Sean Lille

The management of cubital tunnel syndrome: a meta-analysis of clinical studies.

Despite extensive clinical experience in treating cubital tunnel syndrome, optimal surgical management remains controversial. A meta-analysis of 30 studies with accurate preoperative and postoperative staging was undertaken. Patients were staged preoperatively into minimum, moderate, and severe groups on the basis of clinical presentation. Treatment modalities included nonoperative management, surgical decompression, medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition. Statistical analysis using a standard SAS database with analysis of variance and chi-square tests was used to assess the efficacy of each therapeutic modality. For minimum-staged patients, all modalities produced similar degrees of satisfaction. However, total relief occurred most after medial epicondylectomy and least after anterior subcutaneous transposition. Patients treated nonoperatively had the highest rate of recurrence. For moderate-staged patients, submuscular transposition was most efficacious, whereas patients with nonoperative management fared the worst. Finally, for severe-staged patients, current therapeutic modalities were not consistently effective, with medial epicondylectomy producing the poorest operative result. This article reveals statistically significant differences in outcomes among therapeutic modalities, which may assist in treatment planning; it introduces standardized methods to aid in determining, analyzing, and communicating treatment outcomes. (Plast. Reconstr. Surg. 106: 327, 2000.)

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.

Fibrin glue as a delivery vehicle for autologous urothelial cell transplantation onto a prefabricated pouch.

PURPOSE The purpose of the study was to investigate how in vivo expanded urothelium can be transplanted onto a prefabricated capsule-pouch for urinary reconstruction. MATERIALS AND METHODS Urothelial cells from 40 rats were harvested for culture. A tissue expander was used to induce a capsule-pouch on which the cell culture were reimplanted ten days later. As delivery vehicle we compared standard culture media and fibrin glue. RESULTS The histology demonstrated viable, multilayered clusters of urothelium cells only in the group using the fibrin glue delivery vehicle. CONCLUSION We conclude that cultured urothelial cells can be successfully reimplanted onto a prefabricated capsule-pouch via fibrin glue, showing potential for urinary reconstructions.

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.

Free nonvascularized composite nail grafts: an institutional experience.

Free, nonvascularized composite nail grafts have been reported as a successful method to reconstruct nail deformities due to congenital anomalies or traumatic defects. The authors performed a decade review of their experience with nine patients who had had 10 free, nonvascularized composite nail grafts. Patient demographics, mechanism of injury, timing, site of reconstruction, and amount of nail to be replaced were all recorded. Results of nail growth in reconstructed nails were judged as excellent, good, fair, or poor on the basis of the appearance of the nail. The majority of reconstructed nails had half or more of the nail bed replaced. The 10 cases (mean follow-up of 1.8 years) that were reported had two excellent, three good, two fair, and three poor outcomes. There was no apparent relation between the successful outcome of the procedure and patient age, timing of reconstruction, or amount of nail bed replaced. Although the authors’ experience suggests the unpredictable nature of this type of graft, it should be considered for patients who desire nail reconstruction and are not candidates for ablative or vascularized nail complex transfer procedures.

Induction of heat-shock protein 72 in rat skeletal muscle does not increase tolerance to ischemia-reperfusion injury

Ischemia‐reperfusion injury is implicated in the failure of free flap and replant surgeries and is associated with the pathogenesis of a wide variety of clinical diseases including stroke, myocardial infarction, spinal injury, and compartment syndromes. We used a skeletal muscle flap model to test if the induction of heat‐shock protein 72 (HSP72) by mild hyperthermia provides tolerance against ischemia‐reperfusion injury. Immunocytochemistry and Western blot analysis verified increased production of HSP72 in the gracilis muscle of globally heated rats. Neutrophil accumulation in the microvasculature and postischemic muscle survival after ischemia‐reperfusion were unaltered by preischemic hyperthermia, indicating HSP72 induction is not sufficient to provide resistance against severe injury in skeletal muscle.

Capsule induction technique in a rat model for bladder wall replacement: an overview.

The search for a reliable technique for functional genitourinary tissue replacement remains a challenging task. The most recent advances in cell biology and tissue engineering have utilized various avascular and acellular collagen scaffolds with or without seeded cells. These techniques, however, are frequently complicated by tissue necrosis, contracture and resorption due to limited vascularization. We employed a new three-stage, evolving animal model with stage I optimizing the culture delivery vehicle, stage II employing a seeded vascularized capsule flap, and stage III adding a contractile matrix in the form of pedicled gracilis muscle prelaminated with autologous, in vitro-expanded urothelial cells to reconstruct an entire supratrigonal bladder-wall defect in rats.Specimens stained with hematoxylin and eosin (H&E), alpha(1)-actin staining, and a specific immunohistochemical staining (AE(1)&AE(3)-anticytoceratin monoclonal antibody stain) showed a continuous, multilayered, functioning urothelial lining along the transposed prelaminated gracilis flap in the animals of the final-stage experiment. Successful urinary reconstruction requires a contractile neoreservoir resistant to resorption over time and a stable, protective urothelial lining. We demonstrated that a gracilis muscle flap can be seeded with autologous cultured urothelial cells suspended in fibrin glue. This prelaminated flap can be safely transposed onto its pedicle and become successfully integrated into the remaining bladder wall, demonstrating urothelial lining and the potential to contract. Further studies in larger animals with urodynamic assessment is warranted to determine if this type of bladder-wall replacement technique is suitable for urinary reconstruction in humans.

Muscle Prelamination with Urothelial Cell Cultures via Fibrin Glue in Rats

The purpose of the study was to transplant autologous cultured urothelial cells onto a muscle via fibrin glue as a delivery vehicle to create a vascularized, living matrix lined with urothelium that could subsequently be used for urinary reconstruction. Bladder tissue specimens from male Wistar rats (n = 32; 350--500 g) were harvested for urothelial tissue culture. After 8--10 days when the primary cultures became confluent, the cultured urothelial cells were injected underneath the rectus sheath onto the rectus muscle. As delivery vehicle we compared standard culture media and fibrin glue. At 1- and 4-week intervals following urothelial cell grafting, sections of the muscle were analyzed for urothelial graft take using Hematoxylin & Eosin and immunohistochemical staining. The histology demonstrated viable, multilayered clusters of urothelium cells on the muscle surface only in the group using the fibrin glue delivery vehicle. We conclude that a muscle can be successfully prelaminated with autologously cultured urothelial cells via fibrin glue and has therefore potential for urinary reconstructions.

Gracilis muscle flap with a tissue-engineered lining for experimental bladder wall reconstruction.

Objective To assess a pedicled gracilis muscle flap pre‐laminated with autologous, in vitro‐expanded urothelial cells to reconstruct an entire supratrigonal bladder‐wall defect in rats.