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Background: Autologous fat grafting (AFG) has emerged as a promising treatment option for Raynaud phenomenon. However, existing studies are limited by short follow-up, and there is little evidence regarding predictive factors for successful outcomes., Methods: A retrospective chart review and standardized phone interviews were performed for all patients (n = 17, 65% response rate) treated with AFG to the hands or feet at our institution for primary or secondary Raynaud from 2010 to 2021. Each occurrence of AFG was defined as a separate surgery (n = 23), with an average follow-up of 3.7 years., Results: At follow-up, patients reported a 31% reduction in cold attack frequency, a 45% reduction in the intensity of individual attacks, a 29% reduction in the duration of attacks, and a 40% improvement in overall Raynaud Condition Score (P < 0.01). Although initial AFG to an extremity significantly improved symptoms, subsequent attempts were not shown to statistically improve outcomes. Digital ulcers were present in 65% of cases, and AFG resulted in ulcer healing in 87% of those cases. Median duration of maximum symptom relief was 1 year postoperatively, with 74% of patients reporting diminishing symptom relief by 4 years postoperatively. Those with a BMI ≥25, with primary Raynaud phenomenon or without preoperative ulcers experienced significantly longer symptom relief (P < 0.05). Average patient satisfaction was 7.7 of 10, and 91% would recommend the procedure to others., Conclusions: Autologous fat grafting is an effective, albeit sometimes temporary, treatment for Raynaud and digital ulcers. Certain patients may be more likely to experience lasting symptom relief beyond 1 year., Competing Interests: Financial disclosure statement: The authors have no financial conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Autologous fat grafting (AFG) is often used to reconstruct defects after breast conservation therapy (BCT). However, concerns exist about the possibility of AFG-related recurrence or metastasis. This study aims to evaluate the literature to evaluate oncologic outcomes in patients undergoing AFG at the time of BCT., Methods: A systematic review of articles related to AFG based reconstruction at the time of BCT from 1970 to 2021 was performed via PubMed. Patients were grouped based on the presence or lack of AFG usage at the time of BCT, and oncologic outcomes and complications were compared., Results: Of the 146 articles identified, 15 were included. Nine hundred patients underwent BCT alone and 1063 patients underwent BCT with AFG patients. Similar average follow-up time was observed between the groups, 58.7 months (BCT only) and 55.2 months (BCT with AFG). On pooled analysis, no difference was identified in local recurrence 4.8% (43 patients) of the BCT group and 3% (32 patients) in the AFG group (P = 0.8), metastasis 4.8% (43 patients) of the BCT group and 6.9% (73 patients) in the AFG group (P = 0.3), or fat necrosis (P = 0.44). Meta-analysis additionally did not identify any statistically significant odds ratios between the BCT only group and BCT with AFG group when evaluated for total recurrence, local recurrence, metastasis or fat necrosis., Conclusions: The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting has safe outcomes., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review., Methods: An institutional review board-approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ2 test. A P value of 0.05 or less was considered statistically significant for all comparisons., Results: A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/- 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/- 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved., Conclusions: Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures., Competing Interests: Conflicts of interest and sources of funding: This article was funded in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR003096., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: In reconstructive surgery, fat volume augmentation is often necessary for esthetic or functional reasons. As an alternative to synthetic and xenogeneic materials, autologous fat grafting (AFG) based on liposuction is gaining popularity, yet successful transplantation and long-term volume maintenance are difficult. Standard tumescent solution formulations neglect adipocyte and stromal vascular fraction (SVF) cell survival during extraction, as well as SVF differentiation into adipocytes thereafter, all of which are crucial for the success of AFG. Here we hypothesized that addition of ascorbic acid (AA) to the tumescent solution could prevent liposuction-induced cell damage., Materials and Methods: The effect of 0.1 mmol/L AA in tumescent solution was investigated in a previously described ex vivo model of AFG. Briefly, excision fat was infiltrated with tumescent solution, with or without AA, and incubated for 20 minutes at 37°C. Hand-assisted liposuction was then performed with a blunt cannula. Total cell viability, clonogenicity, and differentiation capacity of the SVF cells were assessed., Results: With AA, 10.3% more cells and in particular 14.9% more adipocytes survived liposuction. Clonogenicity, adipocyte and osteoblast differentiation by SVF cells remained unchanged., Conclusions: Addition of AA successfully improved survival of adipocytes during liposuction without affecting SVF growth and differentiation. This study therefore identified a useful supplement to the tumescent solution which may lead to improving AFG success.

