Intracordal injection of autologous auricular cartilage in the paralyzed canine vocal fold.

OBJECTIVE: Vocal fold augmentation by injectable material under direct visual control is an easy and simple operation. However, when autologous fat or bovine collagen is used, resorption creates a problem. And autologous fascia is debating about absorption now days. This study is to evaluate the histology of minced and injected autologous auricular cartilage and fat graft in the augmentation of unilateral vocal fold paralysis using a canine model. METHOD: Nine dogs were operated. At first, a piece of auricular cartilage was harvested from ear and minced into tiny chips with a scalpel, and a piece of fat tissue was harvested from inguinal area and minced into tiny chips with a scalpel. Cutting off a section of the recurrent nerve paralyzed the right vocal fold. The minced cartilage and fat-paste (0.2 mL) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle under direct laryngoscopy. Two animals were sacrificed at 3 days, three at 3 weeks, two at 3 months, one at 6 months, and one at 12 months. Each dog underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior part of the vocal fold were made. RESULTS: There was no significant complication perioperatively and during follow-up. There was acute inflammatory findings in the graft at 3 days and 3 weeks. The injected cartilage remained in the larynx until 12 months. CONCLUSION: The autologous auricular cartilage graft is well tolerated and may be very effective material for volumetric augmentation on paralyzed vocal cord.     

Preserved Particulate Fascia Lata for Injection: A New Alternative

BACKGROUND: Preserved particulate fascia lata, derived from screened human cadavers, has recently become available. This injectable form of the material can be injected when soft tissue augmentation is desired. Historically, preserved fascia grafts have proven efficacy and an excellent safety record over the past 73 years. OBJECTIVE: To examine the clinical response to preserved fascia lata injections in human subjects. METHODS: Clinical subjects (N = 81; 74 women, 7 men, age range 19-56 years) requiring deep, soft tissue augmentation to repair various cosmetic deficiencies were injected with a total of 109 syringes of preserved particulate fascia lata. Three different preparations-<2.0 mm, <0.5 mm, and <0.25 mm particle sizes-were hydrated in 3-5 cc of 0.3% lidocaine solution and injected with needles ranging in size from 16 to 25 gauge. RESULTS: The patients were followed for 6-9 months after implantation without incidence of infections, allergic reactions, or acute rejection. After the treatment day, patients experienced no further discomfort. No dermal inflammation was evident and the local echymosis associated with injections was typically minor. Soft tissue augmentation was evident 3-4 months after grafting or longer in most cases. CONCLUSIONS: This patient series indicates that injectable preparations of preserved fascia lata have the same high biocompatibility as experienced with whole-tissue implants. The safety record of preserved fascia lata implants is reviewed.     

Enhancement of Viability of Fat Grafts in Nude Mice by Endothelial Progenitor Cells

BACKGROUND: A recent discovery showed that endothelial progenitor cells (EPCs) could augment collateral vessel growth to ischemic tissues. OBJECTIVE: The objective was to demonstrate the effects of EPCs on the vasculogenesis and survival of free transplanted fat tissues in nude mice. METHODS: EPCs from human donors were cultured in vitro for 7 days. Human fat tissues were injected subcutaneously into the scalps of 20 6-week-old nude male mice. EPCs stained with CM-DiI were mixed with the transplanted fat tissues and injected into the mice. EBM-2 medium was used as control group. The animals were euthanized 15 weeks after the procedure. Graft volume were measured, and histologic evaluation was performed. The central part of fat tissues was histologically evaluated 15 weeks after the fat injection. RESULTS: The survival volume of the experimental group was significantly greater than that of the control group (p< .05). Less cyst formation and fibrosis was obtained in the experimental group. Histologic evaluation of the central part of fat tissues 15 weeks after the fat injection showed that capillary densities increased markedly in the experimental group mice. CONCLUSION: The results indicate that EPCs have the ability to enhance the survival and the quality of the transplanted fat tissues.     

