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Purpose: Exploring the integration of artificial intelligence in clinical settings, this study examined the feasibility of using Generative Pretrained Transformer 4 (GPT-4), a large language model, as a consultation assistant in a hand surgery outpatient clinic., Methods: The study involved 10 simulated patient scenarios with common hand conditions, where GPT-4, enhanced through specific prompt engineering techniques, conducted medical history interviews, and assisted in diagnostic processes. A panel of expert hand surgeons, each board-certified in hand surgery, evaluated GPT-4's responses using a Likert Scale across five criteria with scores ranging from 1 (lowest) to 5 (highest)., Results: Generative Pretrained Transformer 4 achieved an average score of 4.6, reflecting good performance in documenting a medical history, as evaluated by the hand surgeons., Conclusions: These findings suggest that GPT-4 can effectively document medical histories to meet the standards of hand surgeons in a simulated environment. The findings indicate potential for future application in patient care, but the actual performance of GPT-4 in real clinical settings remains to be investigated., Clinical Relevance: This study provides a preliminary indication that GPT-4 could be a useful consultation assistant in a hand surgery outpatient clinic, but further research is required to explore its reliability and practicality in actual practice., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Carbon monoxide (CO) is an odorless and colorless gas that can lead to fulminant and life-threatening intoxications. Besides an early diagnosis, an appropriate treatment of the intoxication is important. In this context the reduction of CO concentration in blood and tissues is crucial revealing hyperbaric oxygen treatment (HBO) as a highly promising tool. However, the benefit of HBO in CO intoxications is still considered controversial. In this review, we discuss the evidence of the role of HBO treatment in isolated CO intoxication., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Introduction: Local anesthetics (LAs) are routinely administered in plastic and reconstructive surgery, e.g., as tumescent anesthesia adjunct in liposuction. Historically, these substances were assumed to act cytotoxically. Thus, the application of LA was avoided when handling adipose stem cells (ASCs). We recently determined that most LAs are not cytotoxic when ASCs are exposed to concentrations used for tumescent liposuction. However, there is limited information when combining LA with epinephrine and about the effects of prilocaine on ASCs., Methods: We analyzed the effects of prilocaine or lidocaine in co-exposure with epinephrine on the viability of primary human ASCs, i.e., proliferation, metabolic activity, and cytotoxicity, using crystal violet-staining, PrestoBlue®-, and WST-1 assay. We quantified the impact of short-term incubation of lidocaine and epinephrine on the differentiation of ASCs into the adipogenic, chondrogenic, and osteogenic lineage., Results: After 2 h, prilocaine (10 mM) significantly reduced metabolic activity and cell numbers, whereas lidocaine only inhibited metabolic activity. After 6 h, prilocaine (10 mM) and lidocaine significantly decreased metabolic activity as well as cell numbers. The application of high concentrations of epinephrine did not affect cell numbers but diminished metabolic activity. Combining lidocaine with epinephrine had no additional cytotoxic effect. Differentiation into the chondrogenic lineage was significantly inhibited by epinephrine., Conclusions: Deducing from our data, neither lidocaine combined with epinephrine nor prilocaine has a cytotoxic impact on ASCs in vitro at concentrations equivalent to those in tumescent anesthesia and has no long-lasting effect on the differentiation capacity of ASCs into the osteogenic and adipogenic lineage., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

The rat sciatic nerve (SN) is the most frequently used model in experimental research on peripheral nerve injuries. Within the broad range of evaluation methods to determine the experimental outcome, recovery of behavior represents the major criterion to assess functional regeneration. The grasping test indicates when recovery begins and its improvement with time. However, lesions of the SN have yet remained unstudied with this method. Therefore, rats received a SN resection and were divided into experimental groups: 1) control with lesion only, 2) nerve bridge, and 3) autograft. During weekly sessions, the grasping test measured the grip strength, and the locomotor behavior was assessed in the open field. Finally, the nerves were prepared for electrophysiology and histomorphometry. Autograft recovered grasping after 7 weeks with the strongest improvement afterwards. Nerve tube allowed grasping by week 12. Control animals did not recover. In the open field, no differences were observed between the groups. Recordings were possible only in the autograft group, which could be explained by higher number of regenerated fibers. This study indicates that grasping data correspond with physiological and anatomical findings. We conclude that the grasping test is a valid method to evaluate functional recovery after SN resection in rats., Competing Interests: Conflict of interest Declarations of interest: none., (Copyright © 2022 Japan Neuroscience Society and Elsevier Ltd. All rights reserved.)