Background: Autologous fat transfer has been widely used in breast augment surgery. The breast fat graft is different form facial, it needs megavolume grafts. However, most Asian women are thin, who often encounter the fat resource insufficiency during breast augmentation. In fact, some processing methods do contribute to great loss of potential fat that could have been grafted. How to choose a best processing method to achieve optimal transfer in patients with insufficient fat resources is fairly important., Methods: Lipoaspirate was obtained from 10 healthy female patients who underwent liposuction from abdomen. According to the processing methods, 10-mL initial fat grafts divided into 4 groups: decantation (group A), centrifugation (group B), cotton pad (group C), and cell-assisted lipotransfer (CAL) (group D). Lipoaspirate from each group was compared in the vitro and vivo experiments. The content and function of stromal vascular fraction (SVF) were compared as well as lipoaspirate survival after grafting in nude mice., Results: The SVFs were counted in decantation group 4.32 ± 0.75 × 10/mL, centrifuge group 3.48 ± 0.78 × 10/mL, cotton pad group 1.64 ± 0.84 × 10/mL, CAL group 4.08 ± 0.73 × 10/mL. The decantation group was higher than the cotton pad group (P < 0.05). All the groups' SVFs had capability of multilineage differentiation. The fat graft weight in decantation group: 0.3908 ± 0.023 g, centrifuge group 0.3073 ± 0.015 g, cotton pad group 0.1726 ± 0.019 g, and CAL group 0.2396 ± 0.021 g. The weight of the fat graft in the decantation group was greater than that of the centrifugation group, cotton pad group and CAL group (P < 0.05). There was no significant difference in cell integrity, necrotic cysts and fibrosis between the groups. The vascularization degree in the cotton pad group was lower than that in the decantation group (P < 0.05)., Conclusions: Decantation processing can achieve optimal transplantation in patients who have insufficient fat resources.

There have been significant advances in the care of burns over the past decade. As a result of the improved survival of burn patients, attention has shifted to the optimized management of their wounds. Traditionally, autografts have been described as the gold standard treatment in cases of deep second- and third-degree burn wounds; however, they are limited especially in large surface area burns. As such, advancements have been made in the development of biologic dressings, which attempt to mimic the function of the lost epidermis and/or dermis. The ideal biologic dressing is nontoxic, lacks antigenicity, is immunologically compatible, and is sterile. Additionally, easy storage conditions, long shelf lives, and reasonable costs are key determinants of whether biologic dressings may truly be widely used in the clinical setting. Biologic dressings serve an important role as skin substitutes in the setting of acute burn injury. This review aims to summarize the multitude of available biologic dressings and their applications. METHODS: The PubMed and Google Scholar databases were searched for the following terms either alone or in combination: "burn injury," "biologic membrane," "skin substitutes," "biosynthetic dressings," and "acellular membrane."

Objective: Although resident involvement in surgical procedures is critical for training, it may be associated with increased morbidity, particularly early in the academic year-a concept dubbed the "July effect." Assessments of such phenomena within the field of plastic surgery have been both limited and inconclusive. We sought to investigate the impact of resident participation and academic quarter on outcomes for autologous breast reconstruction., Methods: All autologous breast reconstruction cases after mastectomy were gathered from the 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were constructed to investigate the association between resident involvement and the first academic quarter (Q1 = July-September) with 30-day morbidity (odds ratios [ORs] with 95% confidence intervals). Medical and surgical complications, median operation time, and length of stay (LOS) were also compared., Results: Overall, 2527 cases were identified. Cases with residents (n = 1467) were not associated with increased 30-day morbidity (OR, 1.20; 0.95-1.52) when compared with those without (n = 1060), although complications including transfusion (OR, 2.08; 1.39-3.13) and return to the operating room (OR, 1.46; 1.11-1.93) were more frequently observed in resident cases. Operation time and LOS were greater in cases with resident involvement.In cases with residents, there was decreased morbidity in Q1 (n = 343) when compared with later quarters (n = 1124; OR, 0.67; 0.48-0.92). Specifically, transfusion (OR, 0.52; 0.29-0.95), return to operating room (OR, 0.64; 0.41-0.98), and surgical site infection (OR, 0.37; 0.18-0.75) occurred less often during Q1. No differences in median operation time or LOS were observed within this subgroup., Conclusions: Our study reveals that resident involvement in autologous breast reconstruction is not associated with increased morbidity and offers no evidence for a July effect. Notably, our results suggest that resident cases performed earlier in the academic year, when surgical attendings may offer more surveillance and oversight, is associated with decreased morbidity.