全耳再造中改良颅耳角成形术的临床应用研究

目的探讨并评价改良颅耳角成形术在全耳再造中的应用及临床效果。方法 2012年9月至2014年6月,对161例先天性小耳畸形患者进行全耳再造。一期术后6个月行二期手术,采用改良颅耳角成形术完成颅耳角重建:人工骨材料作为支撑支架,耳后筋膜包裹支架,耳后枕部刃厚皮片植皮。结果本组患者术后随访6~18个月(平均12个月),151例患者术后颅耳角形态满意;10患者术后颅耳角瘢痕挛缩较明显,影响颅耳角角度。9例患者颅耳角植皮区下部色泽变深或出现表皮坏死,经换药处理后愈合良好。结论改良颅耳角成形术能较好地呈现满意的颅耳角结构。     

Use of injectable fat to obstruct the urethra in rabbits

Bulking agents have been injected to correct urinary incontinence for at least 15 years. The injection seeks to increase bladder outlet resistance by partially obstructing the urethra and thereby reduce urinary leakage in patients with stress urinary incontinence. Although the implant is effective and requires a shorter in-hospital stay than more traditional procedures, no ideal implant substance has been discovered. To assess the effectiveness of injected fat as a bulking agent, we injected small volumes of perivesical fat into the bladder neck in New Zealand White (NZW) rabbits and tested the effect on the bladder. In eight rabbits, we harvested perivesical fat and partially closed the urethral lumen with an initial injection. A second injection 1 month later completely closed the urethral lumen. We injected six other rabbits with similar volumes of saline as controls. Two weeks after the second injection, we measured micturition frequency, bladder weight, response to electrical field stimulation, and response to bethanecol in each group. Fat implants were present at the injection site in each case 4 weeks after the first injection. Rabbits receiving fat implants had increased micturition frequency, increased bladder weight, and increased response to bethanecol and field stimulation. Previous studies have demonstrated that these changes are characteristic of mild outlet obstruction in rabbits. Injected fat can be made to close the urethra and create bladder outlet obstruction in rabbits. The short-term success of fat as a bulking agent in this experiment is encouraging and suggests the need for longer term studies. © 1995 Wiley-Liss, Inc.     

Depth of the graft bed influences split-skin graft contraction

Contraction of a split-thickness skin graft used for coverage of large defects remains a great problem in plastic, burn and reconstructive surgery. In this study we evaluated healing of split-thickness skin grafts transplanted in wounds on the subcutaneous fat and muscle fascia in pigs. Four young domestic female pigs were included in the study, and the contraction was measured planimetrically during a 3-months' follow-up. At the end of the study the scar tissue was histologically assessed. From day 42 till the end of the study grafts transplanted on the muscle fascia were significantly more contracted than grafts on the subcutaneous fat without (p < 0.001) and with (p < 0.005, unpaired t-test) correction for the growth of the animal. The histological assessment showed that after 3 months the regenerated dermal tissue in the muscle fascia wounds was thicker, and less remodeled (higher tissue cellularity and thinner collagen bundles). In conclusion, in pigs, split-thickness skin grafts transplanted into deeper wounds contract more, and scar tissue maturation seems to last longer.     

Comparison of Different Wound Closure Techniques in Translabyrinthine Acoustic Neuroma Surgery

In a series of 277 patients with translabyrinthine acoustic neuroma, three techniques of wound closure were used to prevent cerebrospinal fluid (CSF) leakage. In the first group, we used a piece of fascia to cover the dural defect and then placed several pieces of fat on the fascia. The incidence of CSF leak was 28.2%; 7.7% required reoperation. In the second group, in addition to the fasia-fat complex, we made a large musculoperiosteal flap to compress the fat. The incidence of CSF leak and revision were not reduced, however. In recent cases, we placed several pieces of fat directly into the operative cavity without fascia graft; then it was covered with a musculoperiosteal flap. With this technique, CSF leak was significantly reduced to 7.4%, and reoperation was rare (3.7%). The direct application of fat into the translabyrinthine operation cavity appears to be effective to prevent CSF leaks.     