Aims: Inflammation during wound healing is both essential and critical for restoring tissue integrity. Participating cells secrete soluble factors to regulate the inflammatory phase and to induce the adjacent regenerative processes. If pro-inflammatory signals are overexpressed, the wound stagnates in the inflammatory phase, which decelerates regular wound healing. The endocannabinoid system is ascribed great significance in maintenance of tissue homeostasis. It mediates several effects through the cannabinoid receptors CB1 and CB2., Main Methods: In order to clarify the role of these receptors in wound healing, excisional wounds were created on wildtype and CB1 and CB2 knockout mice. The wound closure was analyzed over a period of 14 days, and cytokine concentrations of tissue homogenisates were measured by ELISA. MSCs were isolated from the animals' subcutaneous adipose tissue and analyzed for viability and differentiation capacity, in vitro., Key Findings: Deletion of CB2 increased Interleukin (IL)-6 and tumor necrosis factor (TNF)-α but did not affect tissue regeneration. In CB1-deficient animals, wound closure was delayed during early phases of healing, which was accompanied by increased concentrations of monocyte chemoattractant protein (MCP)-1 and TNF-α. CB1 and CB2 knockout MSCs presented altered viability and differentiation capacity compared to wildtype MSCs. The CB1-deficient MSCs released high levels of MCP-1 upon stimulation with TNF-α and IL-1β., Significance: The data indicate that both cannabinoid receptors regulate inflammation, and this study emphasizes the important role of CB1 in wound repair. Furthermore, our findings suggest that the secretome of CB1-deficient MSCs may contribute to the wound healing delay, in vivo., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Determining inhibitory or supportive effects of biological, chemical or physical factors on cell fates, including chondrogenic differentiation of mesenchymal stromal cells (MSCs), requires quantification techniques that are rapid, reproducible, and able to monitor these effects over time. Methods currently used to analyze chondrogenic differentiation are either qualitative staining procedures or indirect DNA quantifications. Because of these limitations, further methods are needed to improve determination of chondrogenic differentiation. In the present study, we applied a histological staining method, which is established for investigation of articular cartilage degeneration by use of Safranin O dye, on chondrogenic differentiated cells in monolayer cultures. MSCs were differentiated on 12-well formats, at increasing concentrations of TGF-β3, cell numbers, and incubation times. Quantification was performed by solubilizing the adsorbed dye into isopropanol followed by determining the optical density (O.D.) through spectrophotometry. Our results show that the O.D. is directly related to cell numbers and incubation periods, and that the technique is applicable to study agents which affect chondrogenic differentiation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The application of tissue engineered constructs is an approach in regenerative therapies to support regeneration of damaged muscular tissue. Therefore the development of highly aligned electrospun scaffolds based on polycaprolactone (PCL) and collagen enables a versatile development towards tailor made applications. However, the application of natural polymers like collagen brings the risk of batch-to-batch inconsistencies, which influence the reproducibility of the electrospinning process. Aligned PCL-Collagen nanofibers were fabricated via electrospinning using benign solvents. The spinnability of different collagen batches and polymer concentrations in diluted acetic acid as solvent was investigated. Furthermore spinning parameters and fiber morphology were investigated in order to determine the most stable spinning conditions and analyze the batch-to-batch variations. Finally the effect of the solution temperature and the time of pure collagen in solution were investigated, to complete the analysis of the influences on the spinning behavior., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Defect reconstruction of the trunk can be performed using microsurgical free flap transplantation. In cases of missing or inappropriate recipient vessels, microsurgical defect reconstruction of the trunk can be achieved by combining free flaps with arteriovenous loops. Here we present our 5-year experience of trunk reconstruction using AV loops and free flaps in a retrospective evaluation. We analyzed 32 cases of trunk reconstruction using a combined approach of free flap transplantation and arteriovenous loops between 2011 and 2016 regarding postoperative complications and perioperative course. Twenty-one patients suffered from sternal defects, 4 from presacral defects, 3 patients presented with lateral chest wall defects, 2 patients suffered from lumbosacral defects, 1 patient