Brian Mailey

Abstract 131: Adipose Derived Stem Cell Count is Influenced by Receipt of Chemotherapy in Breast Cancer Patients.

Suday, M arch 9, 2014 effect. The angiogenic effect of PRP itself and PRP-treated ASCs will enhance the vascular supply to maintain the adipocyte survival within fat graft. Furthermore, the stemness effect of PRP increases the renewal and differentiation capabilities of ASCs which can be the cell depot required in fat graft survival. 131 adipose derived Stem cell count is influenced by receipt of chemotherapy in Breast cancer Patients

A comparison of cell-enriched fat transfer to conventional fat grafting after aesthetic procedures using a patient satisfaction survey.

IntroductionThe role of regenerative cells in adult human fat is still unfolding. At present, limited clinical studies comparing patient satisfaction with cell-enriched fat transfer (CEFT) to conventional autologous fat transfer (AFT) for aesthetic indications have been performed. Herein, we present our data obtained from patient satisfaction questionnaires. MethodsPatients undergoing fat grafting received AFT or CEFT. Study participants were surveyed for overall satisfaction, symmetry, deformity, scarring, and pigmentation. Hospital charts were reviewed for complications, and patient survey responses between the groups were compared. ResultsBetween January 2009 and September 2011, 36 patients had 6-months follow-up and were mailed surveys. Of these, 17 (12 CEFT and 5 AFT) returned completed Patient Satisfaction Rating surveys. At a median follow-up time of 10.7 months, the overall mean satisfaction rate was 5.2 of 6 (5.3 vs 5.0 for CEFT and AFT, respectively, P = 0.42). There were no significant differences about deformity (5.1 vs 4.7, P = 0.50), symmetry (4.5 vs 5.0, P = 0.48), or scarring (5.3 vs 4.5, P = 0.23). However, pigmentation was improved in the CEFT vs the AFT groups (P < 0.001). No patients in the AFT group noted skin pigmentation improvement, whereas 7 of 12 receiving CEFT noted improvement in skin pigmentation. ConclusionsCell-enriched fat transfer to the face and body of aesthetic patients produces high satisfaction rates. Our preliminary data demonstrates similar satisfaction with regard to symmetry, scarring, and deformity in patients treated with CEFT versus AFT, without any complications. Unexpectedly, a clinical and statistical improvement in pigmentation was seen for patients treated with CEFT over AFT. Further studies need to be done to better understand this phenomenon.

Adipocyte-derived stem and regenerative cells in facial rejuvenation.

The identification of regenerative cells in adult human fat has invigorated the field of facial fat grafting. This article reviews traditional and cell-enriched fat grafting methods and the use of fat to create or refine aesthetic results. The rationale and potential applications of adipocyte-derived stem and regenerative cells in facial surgery are also described. The reader is presented with surgical techniques for harvesting and delivering fat grafts to optimize engraftment. Mesotherapy and related applications currently under investigation are also discussed.

Adipose-Derived Stem Cells: Methods for Isolation and Applications for Clinical Use

Adipose tissue sciences have rapidly expanded since the identification of regenerative cells contained within the stromal vascular fraction (SVF) of fat. Isolation of the SVF, containing adipose-derived stem cells (ADSC), can be accomplished efficiently in the operating room or in the laboratory through enzymatic digestion of the adipose tissue and concentration of SVF. Cells can be directly re-injected as a mesotherapeutic agent, recombined with a tissue scaffold (e.g., cell-enriched fat grafts) or expanded in culture for tissue-engineered cell therapeutics. The potential for cell therapy is under current investigation by researchers around the world. This chapter reviews laboratory methods for isolating ADSCs and the ongoing clinical trials evaluating cell therapeutic efficacy across many specialties, including cardiology, neurology, immunology, tissue engineering, sports medicine, and plastic and reconstructive surgery.

