Vascularized composite allografts (VCAs) refer to en bloc heterogenous tissue that is transplanted to restore form and function after amputation or tissue loss. Rat limb VCA has emerged as a robust ...translational model to study the pathophysiology of these transplants. However, these models have predominately focused on hindlimb VCAs which does not translate anatomically to upper extremity transplantation, whereas the majority of clinical VCAs are upper extremity and hand transplants. This work details our optimization of rat forelimb VCA procurement and sub-normothermic machine perfusion (SNMP) protocols, with results in comparison to hindlimb perfusion with the same perfusion modality. Results indicate that compared to hindlimbs, rat forelimbs on machine perfusion mandate lower flow rates and higher acceptable maximum pressures. Additionally, low-flow forelimbs have less cellular damage than high-flow forelimbs based on oxygen uptake, edema, potassium levels, and histology through 2 hours of machine perfusion. These results are expected to inform future upper extremity VCA preservation studies.
Micro-Botox (Micro-btx) was described in 2000 for the paralysis of superficial muscle fibers to address facial rhytides. Increasingly, there are reports of its off-label use for a face-lifting ...effect.
To evaluate the literature for such results.
A systematic review was performed according to PRISMA; only Level ≥ III evidence from 2000 to 2020 were included. Data extracted include patient demographics, type of botulinum toxin, dilution, dosage, injection sites and spacing, needle size and syringe, follow-up, patient and physician assessment, and complications.
Three hundred seventy-two patients (average 35.2 years) underwent different botulinum toxin injections (average 39 units/hemiface) of varying dilutions with 30- to 32-G needles, typically with 1-mL syringes, by forming 0.2- to 0.5-cm wheals 1 cm apart. Follow-up averaged 10.5 weeks with both subjective and objective assessments. Facial asymmetry and minor bruising were common. Subjective assessment of face-lifting effects between patients and physicians was highly discordant and injection sites reported were highly variable.
Much heterogeneity in dosage, injection sites, definition of "face-lifting," and assessment methods remain, all of which preclude accurate and objective evaluation of the current evidence for micro-btx. Future studies should address these variables, given the growing interest in such nonsurgical options for a face-lifting effect.
Since the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite ...immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to irreversible necrosis of the tissue. In the absence of therapeutic options, this complication is inevitably life-threatening.
We report facial retransplantation in a man, 8 years after his first facial transplantation because of extensive disfigurement from type 1 neurofibromatosis and 6 weeks after complete loss of his allograft due to severe CAMR. We describe the chronology of immune-related problems that culminated in allograft necrosis and the eventual loss of the facial transplant, the desensitisation protocol used for this highly immunosensitised recipient, the surgical technicalities of the procedure, the specific psychological management of this patient, and the results from follow-up at 30 months.
Although the patient had a complicated postoperative course with numerous immunological, infectious, cardiorespiratory, and psychological events, he was discharged after a hospital stay of almost 1 year. He has since been able to re-integrate into his community with acceptable restoration of his quality of life.
This clinical report of the first documented human facial retransplantation is proof-of-concept that the loss of a facial transplant after CAMR can be mitigated successfully by retransplantation combined with an aggressive desensitisation process.
Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris.
This article introduces a novel technique for refining the middle third of the nose in preservation rhinoplasty, adhering to the principles established by Teoman Dogan. The technique, applicable ...through both open and closed approaches, maintains the integrity of the nasal dorsum. The J-suture technique is particularly significant for addressing the widening of the middle third of the nose, a common issue in preservation rhinoplasty. This technique utilizes an absorbable percutaneous suture, allowing for the approximation of the upper lateral cartilages and thus thinning of the middle third of the nose. We discuss the technical aspects and advantages of the J-suture, emphasizing its simplicity, predictability, reproducibility, and ease of execution. The technique, requiring minimal training, can be adopted by any surgeon practicing preservation rhinoplasty. The J-suture represents a significant advancement in preservation rhinoplasty, providing a practical solution for enhancing nasal aesthetics while minimizing surgical trauma and promoting patient well-being.
Total penile reconstruction represents a surgical challenge. Autologous reconstructions offer limited aesthetic results as well as variable urinary function recovery. To date, five Genito-Urinary ...Vascularized Composite Allotransplantations (GUVCA) have been performed worldwide. However, in all cases, vascular complications have been reported. The objective of this study is to develop a modified surgical model for penile allotransplantation to limit the number of microsurgical anastomoses while ensuring vascular reliability. We studied penile allotransplantation by performing dissections on 12 subjects. The study was carried out to ensure the vascularization of the entire penis shaft while limiting the number of anastomoses.The penis vasculature includes numerous angiosomes between its different subunits. The penile skin envelope is supplied by both external and internal pudendal vessels. The cavernous and spongy bodies are supplied by terminal branches of the internal pudendal vessels. The anterior pubic osteotomy approach allows access to the root of the cavernous bodies and to the Alcock ducts. This modified surgical model for penile allotransplantation could help future teams involved in GUVCA to improve urinary and sexual function.
This study was conducted to assess the impact of abdominoplasty and lower body lift surgery following massive weight loss on both the general quality of life and the sexual life of patients.
