative randomized study included 60 apparently healthy participants in need for hand rejuvenation who were divided into two groups: group I, two hands of 30 participants were treated by AFG with PRP and fractional CO2 laser. Group II, two hands of 30 participants were treated by AFG with PRP. The evaluation was done by clinical evaluation, ultrasound scanning, histopathology, and patient satisfaction. Participants were followed up for 6 months. Results Significant improvement was detected on both groups after treatment with no significant difference between both sides by clinical evaluation, ultrasound scanning, histopathologic evaluation, and patient satisfaction that persisted for 6 months. However, addition of fractional CO2 laser produced significant improvement in skin pigmentation and improvement with nonsignificant difference in wrinkling. Conclusion The enriched AFG with PRP was very effective and safe in the treatment of hand aging especially in volume restoration and disappearance of visible underlying structures. Moreover, fractional CO2 laser produced more improvement in skin pigmentation.

Autologous Plasma Gel as an Effective Method of Facial Volume Restoration and Skin Rejuvenation

The primary aim of this retrospective study was to investigate the potential effectiveness of autologous platelet gel as a method for facial volume restoration and skin rejuvenation. High‐frequency ultrasonography was utilized to assess the outcomes of the treatment. The study included a cohort of ten female patients aged between 40 and 50 who actively participated in the research. They reported moderate‐to‐severe static and dynamic wrinkles, volume loss, thinning, and roughness of the skin. Each patient received one session of autologous platelet gel injections. The gel was prepared accordingly with the manufacturer’s (INNMEDIS, ATR™) instructions. Medium viscosity gel was injected into the superficial subdermal fat pads in the temples, as well as in the middle and lower face areas, to improve facial volume. A high‐frequency ultrasound (US) device was employed to quantify skin density, skin thickness, and the depth of nasolabial folds. The US images were captured at three time points: before gel administration, one month after the procedure, and three months after the procedure. The imaging focused on the nasolabial folds area to monitor changes and assess the effectiveness of the treatment over time. Based on the analyses, the use of autologous platelet gel is beneficial towards improving skin density and decreasing nasolabial fold depth. However, further research should be conducted into the gel’s effects on dermis thickness to achieve a stronger, more statistically significant conclusion. The level of satisfaction of the enrolled patients regarding their facial appearance was evaluated using the visual analogue scale (VAS). The VAS assessment revealed an average score of 4.1 before the commencement of the treatment, an average score of 7.9 one month after the treatment, and an average score of 7.5 three months following the treatment. The results indicate a significant increase in patient satisfaction following treatment completion. Autologous platelet gel appears to hold promise as a treatment option for volume replacement and skin rejuvenation, making it an attractive choice for individuals seeking natural skin treatments. Despite the encouraging findings from this observation, further validation is required through a larger controlled study to definitively confirm whether autologous platelet gel is indeed an effective method for volume replacement and skin rejuvenation.

Restoration of Nasolabial Volume Using Implants and Secondary Cleft Rhinoplasty in a Patient with Unilateral Cleft Lip and Palate: A Case Report

Restoration of Nasolabial Volume Using Implants and Secondary Cleft Rhinoplasty in a Patient with Unilateral Cleft Lip and Palate: A Case Report

Pyramidal multiple‐theory (multi‐type, multi‐method and multi‐layer) for facial fat grafting

Age-related changes to the face pertinent anatomy and important aspects of autologous fat grafting have been widely applied in facial rejuvenation. Various types of autologous fat products (Macrofat, Microfat, SEFF, nanofat, and SVF-gel) with different properties and applicabilities have been introduced and available for surgeons. Key differences between common techniques for fat processing and infiltration. Develop a plan for patients based on site-specific facial anatomical zones, we suggested a pyramidal multiple-theory (multi-type, multi-method and multi-layer) for facial fat grafting. Based on the complicated mechanism of the face decrepitude in different layers of facial soft tissue, autologous fat products with various particle sizes and components into different layers. Fifty-eight patients underwent this facial fat grafting strategy from June 2020 to Jan 2022. All achieved cosmetic improvements, with higher patients' satisfaction, and minor complications. Our facial fat grafting strategy takes advantage of different fat products and is able to address the physiological tissue changes during aging, more properly and targetedly, than the traditional facial fat grafting. Fat grafting to the face aids in volume restoration and rejuvenation, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. The technique described as "lipo-tumescence" has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.

A Prospective 2-Year Extension Study to Evaluate the Safety and Effectiveness of PMMA-collagen Gel for the Correction of Mid-Facial Volume Loss.

