Soft Tissue Reconstruction Research Articles

Regenerated Fat Induced by a Decellularized Adipose Matrix Can Survive Long-term In Vivo

Decellularized adipose matrix (DAM) is considered to be the most potential biological scaffold for soft tissue repair and reconstruction, as it is able to induce the regeneration of adipose tissue in situ in adulthood. But how does this adipose tissue regeneration happen and develop in vivo? Is it the same as the original autologous one? Temporary existence or long-term survival? These are the key questions that will determine the future applications of DAM. In this study, we investigated the composition, structure and biomechanical properties of DAM before implanting it into the subcutaneous back of immunodeficient mice. The entire regeneration process in vivo was closely monitored histologically from 3 days to 1 year after implantation, including fat regeneration, vascular growth, inflammatory responses, and matrix degradation and remodeling. Transcriptome sequencing was used to analyze the difference in gene expression between regenerated fat and autologous fat at different periods. The results showed that the DAM-induced regenerated fat first appeared at 1w and remained stable over 6m, indicating remarkable similarity to autologous fat at the later stages of implantation. And about (18.3 ± 29.3) % of the regenerated adipocytes were still viable after one year. The process of adipogenesis was enhanced by the decrease in inflammatory infiltration and proceeded in parallel with angiogenesis. Statement of significance: The decellularized adipose matrix (DAM) is the only biological scaffold that can spontaneously generate adipocytes in vivo without the need to add exogenous cells. However, in the previous studies, the longest DAM-related animal experiments were about 3 months. The different stages and characteristics of DAM implantation cannot be fully captured. Comprehensive preclinical researches on the initiation, characteristics, and long-term outcomes of DAM-induced adipose tissue regeneration in adulthood is crucial.In this study, we closely observed various aspects of the entire process in vivo from 3 days to 1 year after implantation including fat regeneration, vascular growth, inflammatory reactions as well as matrix degradation and remodeling. The thorough research will contribute to the understanding of stability and dynamic remodeling of DAM regeneration models.

Using Descending Genicular Artery as the Recipient Artery for Free Superficial Circumflex Iliac Artery Perforator Flap

Summary: This case report presents the use of the superficial circumflex iliac perforator (SCIP) flap for soft tissue reconstruction of the knee, using the descending genicular artery (DGA) as the recipient vessel. A 14-year-old female table-tennis player presented with a right knee mass diagnosed as angiomatoid fibrous histiocytoma. Following resection of the mass, which left a 6.5 × 5.5 cm soft tissue defect over the patella, a free SCIP flap was harvested and used for reconstruction. The SCIP flap was chosen for its thinness and flexibility, making it suitable for the highly mobile knee joint. The superficial circumflex iliac artery (1.2 mm) was anastomosed to the DGA (1.5 mm) in an end-to-end fashion. The flap and deepithelialized skin paddle were routed through a subcutaneous tunnel, and the donor site was closed directly over a drain. The flap survived completely with no postoperative complications. Six months later, despite hyperpigmentation of the scar, the contour was satisfactory with no limitations in knee range of motion. This case underscores the advantages of the SCIP flap, particularly its compatibility with the DGA, reduced donor site morbidity, and excellent aesthetic and functional outcomes. The SCIP flap, combined with the DGA as the recipient vessel, provides an effective solution for complex knee reconstructions, offering a primary option for similar cases.

Hydrophilic Components as Key Active Ingredients in Adipose-Derived Matrix Bioscaffolds for Inducing Fat Regeneration.

