Angela Otto

Histomorphologic and Volumetric Analysis of Implanted Autologous Preadipocyte Cultures Suspended in Fibrin Glue: A Potential New Source for Tissue Augmentation

Abstract. Previous efforts to use adipocyte transplants for tissue augmentation have been limited by high and unpredictable resorption rates. Preadipocytes are precursor cells that are capable of replication and differentiation into mature adipocytes. Furthermore, they are more resilient to ischemia, making them a desirable transplant media. Utilizing fibrin glue as a transport vehicle and a prefabricated intramuscular capsule pouch as the recipient site, we have demonstrated the successful transplantation of cultured preadipocytes without the previously presented resorption sequelae. Histological analysis at 2 weeks has demonstrated establishment of vascular supply and the complete resorption of fibrin glue. Most importantly, using planimetric analysis, volume retention has been demonstrated in implanted areas up to 1 year following implantation. Finally, BrdU labeling has been utilized to demonstrate the lack of increased and uncontrolled replication rate, an index of potentially tumorigenic tissue. In conclusion, we have demonstrated a potentially new and safe source of tissue augmentation in the rat model.

New technique for scarless umbilical reinsertion in abdominoplasty procedures

The most visible scar in the conventional abdominoplasty procedure or TRAM flap donor site closure is the scar around the reinserted umbilicus. In an attempt to increase the aesthetic outcome, the authors have introduced a new technique of umbilical reconstruction and reinsertion during abdominoplasty avoiding any paraumbilical scar, which results in a more natural appearance in that area. This new technique, potential pitfalls, and long-term results are reported.

BLADDER RECONSTRUCTION USING A PREVASCULARIZED CAPSULAR TISSUE SEEDED WITH UROTHELIAL CELLS

PURPOSE Recent advances in cell biology and tissue engineering have involved various avascular or acellular scaffolds with or without seeded cells. These techniques are frequently complicated by tissue necrosis, contracture and resorption. We used a vascularized matrix prelaminated with autologous cultured urothelial cells to reconstruct bladder wall defects. MATERIALS AND METHODS A silicone block inserted into the right groin of 50 male Wistar rats directly superficial to the inferior epigastric vessels was used to induce capsule pouch formation. Urothelial cells harvested simultaneously and cultured were then suspended in fibrin glue and seeded into the newly formed capsule after removing the silicone block. After 1 week the prelaminated flap was transposed into a surgically created bladder wall defect. Experimental groups included rats with a urothelial cell seeded capsule pouch sacrificed at 1 and 4 weeks, respectively, after bladder reconstruction. In control rats scaffolds were treated only with fibrin glue or saline before transposition. RESULTS Hematoxylin and eosin and immunohistochemical staining showed a continuous multilayered urothelial lining along the transposed prelaminated capsule flap in the experimental groups with better survival compared to controls treated only with fibrin glue (80% mortality) or saline (100% mortality). The surviving 3 control animals did not have a urothelial lining. CONCLUSIONS Vascularized prefabricated flaps lined with culture derived urothelial cells were successfully used for bladder reconstruction in a rat model. The technique of prefabricating a vascularized scaffold lined with autologous urothelial cells may provide a method for future reconstruction of the genitourinary systems.

A new contralateral split-breast flap for breast reconstruction and its salvage after complication: an alternative for select patients.

Different approaches to breast reconstruction have been described and nowadays nearly optimized. One major aim in further developments is to reduce donor site morbidity as low as possible. Theoretically, the lowest donor site morbidity could be achieved by using tissue that would be normally discarded during an operation necessary for a different reason. The authors present a new method of breast reconstruction in a mastectomy patient who needed a reduction mammaplasty on the remaining side in addition to the reconstruction. A single-stage split-breast flap from the reduced contralateral side pedicled on its internal mammary perforators was used, thus lowering donor site morbidity by using otherwise discarded tissue. The technical details, patient selection, advantages, possible pitfalls, management of complications, and the risk factors for contralateral malignancy are discussed.

Chronisch rezidivierende, lokal destruierende Silikonome nach Brustaugmentation durch flüssiges Silikonöl