Introduction: There is growing interest in autologous fat grafting (AFG) for breast reconstruction. This systematic review examines the range of outcomes used across studies of AFG, their definitions and whether there is a need for a core outcome set to aid reporting., Methods: Following the protocol of our systematic review, a search of 20 databases (1986 to March 2014) returned 35 studies which met the inclusion criteria. These were assessed independently by two authors. Disagreements were resolved by consensus., Results: Of the 35 studies, 27 (77%) were case series, 5 (14.3%) were cohort studies, and 3 (8.6%) were case reports. A total of 51 different outcomes were reported. These studies each reported a median of five separate outcomes (range, 2-14), of which a median of 3 outcomes were defined (range, 0-14). A median of 2 outcomes per paper were prespecified in the study methods (range, 0-12) and a median of only 2 outcomes per paper (range, 0-12) were both defined and prespecified. The most commonly reported outcome in studies of AFG was that of "operative details," reported by 26 studies, and eight different outcome definitions were used. "Cancer recurrence" was reported by 20 studies, with the use of 10 different outcome definitions. Overall, there was a poor proportion of defined and prespecified outcomes that employed a wide range of different outcome definitions. In addition only 14/35 studies stated the number of patients lost to follow-up., Conclusions: There is a need for a core outcomes set for AFG to the breast to minimise outcome and reporting bias and aid evidence synthesis. Our future research will focus in this direction, titled VOGUE or Valid Outcomes for the Grafting of AUtologous Fat to the BrEast study. We invite all those interested to get in touch with the lead author.

Background: With the increasing popularity of fat grafting over the past decade, the techniques for harvest, processing and preparation, and transfer of the fat cells have evolved to improve efficiency and consistency. The REVOLVE System is a fat processing device used in autologous fat grafting which eliminates much of the specialized equipment as well as the labor intensive and time consuming efforts of the original Coleman technique of fat processing. This retrospective study evaluates the economics of fat grafting, comparing traditional Coleman processing to the REVOLVE System., Methods: From June 2013 through December 2013, 88 fat grafting cases by a single-surgeon were reviewed. Timed procedures using either the REVOLVE System or Coleman technique were extracted from the group. Data including fat grafting procedure time, harvested volume, harvest and recipient sites, and concurrent procedures were gathered. Cost and utilization assessments were performed comparing the economics between the groups using standard values of operating room costs provided by the study hospital., Results: Thirty-seven patients with timed procedures were identified, 13 of which were Coleman technique patients and twenty-four (24) were REVOLVE System patients. The average rate of fat transfer was 1.77 mL/minute for the Coleman technique and 4.69 mL/minute for the REVOLVE System, which was a statistically significant difference (P < 0.0001) between the 2 groups. Cost analysis comparing the REVOLVE System and Coleman techniques demonstrates a dramatic divergence in the price per mL of transferred fat at 75 mL when using the previously calculated rates for each group., Conclusions: This single surgeon's experience with the REVOLVE System for fat processing establishes economic support for its use in specific high-volume fat grafting cases. Cost analysis comparing the REVOLVE System and Coleman techniques suggests that in cases of planned fat transfer of 75 mL or more, using the REVOLVE System for fat processing is more economically beneficial. This study may serve as a guide to plastic surgeons in deciding which cases might be appropriate for the use of the REVOLVE System and is the first report comparing economics of fat grafting with the traditional Coleman technique and the REVOLVE System.

