Pietro Gentile

A Comparative Translational Study: The Combined Use of Enhanced Stromal Vascular Fraction and Platelet-Rich Plasma Improves Fat Grafting Maintenance in Breast Reconstruction

The use of autologous fat grafting is ideal in breast reconstruction. However, published data on long‐term outcomes and instrumental results of fat grafting to the breast are lacking. The purpose of this study was to review the authors experience of fat grafting, evaluating the effects related to the use of enhanced stromal vascular fraction (e‐SVF) and fat grafting with platelet‐rich plasma (PRP) in the maintenance of fat volume in breast reconstruction, comparing the results with a control group. Twenty‐three patients aged 19–60 years affected by breast soft tissue defects were analyzed at the Plastic and Reconstructive Department of the University of Rome Tor Vergata. Ten patients were treated with SVF‐enhanced autologous fat grafts, and 13 patients were treated with fat grafting + platelet‐rich plasma. The patients in the control group (n = 10) were treated with centrifuged fat grafting injection according to Colemans procedure. The patients treated with SVF‐enhanced autologous fat grafts showed a 63% maintenance of the contour restoring and of three‐dimensional volume after 1 year compared with the patients of the control group treated with centrifuged fat graft, who showed a 39% maintenance. In those patients who were treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring and of three‐dimensional volume after 1 year. As reported, the use of either e‐SVF or PRP mixed with fat grafting produced an improvement in maintenance of breast volume in patients affected by breast soft tissue defect.

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse

BackgroundThe aim of this study was to describe the efficacy of alar batten graft in correcting internal and external nasal valve collapse (i.n.v. and e.n.v.) and evaluate the functional and aesthetic results.MethodsFrom July 2006 to September 2008, 80 patients (54 females and 26 males) underwent alar batten cartilage grafting. The patients were divided into three groups: (1) 55 patients with iatrogenic nasal valve collapse (80% i.n.v., 20% e.n.v.), (2) 15 patients with posttraumatic nasal valve collapse (45% i.n.v., 55% e.n.v.), and (3) 10 patients with congenital nasal valve collapse (100% e.n.v.). Patients were evaluated at 6, 12, 24, and some at 36xa0months after surgery. The final follow-up was at least 24xa0months.ResultsThe results of this study revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of alar batten grafts. All the patients noted improvement in their nasal airway breathing and in their cosmetic appearance. No major complication was observed.ConclusionThe alar batten graft is a simple, versatile technique for long-term reshaping, repositioning, and reconstruction of the nasal valve collapse.

Augmentation Rhinoplasty with Autologous Grafts

The authors present their experience with nasal reconstructive surgery using autologous grafts. Currently, grafts are classified into four categories: skin grafts, cartilage grafts, bone grafts, and composite grafts (Tablexa01). A sample of 132 patients with nasal defects requiring reconstruction was selected. Two cases, presenting nasal valve collapse and deformities after aesthetic nasal surgery, were analyzed in detail. Overall, satisfying aesthetic results (balanced tip projection, dorsum fullness, widening of internal nasal valve angle, minor scar retraction) were achieved for both patient and surgeon in 79% of the cases.

The use of infrared radiation in the treatment of skin laxity

Abstract Background: Cosmetic surgery and medicine are extremely interesting fields for a plastic surgeon. Lasers and lights determine ablation, contraction and regenerating stimulus in skin tissues. The aim of this study is to examine the use of infrared lights in treating facial and body skin laxity. Methods: Between 2007 and 2011, in the Department of Plastic and Reconstructive Surgery at the Hospital San Camillo-Forlanini, 303 patients were enrolled in the study and underwent laser therapy. The laser operates in wavelength from 1100 to 1800 nm. The treated areas are: face, neck, eyebrows, abdomen, legs and buttocks. Results: We have noticed no systemic complications. A case of a patient with a three days lasting erythema on both lower eyelids caused by laser therapy healed without any pharmacological therapy. Neither hyper- nor hypopigmentation of the skin was found. The satisfaction degree of patients has been: facial, neck and eyebrow lifting “very satisfactory” for 70% of the patients, “satisfactory” for 10%, “unsatisfactory” for 20%; for the other areas it was “very satisfactory” for 40%, “satisfactory” for 20% and “unsatisfactory” for 40%. Conclusion: The use of infrared radiation represents a valid alternative to surgical lifting, but cannot replace it. The infrared light technique used has turned out to be useful in contrasting skin laxity of the face and other parts of the body. The absence of scars and surgical risk makes this technique useable for a large number of patients.

