Jose Maria Serra-Mestre

Platelet-Rich Plasma Mixed-Fat Grafting: A Reasonable Prosurvival Strategy for Fat GraftS?

BackgroundOne of the most interesting developments in practical applications of fat grafting in recent years is the use of prosurvival strategies to improve maintenance of volume. Platelet-rich plasma (PRP) plays a decisive role in the repair and regeneration of different tissues via the activation and secretion of a great variety of growth factors and other cytokines stored in the alpha-granules of the platelets. This review aimed to assess the efficacy of PRP mixed-fat grafting as a prosurvival strategy for fat grafts.MethodsOnline searches of the Cochrane Library and MEDLINE until January 2014 were conducted. The review included studies with at least one clinical end point in which the effect of PRP on the absorption and viability of the fat graft could be assessed.ResultsThe review comprised 6 preclinical studies with a control group and 9 clinical studies of humans. It also included comparative studies performed with other prosurvival strategies for fat grafts, such as combination with the stromal vascular fraction and second-generation PRP, also called “platelet-rich fibrin.” The results indicate that PRP may have a dose-dependent positive effect on fat grafts and suggest low complication rates.ConclusionsThe development of new growth factor delivery systems or cell therapies to enrich fat grafts is an area that merits further research.No Level AssignedThis 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 www.springer.com/00266.

Breast Reconstruction With Fat Grafting Alone

We describe our technique for breast reconstruction using fat grafting alone in patients with flaccid, elastic skin, via multiple injections of fat tissue. The technique involves following 3 stages: puckering stitches, to remodel the mass each time fat grafting is performed; cone formation-pexia, the creation and lifting of a cone with the tissue from the area; and neoformation of the inframammary fold, in which the cone is anchored in the pectoralis major and the fold at the level of the sixth rib. Using fat grafting and these 3 maneuvers, we obtain satisfactory breast reconstruction.

Periorbital rejuvenation to improve the negative vector with blepharoplasty and fat grafting in the malar area.

Purpose: Periorbital rejuvenation is not achieved by upper and lower blepharoplasty alone; the presence of malar atrophy and the excessive length of the lower eyelid may change the faces oval shape, with the progressive formation of the negative vector. We describe our technique combining blepharoplasty and malar fat grafting to reverse the negative vector. Methods: After thorough anamnesis, we perform the blepharoplasty and canthopexy if necessary. In the upper blepharoplasty, we do not extirpate muscle, and in the lower blepharoplasty, we extirpate the fat pads via the transconjunctival route. In the case of excess skin, we prefer to perform skin pinching without resecting muscle, followed by a canthopexy. We then perform malar fat grafting by using fat obtained with low to moderate-pressure aspiration and centrifugation, injected with criss-cross tunnels in the malar region with a volume of 7 to 12 cm3 of fat on each side. Results: Between 2006 and 2010, we operated on 142 female patients (age range, 45–74 years). The follow-up period was 2 years. In patients with “good fat quality” (n = 129), the results at 24 months were “excellent” in 93.79% of cases, “good” in 3.8%, and “fair” in 2.32%. The medical teams ratings were “excellent” in 97.6% of cases and “good” in 2.3%. In patients with “poor fat quality” (n = 13) at 12 months, a high percentage of the injected fat had been reabsorbed. The application of high-density hyaluronic acid was recommended (16). Conclusion: Periorbital rejuvenation is a part of integral facial rejuvenation and is achieved only if, in addition to the blepharoplasty, the negative vector is also corrected. With the technique of malar fat grafting, we achieve very good remodeling of the oval face shape, correct the negative vector, and shorten the height of the eyelid; the preadipocytes improve the tissue quality, especially in the skin.

Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back.