had a gluteal defect and 1 patient a defect at the clavicle. In all cases, free flap transplantation and arteriovenous loop creation were performed in a two-stage procedure. There were 8 thromboses of the arteriovenous loops with 4 flap failures. Only 1 flap loss was located in the sternal region, whereas one presacral flap and both lumbosacral flaps were lost. Reconstruction of large soft tissue defects of the trunk by a combined approach with an arteriovenous loop creation and consecutive free flap transplantation represents a reliable procedure in ventral and posterior cranial localization, whereas in the caudal posterior region, AV loop thrombosis can occur. Therefore, to minimize flap loss, a two-stage procedure should be performed., (Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Under several conditions such as severe trauma skeletal muscle lack the ability to reorganize and the loss of muscle function is inevitable. The application of tissue engineered constructs is a promising approach in regenerative therapies for damaged muscular tissue. Therefore, the development of highly aligned scaffolds based on polycaprolactone (PCL) has been studied extensively. Nanofiber scaffolds containing collagen have mostly been fabricated via electrospinning using highly corrosive 1,1,1,3,3,3 hexafluoro-2-propanol (HFIP) so far. In this study, aligned Polycaprolactone-Collagen (PCL-Coll) biocomposite nanofibers were fabricated via electrospinning using environmentally benign diluted acetic acid (AcOH) as solvent. Furthermore, ultrasonic treatment was introduced to enhance the intrinsically weak solubility of PCL in AcOH. AcOH was diluted to an ideal concentration for electrospinning of 90%. The final solutions were spun at various conditions and collected with different collector setups in order to determine ideal processing conditions for the fabrication of highly aligned nanofibers., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The aim of this prospective study was to assess the correlation of flap perfusion analysis based on laser-assisted Indocyanine Green (ICG) angiography with combined laser Doppler spectrophotometry in autologous breast reconstruction using free DIEP/ms-TRAM flaps. Between February 2014 and July 2015, 35 free DIEP/ms-TRAM flaps were included in this study. Besides the clinical evaluation of flaps, intraoperative perfusion dynamics were assessed by means of laser-assisted ICG angiography and post-capillary oxygen saturation and relative haemoglobin content (rHb) using combined laser Doppler spectrophotometry. Correlation of the aforementioned parameters was analysed, as well as the impact on flap design and postoperative complications. Flap survival rate was 100%. There were no partial flap losses. In three cases, flap design was based on the angiography, contrary to clinical evaluation and spectrophotometry. The final decision on the inclusion of flap areas was based on the angiographic perfusion pattern. Angiography and spectrophotometry showed a correlation in most of the cases regarding tissue perfusion, post-capillary oxygen saturation and relative haemoglobin content. Laser-assisted ICG angiography is a useful tool for intraoperative evaluation of flap perfusion in autologous breast reconstruction with DIEP/ms-TRAM flaps, especially in decision making in cases where flap perfusion is not clearly assessable by clinical signs and exact determination of well-perfused flap margins is difficult to obtain. It provides an objective real-time analysis of flap perfusion, with high sensitivity for the detection of poorly perfused flap areas. Concerning the topographical mapping of well-perfused flap areas, laser-assisted angiography is superior to combined laser Doppler spectrophotometry., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: Free flap transplantation to vascular reconstructions as arteriovenous (AV) loops has been established in centers as a feasible therapeutic option for defect reconstruction in the absence of proper recipient vessels, caused by oncologic resections, radiation, or trauma. We report our 10-year experience in free flap transplantation after vascular reconstruction with special emphasis on complication rate and postoperative mobility., Patients and Methods: Forty-seven patients (mean age: 60 years, range: 19-86) were included. Defect etiology was posttraumatic in 19 patients; 14 defects were due to oncological resections and seven sternal osteomyelitis; three patients presented with radiation ulcers, two with aseptic femoral head necrosis, and one with defects caused by acne inversa and hip joint prosthesis infection. Long-term follow-up was 45 months (range: 0-126). We performed arterial revascularization with 36 AV loops, eight bypass grafts, and three venous interposition grafts. Subsequent tissue transfer comprised 24 latissimus dorsi, two vastus lateralis, one gracilis, one anterior lateral thigh (ALT), 16 rectus abdominis, one radialis forearm, and two