Subcutaneous Defects Research Articles

Cuttlefish-Bone-Derived Biomaterials in Regenerative Medicine, Dentistry, and Tissue Engineering: A Systematic Review.

Marine ecosystems, covering 70% of Earth's surface, hold immense biodiversity and potential for biomaterials. Cuttlefish bone (CB) and marine resources have gained attention as eco-friendly biomaterials. We aim to comprehensively study biomedical applications of CB-derived materials. By evaluating both in vivo and in vitro investigations, the review seeks to uncover the diverse potential of CB in the biomedical field. A comprehensive search of electronic databases yielded 51 articles from 2408 studies. These studies encompassed in vivo animal studies and in vitro investigations. In vivo studies employed for bone repair, dorsal subcutaneous defects, thermal wound healing, muscle injections, and avian blood testing. In vitro studies focused on HAp synthesis, scaffold development, dental material enhancement, and antimicrobial properties. Risk of bias assessments revealed varying degrees of methodological quality in both animal and in vitro studies, underscoring the need for standardised reporting and rigorous study design in future research. This review fills a gap in the literature by providing a comprehensive overview of the applications of CB-derived materials in the biomedical field. Additionally, it offers valuable insights for researchers, clinicians, and policymakers interested in sustainable and effective biomaterials for diverse medical purposes, advancing the fields of regenerative medicine and dentistry.

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.

Detection and identification of subcutaneous defects using ultrasonic waves in reflective test

Non-destructive ultrasonic evaluation is one of the methods used for inspection in mechanical engineering. This method has diverse applications in various fields, including industry and medicine. The main purpose of this research is to identify a subcutaneous defect with ultrasonic waves. This is done by sending ultrasonic waves into the skin tissue and receiving backward echoes, simulating them using a software, and calculating the time difference using the speed of sound. In this research, the behavior of longitudinal and transverse waves is investigated in collisions with a defect by describing the genesis and application history as well as the principles and definitions of ultrasonic waves. In the test, first, the method of identifying the subcutaneous defect is explained. Then, the dimensions and stiffness of the defect are determined by analyzing the information obtained from the location. Using the 3.5-MHz probe, the defect was detected at a distance of 1.8 mm, indicating a high level of reliability compared to the sonography imaging device. This was while the 10-MHz probe failed to detect the defect just near the skin surface. The results confirm the choice of this method as a suitable method for detecting the subcutaneous defect.

Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.

Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. The minimally invasive intralesional laser treatment can remove foreign substances and the inflammatory reaction, eventually leaving depression and scar tissue in the treated area. Fat grafting can restore volume loss and improve scar tissue. From March of 2010 to February of 2017, 33 patients were studied. All of them had suffered from inflammatory reactions to permanent facial fillers and had been treated with the 808-nm diode laser at the authors' institution. The evacuation of material had left facial asymmetry and visible depression. To restore facial aesthetic units, fat grafting was performed. The minimum follow-up was 6 months. Volume restoration was recognized (according to the Global Aesthetic Improvement Scale) as significantly improved in 22 patients, moderately improved in eight patients, and slightly improved in three patients. Improvement in atrophic and scarred tissues (with an apparent thickening of the skin or even elimination of scars) was also assessed with the following results: 25 patients were very much improved and eight were moderately improved. This is the first study on filler-induced complications of the face treated by intralesional laser treatment followed by lipofilling. A systematic approach to volume restoration is proposed to patients who had filler removal of the face. There was a high degree of patient satisfaction with this technique. Therapeutic, IV.

The size effect of rebars, on the structural integrity of reinforced concrete structures, which are exposed to corrosive environments

The goal of the present study is to mention the importance of underestimation of the corrosion damage developed in critical load bearing areas, on the column bases, where formation of plastic hinges is attended, mainly during strong seismic events (Figure 1). In such cases, plastic hinges are expected to absorb the seismic energy, owed to seismic vibration. However, chloride induced corrosion is responsible for significant degradation of concrete infrastructures located in coastal areas. Forecasting the life expectancy of such structures, in corrosive environments, is a challenge in engineering, given the fact that existing internal, external, as well as subcutaneous defects, in combination with the aggressive environmental factors, may be responsible for the development of subcutaneous damage on steel reinforcement [1], which may diminish the tolerance of the critical regions of the structures. Moreover, it is widely known that penetration of chloride ions into reinforced concrete varies according to its porosity and its permeability, however, the major factor for corrosion initiation is the threshold of chloride concentration, which strongly depends on the exposed surface area of steel. In the present experimental study, the variation of corrosion damage, on bare specimens, was evaluated and correlated with the geometry of the exposed surface of steel in corrosion [2]. Finally, a correlation between short bare specimens and the “injured” areas of the long embedded specimens is estimated as well.