Introduction: There is still no consensus on the ideal material to be used in craniofacial defects. Autogenous bone grafts are mostly preferred owing to their use with fewer complications. The aim of this study was to evaluate whether the scapular bone graft can be used with equal or more advantages to other bone graft resources in orbital, maxillary sinus front wall, and frontal bone defects., Patients and Methods: Twenty-four orbital, maxillary sinus front wall, and frontal bone defects were reconstructed with scapular bone grafts. Sixteen patients presented with complicated orbital fractures, 5 patients presented with isolated orbital floor fractures, and 3 patients presented with frontal bone fractures. The grafts were radiologically evaluated 1 day, 6 months, and 12 months postoperatively by 3-dimensional computed tomography scan., Results: All orbital, maxillary sinus front wall, and frontal bone defects were reconstructed successfully with scapular bone grafts. Clinical evaluation of the patients at 6 to 24 months of follow-up was considered satisfactory. Minimal donor site morbidity was observed. Scapular bone grafts adapted nicely to the recipient area, and bony union was complete as demonstrated by 3-dimensional computed tomography scans., Conclusions: Reconstruction of orbital, maxillary sinus front wall, and frontal bone defects with scapular bone grafts is an easy and safe procedure with minimal donor site morbidity. Scapular bone graft is a good reconstructive option for orbital, maxillary sinus front wall, and frontal bone defects.

Autologous fat graft is becoming a widely used procedure in plastic surgery. Its indications are progressively increasing, ranging from functional to aesthetic surgery. The procedure has now entered in the field of regenerative medicine. Although many have commented on the long-term safety implications of fat grafting, especially to the breast, there is no body of information in the literature that analyzes near-term complications associated with this procedure. We performed a retrospective study of 1000 consecutive fat transplantation cases in our hospital since 2005. Complications were divided between donor-site complications and recipient-site complications. Of 1000 procedures, there were 2 donor-site hematomas and 83 local deformities caused by liposuction. In treated patients, the recipient site, there were 4 infections. One patient reported implant rupture at 1 month after fat graft. There was no skin necrosis in the grafted areas and no systemic complications such as pulmonary embolism, cardiac arrest, or deep venous thrombosis. The complications in fat transplantation are dominated by complications of the liposuction-the donor harvesting phase of the procedure. The relatively low complication rates in the recipient site suggest that fat transplantation, especially considering the recipient, is characterized by a high safety level and our device is simple to use.

Although lipotransfer, or fat grafting, is a commonly used procedure in aesthetic and reconstructive surgery, there is still variability in graft survival and neoadipogenesis from one procedure to the next. A better understanding of the sequential molecular events occurring with grafting would allow us to strategize methods to improve the regenerative potency of the grafted tissue. These steps begin with an autophagic process, followed by the inclusion of stromal vascular fraction and matrix components. By tailoring and modifying each of these steps for a particular type of aesthetic or reconstructive procedure, strategic sequencing represents a dynamic approach to lipotransfer with the aim of maximizing adipocyte viability and growth. In the implementation of the strategic sequence, it remains important to consider the clinical viability of each step and its compliance with the US Food and Drug Administration regulations. This review highlights the basic science behind clinically translatable approaches to supplementing various fat grafting procedures.

Achieving permanent replacement of skin in extensive full-thickness and deep partial-thickness burn injuries and chronic wounds remains one of the fundamental surgical problems. Presently, split-thickness skin grafts are still considered the best material for surgical repair of an excised burn wound. However, in burns that affect greater than 50% of total body surface area, the patient has insufficient areas of unaffected skin from which split-thickness skin grafts can be harvested. The use of cultured epithelial (or epidermal) autografts (CEAs) has achieved satisfactory results. But the take rate of CEAs is poor in full-thickness bed or in chronically infected area. Providing temporary cover with allograft skin, or a more permanent allodermis, may increase clinical take. This review aims to (1) describe the use of CEAs in the regeneration of the epidermis, (2) introduce the application of the acellular dermal matrices (ADMs) in the clinics, and (3) enhance understanding of the CEAs applied with ADM as an appropriate strategy to treat the extended burn injuries. The current evidence regarding the cultured epithelial cell or keratinocyte autograft and dermal grafts applied in the treatment of burn injuries was investigated with an extensive electronic and manual search (MEDLINE and EMBASE). The included literature (N=136 publications) was critically evaluated focusing on the efficacy and safety of this technique in improving the healing of the deep dermal and full-thickness burn injuries. This review concluded that the use of ADM with CEAs is becoming increasingly routine, particularly as a life-saving tool after acute thermal trauma.