Comparison of different wound closure techniques in translabyrinthine acoustic neuroma surgery

In a series of 277 patients with translabyrinthine acoustic neuroma, three techniques of wound closure were used to prevent cerebrospinal fluid (CSF) leakage. In the first group, we used a piece of fascia to cover the dural defect and then placed several pieces of fat on the fascia. The incidence of CSF leak was 28.2%; 7.7% required reoperation. In the second group, in addition to the fasia-fat complex, we made a large musculoperiosteal flap to compress the fat. The incidence of CSF leak and revision were not reduced, however. In recent cases, we placed several pieces of fat directly into the operative cavity without fascia graft; then it was covered with a musculoperiosteal flap. With this technique, CSF leak was significantly reduced to 7.4%, and reoperation was rare (3.7%). The direct application of fat into the translabyrinthine operation cavity appears to be effective to prevent CSF leaks.     

胸腹部皮瓣及全厚皮片修复全面部瘢痕

目的探讨采用腕携式胸腹部联合皮管——腹部皮瓣和胸腹部全厚皮片修复全面部瘢痕的临床疗效。方法采用腕携式胸腹部联合皮管——腹部皮瓣和胸腹部全厚皮片修复11例面颈部瘢痕患者。根据患者面部皮下脂肪的多少，采用腕携式胸腹部联合皮管——腹部皮瓣修复面部瘢痕及鼻再造者3例，采用胸腹部全厚皮片修复面颈部瘢痕者8例。结果术后移植的皮瓣及全厚皮片全部成活，随访患者1～21年，效果良好。结论根据患者面部皮下脂肪的多少，分别采用腕携式胸腹部联合皮管——腹部皮瓣和胸腹部全厚皮片修复面颈部瘢痕疗效好。值得临床应用。     

内板下塞入纱布手术刀环剥式包皮环切术

目的:介绍内板下塞入纱布手术刀环剥式包皮环切术的优点。方法:2000年11月～2006年3月对2100例包皮过长患者行内板下塞入纱布手术刀环剥式包皮环切术,患者年龄6～78岁,平均26岁,其中Ⅰ型包皮过长1799例,Ⅱ型237例,Ⅲ型64例。结果:切口均一期愈合,切口美观。术后6～48h出血12例,迟发性血肿3例,无切口裂开,无切口感染。结论:内板下塞入纱布手术刀环剥式包皮环切术在张力状态下剥离皮肤容易进行,安全,出血少,浅筋膜组织保留多且连续,内板保留少,切口美观,虽然操作较繁琐,仍值得临床推广。     

Does the Investing Layer of the Deep Cervical Fascia Exist?

Background: The placement of the superficial cervical plexus block has been the subject of controversy. Although the investing cervical fascia has been considered as an impenetrable barrier, clinically, the placement of the block deep or superficial to the fascia provides the same effective anesthesia. The underlying mechanism is unclear. The aim of this study was to investigate the three-dimensional organization of connective tissues in the anterior region of the neck.

Methods: Using a combination of dissection, E12 sheet plastination, and confocal microscopy, fascial structures in the anterior cervical triangle were examined in 10 adult human cadavers.

Results: In the upper cervical region, the fascia of strap muscles in the middle and the fasciae of the submandibular glands on both sides formed a dumbbell-like fascia sheet that had free lateral margins and did not continue with the sternocleidomastoid fascia. In the lower cervical region, no single connective tissue sheet extended directly between the sternocleidomastoid muscles. The fascial structure deep to platysma in the anterior cervical triangle comprised the strap fascia.     

E-PTFE补片增强眶隔膜在东方人下睑眼袋整复中的运用

目的报道一种Hamra下睑成形术的改良术式，通过临床病例分析探讨运用补片增强眶隔膜在整复东方人下睑眼袋及沟槽中的意义。方法在经下睑皮肤径路的下睑袋整形术中，当完成弓状缘释放、眶隔重置后．将修剪成月牙形的E—PTFE补片植入眶隔膜和眼轮匝肌下筋膜之间，适当固定以增强眶隔膜和眼睑中层。结果在本组102例中。对92例（其余10例失访）进行了随访，其中89例术后效果满意，维持时间长，2例术后发生了较长时间的水肿，约经2月自行消退。1例因为复发而再次手术。结论在Hamra术式中。通过E-PTFE补片植入增强眶隔膜．可有效地增加眼睑中层结构的力量．并调整和控制释放的眶脂量．防止眼袋复发。     

Endoscopic glabellar approach to the anterior skull base: a technical note.