The Laparoscopically Harvested Omental Free Flap: A Compelling Option for Craniofacial and Cranial Base Reconstruction.

Background Management of craniofacial and cranial base tumors is a challenge due to the anatomic intricacies associated with the calvarium, the pathological diversity of lesions that present, and the potential complications. Clinical outcomes in laparoscopically harvested omentum free flaps for cranial base and craniofacial reconstruction are presented in this paper, in the largest case series to date. Methods A retrospective single-center experience for over 10 years with laparoscopically harvested omentum flaps used to reconstruct craniofacial and cranial base defects. Results A total of 13 patients underwent craniofacial or cranial base reconstruction using laparoscopically harvested omentum free flaps. The mean patient age was 48 years. The anterior skull base represented the most common site of reconstruction. A total of 12 of the flaps survived (92%), with one flap failure due to infection. All patients demonstrated satisfactory aesthetic and functional outcomes. There were no perioperative or intra-abdominal complications. Conclusions The laparoscopically harvested omentum free flap is a safe and effective tool in the armamentarium of the reconstructive surgeon. It is the ideal option to treat complex, three-dimensional subcutaneous defects, such as those encountered in craniofacial and cranial base reconstruction. Its unique angiogenic and immunologic capacity makes it an excellent flap for the previously irradiated and/or infected wound bed.

Management of Complications Caused by Permanent Fillers in the Face: A Treatment Algorithm.

Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. Inflammatory reactions (often termed granulomas) to these materials can be functionally and socially disabling. Most therapeutic options used until now are nonspecific antiinflammatory treatments, targeting an ill-defined immune reaction of undefined cause. The minimally invasive intralesional laser treatment can remove the foreign substance and the inflammatory reaction with an 808-nm diode laser. Two hundred nineteen consecutive patients referred from September of 2006 until June of 2013 for inflammatory reactions to permanent facial fillers and treated with this technique at the authors' institution with a minimum 6-month follow-up were studied. All patients were screened with an ultrasound soft-tissue examination and the lesions were classified as either cystic (implants inserted by bolus injections) or infiltrating (as in microdeposit injection). The authors' therapeutic approach is summarized in an algorithm: infiltrating patterns were treated with intralesional laser treatment alone, whereas cystic distribution cases were also drained through stab wound incisions. The mean patient age was 49 years (range, 23 to 72 years); 204 patients were women. Partial improvement was obtained in 30 percent of patients, whereas 8 percent discontinued the treatment because of a lack of satisfaction. Lesions disappeared completely in 62 percent. Complications included transient swelling in all cases, hematoma in 2 percent, secondary sterile abscess in 9.5 percent, and minimal scarring in 10 percent. A problem-oriented systematic approach to inflammatory complications from permanent fillers is proposed, based on the comprehensive work from the past 7 years, with an overall improvement rate of 92 percent. Therapeutic, IV.

Comparative study of recombinant human bone morphogenetic protein-2 carriers in rat subcutaneous tissues: Pilot study

The purpose of this study was to evaluate and compare the potential of using various biomaterials as a carrier of rhBMP-2 in the subcutaneous layer of rats. 5 subcutaneous defects were made in each of the dorsal surfaces of 10 rats. Then, the rats were divided into the following groups: Control group: sham-surgery control, Experimental group 1: rhBMP-2/Bio-Oss®, Experimental group 2: rhBMP-2/Collatape®, Experimental group 3: rhBMP-2/nCS. Histological and histometrical analysis were performed after the rats were sacrificed at 2 and 4 weeks. Regardless of the type of carrier, the groups treated with rhBMP-2 showed significantly greater bone formation when compared to the control group. The amount of new bone formation was greater at 4 week than 2 week. Total bone formation (%) at 4 week was the greatest in rhBMP/Bio-Oss® (26.76±10.13) group, followed by rhBMP/Collatape® (20.38±5.27) and rhBMP/nCS (4.34±2.58). Within the limitation of this study, the results showed that Bio-Oss®, Collatape®, nanocalcium sulfate all showed new bone formation when used as a carrier of rhBMP-2 in the subcutaneous layer of rats, indicating potential use as carriers for rhBMP-2.