Background: Despite the widespread use of autologous fat grafting in both reconstructive and cosmetic surgery, volume retention remains a significant problem. We aimed to critically appraise the current body of literature in fat grafting to provide a framework to guide application and comparison., Method: Search of scientific databases and gray literature was conducted. Articles examining nonadipogenic applications of adipose tissue and those specific to breast reconstruction were excluded., Results: One hundred three articles were included. These fell under the headings of donor site, effect of infiltration solution, harvest method, effect of centrifugation, reinjection method, supplementation, the role of adipose-derived stem cells, and scaffolding., Conclusions: Despite the significant research effort in this field, there remains no consensus as to the optimum technique. This stems from the vast array of research methods and short follow-up durations. Further, extrapolation of in vitro results to clinical settings has led to many conflicting practices.

The development of autologous fat grafting to augment or reconstruct tissue defects has become an increasingly popular modality among plastic surgeons. Despite its popularity, a standardized fat grafting protocol has yet to be developed. Great variations exist with regard to almost all the technical features, yielding a reported fat graft survivability that ranges from 40% to 80%. Recent bench approaches have been proposed to improve the long-term viability of fat grafts: although promising results have been shown, empirical evidence has yet to prove the superiority of one particular method. Nevertheless, currently available literature still provides some evidence for optimal results in differing clinical scenarios, in the wait of validating and ultimate studies.The issues of enriched fat grafting techniques and variations in harvesting and delivery in the background of US regulatory constraints demand alterations and variations in techniques. These only complicate the process of validation of any single technique. However, recent studies have brought us closer to making informed decisions on technical choices in lipotransfer. These are elaborated on in this review.

Background: There are several methods that may be used to confirm the status of rib cartilage, such as physical examinations or chest radiography, for subjects with microtia. However, these methods are limited because of clinicians' inability to gain accurate information about the rib cartilage. We performed 3-dimensional chest computed tomography to preoperatively evaluate the accuracy of rib cartilage imaging., Methods: A total of 37 patients preparing for auricular reconstruction using a rib cartilage graft underwent preoperative 3-dimensional rib cage computed tomography (3-D rib CT). The 3-D rib CT was performed in cases of secondary revisional reconstruction, those with a history of surgery using rib cartilage, in those with a history of trauma related to the rib cage, older patients with question of calcification of rib cartilage, or those with a suspected rib cartilage anomaly on physical examination. Preoperatively, the appropriateness of using the rib cartilage were evaluated., Results: With the aid of the 3-D rib CT, successful autogenous auricular reconstruction was achieved in 36 patients. Framework fabrication in combination with a porous polyethylene implant and autogenous rib cartilage was performed in the remaining patient as planned preoperatively. By analyzing the 3-D rib CT image preoperatively, auricular reconstruction using a recycled rib cartilage graft with newly harvested rib cartilage was performed successfully in 13 of 14 secondary revisional cases. Based on preoperative CT images, modified surgical planning in terms of cartilage harvest and framework fabrication was needed in 8 of 11 patients who had a history of operation using rib cartilage and in 3 of 5 subjects with suspected rib cage anomalies on physical examination. Successful reconstruction was achieved using the modified surgical plan., Conclusions: A preoperative 3-D rib CT helps in surgical planning for autogenous auricular reconstruction for microtia, especially in patients with suspicious rib cartilage status.

Management of soft tissue deficits resulting from congenital abnormalities, trauma, systemic disease, and tumors is a particularly challenging field of plastic and reconstructive surgery. Fat grafting, a technique traditionally used in the correction of facial asymmetry, is commonly seen in aesthetic procedures which use the grafted fat for soft tissue augmentation and recontouring. Despite its widespread use in reconstruction and aesthetic surgery, therapeutic modalities applied in fat grafting are crude and the results of this intervention are unpredictable. The aim of this review was to present the most recent evidence regarding experimental studies and designs which confirmed or disproved fat volume expansion or fat maintenance after autologous fat grafting.