BackgroundResults obtained with breast-conserving therapy are not always satisfactory. Reconstruction with a pure latissimus dorsi muscle flap is a useful option. The techniques described for endoscopic dissection of the flap create several scars on the back. As a result, they do not improve on the open approach, which causes a horizontal scar at the level of the bra strap. The authors’ technique avoids all scars on the back using a single incision in the highest folds of the axilla, which also is used for the sentinel node biopsy or lymphadectomy and quadrantectomy.MethodsThe study was performed with 23 patients. The tumor was extracted via a clockwise downward periareolar incision and via another incision in a fold of the axilla. Through this axillary incision, the sentinel lymph node biopsy or lymphadectomy was performed, and the external part of the latissimus dorsi muscle was harvested endoscopically for the reconstruction.ResultsBoth the medical team and the patients reported high satisfaction with the aesthetic and functional results due to the preservation of the breast shape and the absence of any scarring on the back.ConclusionEndoscopy-assisted techniques make either three small scars on the back or one long scar, with the muscle sectioned distally, or a vertical incision in the midaxillary line, which may form a hypertrophic or keloid scar. The authors’ approach avoids the creation of these scars on the back because the endoscopy and the distal sectioning of the muscle flap are performed through the single axillary incision.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Endoscopic management of osteomas of the forehead

Transcutaneous resection is the most common technique for the removal of facial lesions. In recent years, endoscopic techniques have been used in aesthetic surgery of the face, and have achieved good results. We know of few descriptions of this approach. We describe 9 patients who had endoscopic removal of osteomas of the forehead through a single 3 cm incision of the midline, which was concealed 2 cm behind the hairline.

Facial Fat Grafting

To obtain the most natural-looking results possible, it is necessary to reestablish a rejuvenated facial contour, complementing conventional approaches that can correct excess skin laxity with procedures to provide volume at the points where it has been lost.

Expanded Flaps in Surgical Treatment of Pressure Sores: Our Experience for 25 Years.

BackgroundBecause the ischial region is the main weight-bearing area in sitting, it is one of the areas most frequently affected by pressure ulcers in paraplegic patients resuming the sitting position during the subacute and chronic stages. The techniques described to date have not been able to reduce the high rates of recurrence and flap dehiscence. Other groups have described successful tissue expansion in the treatment of pressure ulcers, but to date, the long-term results of the procedure have not been reported. MethodsThe long-term follow-up of 138 reconstructions of the ischial region in patients with pressure ulcers types III to IV treated with posterior thigh expanded rotation flaps is reported. ResultsAll patients achieved complete resolution, with adequate coverage of deeper layers, although 15.94% presented minor complications. None of these complications impeded full repair of the lesion. The 28 lesions that recurred were all reconstructed with the re-expansion of the same flap. There were no cases of flap dehiscence. ConclusionsThe use of tissue expanders to treat ischial pressure ulcers, especially in patients with long life expectancy, offers important advantages over other approaches. The procedure provides abundant, high-quality tissue and may be repeated many times without creating new scars. With the use of tissue expanders, other reconstructive options can be reserved for the future.

Reconstruction of nasal septal perforations in cocaine-addicted patients with facial artery mucosa-based perforator flap.

It allows rapid manipulation and understanding of an individual’s anatomy by physically holding the object and being able to visualize it in multiple planes. This can be useful for teaching learners, and can be used as a tool to better explain the proposed surgery to patients using their own anatomy. One limitation of the process is the cost associated with production of the model, which can be anywhere from

Reparación de fístula traqueoesofágica recurrente con colgajo gastro-omental libre en un paciente irradiado

400 to

Endoscopic Delayed Breast Reconstruction With Expanders and Implants via the Axillary Incision Made for Sentinel Lymph Node Biopsy or Lymphadenectomy

1200. Also, due to the minuteness of perforator vessels, some smaller vessels do not endure the printing process due to the resolution limitations of the three-dimensional printer. This can be ameliorated with a larger model, albeit at a higher cost. Also, the materials used to make certain models are delicate, and rough handling can cause perforator branches to crack. However, postprinting processing with materials such as wax can create a durable model that can be used in clinics and teaching sessions. DOI: 10.1097/01.prs.0000436523.79293.64