The musculocutaneous flap based on the tensor fasciae latae muscle – breast reconstruction – anatomical dissection on a cadaver

Abstract The cutaneous and subcutaneous defects resulting from surgical excisions are a problem and, at the same time, a challenge for surgeons. The breast is an expression of feminine beauty. Materials and methods: Dissection on a fresh female cadaver, aged 57, in order to harvest the musculocutaneous flap based on the tensor fasciae latae muscle, from the lateral region of the thigh, using microsurgical loupes. For rendering the stages of the harvesting of the musculocutaneous flap based on the tensor fasciae latae muscle, a high-definition camera was used. The result: the harvesting of the musculocutaneous flap based on the tensor fasciae latae muscle, and the closure of the donor area. Conclusions: guidelines, advantages and disadvantages of using the musculocutaneous flap based on the tensor fasciae latae muscle

Preclinical Safety Studies on Autologous Cultured Human Skin Fibroblast Transplantation

Recently, FDA approved the clinical use of autologous fibroblasts (LAVIV™) for the improvement of nasolabial fold wrinkles in adults. The use of autologous fibroblasts for the augmentation of dermal and subcutaneous defects represents a potentially exciting natural alternative to the use of other filler materials for its long-term corrective ability and absence of allergic adverse effects proved by clinical application. However, compared to the clinical evidence, preclinical studies are far from enough. In this study, human skin-derived fibroblasts were cultured and expanded for both in vitro and in vivo observations. In vitro, the subcultured fibroblasts were divided into two groups. One set of cells underwent cell cycle and karyotype analysis at passages 5 and 10. The second group of cells was cocultured in medium with different concentrations of human skin extract D for the measurement of collagen concentration and cell count. In vivo, the subcultured fibroblasts were injected into nude mice subcutaneously. Biopsies were taken for morphology observation and specific collagen staining at 1, 2, and 3 months after injection. The results in vitro showed no significant differences in cell cycle distribution between passages 5 and 10. Cell proliferation and secretion were inhibited as the concentration of extract D increased. In vivo, the fibroblasts were remarkably denser on the experimental side with no dysplastic cells. Mitotic cells were easily observed at the end of the first month but were rare at the end of the third month. Type III collagen was detected at the end of the first month, while collagen type I was positive at the end of the second month. The content of both collagens increased as time passed. The above results indicated that the use of the autologous fibroblasts was safe, providing a basic support for clinical use of fibroblasts.

Erratum to: First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

Erratum to: First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

Background Deep excision down to the muscle fascia and split-thickness skin grafting is a necessary part in modern surgical care of adult burn patients presenting with full-thickness wounds. We evaluated a new surgical approach combining a dermal matrix, autologous fat-transfer, and split-thickness skin grafting.

Preliminary Survival Studies on Autologous Cultured Skin Fibroblasts Transplantation by Injection

In the correction of aesthetic impairments on the face, dermal, and superficial subcutaneous defects, adequately safe implant material is required. Cultured autologous skin fibroblasts, as a protein repair system, create a living injectable system that has been utilized effectively to treat rhytids, depressed scars, subcutaneous atrophy, acne irregularities, and laser wounds. To evaluate the new method, we have investigated the survival and collagen secretion of autologous transplanted fibroblasts. In this study, rabbit fibroblasts were cultured and expanded. Cells (8 x 10(7)/ml) were injected into the superficial and deep dermal junction of the dorsal ears. Two rabbits were injected independently with labeled [3H]TdR fibroblasts; similarly, eight rabbits were given unlabeled transplanted cells in the right ear and vehicle in the left. Each site was injected three times with the same amount of cells every 2 weeks. The grafts were evaluated for 5 months. After explantation, the samples were collected from the injected sites and stained with autoradiography, H&E, and sirius red, respectively. According to the histological observations, the [3H]TdR-labeled cells survived and large amounts of embryo fibroblasts were found in the experimental subgroup of the labeled cell group. The depth of dermis was significantly different between the experimental subgroup (701.3 +/- 31.5 microm) and the control subgroup (638.3 +/- 23.9 microm) of the unlabeled group (p < 0.01). There was also a significant difference of collagen III between the experimental subgroup (2.63 +/- 1.41 cm2) and the control subgroup (1.05 +/- 0.90 cm2) (p < 0.05). There was no significant difference of collagen I between the experimental subgroup (56.25 +/- 14.41 cm2) and the control subgroup (55.41 +/- 16.59 cm2) (p > 0.05). The results obtained demonstrate that the distinction of the depth of dermis should be interpreted by the increase of collagen III, instead of collagen I, which is produced by the transplanted fibroblasts. The investigation indicated that transplanted autologous skin fibroblasts could provide a potential and effective approach to treat minor facial tissue deficiencies.