Background: The quality and quantity of costal cartilage allow for versatile and stable cartilage supply for various nasal deformities, but the apparent scar on the chest wall can be a major concern in cosmetic surgery of Asians. The authors describe a new method for harvesting costal cartilage by transumbilical endoscopic approach to avoid any scar on the chest wall and to fulfill the requirements of cosmetic procedures., Methods: An endoscopic retractor paired with a 10-mm and 30-degree down-viewing rigid endoscope is used to harvest the seventh, eighth, and ninth rib cartilage on the right. Elevators and eletrocautery units designed for conventional endoscopic procedures are used for cartilage dissection. Adequate amount of cartilage graft can be obtained through umbilical incision., Results: Eight patients underwent rhinoplasty with costal cartilage harvested using this method. The length of the harvested blocks from the seventh and eighth ribs ranged from 4.5 to 7 cm. The cartilage blocks harvested from the ninth ribs were 2.5 and 3.5 cm in length. The operative time of cartilage harvesting ranged from 2 to 2.5 hours. There were no associated intraoperative complications. In all cases, no signs of pneumothorax were detected after operation. The umbilical wounds healed without significant scarring within 2 weeks., Conclusions: This technique provides an effective alternative for costal cartilage harvesting with an inconspicuous scar hidden by the umbilicus that can be applied to selective rhinoplasty cases.

Background: Tendon gliding is key to optimal recovery of hand function after complex tendon injuries. Gliding is facilitated by a low-friction gliding surface that is normally provided by the periosteum of the underlying bone. However, significant injuries may damage the periosteum, which must be reconstructed to allow uninterrupted tendon excursion. The absence of the periosteum may compromise a tendon's ability to glide freely, thereby limiting the range of motion., Methods: Six digits in 4 patients with complex, composite soft tissue defects involving tendon, periosteum, and skin of the hand underwent surgical repair. Each digit had disruption of the bony cortex underlying the tendon injury including periosteal loss. Through an incision on the dorsum of the ipsilateral wrist, an extensor retinaculum graft corresponding to the size of the periosteal defect was harvested. It was then sutured into place over the bare cortex to replace the lost periosteum., Results: All the 6 digits in the 4 patients had complete return to function. Additionally, all patients had near normal strength in the repaired hand along with excellent tendon excursion in both flexion and extension. The average time of follow-up of this series of patients was 1.5 years., Conclusions: Extensor retinaculum grafting to replace lost periosteum is a technique that is easily used, uses locally available autogenous tissues, and produces excellent tendon function. Additionally, the histologic similarities between extensor retinaculum and periosteum add scientific merit to this novel approach. On the basis of our experience, we recommend the use of extensor retinaculum for periosteal reconstruction to provide an adequate gliding surface for a reconstructed tendon.

For tumors that are located beside the main peripheral nerve, combined wide resection of both the tumor and peripheral nerve is mandatory. We here present an interesting case with synovial sarcoma of the wrist. An 8 cm of ulnar nerve defect was reconstructed by vascularized, folded sural nerve graft with the peroneal flap, whereas an 8 cm of distal ulna was reconstructed using extracorporeally irradiated osteochondral autograft. Our case showed excellent nerve regeneration. Extracorporeal irradiated osteochondral graft was a good option for reconstruction of the distal ulna. This procedure should be indicated for the reconstruction of non-weight-bearing joints. These kinds of reconstruction have been addressed in only a few cases of oncological reconstruction.

Parry first described the syndrome of progressive facial atrophy in 1825, followed by Romberg in 1846. The clinical hallmark of the syndrome is atrophy of the facial soft tissues, including fat and muscle as well as underlying bone. Clinicians have classically reserved treatment until the end of the disease process, after the "burn out" stage. Various treatment modalities have been attempted with differing results. In this study, we present a case of Parry-Romberg syndrome treated with autologous fat grafting. This case report reviews the history of the disease, examines the safety and clinical outcomes of fat grafting as a treatment modality, and challenges the classic timing of that treatment. Additionally, long-term follow-up with photos and histological analysis of specimens are included.

