吸脂组织中脂肪干细胞分离和定向分化的研究

目的探讨吸脂组织中的干细胞分离和体外诱导分化为表皮样细胞、成骨细胞及脂肪细胞的可能性。方法通过电动负压吸引获取1例行吸脂手术的30岁女性腹部脂肪组织,酶消化法获取脂肪来源干细胞,体外培养扩增,通过流式细胞仪检测表面抗原的表达。取生长良好的第3代人脂肪来源干细胞,分别应用成表皮诱导培养液（70％培养液A＋30％成纤维细胞培养基上清液＋10ng／L表皮生长因子）,成骨诱导培养基（DMEM／10％FBS,0．1μmol／L地塞米松,50μmol／L维生素C,10mmol／Lβ-甘油磷酸钠,100U／ml青霉素,100U／ml链霉素）和成脂肪细胞诱导培养基（DMEM＋10％FBS＋500μmol／L1-甲基-3-异丁基黄嘌呤＋1μmol／L吲哚美辛）诱导20d后,分别对成表皮诱导组进行免疫组化检测CK19表达,成骨诱导组进行碱性磷酸酶检测,成脂诱导组进行油红O检测。结果流式细胞仪鉴定结果示,人脂肪来源干细胞CD44和CD49d为阳性,CD34为阴性。诱导20d后,成表皮诱导组示免疫组织化学鉴定结构显示有CK19的表达;成骨诱导组示细胞碱性磷酸酶染色阳性;成脂肪细胞诱导组示油红O染色,胞质内脂滴均被染成红色,证实为脂性液体。结论从吸出的脂肪组织中分离出脂肪来源干细胞,在体外进行了脂肪干细胞的扩增和传代,所分离的脂肪来源干细胞具备多向分化能力。     

Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia

BACKGROUND: Bilateral reduction mammoplasty has been described as a surgical option for treatment of breast cancer in women with large, pendulous breasts. Using this technique can provide unique surgical oncologic challenges. METHODS: Retrospective chart review. RESULTS: Thirty-seven patients were identified. The average weight of tissue removed was 653 g. Tumor size ranged from 0.6 to 5.2 cm. One patient had microscopically positive surgical margins on final pathology. The tumor bed was not marked, and completion mastectomy was required. Two patients had unexpected malignancy in the contralateral breast. One patient required completion mastectomy for positive nonoriented margins. In another patient, tissue from the contralateral side was oriented, and mastectomy was avoided. CONCLUSIONS: Bilateral reduction mammoplasty with lumpectomy is an ideal option in women with macromastia. We recommend marking the tumor bed on the flaps and pedicle as well as orienting tissue removed from the contralateral side as maneuvers that will decrease need for completion mastectomy.     

环乳晕切口腺体瓣悬吊并沿等高线环缩缝合法乳房缩小成形术

目的 介绍经环乳晕切口采用乳腺瓣悬吊，并沿等高线呈梯级环缩缝合的乳房缩小成形术的方法和经验。方法 经乳晕周缘切口，在皮下脂肪组织和乳腺腺体之间广泛分离，形成“帐篷状”皮瓣和“圆椎形”乳腺腺体；在乳腺上部形成3cm宽纵向乳腺瓣，切除乳腺瓣内、外侧部分乳腺组织，将乳腺瓣上提折叠缝合固定(或切断后重叠缝合)以悬吊乳房；将“帐篷状”皮瓣和“圆椎形”乳腺腺体沿等高线环缩缝合，缝针交替穿经皮瓣和乳腺腺体，最后环乳晕间断缝合皮肤。结果采用此法矫治轻中度巨乳房、单纯乳房下垂共8例16侧，术后乳房外形美观，效果满意。结论本术式简便易行、瘢痕不明显，对轻中度巨乳及乳房下垂者可作为理想首选术式。     