OBJECT: An endoscopic glabellar transethmoidal approach via a small nasional incision to the anterior skull base is reported as a minimally invasive neurosurgical technique. SURGICAL TECHNIQUE: A frontonasal craniotomy (2 x 2 cm in size) between the medial orbits is made via a nasional skin incision approximately 3-cm in length. An ethmoidectomy is performed in order to expose the skull base at the anterior cranial fossa. Anterior and posterior ethmoidal arteries, which provide blood-supply to the tumor, are interrupted during the ethmoidectomy. The tumor located at the anterior cranial fossa is removed under an endoscope. A rod-lens endoscope, which is 4-mm in diameter and 18-cm in length, is used. The dura mater is reconstructed with dural graft placement. The skull-base bone at the anterior cranial fossa is reconstructed with autogenous bone or a piece of titanium mesh. The ethmoidectomy site is filled with abdominal fat graft material. The craniotomy bone flap is secured with titanium microplates and screws. Two demonstrative patients are reported. The benefits of the minimally invasiveness of this surgical technique have been observed in patient recovery. CONCLUSION: An endoscopic glabellar transethmoidal approach to the anterior cranial fossa via a small nasional incision is reported with two patients with olfactory groove meningiomas.     

Transplant Islets Into the Pinna of the Ear: A Mouse Islet Transplant Model

BackgroundIslets transplanted under the ear skin would allow easy observation of the graft response and survival in vivo. This research was designed to establish an efficient mouse islet transplant model to probe the dynamic cellular interplay in vivo.MethodsGreen fluorescent protein transgenic mice and BALB/c mice were used as donors and recipients. All recipients were divided into 6 groups of 6 mice each. First, we treated the transplant recipients, including diabetes induction, autologous epididymal fat pad, and MATRIGEL transplant to the ears. Then, 1. we transplanted isolated islets to the ear/ear with fat/ear with MATRIGEL; and 2. transplanted islets with collagen + basic fibroblast growth factor or islets with collagen + vascular endothelial growth factor. Mice in the control group received a sham transplantation with phosphate buffer saline. All recipients were then observed for 30 days with blood glucose (BG) monitoring. Finally, ears were removed with graft on day 28 for histologic examination.ResultsIt was suggested that transplant of islets alone could not correct hyperglycemia. Fat, MATRIGEL, collagen, and growth factors have the similar function to form a microenvironment conducive to islet survival. The effect of islet transplantation for correcting hyperglycemia of the fat modification group was better than other groups (P < .05). BG could be normalized, and living islets were detected by anti-insulin immunohistochemistry.ConclusionsTransplant islets into the ear with transplanted autologous fat is the optimal way which can be used to analyze the allograft response in vivo and track cell population and migration using labels by confocal microscopy.     

Banked Fascia Lata in Sellar Dura Reconstruction after Endoscopic Transsphenoidal Skull Base Surgery

Objectives Cerebrospinal fluid (CSF) leakage is an undesirable complication of transsphenoidal skull base surgery. The issue of the most appropriate sellar dura repair remains unresolved, although a multilayer technique using autologous fascia lata is widely used. We describe the novel application of a homologous banked fascia lata graft as an alternative to an autologous one in the reconstruction of sellar dura defects in endoscopic transsphenoidal surgery. Design The clinical records of patients who underwent endoscopic transsphenoidal surgery at our department from June 2012, when we started using homologous fascia lata, up to July 2014 were reviewed retrospectively. The data concerning diagnosis, reconstruction technique, and surgical outcome were analyzed. Results We treated 16 patients successfully with banked fascia lata. Twelve patients presented intraoperative CSF leakage, and four patients were treated for postoperative rhinoliquorrhea. Banked fascia lata was used in a single-to-multilayer technique, depending on the anatomical features of the defect and of the sellar floor. No complications or failures in sella reconstruction occurred. Conclusion A banked fascia lata graft proved reliable and safe in providing an effective sellar dura reconstruction. Used in a multilayer strategy, it should be considered a viable alternative to an autologous fascia lata graft.     