Complications of fingertip injury include pain, hyper- or dyssensitivity, cold intolerance, and fingertip atrophy. Especially in cases of soft-tissue defect or atrophy which result from crushing injury, fingertip pain often occurs when a finger touches the objects. To overcome this problem, several techniques including local flaps or free flaps were suggested. But these methods require intricate and multistaged procedures.Twelve patients who had fingertip pain with pulp atrophy were treated with pulp graft between March 2004 and March 2006. Under the local anesthesia, we made a fish-mouth incision at the most prominent portion of fingertip and elevated volar flaps. Composite tissue was harvested from the lateral aspect of great toe, and inserted between the previously elevated volar flaps. The harvested composite pulp tissue contained about 3- to 5-mm thick fat layer. Moisture dressing was performed. The visual analogue scale (VAS) was used to evaluate the degree of pain postoperatively. The follow-up period was in the range between the 12 and 24 months (average, 19 months). Pre- and postoperative differences in VAS scores were analyzed for statistical significance, using the Wilcoxon rank sum test. In addition, patients were asked about their level of satisfaction with the procedure. To evaluate the postoperative sensation of the graft, we performed the Semmes-Weinstein monofilament test, and static and dynamic 2-point discrimination test at 1 year postoperatively.The size of the graft was ranged from 276 mm (12 × 23 mm) to 750 mm (25 × 30 mm). At final follow-up review, 5 patients were very satisfied and 7 were satisfied. Atrophy of the fingertip was also improved. Fingertip pain reduced from 8.5 preoperative to 3.1 postoperative on VAS. These improvements were statistically significant. Semmes-Weinstein monofilament test was green (∼2.83) in 9 patients (75%) and blue (3.22-3.61) in 3 of 12 patients (25%). Static and dynamic 2-point discrimination test results came out as 6 and 5 mm, respectively.Composite graft applied to the fingertip is a simple technique, and gives few complications. This procedure can be performed under local anesthesia and gives a fairly high degree of satisfaction to patients. We believe this method is useful for treating fingertip pain with atrophy of pulp.

Autologous fat grafting has become a common technique for revisional breast surgery. The purpose of this series is to review our experience with fat grafting for the correction of acquired breast deformities. A retrospective review was performed on 107 patients with a history of breast cancer between 1996 and 2010, who had autologous fat grafting at the time of secondary breast reconstruction. The indications were for improvement in contour, shape, and volume of the breast following transverse rectus abdominis myocutaneous (TRAM) flap reconstruction (n = 55), latissimus dorsi with or without implant (n = 20), implant reconstruction (n = 20), and breast conservation therapy deformity (n = 12). The average volume of injection was 40 mL (range, 5-150 mL), the most common location being upper and medial quadrants. Fat was harvested mainly from the abdomen, thighs, and flanks. Complications occurred in 11% of the patients, and included fat necrosis, erythema, keloid scarring, and pain. Complications were higher when performed with implant reconstructions. Repeat fat injection was performed in 25% (n = 27/107), which increased with the length of follow-up. Patients with a history of radiation therapy had an increased incidence of repeat injections (36% vs. 18%). Patients with >6 months follow-up reported an improvement of about 83%. Autologous fat grafting is a safe and effective tool for secondary breast reconstruction. It is helpful in all types of reconstructions to improve contour, volume, and overall breast shape and symmetry. Repeat injections are often required and this is more common in patients with longer follow-up and in those with a history of radiation therapy. The popularity of this approach in reconstructive breast surgery will likely continue to increase.

The author reports an alternative method of caring for the donor sites of split-thickness skin graft that involves the immediate return of superficial thin-layer split skin graft to the donor sites while using the deep split-thickness skin graft for replacement over the defects. The proposed method would decrease the morbidity associated with other established techniques of donor site management, including prolonged healing time, fluid loss, discomfort, pain, and undesirable cosmetic results. As for the recipient site, satisfactory cosmetic effects and less pigmentation changes could be achieved with this type of simple modification of a laminated graft.

Successful survival and growth of autogenous cartilage graft has been well proved in the experimental studies of Dupertuis and Peer. However, it is still unknown whether multilayer cartilage graft has the same survival and growth as a single-layer graft. The authors studied any difference of survival and growth rate between single and multilayer cartilage grafts in rabbits. Single, double, and triple layers of autogenous cartilage grafts were inserted into three separate pockets in a single rabbit ear. The three grafts were left in place for 6 months. They performed this procedures in 10 rabbit ears. Proliferating activity of chondrocytes was measured with a method of proliferating cell nuclear antigen immunolabeling. The authors found that there were more proliferating cell nuclear antigen-positive cartilage cells in the graft than in the host bed, but no difference in weight and thickness of the graft among the three groups.