The ...authors performed a multicenter prospective study on the quality of life after massive weight loss using three scoring questionnaires: The Short-Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of Life Questionnaire. Seventy-two patients who underwent lower body lift and 57 patients who underwent abdominoplasty in three centers with preoperative and postoperative evaluation were included.
The mean age of the patients was 43.2 ± 13.2 years. All categories of the Medical Outcomes Study Short-Form 36 Health Status Survey questionnaire were statistically significant at 6 months, and all categories except health change were significantly improved at 12 months postoperatively. Overall, the Moorehead-Ardelt questionnaire showed a higher quality of life in general (1.78 ± 0.92 and 1.64 ± 1.03 at 6 and 12 months, respectively) and in all domains (ie, self-esteem, physical activity, social relationships, work performance, and sexual activity). Interestingly, global sexual activity improved at 6 months but not at 12 months. Some domains of sexual life improved at 6 months (ie, desire, arousal, lubrication, satisfaction), but only desire remained improved at 12 months.
Abdominoplasty and lower body lift improve the quality of life of patients after massive weight loss and the sexual quality of life. This should be an additional valid reason for promoting reconstructive surgery for massive weight loss patients.
Therapeutic, IV.
SUMMARYTotal penile reconstruction represents a surgical challenge. Autologous reconstructions offer limited aesthetic results and variable urinary function recovery. To date, five genitourinary ...vascularized composite allotransplantations have been performed worldwide. However, in all cases, vascular complications have been reported. The objective of this study was to develop a modified surgical model for penile allotransplantation to limit the number of microsurgical anastomoses and ensure vascular reliability. The authors studied penile allotransplantation by performing dissections on 12 subjects. The study was carried out to ensure the vascularization of the entire penis shaft while limiting the number of anastomoses. The penis vasculature includes numerous angiosomes between its different subunits. The penile skin envelope is supplied by both external and internal pudendal vessels. The cavernous and spongy bodies are supplied by terminal branches of the internal pudendal vessels. The anterior pubic osteotomy approach allows access to the root of the cavernous bodies and to the Alcock ducts. This modified surgical model for penile allotransplantation could help future teams involved in genitourinary vascularized composite allotransplantations to improve urinary and sexual function. CLINICAL RELEVANCE STATEMENTThe authors introduce an improved surgical technique for penile transplantation that enhances vascularization and graft viability. This innovative procedure optimizes blood flow through meticulous microsurgical anastomosis, resulting in improved functional outcomes. Its potential to revolutionize penile transplantation warrants further exploration and validation within the surgical community.
The standard in nipple reconstruction remains the autologous skin flap. Unfortunately, the results are not satisfying, with up to 75% loss of nipple projection over time. Existing studies ...investigated the use of primates as a source of implants. The authors hypothesized that the porcine nipple can serve as a perfect shape-supporting implant because of functional similarities to the human nipple. A decellularization protocol was developed to obtain an acellular nipple scaffold (ANS) for nipple reconstruction.
Tissue samples were collected from eight disease-free female Yorkshire pigs (60 to 70 kg) and then decellularized. The decellularization efficiency and extracellular matrix characterization was performed histologically and quantitatively (DNA, total collagen, elastin, and glycosaminoglycan content). In vitro and in vivo biocompatibility was determined by human dermal fibroblast culture and subcutaneous implantation of six ANSs in a single Yorkshire pig (60 to 70 kg), respectively. Inflammation and adverse events were monitored daily based on local clinical signs.
The authors showed that all cellular structures and 96% of DNA 321.7 ± 57.6 ng DNA/mg wet tissue versus 11.7 ± 10.9 ng DNA/mg wet tissue, in native and ANS, respectively ( P < 0.001) can be successfully removed. However, this was associated with a decrease in collagen 89.0 ± 11.4 and 58.8 ± 9.6 μg collagen/mg ( P < 0.001) and elastin 14.2 ± 1.6 and 7.9 ± 2.4 μg elastin/mg ( P < 0.05) and an increase in glycosaminoglycan content 5.0 ± 0.7 and 6.0 ± 0.8 ng/mg ( P < 0.05). ANS can support continuous cell growth in vitro and during preliminary biocompatibility tests in vivo.
This is a preliminary report of a novel promising ANS for nipple reconstruction, but more research is needed to validate results.
Breast cancer is very common among women. Treatment involves mastectomy, but its consequences affect patient mental well-being, and can lead to depression. Nipple-areola complex reconstruction is critical, and existing methods lead to unsatisfactory outcomes.
Introduction: Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin ...grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. Patients and Methods: PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. Results: Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. Conclusions: Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.
For major upper limb defects, a wide range of established pedicled and free flap options can be used. These include the latissimus dorsi/thoracodorsal artery perforator, lateral arm, posterior ...interosseous artery, rectus abdominis, gracilis, and anterolateral thigh flaps. Technical proficiency is essential, and favorable success rates in terms of functional and esthetic outcomes can be achieved. Herein, alternative flap options (both pedicled and free) are introduced and discussed through a few illustrative case examples.
