Francesco Simonacci

The biological and clinical basis for the use of adipose-derived stem cells in the field of wound healing

Worldwide, hard-to-heal lower limb wounds are estimated to affect 1.5–3% of the adult population with a treatment-related annual cost of

Procedure, applications, and outcomes of autologous fat grafting

10 billion. Thus, chronic skin ulcers of the lower limb are a matter of economic and public concern. Over the years, multiple medical and surgical approaches have been proposed but they are still inadequate, and no effective therapy yet exists. Regenerative medicine and stem cell-based therapies hold great promise for wound healing. Recently, many plastic surgeons have studied the potential clinical application of adipose-derived stem cells (ASCs), which are a readily available adult stem cell population that can undergo multilineage differentiation and secrete growth factors that can enhance wound-healing processes by promoting angiogenesis, and hence increase local blood supply. ASCs have been widely studied in vitro and in vivo in animal models. However, there are few randomized clinical trials on humans, and these are still ongoing or recruiting patients. Moreover, there is no consensus on a common isolation protocol that is clinically feasible and which would ensure reproducible results. The authors aim to provide readers with an overview of the biological properties of ASCs as well as their clinical application, to help better understanding of present and future strategies for the treatment of hard-to-heal wounds by means of stem cell-based therapies.

Autologous fat transplantation for breast reconstruction: A literature review

Objective To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. Patients and methods Literature review of publications concerning autologous fat grafting. Results Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The “wet” method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. Conclusions Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

Analysis of Complications in Postbariatric Abdominoplasty: Our Experience.

Introduction The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published. Presentation of case We performed a literature review of this technique, highlighting the crucial role of lipofilling in breast cancer reconstruction. Discussion The efficacy of the fat graft transplantation depends on the experience and the technique used by the surgeon. The ASCs (adipose-derived stem cells) contained in the fat graft has proven to be crucial for breast reconstruction by mean the regeneration of tissue, through the chemotactic, paracrine, and immunomodulatory activities and their in situ differentiation. Conclusion The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.

Adipose-derived stem cells: Comparison between two methods of isolation for clinical applications

Abdominoplasty is one of the most popular body-contouring procedures. It is associated with a significant number of complications: the most common ones are seroma, hematoma, infection, wound-healing problems, and skin flap necrosis. From January 2012 to December 2014, 25 patients (18 women and 7 men) (mean age: 51 years) underwent abdominoplastic surgery at the Plastic Surgery Section, Department of Surgical Sciences, University of Parma, Italy. All patients reported a weight loss between 15 kg and 47 kg. All of the of 25 patients were included in the study; minor and major complications were seen in 17 (68%) and 8 (32%) patients, respectively. The percentage of complications in our patients was as follows: 9 patients with seroma (36%); 4 patients with wound dehiscence with delayed wound healing (16%); 3 cases with hematoma (12%); 2 patients with postoperative bleeding (8%); 1 patient (4%) with an umbilical necrosis; 1 patient (4%) with a deep vein thrombosis; 3 patients with infected seroma (12%); and 2 patients with wound infection (8%). There were no cases of postoperative mortality. The aim of this study is to analyze our complications in postbariatric abdominoplasty.

Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature

Background Adipose-derived stem cells are recognized as being an effective mesenchymal stem cell population with enormous potential in different fields of regenerative medicine and stem cell therapy. Although there is unanimous agreement on the harvesting procedure for adipose tissue, there are various protocols for adipose-derived stem cell isolation. The aim of this study was compare two methods of adipose-derived stem cells (ASCs) isolation, one based on a mechanical + enzymatic (ME) procedure and the other one exclusively mechanical (MC), in order to determine which one was superior to the other in accordance with current European and US legislation. Methods We reported step by step the two different methods ASCs isolation by comparing them. The ME procedure included the use of a centrifuge, an incubator and collagenase digestion solution (Collagenase NB 6 GMP Grade 17458; Serva GmbH, Heidelberg, Germany). The MC procedure was performed by vibrating shaker and centrifuge, both placed in a laminar airflow bench. Results With the ME procedure, a mean of 9.06 × 105 ASCs (range, 8.4 to 9.72 × 105; SD ± 6.6 × 105) was collected, corresponding to 25.9% of the total number of harvested cells. With the MC procedure, a mean of 5 × 105 ASCs (range: 4.0 to 6.0 × 105; SD, ±1 × 105) was collected, corresponding to 5% of the total number of harvested cells. Conclusion Based on data collected, from the same amount of lipoaspirate the ME procedure allowed to isolate a greater number of ASCs (25,9%) compared to the MC one (5%).

Off-label use of adipose-derived stem cells

One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of “the ideal breast size”, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article.

Surgical Treatment of Frontal and Occipital Migraines: A Comparison of Results

Background Adipose-derived stem cells (ASCs) have a broad range of clinical applications. The ease of cell harvest and high yield with minimal donor-site morbidity makes adipose tissue an ideal source of stem cells. Further, the multi-lineage potential of these cells present significant opportunities within the field of tissue engineering, with studies successfully demonstrating their ability to produce a range of tissue types. Materials and methods Literature review of publications on the use of ASCs, in the context of current European and US regulations. Results According to European and US regulations, many clinical trials reported in literature to date could be considered off-label. Conclusion In Europe, clinical trials involving cultured ASCs and/or the use of collagenase, which causes changes in the structural and functional properties of stem cells, and/or ASCs application in non-homologous tissue, should be considered off-label. ASCs should be non-cultured, isolated mechanically, and used only in the subcutaneous tissue.

The Art and Science beyond Body Contouring A Solution for Massive Weight Loss Patients

METHODS We performed a retrospective comparison between 2 surgical procedures: our modified technique of selective endoscopic myotomies of corrugator supercilii, depressor supercilii, and procerus muscles6–8 for frontal migraine (group A) versus the surgical isolation of the greater and the lesser occipital nerves for disease originating on the posterior region (group B). Both procedures were performed under local anesthesia as 1-day surgery. Group A was constituted by 43 patients who, after a 1.5-cm long midline scalp incision (Fig. 1) and subgaleal dissection, underwent selective myotomies and decompression of the supraorbital and supratrochlear nerves. In group B, 22 patients, after an 8-cm-long scalp incision along the superior nuchal midline (Fig. 2) and dissection of local muscles, underwent release of the greater and the lesser occipital nerves by ligation of the (usually dilated) occipital vascular bundles. For both groups, followup ranged from 6 to 24 months.

Nipple Reconstruction Techniques: Which is the Best Choice?

The massive weight loss often resulted in an excess of loose skin mainly in the abdomen, upper arms, thighs, chest, back, and laterally on the back. Consequently, most patients sought for a solution, provided by the plastic surgery through the body-contouring surgery. Abdominoplasty, arm lift, tight lift, breast lift, and liposuction are all body contouring procedures that aim to reshape the patients’ body. Furthermore, body-contouring surgery can improve the patients’ physical discomfort in daily life, also helping in the maintenance of normal BMI (body mass index) in formerly obese patients, thus having a positive aesthetic and psychosocial outcome. A key component of body contouring after massive weight loss is managing patient expectations. Understanding the risks of body contouring’s procedures is important for patient counseling and the informed consent process. The goal of this study was to perform a literature review concerning the indication, surgical technique, outcomes and complications of body-contouring surgery.