osteocutaneous vascularized fibula flaps., Results: Complications occurred in 25/47 patients (53%). Early complications included five acute occlusions of arterial reconstructions and six major bleedings. There were six flap losses and three major amputations. Two in-hospital deaths were observed (4%). Overall survival accounted for 89.0 and 74.7% after 1 and 5 years, respectively., Conclusion: The 5-year survival rate in long-term follow-up is favorable, despite an initially elevated complication rate. Successful defect coverage can be achieved by this method in a high percentage of patients., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: To compare the Ramirez technique for the operative closure of large open myelomeningocele defects with conventional closure techniques in newborns. We hypothesized that the immediate surgical treatment with the Ramirez technique is superior to prior used operative techniques., Methods: From 2003 to 2010, 23 children (8 female, 15 male) underwent closure of large open myelomeningocele defects using the Ramirez technique (group A), while from 1993 to 2002, 23 children (6 female, 17 male) underwent conventional closure techniques (group B). All children were included in the retrospective analysis with a mean follow-up period of 3.4 years., Results: Perioperative variables were similar in both groups (P = ns). There were no hospital deaths in both groups. The operation time was significantly higher in group A (228.7 ± 76.8 versus 157.8 ± 70.3 min, P = 0.003). Mean length of hospital stay was significantly lower in group A (30.7 ± 16.4 days versus 52.0 ± 38.5; P = 0.02). Postoperative complication rate was significantly lower in group A (P = 0.01). Beyond postoperative day 10, liquor fluid leakage was significantly lower in group A (P = 0.05). During follow-up, there were no complications in group A. In group B, 2 children developed liquor fistulas., Conclusions: The Ramirez technique allows efficient and safe closure of large open myelomeningocele defects and reduces incidence of postoperative liquor fistulae. The increased operation time and surgical efforts seem to be justified. Treatment of large myelomeningocele defects requires an interdisciplinary team including paediatrician-neonatologists, neurosurgeons and plastic surgeons., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: Combined vascular reconstruction and free flap transfer has been established in centers as a feasible therapeutic option in cases with critical limb ischemia (CLI) and large tissue defects otherwise destined for major amputation. However, the number of patients treated with this combined approach is limited, and data regarding long-term follow-up and functional outcome are scarce. We therefore report our 10-year experience in free flap transplantation after vascular reconstruction as a last attempt for limb salvage, with special emphasis of complication rate, limb salvage, and postoperative mobility., Methods: CLI patients undergoing combined vascular reconstruction and consequent free flap transfer from 2003 to 2013 were retrospectively observed. Of 80 cases in total, patients with traumatic and oncologic indications were excluded; 33 (mean age, 66 years; range, 51-82 years) of these cases were performed for limb salvage and were included in this study. Long-term follow-up was possible in 32 of 33 patients (mean, 58 months; range, 2-126 months)., Results: Thirty-three patients were analyzed. We performed arterial revascularization with 9 arteriovenous loops, 23 bypass grafts (10 popliteal-pedal, 9 femoral-crural, and 4 femoral-popliteal), and 1 venous interposition graft. For defect coverage, tissue transfer was comprised of six different flap entities (10 latissimus dorsi, 2 gracilis, 1 anterior lateral thigh, 7 rectus abdominis, 11 radialis, and 2 greater omentum flaps). Complications occurred in 16 of 33 patients (49%). Early complications included eight acute occlusions of arterial reconstructions; major bleedings were seen in eight patients as well. There were two flap losses and one major amputation in the early postoperative period. No in-hospital deaths were observed. Late results revealed a limb salvage rate of 87% after 1 year and 83% after 5 years. Amputation-free survival was 87% after 1 year and 75% after 5 years. Overall survival was 100% and 87% after 1 year and 5 years, respectively. Follow-up showed 42% of patients with no limitations in ambulation, 54% with maintained preoperative ambulatory status, and one bedridden patient., Conclusions: The combined approach for limb salvage in CLI patients is associated with excellent results in limb salvage and functional outcome in patients who would otherwise be candidates for major amputation, despite an initially elevated complication rate. The option of combined revascularization with free tissue transfer should be evaluated in all mobile patients with CLI, large tissue defects, and exposed tendon or bone structures before major