辅助以内窥镜和吸脂术的除皱手术

目的 介绍辅助以内窥镜和吸脂术行面部除皱的手术方法及临床效果。方法 对于面部脂肪增生或脂肪下垂堆积及皮肤松弛者，行内窥镜额颞部上提，颊脂肪垫去除，面中、下部肿胀吸脂,深层组织的悬吊。结果 28例患者均获得良好的手术效果,面部外形明显变小,轮廓更加清晰,皮肤松垂得到复位,同时避免额颞部冠状切口,无脱发、瘢痕形成,无并发症（血肿,面神经损伤,皮肤坏死等）发生。满意率达100%。结论 避免了传统手术方法的大切口,同时也避免了头部的瘢痕、麻木等不良反应的出现,面部的软组织弹性更加良好、轮廓更加清晰。     

Viability of fat obtained by syringe suction lipectomy: effects of local anesthesia with lidocaine

The results of transplantation of free autologous fat obtained by blunt syringe suction lipectomy are unpredictable. We examined if adipose tissue viability is compromised by using syringe suction lipectomy and by infiltration of the tissue with local anesthetics. As reference, we used adipose tissue samples excised during elective surgery. Fat obtained intraoperatively and by lipectomy was digested with collagenase to isolate adipocytes. The mechanical damage associated with sample handling and cell isolation in both procedures was similar and did not exceed 6% of the total cell mass. In addition, cells isolated from intraoperative and lipectomy samples did not differ functionally, responded similarly to insulin stimulation of glucose transport and epinephrine-stimulated lipolysis, and retained the same growth pattern in culture. Since during fat transplantation the graft is exposed to local anesthetics at both the donor and the recipient sites, we reexamined adipocyte function in the presence of lidocaine. Lidocaine potently inhibited glucose transport and lipolysis in adipocytes and their growth in culture. That effect, however, persisted only as long as lidocaine was present; after washing, the cells were able to fully regain their function and growth regardless of whether the exposure was as short as 30 minutes or as long as 10 days. These results indicate that adipose tissue obtained by syringe lipectomy consists of fully viable and functional adipocytes, but local anesthetics may halt their metabolism and growth.     

Postoperative course after suction lipectomy —immediate,medium-term and long-term outcomes

Summary The final result of suction lipectomy depends in part on the immediate and medium-term developments. The two factors, skin retractility and surface unevenness which exert an important influence on the results, are analyzed in an attempt to determine the relative parts played by the surgical procedure and by the patient's characteristics. The outcome of suction lipectomy is studied, and the criteria used to select suitable patients are discussed. The events that may occur postoperatively are examined in order to see how they may affect long-term results. The following points are analyzed: (1) The immediate outcome, including the problems of ecchymosis and surface unevenness, and the influence of the skin's retractile property. (2) The problem of secondary bulges; and (3) the long-term developments.     

Reduction mammoplasty and mastopexy: A personal technique

Surgical correction of the ptotic or hypertrophic breast is performed with increasing frequency. Many different techniques are widely practiced and give predictably reliable results. Greater consideration needs to be given to the long-term aesthetic results, breast shape, quality of scars, and preservation of nipple sensation. This paper presents a personal technique practiced for the past 10 years in which consideration is given to achieving better nipple projection and less conspicuous scars. In addition, a method of wide tissue overlapping is advocated to maintain better long-term breast contour.     

An alternative approach to reduction mammoplasty

The female breast can be reduced by a number of operative techniques. Their goal is to transform different deformities into a so-called ideal form. The ideal form is obtained by small changes such as fixing the nipple's position in relation to predetermined anatomical marks. Under certain conditions we have to deviate from the ideal form. In these cases the operative method used is not determined by the deformity but by the desired form. Reduction mammoplasty techniques are just variations of a single method whose principles still need to be defined.Presented at the Xth Congress of the International Society of Aesthetic Plastic Surgery, Zurich, September 14, 1989     

Suction lipectomy: An excellent adjutant to improve the results of breast reconstruction with RAM flaps