Temporoparietal Fascia Plication in Rhytidectomy

Background The temporal region has a complex subcutaneous fascial structure known as the temporoparietal fascia, which is part of the subcutaneous musculoaponeurotic system. The temporoparietal fascia is continuous with the superficial musculoaponeurotic system (SMAS) of the face in the inferior border, the frontalis muscle, and the orbicularis oculi muscle in the anterior border. Therefore, a properly planned temporoparietal fascia plication can increase the tightness of the SMAS. In addition, plication of the temporoparietal fascia can provide lifting to decrease lateral canthal wrinkles with elevation of the lateral brows in rhytidectomy. Furthermore, plication of the temporoparietal fascia can yield deep tissue support, which prevents alopecia and visible scar formation in the temporal region by decreasing the tension along the skin incision. Methods Plication of the temporoparietal fascia was performed for 16 patients who had undergone face-lifts over the previous 10 years. Careful subcutaneous dissection, performed immediately under the hair follicles to avoid frontal nerve injury, provides excellent exposure of the temporoparietal fascia for plication in rhytidectomy and protects the auriculotemporal nerve and the superficial temporal vessels. Results There were no complications such as hematoma, facial nerve injury, alopecia, or visible scar formation attributable to the temporoparietal fascia plication. Conclusion Temporoparietal fascia plication can be performed simply during rhytidectomy as an additional procedure. It not only augments the effects of the rhytidectomy, especially in the lateral brows, the lateral canthal, and the temporal regions, but also decreases the risk of possible complications.     

Post-Transplant Immune Tolerance in Rats Following Lymphocyte Injection Into the Anterior Chamber of the Eye

ObjectiveWe aimed to compare the clinical and histopathological results of skin graft transplants between rats that had been injected with lymphocytes into the anterior chamber of the eye with those that had not.MethodsA total of 16 Wistar albino, male rats were included in the study. Subjects were divided into 2 groups, namely a test group and a control group. Lymphocyte suspensions derived from the subjects of the control group were injected into the anterior chamber of the eye of each opposing subject of the test group. Also, an identical volume of physiological saline was injected into the anterior chamber of each subject in the control group to prevent bias. One week after this procedure, circular skin grafts of 1 cm in diameter were transplanted within the opposing groups. After a period of 1 week, transplanted graft tissues were excised to compare tissue healing.ResultsThe occurence of granulation and reepithelialization was more evident in the test group (96% and 33%, respectively, vs 80% and 17% for the control group, respectively). On the other hand, it was determined that acute inflammation was more intense in the control group (77% vs 50% for the test group).ConclusionWe had created immune tolerance in rats through anterior chamber lymphocyte injection, which slowed down the rejection process. If this can be successfully implemented in practice, survival for transplant patients without long-term rejection will move closer to becoming a reality.     

Poor Surgical Outcomes after Fascia Lata Allograft Slings

The objective of this retrospective case control study was to determine whether our poor surgical outcomes were associated with the material used to construct our pubovaginal slings. Autologous rectus fascia was used in 33 patients and cadaveric fascia lata was used in 12 patients who underwent pubovaginal sling placement for intrinsic urethral sphincter deficiency (ISD). Treatment was successful in 78.8% and 33.3% of patients who underwent rectus fascia and fascia lata allograft slings, respectively (P=0.006). Based on regression analysis, the sling material was found to be strongly associated with surgical outcome after controlling for all confounding variables (β coefficient = 1204.6, P<0.00005). We conclude that fascia lata allografts are a poor choice for pubovaginal slings.     

枕动脉岛状筋膜瓣修复再造耳支架外露

目的：介绍一种修复再造耳支架外露的有效方法。方法：2000年12月至2001年12月，采用枕动脉岛状筋膜瓣＋游离皮片移植修复再造耳支架外露6例7耳。结果：6例7耳枕动脉岛状筋膜瓣全部成活，无一例发生坏死及支架再露，再造耳支架外露修复外形满意。结论：枕动脉岛状筋膜瓣＋游离皮片移植是修复再造耳支架外露的一种有效方法。     

Incisional Hernia Repaired Using Thigh Muscle Fascia After Kidney Transplantation: A Case Report

BackgroundAlthough monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient.Case PresentationA 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery.ConclusionsHernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection.