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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for Traumatology The Research Center in Cooperation with AUVAViennaAustria University Clinic of Dentistry Medical University of ViennaViennaAustria department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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New autologous material for the frontalis suspension technique:superficial temporal fascia

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International Journal of Ophthalmology(English edition) 2016年第2期9卷 315-317页

作者： Elif Sari Hulda Rifat Ozakpinar Ali Teoman Tellioglu department of Plastic Reconstructive and Aesthetic Surgery Kirikkale University Faculty of Medicine Clinic of Plastic Reconstructive and Aesthetic SurgeryDiskapi Yildirim Beyazit Education and Research Hospital department of Plastic Reconstructive and Aesthetic Surgery Yildirim Beyazit University Faculty of Medicine

The frontalis suspension technique, which is a well-known surgical procedure, has been used for congenital ptosis for many years [1]. Several autologous and foreign grafts or materials have been preferred for this suspension, such as collagen, tensor fascia lata, palmaris longus tendon, deep temporal fascia, catgut, prolene, silicone, stainless steel, and supramid suture . Each of these have their own advantages and disadvantages; however, the superficial temporal fascia has not been used for the frontalis suspension method before.

关键词： Figure New autologous material for the frontalis suspension technique

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Lateral Crus Graft with Autologous Rib Cartilage for Cleft Lip Nostril Asymmetry: A Report of 35 Cases

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第3期34卷 387-392页

作者：曹玮郗敏周芳冯幼平黄立 department of Plastic and aesthetic surgery Tongji Hospital Tongji Medical College Huazhong University of Science Technology

Summary： A surgical technique of lateral crus strut graft to correct the deformity of nostril contour and improve asymmetric nostril shape by autologous rib cartilage was reported. Thirty-five patients （20 males and 15 females）, with a mean age of 19 years （range of 16-26 years） were included in this study. All of the patients suffered moderate to severe unilateral cleft lip nostril deformity and underwent surgical technique of lateral crus strut graft by autologous rib cartilage to correct the asymmetric nostril contour from 2010 to 2012. The views of the nostril contour on both sides were reviewed and some parameters were measured at different time points （preoperatively, and 3 months and one year postoperatively） including the long axis and short axis of the nostrils. The differences in nostrils including long axis, short axis, elliptical area and eccentricity on the both sides were compared at different time points. The differences in the long axis and eccentricity of the nostrils on the two sides were decreased significantly between the preoperative view and postoperative view （P〈0.05）. The surgical technique of lateral crus graft with autologous rib cartilage is effective to correct the abnormal nostril contour and improve the asymmetry for unilateral cleft clip patients.

关键词： cleft lip rib cartilage nostril

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Differential diagnoses and treatment of lipedema

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Plastic and aesthetic Research 2020年第3期7卷 1-10页

作者： Maria Wiedner Donia Aghajanzadeh Dirk F.Richter department for Plastic and aesthetic surgery Dreifaltigkeitskrankenhaus WesselingWesseling 50389Germany

Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips,which affects almost purely *** beginning of the disease usually occurs with hormonal changes,such as puberty,pregnancy,or *** suffer from pain,easy bruising,and disfigurement,which may lead to early immobility and social *** diagnosis and treatment are *** differentiation between obesity and lipedema is difficult,as these two different entities often occur *** differential diagnoses are lymphedema,benign lipohypertrophy,and Dercum's disease.A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified *** physical therapy is the basic conservative treatment,which is usually necessary ***,liposuction has led to a paradigm shift in the treatment of *** purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.

关键词： Lipedema lymphedema obesity symmetrical limb enlargement adipositas dolorosa

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The impact of COVID-19 on clinical outcomes of burn patients

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Burns & Trauma 2023年第1期11卷 792-799页

作者： Elliot T.Walters Alen Palackic Camila Franco-Mesa Nikhil R.Shah Michael J.Erickson Steven E.Wolf department of surgery University of Texas Medical Branch301 UniversityGalvestonTXUSA Division of Plastic Aesthetic and Reconstructive SurgeryDepartment of SurgeryMedical University of GrazGrazAustria

Background:Multiple studies have shown the SARS-CoV-2 virus(COVID-19)to be associated with deleterious outcomes in a wide range of *** impact of COVID-19 has not been well investigated among burned *** suspect that patients will have worsened respiratory and thrombotic complications,ultimately leading to increased *** objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn ***:This is a retrospective,propensity matched,cohort *** examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020,to 31 July 2021,and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease,tenth revision(ICD-10)*** participants included adults who were treated for a burn injury during the study ***:We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection(total 1472 patients,mean age 36.3±24.3).We found no significant increase in mortality observed for patients with concurrent COVID-19(OR 1.203,95%CI 0.517-2.803;p=0.6675).We did observe significant increase in infections(OR 3.537,95%CI 2.798-4.471;p=0.0001),thrombotic complications(OR 2.342,95%CI 1.351-4.058;p=0.0018),as was the incidence of hypertrophic scarring(OR 3.368,95%CI 2.326-4.877;p=0.0001).Conclusions:We observed that concurrent COVID-19 infection was associated with an increase in infections,thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

关键词： COVID-19 infection mortality burn thrombosis scarring

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Salvage anastomosis in free PAP-flap breast reconstruction:What about free flap neovascularization?

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Chinese Journal of Plastic and Reconstructive surgery 2023年第4期5卷 178-181页

作者： Michael Hepp Aline Berners Christine Deconinck Genevieve Pirson Maxime Servaes Philippe Fosseprez department of Plastic Reconstructive and Aesthetic SurgeryCHU UCL NamurNamur 5000Belgium

Since the emergence of microsurgery in reconstructive surgery, free flaps have become a key tool in the management of patients with breast cancer. One such flap is the profunda artery perforator(PAP) flap. To date,there is no scientific consensus on whether voluminous free flaps remain dependent on their vascular pedicle throughout their lifespan. Therefore, the pedicle should always be carefully protected during revision *** this article, we review the case of a middle-aged woman who suffered a pedicle transection needing reanastomosis during revision surgery six months after free-flap breast reconstruction. A 52-year-old woman who noticed a firm nodule in her right breast and armpit was referred to our department for surgical management. The Caucasian woman presented with no significant medical history or symptoms at the first consultation. Ultrasound-guided biopsy confirmed an invasive grade Ⅲ lobular carcinoma. Following staging,the patient underwent neoadjuvant chemotherapy before a right mastectomy with a complete homolateral axillary lymph node dissection and postoperative radiotherapy. One year after completing radiotherapy, free flap reconstruction with a PAP flap was performed, and six months later, revision surgery was required to enhance the volume of the reconstructed breast with a tissue expander and later an implant. Unfortunately,pedicle transection occurred during revision surgery, causing complete devascularization of the flap, which was confirmed by intraoperative Indocyanine Green imaging. The authors elected to perform salvage reanastomosis during the surgery. In keeping with the author’s 23-year experience with free flaps, the vascular pedicle should always be preserved in voluminous free flaps, as neovascularization alone may not ensure whole flap survival. The authors suggest always attempting re-anastomosis if vessels are compromised during revision surgery.

关键词： Free flap Autonomy Vascular pedicle Revascularization PAP flap Microsurgery

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Clinical outcomes for Conduits and Scaffolds in peripheral nerve repair

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World Journal of Clinical Cases 2015年第2期3卷 141-147页

作者： David J Gerth Jun Tashiro Seth R Thaller Division of Plastic Aestheticand Reconstructive SurgeryDe Witt-Daughtry Family Department of SurgeryLeonard M. Miller School of MedicineUniversity of Miami

The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, *** include limited availability of donor tissue,sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies,researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive *** of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes.

关键词： Plastic surgery Reconstructive surgical procedures Nerve tissue Conduit Scaffold

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Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery

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World Journal of Clinical Oncology 2016年第1期7卷 114-121页

作者： Michael S Pollhammer Dominik Duscher Manfred Schmidt Georg M Huemer Section of Plastic Aesthetic and Reconstru-ctive Surgery Department of General Surgery Kepler University Hospital Linz MAZ - Microsurgical Training and Research Center

Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960 s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast recon-struction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.

关键词： Breast cancer Microsurgery Autologous tissue transfer Breast reconstruction Flap Transverse musculocutaneous gracilis Fasciocutaneous infragluteal Deep inferior epigastric perforator

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surgery for scar revision and reduction:from primary closure to flap surgery

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Burns & Trauma 2019年第1期7卷 58-65页

作者： Rei Ogawa department of Plastic Reconstructive and Aesthetic SurgeryNippon Medical School1-1-5 Sendagi Bunkyo-kuTokyo 113-8603Japan

Scars are the final result of the four processes that constitute cutaneous wound healing,namely,coagulation,inflammation,proliferation,and *** scars are produced if the wounds reach the reticular *** nature of these scars depends on the four wound healing *** the remodeling process is excessive,collagen degradation exceeds collagen synthesis and atrophic scars are *** the inflammation phase is prolonged and/or more potent for some reason,inflammatory/pathological scars such as keloids or hypertrophic scars can *** these pathological scars are located on joints or mobile regions,scar contractures can *** used with the appropriate timing and when selected on the basis of individual factors,surgical techniques can improve mature *** review paper focuses on the surgical techniques that are used to improve mature scars,burn scars,and scar *** methods include z-plasties,w-plasties,split-thickness skin grafting,full-thickness skin grafting,local flaps(including the square flap method and the propeller flap),and expanded flaps,distant flaps,regional flaps,and free flaps.

关键词： Scar Keloid Hypertrophic scar Scar contracture surgery Z-plasty W-plasty Local flap Expander Perforator flap

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Effect of Image Noise on the Classification of Skin Lesions Using Deep Convolutional Neural Networks

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Tsinghua Science and Technology 2020年第3期25卷 425-434页

作者： Xiaoyu Fan Muzhi Dai Chenxi Liu Fan Wu Xiangda Yan Ye Feng Yongqiang Feng Baiquan Su the Medical Robotics Laboratory School of AutomationBeijing University of Posts and TelecommunicationsBeijing 100876China. the department of Laser aesthetic surgery Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100144China.

Skin lesions are in a category of disease that is both common in humans and a major cause of *** classification accuracy of skin lesions is a crucial determinant of the success rate of curing lethal *** Convolutional Neural Networks(CNNs)are now the most prevalent computer algorithms for the purpose of disease *** with all algorithms,CNNs are sensitive to noise from imaging devices,which often contaminates the quality of the images that are fed into *** this paper,a deep CNN(Inception-v3)is used to study the effect of image noise on the classification of skin *** noise,impulse noise,and noise made up of a compound of the two are added to an image dataset,namely the Dermofit Image Library from the University of ***,based on t-distributed Stochastic Neighbor Embedding(t-SNE)visualization,Receiver Operating Characteristic(ROC)analysis,and saliency maps,demonstrate the reliability of the Inception-v3 deep CNN in classifying noisy skin lesion images.

关键词： skin lesion deep convolutional neural network image noise

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