The safety and efficacy of polymethylmethacrylate (PMMA)-collagen gel for long-lasting correction of mid-face volume deficit was established for 12 months. To determine the long-term safety, efficacy, and durability of PMMA-collagen gel for midface volume restoration at 24 and 36 months. This prospective, single-center, 2-year extension study enrolled 22 patients treated with PMMA-collagen gel in the initial study. The primary endpoint was a 2-point improvement from baseline at 24 and 36 months on the Midface Volume Deficit Scale (MFVDS). Secondary endpoints included improvement from baseline to 24 and 36 months on the Physician- and Subject-rated Global Aesthetic Improvement Scales (PGAIS and SGAIS, respectively). The primary endpoint was met in 100% of the subjects, and the improvement in MFVDS score from baseline was significant at both 24 and 36 months (P&lt;0.0001). PGAIS scores were rated as at least improved in 100% of subjects at 24 months and in 95% at 36 months. Similarly, 91% of participants at 24 months and 95% at 36 months reported enhanced appearance as measured by SGAIS. No additional adverse events were reported over the extension study. PMMA-collagen gel is a safe, effective, and durable treatment for restoring mid-face volume. J Drugs Dermatol. 2023;21(1): doi:10.36849/JDD.6966.

Therapeutic potential of adipose tissue-derivatives in modern dermatology.

Stem cell-mediated therapies in combination with biomaterial and growth factor-based approaches in regenerative medicine are rapidly evolving with increasing application beyond the dermatologic field. Adipose-derived stem cells (ADSCs) are the more frequently used adult stem cells due to their abundance and easy access. In the case of volumetric defects, adipose tissue can take the shape of defects, restoring the volume and enhancing the regeneration of receiving tissue. When regenerative purposes prevail on volume restoration, the stromal vascular fraction (SVF) rich in staminal cells, purified mesenchymal stem cells (MSCs) or their cell-free derivatives grafting are favoured. The therapeutic efficacy of acellular approaches is explained by the fact that a significant part of the natural propensity of stem cells to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines and extracellular matrix components. Therefore, the secretome's ability to modulate multiple targets simultaneously demonstrated preclinical and clinical efficacy in reversing pathological mechanisms of complex conditions such atopic dermatitis (AD), vitiligo, psoriasis, acne and Lichen sclerosus (LS), non-resolving wounds and alopecia. This review analysing bothin vivoandin vitromodels gives an overview of the clinical relevance of adipose tissue-derivatives such as autologous fat graft, stromal vascular fraction, purified stem cells and secretome for skin disorders application. Finally, we highlighted the major disease-specific limitations and the future perspective in this field.

Filler-based correction of tear trough depressions and eye bags in Japanese patients: A classification system and treatment algorithm.

Tear trough depressions are widely treated with fillers. However, it is questionable whether the same strategies can always be used for Caucasian and Japanese patients, owing to differences in bone and skin structures and epithelial thickness. To assess a novel classification system and treatment algorithm for correcting tear trough depressions and eye bags in Japanese patients. Tear trough depressions can be classified into three types according to the presence or absence of a "negative vector" based on retrusion of the maxilla relative to the anterior corneal surface, with or without eye-bag protrusion when smiling. Type 1 patients (without the negative vector) can be treated simply by filling the depression in the tear trough and the palpebromalar groove region. Type 2 patients (with a negative vector and no eye-bag protrusion on smiling) also require volume restoration in the mid-cheek (deep medial cheek fat, suborbicularis oculi fat, and pre-maxillary space); this not only enables volume recovery but also compensates for maxillary deficiency. Type 3 patients (with a negative vector and eye-bag protrusion on smiling) require an additional step, based on placing a filler in front of the eye bags and pushing orbital fat backward. Case presentations demonstrate the utility of the techniques involved. This system provides a simple and practical method for classifying and treating Japanese patients with tear trough depressions and eye bags. Further studies are warranted.

Virtual Surgical Planning and 3-Dimensional Printing for the Treatment of Zygomaticomaxillary Complex and/or Orbital Fracture.

Traditionally, in zygomaticomaxillary complex and orbital fractures, miniplates and titanium orbital mesh are used and adapted intraoperatively, which may cause fatigue of the metal and increase the surgical time. Recently, computer-assisted surgery and 3-dimensional printing enable the surgeon to employ 3-dimensional segmentation and mirroring tools, which mimic the pretraumatized anatomy on which the miniplates and titanium orbital mesh are preoperatively molded to precisely duplicate the orbital volume, enophthalmos, and zygomatic bone position. To evaluate the results of computer technology using 3-dimensional printing model to prebend miniplates and titanium orbital mesh in the restoration of orbital volume, enophthalmos, and zygomatic bone position in the initial management of patients with zygomaticomaxillary complex and/or orbital fractures. This prospective clinical study included 10 Iraqi male patients who met the eligibility criteria and subjected to open reduction and internal fixation utilizing virtual surgical planning and a 3-dimensional model to prebend miniplates and titanium orbital mesh as a treatment modality for facial fractures. The data were analyzed according to the orbital volume, enophthalmos, zygomatic bone position, age, gender, etiology of the fracture, and complications. The patients were radiographically followed up with a computed tomography scan at 4 months postoperatively. The statistical analysis was performed using percentages, the mean±SD, Shapiro-Wilk test, Paired t test, One Way Anova, and Independent t test. The age of the patients ranged from 18 to 66 years, with an average of 28.6 years and a SD of±14.5 years. Regarding gender, all patients were males. By utilizing virtual surgical planning and 3-dimentional model to prebend miniplates and titanium orbital mesh and concerning the fracture types, which include the zygomaticomaxillary complex, orbital, and combined fractures, there was no significant difference between the measurement of intact side and 4 months postoperatively in orbital volume, enophthalmos, and zygomatic bone position ( P >0.05). This study demonstrated that computer-aided techniques, virtual planning, and the use of prebend miniplates and titanium orbital mesh enable anatomically precise reduction and fixation of the orbital, zygomaticomaxillary complex, and combined fractures regarding orbital volume, enophthalmos, and zygomatic bone position.