Robot-Assisted Plastic Surgery

Robot assisted surgery is a technology that is being used frequently among multiple surgical specialties; robot assisted microsurgery (RAMS) and transoral robotic surgery (TORS) are applications relevant to plastic surgery that are being studied and clinically utilized. Advantages of RAMS include elimination of tremor and the ability to provide enhanced exposure. TORS facilitates oropharyngeal tumor excision and reconstruction without mandibular splitting. This article investigates current and potential uses of the surgical robot in plastic surgery as well as obstacles to its application.

Evaluation of Facial Volume Changes after Rejuvenation Surgery Using a 3-Dimensional Camera

BACKGROUND Surgical rejuvenation alters facial volume distribution to achieve more youthful aesthetic contours. These changes are routinely compared subjectively. The introduction of 3-dimensional (3D) stereophotogrammetry provides a novel method for measuring and comparing surgical results. OBJECTIVES We sought to quantify how specific facial areas are changed after rejuvenation surgery using the 3D camera. METHODS Patients undergoing facial rejuvenation were imaged preoperatively and postoperatively with 3D stereophotogrammetry. Images were registered using facial surface landmarks unaltered by surgery. Colorimetric 3D analysis depicting postoperative volume changes was performed utilizing the 3D imaging software and quantitative volume measurements were constructed. RESULTS Nine patients who underwent combined facelift procedures and fat grafting were evaluated. Median time for postoperative imaging was 4.8 months. Positive changes in facial volume occurred in the forehead, temples, and cheeks (median changes, 0.9 mL ± 4.3 SD; 0.8 mL ± 0.47 SD; and 1.4 mL ± 1.6 SD, respectively). Negative changes in volume occurred in the nasolabial folds, marionette basins, and neck/submental regions (median changes, -1.0 mL ± 0.37 SD; -0.4 mL ± 0.9 SD; and -2.0 mL ± 4.3 SD, respectively). CONCLUSIONS The technique of 3D stereophotogrammetry provides a tool for quantifying facial volume distribution after rejuvenation procedures. Areas of consistent volume increase include the forehead, temples, and cheeks; areas of negative volume change occur in the nasolabial folds, marionette basins, and submental/chin regions. This technology may be utilized to better understand the dynamic changes that occur with facial rejuvenation and quantify longevity of various rejuvenation techniques. LEVEL OF EVIDENCE 4 Diagnostic.

Necrotizing metachronous facial ulcerations after "stem cell face lift".

IntroductionA 63-year-old woman underwent face and neck lift with autologous fat transfer—called by her physician a “stem cell face lift.” MethodsFatty aspirate from her abdominal wall was enriched by hyaluronic acid, triiodothyronine, thyroxine, insulin, dimethylaminoethanol, estriol, dexamethasone, indomethacin, and fibroblast growth factor before injection into the face. ResultsAt approximately 4-weeks postoperative, the patient developed facial swellings, erythema, necrotizing ulcers, and an orocutaneous fistula. New lesions continued occurring up to 16 weeks after surgery. After multiple surgical debridements and an oral course of rifampin, a decisive reduction in inflammation and healing was observed. Differential diagnosis included (1) mistaken transfer of allogeneic fat (ruled out), (2) toxic impurities in transferred material, (3) microbial contaminant(s) from multiple use liposuction cannula or tissue markers, and (4) endogenous anaerobic orofacial infection (history of previous radiation for tonsillar cancer and dental implants). ConclusionsThe most probable etiology was mycobacterial infection. This is based on a single colony of mycobacterium isolated, histologic finding revealing granulomatous inflammation, and the favorable response to rifampin. The patient underwent subsequent autologous fat transfers, which successfully reduced some disfigurement and scarring.