Abstract. At the beginning of the sixties the injection of liquid silicon oil was frequently used for breast augmentation. It was thought to be safe, simple and effective. But as complications such as local silconomas, inflammatory reactions, induration, foreign body extrusion and foreign body migration were published this procedure was not used anymore. We report about a 45-year-old female patient who suffered from late complications, chronic recurrent local destructive siliconomas, which have not been described in the literature yet. Because of the destruction forced by the primary siliconimplant a bilateral subcutaneous mastectomy had to be performed and siliconomas were excised at regions different from the original injection site. Several breast reconstructions have been performed but this tissue has also been destroyed by the recurrent and aggressive siliconomas. As there can be a long period of latency before the aforementioned complications of liquid silicon injections can occur, we recommend careful follow-up for these patients.Zusammenfassung. Anfang der 60 er Jahre war die Augmentation der Brust durch Injektion von flüssigem Silikon eine sicher geglaubte Methode, welche ob des simplen Eingriffs und des raschen Erfolgs allzu oft unkritisch angewandt wurde. Als Komplikationen, welche diese Methode in Verruf brachten, wurden lokale Silikonome, entzündliche Infiltrationen und Indurationen, Fremdkörperextrusionen, sowie Fremdkörpermigrationen beschrieben. In der vorliegenden Arbeit wird über den Jahrzehnte langen Krankheitsverlauf einer 45 jährigen Patientin mit einer in der Literatur noch nicht erwähnten Spätkomplikation, der chronisch rezidivierenden, lokal destruierenden Form eines Silikonoms, berichtet. Die lokal destruierende Wirkung des flüssigen Silikons und der sekundären Silikonome erforderte eine beidseitige subcutane Mastektomie, sowie zahlreiche Silikonomexstirpationen auch außerhalb der ursprünglichen Applikationsstelle. Mehrfache plastisch-chirurgische Brustrekonstruktionen wurden durch den ungewöhnlich aggressiven und rezidivierenden Verlauf der Silikonome zerstört. Aufgrund der möglichen jahrelangen Latenz Silikon-assoziierter Komplikationen empfehlen wir eine konsequente Nachuntersuchung für betroffene Patienten aus den frühen Tagen der flüssigen Silikoninjektion.

Treatment of chronic thoracic duct fistula with the sternocleidomastoid muscle flap

Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. The fistulae can be difficult to treat, and several techniques, both operative and nonoperative, are advocated. We present a simple technique for the treatment of chronic thoracic duct fistula where other procedures have failed. After identification and ligation of the duct, the area is covered with the clavicular head of the sternocleidomastoid muscle.

Ohrmuschelverletzungen : Klassifizierung und Therapiekonzept

ZusammenfassungDie detailgetreue und nach ästhetischen Gesichtspunkten korrekte Versorgung von Ohrmuschelverletzungen bis hin zur Amputation stellt eine anspruchsvolle Aufgabe für den erstbehandelnden Chirurgen dar. Versäumnisse bei Primärbehandlungen führen zu erschwerten Bedingungen bei der Rekonstruktion, die ästhetischen Resultate sind in der Regel dann nicht zufriedenstellend.Vorgestellt und vorgeschlagen wird eine Klassifikation nach Art der Ohrverletzung. Das differenzierte Behandlungskonzept trägt den verschiedenen Belangen Rechnung. Falldarstellungen werden zu verschiedenen Methoden gezeigt und mit der vorhandenen Literatur verglichen und diskutiert.AbstractThe treatment of traumatic defects of the auricle concerning the exact reconstruction of details and aesthetic aspects is exacting for the surgeon. To face the expectations towards best trauma care, the different locations and extent of auricular injuries should be included in the different therapeutic strategies. The insufficient treatment results in mostly difficult secondary conditions.We present a classification for ear traumas, which considers size and location of defects. Depending on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are pointed out and discussed with several examples and with the present literature.

IDIOPATHIC ISOLATED BILATERALLY SYMMETRICAL BRACHYMETACARPIA OF THE FIFTH METACARPAL: Case report

We report a rare case of a 32-year-old woman with idiopathic isolated bilaterally symmetrical brachymetacarpia of the fifth metacarpal bone, which had been present since the age of 14. Movement, and sensory and motor function were within normal limits, and she had no symptoms. No treatment was recommended. We know of no similar case reports.

Total gluteal pouching with pseudoanus caused by burn injury

PURPOSE: We report the case of a 69-year-old man who had suffered a third-degree burn injury of the buttocks close to the perianal region at the age of 2 years. Although initial attempts for conservative treatments failed, wound healing was achieved after numerous skin grafts. However, after prolonged healing, the patient developed scar contracture, resulting in total effacement of the gluteal folds and natal crease, and formation of a gluteal pseudoampulla and a pseudoanus. As a result of misinterpretation of the local anatomy, for the next 50 years the patient had to defecate into the gluteal pouch and empty this pseudoampulla by manually compressing the buttocks and irrigating with chamomile tea. METHOD: After a thorough examination revealed the presence of a normal, uninjured anus hidden by the scarred pouch, we excised this burn scar to expose the unburned perianal tissue and covered the resulting defect with a meshed, split-thickness skin graft. RESULT: Anorectal function was preserved, the anatomic contour was restored, and primary wound healing was achieved after one single-stage operation. CONCLUSION: To prevent such deformities, we recommend early excision and skin grafts as initial treatment, as opposed to conservative treatment, and thorough follow-up examinations to avoid misinterpretation of such a complex, altered local anatomy.