amputation. However, further studies are required to support these results., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Local perforator flaps have become a standard procedure in reconstructive surgery. They allow the transfer of large tissue units with minimal donor-site morbidity. However, clinical studies on flap perfusion changes over time are lacking. The aim of this study was to investigate the perfusion of free-style single perforator flaps with an eccentrically located main perforator by combined laser Doppler spectrophotometry., Patients and Methods: Ten patients (six male, four female, 29-71 years) were included in this prospective clinical study. All flaps were based on one perforator. Flaps were harvested from the trunk (n = 6) or the proximal upper or lower extremity (n = 4). Flap perfusion was assessed using a combined laser Doppler spectrophotometry (CLDS) device (O2C, Oxygen to See, LEA Medizintechnik, Giessen, Germany) at days 0, 1, 7 and 14 in different zones., Results: Flap dimensions were 18.6 ± 4.7 × 7.2 ± 1.6 cm. Two flaps developed minor tip necroses (<10%), eight flaps survived completely. CLDS proved to be very sensitive for the detection of regional perfusion problems. A considerable perfusion gradient was observed at days 0 and 1. Here, reduced blood flow and post-capillary oxygen saturations were found at the tip when compared to the region above main perforator (RAMP). Blood flow remained stable proximally while it improved significantly from day 1 to 14 at the tip region., Conclusion: CLDS is an effective method for objective evaluation of flap perfusion. Although distal flap perfusion is diminished initially, the majority of perforator flaps with eccentrically located perforators survive completely. Obviously, flap perfusion improved between days 1 and 14. This clinical finding might be explained by reorganisation of the vascular system with opening of so-called connecting or choke vessels. This knowledge might influence decision making in perforator flap surgery., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

We present the case of an 8-year-old girl who suffered from acute myeloid leukaemia-related necrotising fasciitis in her early childhood resulting in severe skin and soft-tissue loss with subsequent circumferential thoracic scar formation. While tissue expander use yielded successful skin replacement for median scar areas, ribs were covered with ultrathin skin envelope at the lateral thoracic wall leading to growth and shoulder abduction impairment. Skin and soft-tissue reconstruction of these extended rib areas was aimed for in a one-step approach. Both lateral thoracic walls were successfully reconstructed with free microsurgical transfer of large pre-expanded tensor fasciae latae flaps, in order to enable future thoracic growth., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Three-dimensional (3D)-imaging modalities for pre-operative mapping of perforators in DIEP and ms-TRAM flap surgery are well established. While zonal perfusion of such flaps has been extensively studied pre-, intra- and post-operatively, the role of objective perfusion assessment for decision making between different possible perforator configurations has not been investigated yet. In this study, a combined lased Doppler spectrophotometry (CLDS) system was applied intra-operatively to support the surgeon's decision-making process., Methods: In this prospective study, 25 consecutive unilateral abdominal flaps were included. Computed tomographic angiography (CTA) was performed prior to surgery. By CLDS the post-capillary oxygen saturation, relative haemoglobin content and relative bloodflow were determined at different time points and in four standardised zones in dependence of different possible perforator/pedicle vessel configurations (with selective clamping of different perforators and/or the superficial inferior epigastric vein). Results were correlated with clinical findings and late results were evaluated after 6-16 months., Results: Ninety-six percent of the flaps survived. No significant fat necrosis was observed. While there was a high correlation between clinical findings and CLDS results, CLDS was more sensitive in identification of venous congestion of DIEP flaps. The technique helped to identify the dominant perforator(s) in flaps where perfusion patterns were unclear. CLDS influenced intra-operative decision making in five cases (two venous and one arterial in-flap anastomosis and inclusion of additional perforators in two flaps)., Conclusion: Intra-operative use of CLDS helps to objectively determine perfusion patterns in abdominal flaps. CLDS might be applicable in 'complex' abdominal flaps (e.g., after previous abdominal surgery or when preoperative CTA does not provide conclusive results) and supports, in these cases, intra-operative decision-making., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Early and reliable closure of large meningomyelocoele defects in newborns