The radial artery is used frequently in cardiac revascularization and requires an average 23-cm forearm incision. With proper instrumentation (Tsukuba-West Virginia Endoscopic Radial Artery: TW-ERA series, Takumi Cardio Co., Chiba, Japan), the radial artery can be harvested utilizing two small transverse incisions. The authors report six cases of endoscopic harvest of a radial artery graft. Length of the endoscopic incision is 2 cm proximally and 3 cm distally. Operation time and tourniquet times were approximately 80 to 120 minutes. No complications such as hematomas, nerve damage, or delay in healing were observed at the donor sites. Plastic surgeons, with their expertise in radial forearm flaps, hand surgery, and subcutaneous endoscopic techniques, can contribute greatly to the minimally invasive harvesting of the radial artery, preventing associated morbidity and improving the aesthetic and functional outcome of the donor site.

Lip augmentation is a well tolerated procedure that can lead to a more youthful appearance. Autologous tissue offers the safest and most long lasting results. Recently, a new source of autologous tissue, breast implant capsule, was described in the performance of permanent lip augmentation. Long term data in thirteen patients is presented and documents persistence of volume enhancement of over one year postoperatively.

Thirty-seven patients with various coverage problems and with lower extremity occlusive disease underwent free transfer of the greater omentum into the defect with a favorable clinical success rate. There are a number of advantages of this technique for such reconstructive problems.

Metastatic malignant melanoma has been regarded traditionally as an aggressive cancer highly refractory to standard doses of chemotherapy. Complete responses to standard chemotherapy are less than 5%. To overcome resistance, autologous bone marrow transplantation has been employed in the treatment of this disease. High-dose chemotherapy followed by autologous bone marrow rescue has been associated with increased response rates when compared with standard chemotherapy. A recent survey indicates that at least 283 patients with metastatic melanoma have been treated with this form of therapy thus far. Evaluation of the literature indicates that overall response rates for melanoma patients undergoing autologous bone marrow transplantation range from 46 to 65%, with complete response rates as high as 16%. Although few patients are long-term responders, several patients remain in complete remission for periods of more than one year. Multiple centers are evaluating the utility of high-dose therapy in the high-risk adjuvant setting for patients who present with poor prognosis disease. Data concerning the long-term outcome of this therapy are not available. This article reviews the concepts of high-dose therapy followed by autologous bone marrow transplantation, and the outcomes of patients with malignant melanoma who are treated in this manner.

Bioartificial mucosa can be fabricated with living cells in vitro and used for mucosal grafting. In this report, we describe our culturing methods for preparation of bioartificial mucosa and its morphological characteristics. Bioartificial mucosa has bilayered components, namely, mucosal epithelium and submucosal tissue. Submucosal tissue was composed of fibroblasts and type I collagen lattice. Mucosal epithelium was formed by an epithelial segment grafted on the submucosal tissue surface. Between epithelial and submucosal tissues, basement membrane was observed under a transmission electron microscope. In animal experiments, the bioartificial mucosa was well vascularized and survived completely without immunological rejections. Based on the findings from these animal experiments, we applied this bioartificial mucosa to humans and succeeded in reconstructing their mucosal defects. We also present an overview of the problems relevant to the use of such methods.

The in situ rib split graft was devised in response to experimental data demonstrating superior survival of autograft bone bearing periosteum. A more compelling reason for adopting the technique as a standard means for obtaining limited amounts of rib graft is the marked decrease in pain and pulmonary morbidity postoperatively. This is achieved by leaving the inner half of the rib in continuity and resecting only the outer half as the graft.

Cranioplasty using a synthetic material is less than ideal, especially if there is a history of infection at the defect site. Split-rib cranioplasty is a practical approach even in patients with a positive history of infection at or around the defect. We briefly review the historical background of split-rib cranioplasty and report our experience with this procedure in 12 patients. Forty-two pieces of rib, with an average length of 13 cm. were used for reconstruction. We had only 1 complication-a pneumothorax following removal of the rib graft. The follow-up period ranged from three to thirty-six months. All patients had complete regeneration of the donor rib and solid protection of the brain.

Severe genitoperineal trauma with total avulsion of testicles in a 7-year-old boy resulted from a road accident. Soft tissues were reconstructed by local flaps and skin grafts. The only testicle that was found was reimplanted in his biceps muscle in an attempt to restore endocrine function. A human chorionic gonadotropin test showed no response, indicating that the transplanted tissue did not survive.

A new and simple way of harvesting skin graft from a degloved flap is presented. This technique allows precise harvesting and does not require assistance. The split-thickness skin excision is also a reliable diagnostic tool for determining degloved flap avascularity.