It has been said about breast reconstruction with implants that a patient should not expect more than a mound that will fill out her brassiere or bathing suit. Autogenous tissue breast reconstruction has changed this. One of the great advantages of autogenous reconstruction over implants is that the breast remains soft, supple, and warm, improving with time as the scars begin to fade and becoming more natural and pendulous. Furthermore, since the new breast is made of fat, we can change its size, enhance its shape, and sculpture it with a suction lipectomy cannula to make it look practically identical to the opposite. We look upon breast reconstruction with rectus abdominis myocutaneous (RAM) flaps as a torsoplasty because of the improvements to the two areas involved: the reconstructed breast and the resulting abdominal lipectomy. This torsoplasty is done in two stages: One is the actual transfer of the rectus abdominis flap in which the skin and fat involved is designed to try to give an aesthetic dermolipectomy but without compromising the vascularity of the flap. Three or four months later, we perform the second-stage torsoplasty where the suction-assisted lipectomy plays a fundamental role and which is the subject of this article.Presented at the Lipoplasty Society of North America, 7th Annual Meeting, San Francisco, October 1989     

Reduction mammoplasty: General approach and basic considerations

Reduction mammoplasties must take into consideration volume, mammary base, and forward projection in establishing criteria for a standard breast. Any reduction procedure involves the mammary gland or mass, the skin, and the nipple-areola complex.Since 1969, we have used a dermal vault technique on over 1,200 patients with satisfactory results. It produces a short, well-situated scar, a pleasing form, ideal residual mammary volume, and good stability.     

Fat-suction of the submental and submandibular regions

The author presents a clinical classification of fat-suction cases in which treatment of excessive adiposity of the face and neck is discussed. Selection of the patient is a very important preoperative procedure. Fat suction is performed only on the adipose tissue lying between the skin and the platysma muscle and is not indicated for fat lying below the muscle structures. The author presents several improvements on the Illouz technique in comparison with more conventional lipectomy surgical procedures.     

Abdominal lipectomy and mesh repair of midline periumbilical hernia after bariatric surgery: How to spare the umbilicus

Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the umbilicus. Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing the vascular supply of the umbilicus on one side only. Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m² (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and another experienced necrosis of only the epidermis that recovered fully. Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk of umbilical necrosis.     

Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery

Three-dimensional (3D) imaging technology currently is used by various commercial industries as a method for analyzing objects and shapes. Recent work from our group and others offer data to support the use of 3D imaging as a valuable tool in aesthetic and reconstructive breast surgery. We have developed a system for creating 3D breast models that provides clinical data that can help guide surgical management. With 3D breast models, surgeons are able to visually assess the size, shape, contour, and symmetry of the breast, as well as obtain quantitative breast measurements and volumetric calculations. Three-dimensional imaging may be applied to various plastic surgery procedures including breast reconstruction with implant/tissue expanders, local flap reconstruction, free-flap reconstruction, breast augmentation, and breast reduction surgery. The novel application of 3D imaging in these settings represents a significant advance from traditional approaches to aesthetic and reconstructive breast surgery in which surgical procedures are based on 2-dimensional photographs and visual size estimates.     

Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions

IntroductionContralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics.Materials and methodsThe study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammaplasty between 1/2007 and 12/2011. The data was retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and postoperative follow-up.ResultsReduction mammaplasty specimens revealed abnormal findings in 68 (21.5%) patients. High-risk lesions (ADH, ALH, and LCIS) were revealed in 37 (11.7%), and cancer in six (1.9%) patients. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Abnormal histopathological findings were more frequent in patients with reduction mammaplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064).ConclusionThe incidences of malignant and high-risk lesions are doubled compared to patients without prior breast cancer. Patients with abnormal histopathology cannot be preoperatively identified based on demographics. If reduction mammaplasty is performed before oncological treatment, the incidence of abnormal findings is higher. In the light of our results, contralateral reduction mammaplasty with histopathological evaluation in breast cancer patients offers a sophisticated tool to catch those patients whose contralateral breast needs increased attention.     