Decellularized adipose-derived matrix (DAM) has emerged as a promising biomaterial for soft tissue reconstruction. However, due to a lack of research on its complex composition, the understanding of the key components in DAM remains limited, leading to inconsistent adipogenic properties and challenges in optimizing preparation methods purposefully. In this study, it is proposed for the first time that DAM comprises two distinct components: hydrophilic (H-DAM) and lipophilic (L-DAM), each with markedly different effects on fat regeneration. It is confirmed that H-DAM is the key component for inducing fat regeneration due to its enhanced cell-cell and cell-scaffold interactions, primarily mediated by the Hedgehog signaling pathway. In contrast, L-DAM exhibits poor cell adhesion and contains more antigenic components, leading to a higher immunoinflammatory response and reduced adipogenesis. In addition, it is found that intracellular proteins, which are more abundant in H-DAM, can be retained as beneficial components due to their hydrophilicity, contrary to the conventional view that they shall be removed. Accordingly, a purified bioscaffold with unprecedented efficacy is proposed for fat regeneration and reduced immunogenicity. This finding provides insights for developing scaffolds for fat regeneration and promotes the realization of xenotransplantation.

Management of Xylazine-Induced Soft-Tissue Necrosis: A Review of 20 Cases.

The illicit injection of xylazine has recently been designated as an emerging public health threat. The use of this drug is associated with devastating soft-tissue necrosis that may lead to limb amputation. This study aimed to (1) report cases of soft-tissue injury from xylazine and (2) describe a staging and management algorithm for wounds related to xylazine use. A retrospective review was conducted to identify patients treated for xylazine-related soft-tissue necrosis at a trauma center. Clinical cases, treatment strategy, and available outcomes were presented. In addition, a comprehensive literature search was conducted using the keywords "xylazine" and "soft tissue." The management of seven patients with xylazine-related upper extremity soft-tissue necrosis was included, in addition to summarizing findings of five studies reporting on 13 additional cases. These cases were managed with local wound care (2 patients), soft-tissue reconstruction (4 patient), osseous reconstruction (1 patient), and limb amputation (10 patients). Acute treatment of xylazine-related soft-tissue necrosis is ideal to minimize morbidity and prevent limb loss. Management strategies of these wounds should be based on the depth of tissue involvement. Superficial ulceration involving the skin and subcutaneous tissue (Stage 1) should be managed with local wound care. Deeper ulceration involving tendons and/or muscle (Stage 2) requires surgical débridement and soft-tissue reconstruction. Deeper ulceration involving bone (Stage 3) requires osseous débridement and reconstruction. Finally, when all tissues in the extremity are involved (Stage 4), amputation is often necessary.

Efficacy of superficial femoral artery as a recipient in free flap reconstruction around the knee: Four case reports and a literature review

PurposeReconstructing soft tissue defects around the knee with free flaps presents challenges in recipient vessel selection. Although the superficial femoral artery (SFA) offers exposure ease and anatomical stability, concerns arise regarding its distance from the defect site, difficulty in performing anastomosis and potential peripheral ischaemia. This study aimed to reassess the suitability of SFA as a recipient vessel for knee reconstructions by examining our cases and those from previous reports. MethodsWe reviewed four cases of knee soft tissue defects reconstructed with free flaps using the SFA, detailing surgical techniques and outcomes. Additionally, a comprehensive literature search was conducted for articles on using SFA as a recipient vessel for knee free flaps, using PubMed, Web of Science and EBSCOhost databases. ResultsIn all four cases, latissimus dorsi (LD) flaps were used, with end-to-side anastomosis performed using a large slit-shaped arteriotomy. All flaps demonstrated successful survival without complications. Our analysis included 85 cases, comprising four of our cases and 81 cases from 16 articles. Sarcoma resection was the most common aetiology, followed by total knee prosthesis-related defects, trauma and osteomyelitis. Complete flap necrosis occurred in 5% of cases. The LD flap was the predominant choice, alongside other long-pedicle flaps. The SFA provided coverage for all knee areas except the distal lateral patellar region. ConclusionDespite the limited evidence, the SFA appears to be a reliable recipient vessel for knee soft tissue reconstruction. Comprehensive understanding of the characteristics of the SFA and flaps used enhances the safety and efficacy of soft tissue defect reconstruction around the knee.

Immediate and delayed flap reconstruction have equivalent outcomes and associated costs following soft tissue sarcoma surgery.

Surgical treatment of soft tissue sarcoma (STS) involves wide resection of the tumor, which can necessitate soft tissue reconstruction with local or free tissue flaps. This retrospective study compares cost, surgical and oncologic outcomes between patients undergoing reconstruction with immediate versus delayed flap coverage following STS resection. Thirty-four patients who underwent planned flap reconstruction following resection of primary STS were identified retrospectively. Twenty-four (71%) received immediate reconstruction during the index surgery and 10 (29%) underwent planned delayed reconstruction. Preoperative patient-specific metrics, tumor characteristics, and surgical and patient outcomes were collected. Total hospital charges associated with every encounter during the perioperative period were obtained. Patient demographics, comorbidities, tumor metrics, and surgical characteristics were equivalent between groups. Postoperative wound complications, reoperations, readmissions, and disease-specific survival did not differ between cohorts. Costs associated with each reconstruction strategy were equivalent on bivariate and multivariate testing, when accounting for operating room time, hospital length of stay, and reoperation rate. Our study identifies no significant difference in patient outcome measures or cost between planned immediate and delayed flap reconstruction following STS resection. These results support the implementation of either treatment strategy in keeping with patient-centered, multidisciplinary care principles.

Medial Sural Artery Islanded Pedicled Perforator Flap for Resurfacing Areas in the Popliteal Fossa Following Postburn Contracture Release Using Normal versus Scar Tissue

Abstract Background The medial sural artery perforator (MSAP) flap is reliable in resurfacing defects of the popliteal fossa. There is possibility of resurfacing the popliteal fossa defects after postburn contracture release with scarred MSAP flaps with good overall long-term outcomes. Materials and Methods A study was conducted from June 2017 to July 2023 to evaluate the functional and surgical scar aesthetic outcome in patients with soft-tissue defects in the popliteal fossa after postburn contracture release that were reconstructed using scarred and unscarred MSAP flap with 10 patients in each group. Results The clinical outcome was assessed in terms of the perioperative and late postoperative complications, range of motion of the knee joint along with surgical scar outcome using the Patient and Observer Scar Assessment Scale (POSAS). The functional results in the scar tissue flap group were comparable with those in the normal tissue flap group, but the aesthetic outcome of surgical scar was found to be better in the normal tissue flap group. Conclusion The MSAP flap provides ideal tissue for soft-tissue reconstruction with minimal donor site morbidity for popliteal fossa defects after postburn contracture release in both the scarred and unscarred flap groups.

Initial experience with ovine forestomach matrix graft for glossectomy defect reconstruction: A case series

Soft tissue reconstruction of oral cavity defects, such as glossectomy defects secondary to malignancy, pose a challenge for head and neck, oral, and maxillofacial surgeons. Reconstruction options for mucosal defects include primary closure, healing by secondary intention, full mucosal and split-thickness skin grafts, pedicled flaps, and microvascular free flaps. Biological grafts have become an integral part of the modern reconstructive ladder and are widely used for the regeneration of various soft tissue defects, including oral defects. This case series describes our initial experience using ovine forestomach matrix grafts in tongue and oral cavity reconstruction. Oral reconstruction using ovine forestomach matrix grafts was undertaken on three patients post wide excision and resulted in good functional and cosmetic outcomes. The rate of tissue formation provided by the graft and the grafts’ relative resistance to the hostile environment of the oral cavity support further clinical research to validate the use of these devices in oral reconstruction.

Concurrent plate fixation and pedicled flap coverage for open fractures complicated by soft tissue loss of the tibia in pediatric cohort: a clinical series.

The optimal treatment of open fractures complicated by soft tissue loss of pediatric tibial fractures remains inconclusive. The author described a protocol of concurrent plate fixation and pedicled flap coverage and retrospectively reviewed the outcomes of such injuries. A total of 25 pediatric cases with Gustilo lllB open tibial fracture were treated by single-stage plate fixation and pedicled flap reconstruction. The reviewed information consisted of time to fix and flap, type of plate, type of pedicled flap, fracture union time, postoperative complication and the clinical outcomes by objective scoring system. Fix and flap was undergone between 7 and 12days after injury with the average time of 8.2days. Regarding the type of plate, narrow LCP was applied in 8, 3.5mm precontoured LCP in 10, 5.0mm precontoured in 2 and double LCP in 5. According to soft tissue reconstruction, the medial gastrocnemius flap was selected in 6 cases, myocutaneous medial gastrocnemius flap in 2, soleus flap in 3, hemisoleus flap in 5, reverse sural flap in 6 and combined medial gastrocnemius and hemisoleus flaps in 3. No flap-related complication was demonstrated. All cases established fracture union in between 12 and 24weeks with an average time to union of 17.7weeks. According to postoperative complications, infected plate occurred in 2 cases and implant irritation in 5. According to Puno functional score, excellent results were presented in 7 cases and good results in 18 cases. Single-stage plate fixation and pedicled flap coverage are a reliable regimen for pediatric open fractures complicated by soft tissue loss of the tibia.

Evolving Role of Exosomes in Plastic and Reconstructive Surgery and Dermatology.

Exosomes, or extracellular vesicles, represent the latest cell-free addition to the regenerative medicine toolkit. In vitro preclinical studies have demonstrated the safety and efficacy of exosomes, which vary based on source and biomanufacturing, for a myriad of potential therapeutic applications relevant to skin and soft tissue reconstruction. Primary search was performed in September 2021 on the MEDLINE database via PubMed and Ovid, with focus on articles about therapeutic application of exosomes or extracellular vesicles. In total, 130 articles met criteria for applicability, including early-stage clinical trials, preclinical research studies with in vivo application, and articles applicable to plastic and reconstructive surgery and dermatology. Most studies used animal models of human disease processes, using either animal donor cells to isolate exosomes, or human donor cells in animal models. Exosome technology has catapulted as an acellular therapeutic vehicle with off-the-shelf accessibility. These features eliminate prior threshold for broad adoption of regenerative cell-based therapies into surgical and medical practice. To date, there are no exosome products approved by the US Food and Drug Administration. This review highlights exosomes as the new frontier in regenerative medicine and outlines its preclinical therapeutic applications for cutaneous repair and restoration.

Salvage neck dissection following definitive radiation

Salvage neck dissection describes removing cervical lymph nodes and disease following definitive radiation. Unique challenges include a fibrotic field with disease that is frequently more advanced than surgery in the primary setting. The surgical approach may vary depending on the extent of locoregional disease. Review of clinical data is necessary to design a surgical plan. Special considerations include having a reconstructive plan, if needed, for soft tissue reconstruction and great vessel coverage.

Geriatric nutritional risk index as a predictor for surgical site infection in malignant musculoskeletal tumours of the trunk.

Surgical site infection (SSI) is common in surgery for malignant musculoskeletal tumours, specifically those arising from the trunk. In this study, we investigated the risk factors for SSI after resection of musculoskeletal tumours of the trunk. This retrospective observational study included 125 patients (72 males, 53 females) with musculoskeletal tumours of the trunk in our hospital from 1 April 2008 to 31 August 2023. The incidence of SSI and its risk factors were investigated. SSI was observed in 26% (32/125), and the median time to SSI was 22days. On multivariate analysis, the following were identified as risk factors for SSI: tumours arising caudal to Jacoby's line (hazard ratio [HR] 4.04; P =.0107), soft tissue reconstruction (HR 3.43; P =.0131), and low Geriatric Nutritional Risk Index (GNRI) (HR 0.96; P =.0304). Patients were classified into two risk categories based on GNRI scores: the risk group (GNRI ≤98) and no risk group (>98). The risk group showed a significantly lower overall noninfection survival rate (P =.023). Tumours arising caudal to Jacoby line, soft tissue reconstruction, and lower GNRI were risk factors for SSI. Preoperative and postoperative nutritional interventions should be considered to improve GNRI.

Evaluating Hyperbaric Oxygen Therapy to Improve Single-Stage Dermal Substitute and Skin Grafting: A Comparative Study

Abstract Background Dermal substitutes offer a valuable tool in soft-tissue reconstruction, reducing the need for donor site tissue and its associated complications. However, conventional approaches often require multiple surgeries. This study aimed to compare the effectiveness of a single-stage procedure combining dermal substitute and skin grafting with hyperbaric oxygen (HBO) therapy to the standard multistage protocol. Materials and Methods A comparative study was conducted from January 2022 to December 2023. The medical records of 24 patients who underwent soft-tissue reconstruction were reviewed. Patients were categorized into two groups based on whether they received HBO therapy (HBO group) or followed the standard multistage protocol (control group). Outcomes were compared between the groups. Results The study included 18 males and 6 females with an average age of 43 years (range: 5–91 years). Underlying medical conditions included diabetes mellitus (n = 11) and peripheral vascular disease (n = 2). Wounds were due to various causes, including necrotizing fasciitis (n = 2), trauma (n = 10), diabetic ulcers (n = 6), postburn hypertrophic scars/contractures (n = 3), chronic ulcers (n = 1), and sternal wound dehiscence (n = 1). All the patients achieved successful wound closure with dermal substitute application, eliminating the need for additional surgery. Notably, the group receiving HBO therapy experienced a shorter overall hospital stay compared with the standard multistage group. Conclusion This study demonstrates the effectiveness of dermal substitutes in soft-tissue reconstruction. Furthermore, the addition of HBO therapy in a single-stage procedure appears beneficial for successful outcomes, potentially reducing hospital stay compared with the traditional multistage approach.

The Role of Negative Pressure Wound Therapy in Temporizing Traumatic Wounds before Lower Limb Soft Tissue Reconstruction: A Systematic Review.

In practice, there is often a delay from initial debridement and temporary fixation to definitive soft tissue coverage of traumatic leg wounds. Without clear evidence, conservative negative pressure wound therapy (NPWT) is increasingly used to temporize these wounds. This systematic review summarizes and synthesizes the literature on using NPWT to temporize traumatic leg wounds before surgery in adult surgical patients. A comprehensive search of Medline, Embase, and Cochrane Library was performed from inception until July 2022, inclusively. Two independent reviewers performed screening, data extraction, and risk of bias assessment. Primary English studies, including adult patients (≥16 years old) with a fracture below the knee up to and including the ankle that received NPWT to temporize wounds before definitive soft tissue reconstruction with a flap and/or graft, were included. Thirty-four studies, including 804 patients who received NPWT, were included. The partial/total flap loss rate was 6.95% (n = 9 studies), the infection rate was 19.5% (n = 25 studies), the nonunion rate was 18% (n = 15 studies), the delayed union rate was 9.31% (n = 3 studies), and the amputation rate was 15.4% (n = 6 studies). The mean late stay was 43.1 days (n = 9 studies), and the follow-up length was 23.7 months (n = 9 studies). The mean time to wound healing was 5.63 months (n = 2 studies), and the time to soft tissue coverage was 40.8 days (n = 12 studies). The mean time to achieve bone union was 7.26 months (n = 6 studies). NPWT can be used to temporize traumatic wounds while awaiting soft tissue reconstruction.

Bone-flap-harvest-related donor site morbidity in reconstructive jaw microsurgery: Retrospective analysis based on 220 patients over a ten-year period