Comparing different nanofat procedures on scars: role of the stromal vascular fraction and its clinical implications

AIMnRecently, a new fat grafting technique termed nanofat grafting was proposed which improved tissue repair by the stem cells contained in the stromal vascular fraction (SVF) of nanofat. Here, we reported the clinical outcomes of different nanofat procedures in the treatment of scars in relation with SVF cell yield.nnnMETHODSnThree different modified nanofat grafting procedures (supercharged-, evo- and centrifuged-modified nanofat) were compared with the classic nanofat method, and histological analysis was performed to assess skin regeneration. Residual nanofat samples were analyzed to determine SVF immunophenotype and yield from each procedure.nnnRESULTSnSupercharged-modified nanofat gave the best results in terms of clinical outcome and SVF yield. Histological analysis revealed similar skin regeneration in all treatments.nnnCONCLUSIONnThis work suggested a positive correlation between SVF yield and clinical outcomes in the nanofat treatment of scars.

Chronic ulcers: MATRIDERM® system in smoker, cardiopathic, and diabetic patients

Diabetic ulcers and pressure ulcers represent a more frequent cause of chronic wounds in aging populations. It is estimated that approximately 15% of the diabetic population will develop diabetic ulcers during their life and over half of these patients develop an infection, often osteomyelitis, with 20% requiring amputation. The authors report a case of a 65-year-old woman affected by a post-traumatic loss of substance due to road accidents with soft tissue exposure (comprising muscle tendon) of the left knee combined with the fracture of the right fibula previously subjected to surgery and reconstruction of muscle tendon. The patient was affected by diabetes type II, hypertension, and ischemic heart disease. In 2008, she underwent a double bypass surgery and coronary angioplasty. Initially, the patient was treated with cycles of advanced dressings, with fibrinolytic ointments, hydrocolloid, and subsequently, when the bottom began granulated with fibrinolytic and idrocellulosa, Hydrofibra-Ag, and Ag-alginate, three times a week for 30 days. In the second step, the authors decided to treat the ulcer with the MATRIDERM system and auto skin graft. Following the first treatment, 7 days after the procedure, the authors found the reduction of the loss of substance until its complete closure. The wound’s infection was evaluated by a buffer negative confirmation performed every 2 weeks four times. We obtained decrease of limb edema and full functional rehabilitation. The skin appeared renovated, with volume restoration and an improvement of the texture.

Long‐term follow‐up comparison of two different bi‐layer dermal substitutes in tissue regeneration: Clinical outcomes and histological findings

Double layer dermal substitute (DS) consist of a 3‐dimensional collagen structures and a superficial silicon layer that are positioned within the defect provide to promote tissue regeneration in skin wounds. DS often have unique physical characteristics due to differences in manufacturing techniques. The aim of this study is the clinical and histological comparison of Nevelia and Integra double layer DSs in patients with post‐traumatic injury wounds. Thirty patients with post‐traumatic wounds localised on the inferior limbs were randomised in 2 groups Nevelia or Integra, followed by autologous dermal epidermal graft (DEG). Clinical results were evaluated through the healing time; Manchester Scar Scale (MSS) and Visual Analog Scale (VAS) at 1, 2, and 3 weeks and after 1 and 3 years. Histological and immunohistochemical evaluation were performed at 0, 2, and 3 weeks. The difference in healing time between groups (Pu2009=u2009.467, log‐rank test), pain and self‐estimation was not statistically significant after 35, 42, and 49 days and at 1‐year follow up. Histological data showed evident healing of wound after 2 weeks compared with preoperative with both DSs. At 3 weeks reepithelialisation and dermal regeneration were evident with both substitutes; however Nevelia showed early regenerative properties in terms of epidermal proliferation and dermal renewal compared with Integra. Nevelia showed also a more evident angiogenesis vs Integra evaluated as α‐SMA immunohistochemistry. Differences in the MSS score were statistically significant at 3 years follow up in favour of Nevelia group (Pu2009=u2009.001). At long‐term follow up, Nevelia showed a better clinical outcome measured as MSS score vs Integra measured as MSS. Histological and immunohistochemistry data showed that Nevelia allows faster neoangiogenesis and tissue regeneration with neoformed tissue architecture closer to the physiology of the skin.