置管并负压引流治疗颈椎前路手术并发食管瘘

目的探讨颈椎前路手术并发食管瘘的原因及预防措施,并观察置管冲洗负压引流治疗的效果。方法回顾性分析自2001-03—2014-10诊治的18例颈椎前路手术并发的食管瘘。3例行一期清创、瘘道口缝合,放置引流管引流。4例行一期清创、瘘道口部分缝合,伤口畅开呋喃西林纱条填塞。11例行一期清创、瘘道口缝合,放置冲洗管和负压引流管。结果 18例均获得随访2~36个月,平均12个月。一期清创、瘘道口缝合、负压引流11例中1例因瘘道口未愈合,反复感染,经长期换药20周窦道形成,随访36个月后窦道未完全愈合。将一期清创、瘘道口缝合、单纯引流和呋南西林纱条填塞治愈的7例定为换药组,将一期清创、瘘道口缝合、负压引流治愈的10例定为冲洗组。换药组食管瘘停止时间为(11.2±6.8)周,冲洗组为(4.2±4.9)周,冲洗组食管瘘停止时间明显早于换药组,差异有统计学意义(t=2.848,P0.05)。结论颈椎前路术后并发食管瘘治疗较棘手,在结合手术修补、全身支持治疗的同时,采用置管冲洗并负压引流的方法治疗可以取得较满意的疗效。     

Effects of prior augmentation and reduction mammoplasty to sentinel node lymphatic mapping in breast cancer

Previous plastic surgery procedures such as breast augmentation or reduction mammoplasty can potentially alter the lymphatic drainage of the breast. The purpose of this study is to determine the success rates of sentinel node lymphatic mapping in patients with previous plastic surgical procedures of the breast. A total of 83 patients with a history of plastic surgery of the breast that underwent subsequent sentinel node mapping between 1996 and 2008 were retrospectively analyzed. Eight-three patients that underwent a total of 108 sentinel node biopsies. Hundred cases (93%) previously underwent breast augmentation and eight cases (7%) previously underwent reduction mammoplasty. The mean time between the previous plastic surgical procedures and the sentinel node biopsy was 10.3 years (range: 2 months-32 years). Indications for the mapping procedure were invasive cancer (n = 64), ductal carcinoma in situ (n = 17), and prophylactic mastectomy (n = 27). The identification rate of the sentinel node was 95.3% (103/108). The success rate based on type of procedure was 96% (96/100) for augmentation and 87.5% (7/8) for reduction mammoplasty. With a mean follow-up of 3.4 years, there has been only one local axillary recurrence that occurred at the time of an ipsilateral breast recurrence following lumpectomy. Lymphatic mapping can be successfully performed in patients who have previously undergone plastic surgery operations.     

Evaluation of the central pedicled,modified Wise‐pattern technique as a standard level II oncoplastic breast‐conserving surgery: A retrospective clinicopathological study of 190 breast cancer patients

Involving 207 breast cancer patients a retrospective study was performed to facilitate the acceptance of the central pedicled, modified Wise‐pattern therapeutic mammoplasty technique as a standard volume‐displacement level II oncoplastic breast‐conserving surgery (OBCS). The overall local recurrence rate was 5.8% with an average follow‐up of 43.9 months. The median time to the initiation of the adjuvant treatment was 4.9 weeks. Due to positive surgical margins, 13 (6.84%) completional surgeries were performed. In total, 45 complications (12.9%) were recorded. The median values of the esthetic outcomes represented improved cosmetic results. The modified Wise‐pattern technique could be a standard, safe and repeatable level II volume‐displacement OBCS.     

Tumescent technique as an adjunct to breast implant removal and capsulectomy

Hydrodissection has long been used in plastic surgery to facilitate dissection. The addition of epinephrine to the solution is thought to add to hemostasis, whereas the use of local anesthetic reduces intraoperative pain. Removal of breast implants and the associated capsules can be a tedious procedure with adhesions between the capsule and the parenchyma brought about by the prolonged presence of the device. The use of a mixture of Ringer's lactate and lidocaine with epinephrine has been used in this group of patients. Its use is described along with the benefits and pitfalls of the technique.     

Stereotactic angiographic localization as an adjunct to surgery of cerebral mycotic aneurysms: Case report and review of the literature

Summary Less than 10% of all aneurysms affecting the arterial cerebral circulation are mycotic in nature. They occur in the setting of bacterial endocarditis and are the cause of considerable morbidity and mortality of affected patients. In selected cases surgery may play a curative role in the treatment plan. These aneurysms frequently arise in distal arterial branches, and their localization during surgery may at times prove laborious. We report the case of a mycotic aneurysm of a distal branch of the anterior cerebral artery surgically treated with the help of angiographic stereotactic localization. Stereotaxy should thus be regarded as a pertinent adjunct in selected cases of surgical treatment of distal mycotic cerebral aneurysms.