Microsurgery is the gold standard for hard and soft tissue reconstruction in head and neck neoplasia and malformations. Fibular, iliac crest, and scapular free flaps are the main choices for reconstructive surgery of the jaws. Although widely described in the literature, no statistical comparison analysis of the donor site morbidity of these has been performed to our knowledge. Therefore, in this study, the medical records of patients who underwent microsurgical jaw reconstruction at the Maxillofacial Oncological Reconstructive Surgery Unit of Umberto I General Hospital in Rome between 2011 and 2021 were analysed retrospectively. Inclusion criteria were complete clinical and radiological records, microsurgical reconstruction harvesting one of the three flaps, and a minimum follow up of 12 months. Principal donor site complications were recorded and compared among the flaps. The data were analysed using IBM SPSS Statistics (28.0.1.1, IBM Corp). The study enrolled 220 patients: 103 with deep circumflex iliac artery (DCIA) flaps, 87 with fibular free flaps (FFF), and 30 with scapular bone flaps (SBF). The main DCIA donor site complications were dysaesthesia (13.6%), abdominal hernia (2.9%), dehiscence (1.9%), infection (1.9%), and anterior superior iliac spinal fracture (1.9%). Similarly, the main FFF complications were dehiscence (8%), skin graft necrosis (6.9%), infection (5.7%), and dysaesthesia (3.4%). Subcutaneous seroma occurred in 13.3% of SBF patients and dehiscence in 6.7%. Regional dysaesthesia occurred significantly (p < 0.05) more often in DCIA than FFF or SBF patients. Dehiscence was significantly (p < 0.05) more frequent in FFF than DCIA or SBF patients. All flaps were safe and associated with low donor site morbidity. The jaws should be reconstructed selecting the flap that best satisfies the reconstructive needs based on the patient’s clinical features.

Outcomes of Biodegradable Temporizing Matrix for Soft Tissue Reconstruction of the Hand and Extremities.

NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction. All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded. A total of 86 cases from 54 patients (53.7% pediatric; age range: 0-81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (<0.05). This study contributes to the growing body of evidence favoring BTM use in challenging reconstructive cases. Although prospective comparative studies are forthcoming, BTM likely has broad applications in reconstructive surgery.

Poster 298: Complications Following Tibial Tubercle Osteotomy (TTO) at a Tertiary-Care Institution

Objectives: Tibial tubercle osteotomy (TTO) can be used to treat patellar instability, patellar maltracking/compression, and patellofemoral cartilage damage. Reported complication rates following TTO range from 1% to 46%, with varied definitions of complication. The purpose of our study was to define the incidence of complications following TTO in a large cohort at a tertiary-care institution. Methods: Patients who underwent TTO between 2011 and 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up were excluded. Revision cases were excluded. Information about complications was obtained through review of the electronic medical record. Major complications included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, re-dislocation, reoperation for other indications, readmission, and revision. Minor complications included superficial infection, deep venous thrombosis (DVT), wound dehiscence, and postoperative neurapraxia. Chi-square tests were used for categorical variables, t tests for continuous variables. Results: Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years. Patients were 68.5% female with average age 28.3 years.The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of patients, and minor complications in 8.4% of patients. Reoperation was required in 16.6% of patients at an average of 14 months after index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (5.0%). These and other complications are reported in Table 1 at 30 days, 90 days, 1 year, and final follow-up. Table 2 compares patient characteristics for those who had a major complication versus those who did not. Patients who had a major complication were older than those who did not (30.2 vs 27.7, p = .013). A higher proportion of patients who had a major complication had a previous ipsilateral surgery (57.5% vs. 36.6%, p &lt; .001), had an indication of cartilage lesion/arthritis (71.7% vs. 60.6%, p = .034), and underwent a concomitant cartilage reconstruction/repair procedure (51.8% vs. 39.1%, p = .012). A lower proportion of patients who had a major complication had an indication of instability (56.6% vs. 67.2%, p = .043) and underwent a soft tissue reconstruction (46.4% vs. 60.1%, p = .012). There were no differences in the proportion of major complications by sex or American Society of Anesthesiologists score. Mean body mass index (BMI) did not differ significantly between patients who had a major complication and those who did not. Hardware removal was required in 6.5% of patients. More patients with headed as compared to headless screws required hardware removal (13.2% vs. 1.7%, p &lt; .001). Arthrofibrosis requiring reoperation was observed in 5.7% of patients. A significantly higher proportion of patients who underwent a concomitant cartilage restoration/repair procedure had arthrofibrosis postoperatively (10.0% vs. 2.5%, p &lt; 001). There was no difference in arthrofibrosis requiring reoperation by race, sex, age, BMI, smoking status, prior ipsilateral surgery, or other concomitant procedures. Conclusions: The complication rate following TTO was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and a reoperation rate of 16.6% at a mean follow-up of 1.9 years. Major complications were observed in 23.7% of patients and were more common in older patients, patients with an indication of cartilage lesion/arthritis, patients who underwent a cartilage restoration/repair procedure, and patients with a previous ipsilateral surgery. Hardware removal was more common in patients with headed screws. Arthrofibrosis was more common in patients who underwent a concomitant cartilage restoration/repair procedure.