The Combined Use of Enhanced Stromal Vascular Fraction and Platelet-Rich Plasma Improves Fat Grafting Maintenance in Breast Reconstruction: A Comparative Translational Study

The use of autologous fat grafting is ideal in breast reconstruction. However, published data on long-term outcomes and instrumental results of fat grafting to the breast are lacking. The purpose of this chapter was to review the authors’ experience of fat grafting, evaluating the effects related to the use of enhanced stromal vascular fraction (e-SVF) and fat grafting with platelet-rich plasma (PRP) in the maintenance of fat volume in breast reconstruction, comparing the results with a control group. As reported, the use of either e-SVF or PRP mixed with fat grafting produced an improvement in maintenance of breast volume in patients affected by breast soft tissue defect.

Obesity phenotypes and resorption percentage after breast autologous fat grafting: Rule of low-grade inflammation

Background: One of the main reasons why the breast fat grafting was questioned is that there may be lipofilling resorption. In the literature, the resorption rate reported over the 1st year is highly variable (20–90%). Objective: The aim of this work was to identify the biochemical and clinical parameters, which increase fat graft maintenance in breast reconstruction. Materials and Methods: A sample of 19 patients was treated with fat grafting mixed with platelet-rich plasma. A complete screening of anthropometry, body composition, and blood biochemical parameters was assessed using the standardized equipment. Pre- and post-operative evaluation was performed, which included a complete clinical examination, photographic assessment, nuclear magnetic resonance imaging of the soft tissue, and ultrasound. The follow-up period was 2 years. Results: The authors divided the results into two types of patients: “responder” and “not a responder.” In the “responder” group patients with normal weight, gynoid fat distribution, obese, with normal blood biochemical parameters, and atherogenic indices but with high preoperative values of platelet-to-lymphocyte ratio (PLR) (174.49) and neutrophil-lymphocyte ratio (NLR) (2.65) showed a greater increase of fat graft maintenance at 6 and 12 months after the last lipofilling session. In the “not responder group” patients with overweight, android fat distribution, obese, high values of atherogenic indices, but with normal preoperative NLR and PLR ratios showed a lower fat graft maintenance at 6 and 12 months. Conclusion: We assume, the problem of fat resorption may be resolved by analysis of body composition and by examine the predictive role of preoperative markers of low-grade inflammation.

Platelet-rich plasma and blood components for non-transfusion use: technical and medicolegal aspects:

There are a large number of publications describing the use of platelet-rich plasma (PRP) in multiple fields of application. These illustrate a large number of therapeutic elements with different and specific actions within ‘platelet gel’ (this term is used in the current regulations to define this product). This term, however, lacks specificity and, depending on the method used in its production is variable both in its blood composition and in platelet concentration, and several publications consider better and easier methods of platelet gel production, which may or may not lead to greater standardization in the product. The authors illustrate the general aspects of PRP and other blood components for non-transfusion use, briefly touching on the history and different fields of application and the rational of for its use. Given the increased use of such preparations, the authors describe critically the regulations in force in Europe and propose a new regulatory framework aimed to simplify and facilitate the use of such material as a therapeutic agent within medicine.