is critical to prevent severe infectious complications and neurologic deterioration. Here, we introduce a new surgical method for the reconstruction of large horizontal meningomyelocoele defects, in which we use unilateral myocutaneous tissue based on the superior gluteal artery (SGA) as a propellar flap. This procedure permits a tension-free and durable multilayer closure of difficult, large-scale horizontal defects that cannot adequately be treated by conventional myocutaneous advancement flaps. The technique is reliable and straightforward and requires no skin grafts or relaxing incisions. The SGA-based myocutaneous propeller flap might be a promising alternative for complex meningomyelocoele reconstructions in the future., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Propeller perforator flaps supplied by branches from the transverse cervical artery allow transport of skin from the back region to supraclavicular defects. This article describes a soft tissue defect following resection of melanoma metastasis that was successfully reconstructed using a propeller flap based on a perforator originating from the anterior part of the cranial trapezius muscle. This technique should be considered as an alternative to commonly used muscle or myocutanous flaps in selected cases., (Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. We aimed to compare functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs)., Methods: Between 2003 and 2006, 52 patients (24 DSFs and 28 PBFs) were included. For increased reliability, all extended sural flaps were delayed for 3-15 days. At the end of the follow-up period (minimum 12 months), patients were asked to fill out a modified foot and ankle score (Foot and Ankle Outcome Score (FAOS)) questionnaire. In addition, a chart review and a physical examination were performed., Results: Total hospital stay and total number of operations were significantly lower in the PBF group. Minor flap necrosis (<10%) was observed in 21% of the DSF and 7% of the PBF group, and partial (>10%) or total flap loss occurred in one and three patients from the DSF group, respectively. Patient satisfaction, FAOS results and range of motion were comparable in both groups. Defect aetiology and patient age did not influence surgical outcome., Conclusion: Donor-site morbidity and functional outcome after DSF and PBF are comparable. A higher rate of complications was observed in the DSF group. Based on our findings, the PBF is recommended as first-line procedure for reconstruction of small- to medium-sized defects at the distal tibia, fibula, ankle and heel. The sural flap might be chosen for extended skin defects especially when a larger arc of rotation is required., (Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Our study addressed the question of whether surface properties of modern standard gel prostheses may have a measurable impact on the fibrogenic properties of cultured human dermal fibroblasts. Fibroblasts were isolated from breast implants by using the explant culture technique and incubated either on smooth or on textured silicone elastomere surfaces. Fibroblast growth was observed 4 weeks following incubation. Expression of transforming growth factor (TGF)-β1 was measured after cell culture. Incubated fibroblasts on textured surfaces showed a fivefold lower growth rate during all experiments. TGF-β1 expression was lowered in smooth surface fibroblasts compared with textured surface cultures. Our results show that smooth and textured silicone surfaces of modified gel breast implants have a different impact on the fibroproliferative properties of dermal fibroblasts. These preliminary results seem promising and we aim to further perform qualitative and quantitative analyses of the inflammatory processes in the environment of the implant and their link to the TGF-β pathway., (Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

There is still sparse information published about the surgical correction of female funnel chest deformity. Women with severe asymmetric funnel chest deformity often present with asymmetric, hypoplastic breasts. These patients frequently complain of physiological limitations in connection with gross aesthetic impairment. To correct these two features a combined approach is presented in this study. 10 women were operated with correction of the thoracic wall deformity by open retrosternal mobilisation and metal plate fixation. Either during the same procedure or in a secondary operation, submuscular breast augmentation was performed to correct breast hypoplasia and asymmetry. All patients tolerated the operation very well without any complications. Aesthetic outcome was rated good to excellent in secondary breast augmentation, whereas simultaneous implant positioning was prone to cause symmastia. In conclusion we recommend correction of female asymmetric funnel chest by primary sternal reduction with secondary breast augmentation during metal plate removal 1 year after.