Comparison of Stored and Fresh Injectable Acellular Adipose Matrix in Soft Tissue Reconstruction in a Murine Model.

We previously showed comparable volume effects of injections of acellular adipose matrix (AAM), an adipose tissue-derived extracellular matrix, and conventional fat grafting in a murine model. Thus, AAM could be a novel allogenic injectable product. However, its retention rate poses a concern, as repeated AAM injections may be required in some cases. This study investigated the biological properties and therapeutic value of stored AAM and compared them with those of fresh AAM, in a murine model. AAM was manufactured from fresh human abdominoplasty fat. Fresh and stored injectable AAM was prepared within 24 h and 3 months after generation, respectively. Either fresh or stored injectable AAM was injected into the scalp of athymic nude mice (0.2 mL/sample, n = 6 per group). After 8 weeks, graft retention was assessed through weight measurement, and histological analysis was performed, including immunofluorescence staining for CD31 and perilipin. Retention rate was significantly reduced in the stored compared to the fresh injectable AAM group. Nevertheless, histological analysis revealed comparable inflammatory cell presence, with minimal capsule formation, in both groups. Adipogenesis occurred in both groups, with no significant difference in the blood vessel area (%) between groups. Although the volume effects of stored AAM for soft tissue reconstruction were limited compared to those of fresh injectable AAM, stored AAM had similar capacity for adipogenesis and angiogenesis. This promising allogeneic injectable holds the potential to serve as an effective "off-the-shelf" alternative for repeated use within a 3-month storage period. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Unmasking the face: A case report of soft-tissue reconstruction after degloving injury

Facial degloving injuries present a complex medical challenge, where the skin and underlying tissues detach from the muscles, fascia, and bones beneath. These injuries pose significant difficulties for surgeons, particularly when complicated by wound infection or tissue necrosis. This case report details the experience of a 26-year-old male patient with a history of trauma, who suffered a facial degloving injury requiring reconstructive soft-tissue surgery. It outlines the challenges encountered during both the surgical and post-operative phases in managing a patient with a full-thickness avulsed flap extending from the lower face to the suprahyoid area of the neck.

Acute and post-acute soft tissue reconstruction

The precise analysis of the injured structures requiring reconstruction in complex wound defects is aprerequisite for successful restoration. The fundamental reconstructive strategies for soft tissue defects of the extremities including injuries to vessels, nerves and burn wounds in the context of the acute and post-acute trauma phases are presented. The different phases of soft tissue reconstruction are described. Recommendations for action with respect to the reconstruction of the functional structures are described. Two clinical case examples illustrate the approach. The acute reconstruction phase is defined as the period 0-72 h after the traumatic event and includes surgical debridement, primary reconstruction of nerves and vessels using interpositional grafts if necessary and temporary soft tissue reconstruction. Combined thermomechanical trauma requires early debridement combined with internal fixation of open fractures. In the post-acute reconstruction phase, which is generally defined as aperiod of up to 6weeks after the traumatic event, definitive soft tissue reconstruction is performed. In the case of long reinnervation distances, nerve transfer or motor replacement plastic surgery is performed in the post-acute phase. The reconstruction of soft tissue after trauma necessitates a stage-dependent approach. In the acute phase procedures aim at the immediate preservation of the limb. In the post-acute phase, definitive soft tissue reconstruction is performed to enable maximum functional preservation. Combined thermomechanical injuries require early surgical treatment in order to prevent infections.