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups

Traumatic brain injurySodiumClinical outcomes.

Autologous fat grafting in patients with volume restoration, soft tissues and skin defects correction

Objective. To analyze the results of fat grafting in volume restoration, soft tissues and skin defects correction.&#x0D; Materials and methods. Autologous fat grafting was performed for aesthetic soft tissues correction in 30 women, as well as in 3 patients with long-term non-healing trophic ulcers to obtain a regenerative effect. Subcutaneous fat aspiration was implemented using standard liposuction techniques, water jet, mechanical and syringe.&#x0D; Results. The volume of fat graft varied depending on the area requiring correction, and averaged 90 (33195) ml. The areas, most often subjected to fat grafting, were the mammary glands 10 (33 %), shins 8 (27 %), buttocks 5 (17 %), hands 2 (7 %), lips and nasolabial region 2 (7 %), the outer surface of the thigh 1 (3 %). Despite partial decrease of fat graft volume in the postoperative period, all patients were satisfied with the results; no complications of the procedure were noted. The preparation of fat graft for the correction of trophic defects included its washing with saline and filtering with 1.4 and 1.2 mm anaerobic fat transfers; the fat was grafted through a 2 mm cannula into the subcutaneous tissue directly under and around the ulcerative defects. It improved the regeneration of the epithelium around the trophic ulcers and reduced their size.&#x0D; Conclusions. Thus, the efficiency and safety of using the technique of autologous fat grafting for volumizing and regenerative purposes has been clinically confirmed.

Current developments in primary and secondary surgical treatment of midface and periorbital trauma

Fractures of the periorbita and the midface are among the most common bony facial injuries. Aesthetic and functional reconstruction is achallenge in clinical routine. This article illustrates recent developments in the primary and secondary surgical treatment of midface and periorbital trauma. Resorbable patches and films increase the anatomic reconstructive capacity and enable treatment of extensive orbital fractures. Orbital fractures with involvement of supporting key structures are advantageously reconstructed using patient-specific implants (PSI), which are fabricated by computer-assisted manufacturing techniques and positioned by intraoperative navigation. If late complications such as bulbar malposition and enophthalmos have occurred after the initial procedure, they can be addressed by overcorrective restoration of orbital volume. The use of PSI for initial fracture restoration of the midface is not yet established but may be useful in re-osteotomies of misconsolidated fragments. Extensive midface defects with significant soft tissue involvement can be reconstructed using microvascular grafts. Consecutive reconstructive procedures may include orthognathic surgery and local flap reconstruction. In summary, the integration and advancement of computer-assisted techniques now offers individualized reconstruction procedures, which may be aviable alternative to conventional implants and compression miniplates. Future developments may focus on the search for innovative biomaterials, which can be integrated into computer-aided design and manufacturing processes.

Plasma volume expansion reveals hidden metabolic acidosis in patients with diabetic ketoacidosis

BackgroundHyperchloremic metabolic acidosis that develops during the treatment of diabetic ketoacidosis is usually attributed to the chloride content of resuscitation fluids. We explored an alternative explanation, namely that fluid-induced plasma volume expansion alters the absolute differences in the concentrations of sodium and chloride (the Na–Cl gap) enough to affect the acid–base balance. We analyzed data from a prospective single-center cohort study of 14 patients treated for diabetic ketoacidosis. All patients received 1 L of 0.9% saline over 30 min on two consecutive days. Blood gases were sampled before and after the infusions.ResultsThe initial plasma volume was estimated to be 25 ± 13% (mean ± SD) below normal on admission to the intensive care unit. At that time, most patients had an increased actual Na–Cl gap, which counteracts acidosis. However, the correction of the plasma volume deficit revealed that these patients would have had a decreased Na–Cl gap upon admission if they had been normovolemic at that time; the estimated “virtual Na–Cl gap” of 29 ± 5 mmol/L was significantly lower than the uncorrected value, which was 39 ± 5 mmol/L (P < 0.001). On Day 2, most patients had a decreased actual Na–Cl gap (33 ± 5 mmol/L), approaching the corrected value on Day 1.ConclusionsThe hyperchloremic acidosis commonly seen in diabetic ketoacidosis may not be primarily caused by the chloride content of resuscitation fluids but, rather, by the restoration of plasma volume, which reveals the hidden metabolic acidosis caused by a decreased Na–Cl gap.Trial registration Clinical Trials Identifier NCT02172092, registered June 24, 2014, https://www.clinicaltrials.gov/NCT02172092