Early two-stage repair of clefts in holoprosencephaly

UNLABELLED Holoprosencephaly (HPE) presents with a spectrum of severity, but in its totality is the most common malformation of the embryonic forebrain occurring 1 in 10,000 to 1 in 20,000 live births. Due to the poor prognosis, treatment of mid-face clefts in HPE patients have classically been addressed in a delayed fashion after 1-year of age. Improvements in the ability to manage medical complications associated with HPE along with an increased understanding and lower mortality rates in less severe forms have challenged these previous practiced routines. Accompanied by advances in understanding of HPE and identification of genes responsible for sporadic forms, we are able to better guide timing of surgical intervention. We present a patient with lobar HPE and a type IV facial deformity treated with early repair of the median facial cleft. We believe this treatment strategy was safe, given her relatively good prognosis. We propose that patients with HPE displaying less severe neural non-cleavage may be good candidates for earlier two-stage intervention. SUMMARY The historically poor prognosis of patients with holoprosencephaly (HPE) has led to midline facial clefts have being addressed in a delayed fashion after 1-year of age. Improvements in the ability to manage medical complications associated with HPE and lower mortality rates in less severe forms have challenged these previous practiced routines. Additionally, the identification of genes responsible for sporadic forms of HPE can better guide timing of surgical intervention and improve developmental outcomes. We present a patient with lobar HPE and a type IV facial deformity treated with an early two-stage repair of the median facial cleft. We propose patients with HPE displaying less severe neural non-cleavage may be good candidates for earlier intervention.

Treatment of a giant congenital melanocytic nevus in the adult: review of the current management of giant congenital melanocytic nevus.

AbstractGiant congenital melanocytic nevi (GCMNs) create cosmetic disfigurements and pose risk for malignant transformation. Adult GCMN cases are uncommon because most families opt for surgical treatment during childhood. We review the current literature on GCMN and present an interesting case of an adult with a GCMN encompassing the entire back with painful nodules exhibiting gross involvement of his back musculature, without pathologic evidence of malignancy. Surgical management was deferred in childhood because of parental desires to allow the patient to make his own decision, and treatment in adulthood was pursued on the basis of the significant impairment of the patient’s quality of life and self-esteem due to the massive size and deforming nature of the nevus.The treatment strategy used for this young adult male patient involved a massive en bloc excision of the GCMN with partial resection of the latissimus dorsi, followed by a 5-week staged reconstructive process using dermal regenerative matrices and split-thickness skin grafting. Because of the shift in GCMN management from early surgical management to more conservative management, we may see an increase in adult cases of GCMN. Thus, it is critical to better understand the controversy surrounding early versus delayed management of GCMN.

Independent plastic surgery residency match rate trend.

has to select the program that best matches what he or she is looking for. But where does one even begin? After flying in and out of numerous cities, it can be quite daunting to try to remember the details of each program. Having recently completed the independent match myself, I realized the difficulty of assigning an order of preference to each program when putting together a rank list. Many individual residency programs have developed their own scoring systems to more objectively evaluate applicants interviewing with them.2 Consequently, I designed a weighted scoring system for applicants to objectively evaluate plastic surgery programs based on each applicant’s unique personal preferences. To my knowledge, this is the first such scoring system in the literature, not only for plastic surgery but for all medical specialties. Figure 1 is a blank template applicants may take with them to each interview. In the first column, there are 10 categories for evaluating a plastic surgery program. In the second column, the applicant must assign a weighted percentage to these categories based on how important each one is to the applicant; the sum of all of the percentages should equal 100 percent. These values will remain the same for all interviews. In the third column, the applicant enters a rating from 1 to 10 for each category based on his or her impression immediately after each interview, with 10 being the best possible rating. For each category, the percentages (column 2) and the ratings (column 3) are multiplied and entered in column 4 as a weighted score. The values in column 4 are then added together to produce a final score below. Each program will then have a score out of 10, and the programs can be placed in order from greatest to least score to objectively produce a rank list. Table 1 is an example of what a completed table may look like; the weights and ratings were chosen arbitrarily for demonstration. For the applicants with family considerations, geographic location may be the most important quality in a program. For the applicant who aspires to a career in academia, academic reputation or research opportunities may be given the greatest consideration. Using this algorithm, applicants may objectively evaluate plastic surgery programs and create their rank list based on the qualities they deem to be most and least important. DOI: 10.1097/PRS.0b013e318278d801