Solitary skull metastasis as initial manifestation of hepatocellular carcinoma

BackgroundA solitary skull metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor without liver dysfunction is a very rare event.Case presentationA 71-year-old male, without known liver disease, presented to our institution with a palpable occipital scalp mass. On brain magnetic resonance imaging (MRI), a highly enhanced and osteolytic skull tumor was observed. The histological diagnosis obtained from the percutaneous needle biopsy was a cranial metastasis from HCC. The metastatic tumor was removed via occipital craniectomy, and the two primary liver mass lesions were subsequently treated by transarterial chemoembolization.ConclusionAn isolated skull metastasis may be the sole initial presentation of HCC. Early diagnosis is essential in order to treat the primary disease. A skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.

Gluteal retractions: Classification and treatment techniques

The buttocks can be affected by many different kinds of retractile notches, all of them caused by histologic alterations of the subcutaneous tissues, gluteal fascia, or muscle at different levels of severity. Until now, no attempt has been made to systemize the diagnosis of these defects or to describe a treatment approach from the aesthetic viewpoint. We present a definition and a classification of gluteal retractions based on the anatomic structures affected, the assessment used to identify each type of defect, and the techniques used to correct different problems. The affected muscle fibers or fibrous fascial segments were lysed and removed through an incision on the intergluteal crease, under epidural block. Subcutaneous defects were treated percutaneously by fat grafting and fiber lysis and addressed under local anesthesia or epidural anesthesia when combined with correction of a muscular or fascial retraction. Treatment results in a series of 214 patients were satisfactory. Complications included seroma in 2 cases of fascial fibrosis, 1 of which was followed by infection; residual inelastic muscle fibers in 2 cases; overcorrection in 8 cases; and infection in 1 case of fat grafting. In 31.2% of patients with subcutaneous defects, more than one fat grafting session was required to correct subcutaneous defects. The classification system and algorithm based on physical examination presented here for the treatment of gluteal retractions have been shown to be useful tools for diagnosis and treatment of specific types of defects.

Microsurgical soft tissue transplantation

Since the first microsurgical transplantation in 1971, numerous tissue regions which are appropriate for transplantation have been researched. In particular, cutaneous or fasciocutaneous and musculocutaneous, as well as jejunum and fat tissue transplants are involved. In maxillofacial surgery, predominantly radial underarm flaps and scapular or parascapular flaps are used. The indications for both kinds of flaps range from intraoral defects, including tongue defects, and defects after maxillary resection, to defects following tumor resection of the face. In the framework of radical tumor surgery involving regional lymph drainage ducts, the musculus latissimus dorsi flaps and the musculus rectus abdominis flaps are indicated for the covering of deep-reaching defects. Jejunum transplants are appropriate mainly in the region of the soft palate and pharyngeal walls. Free microsurgical fat tissue transplants are indicated for extensive subcutaneous defects. The technique of lifting transplants and transferring them is so refined that results are comparable to those attained by using conventional flaps.

FAT TRANSPLANTATION

Fat transplantation has been used by physicians for over 100 years; however, this technique has been refined considerably since the development of liposuction in the late 1970s. Fat transplantation can be used for augmentation of subcutaneous defects throughout the body. It continues to be the safest and most versatile form of soft tissue augmentation.

Microlipoinjection and Autologous Collagen

There has been a resurgence over the past decade of microlipoinjection. Adipose tissue has proved to be a safe and effective filler substance for subcutaneous defects. More recently, lipocytic dermal augmentation, or autologous collagen, has been used to correct dermal defects.

Reconstruction of the face by means of the angle-rotation flap.

This article deals with defects in the face. A cervical flap called the angle-rotation flap was created by Schrudde 16 years ago to cover defects such as scarred skin after deep burn injuries as well as skin and subcutaneous defects following removal of dysplastic skin or after accidents. Indications and the method are described.

Treated dermis as a source of reparative tissue.

FOR NEARLY a century surgeons have sought for a safe simple method of utilizing fibrous tissue in the repair of subcutaneous defects. Kirschner,¹Neuhof,²and Gallie and LeMesurier³published reports on the use of fascia lata; others, notably Loewe,⁴Rehn,⁵Uihlein,⁶Mair,⁷Cannady,⁸Peer and Paddock,⁹Harkins,¹⁰and Marsden,¹¹published experimental and clinical data on the use of whole-thickness skin, or dermis. The final answer to the clinical use of skin as a reparative tissue would appear to be contained in Strahan's paper.¹²He reported 413 herniae in which buried skin was used as a reinforcing tissue. A substantial number of postoperative cysts and chronic sinuses due to persistent epithelial cells occurred without an offsetting reduction in the recurrence rate. That cysts would probably be formed if living epithelial cells were buried in mesothelial tissues was pointed out