Soft tissue regeneration with cell and tissue engineering-based approaches has numerous potential applications in plastic and reconstructive surgery. Adipose-derived stem cells (ASC) have been proved as a feasible source for adipose tissue engineering as they possess high proliferative and differentiation capacity. The purpose of our study was to evaluate adipogenic differentiation of human ASC in four different 3D scaffolds of natural origin, namely human platelet-poor plasma, alginate, fibrin gel and collagen sponge, to define their suitability for adipose tissue engineering and potential clinical applications. ASC were isolated from lipoaspirates of three adult female patients, seeded in the scaffolds, and adipogenic differentiation was induced. After two weeks of cultivation, the constructs were assessed for their mechanical and handling properties, cell viability and adipogenic differentiation. Additionally, the expression of vascular endothelial growth factor (VEGF) was analysed in different culture systems. The results indicate that the levels of specific adipogenic markers and VEGF expression were increased in 3D cultures, as compared to 2D culture. Among 3D scaffolds, fibrin gel showed optimal combination of mechanical characteristics and support of adipogenic differentiation; it was easy to handle, allowed high cell viability, and at the same time supported adipogenic differentiation and VEGF expression.
Fat necrosis within a deep inferior epigastric artery perforator flap reconstructed breast is considered a minor complication from reconstructive point of view, but one that can induce anxiety, inconvenience and concerns about cancer recurrence to the oncologist and the patient. A series of 100 consecutive unilateral deep inferior epigastric artery perforator flap breast reconstructions were reviewed to identify the institutional incidence as well as potential risk and predictor factors of fat necrosis. Examination revealed 37 reconstructed breasts with palpable firmnesses (described as clinical fat necrosis) and ultrasonography and mammography confirmed signs of fat necrosis in 30 reconstructed breasts. Flaps harvested on a single perforator, obese patients with body mass index > or = 30 and revision operations were all statistically significant predictors in our statistical model. Postoperative radiotherapy, a reconstructed breast volume over 500 mL and a pedicle raised on a single row of perforators were statistically significant only after univariate analysis and their statistical strength was lost after introducing them with multivariate model. This study helped us to further clarify criteria for selection of patients undergoing breast reconstruction with flaps from the abdomen.
Cell therapies present a feasible option for the treatment of degenerated cartilaginous and intervertebral disc (IVD) tissues. Microenvironments of these tissues are specific and often differ from the microenvironment of cells that, could be potentially used for therapy, e.g. human adipose-derived stem cells (hASC). To ensure safe and efficient implantation of hASC, it is important to evaluate how microenvironmental conditions at the site of implantation affect the implanted cells. This study has demonstrated that cartilaginous tissue-specific osmolarities ranging from 400-600 mOsm/L affected hASC in a dose- and time-dependent fashion in comparison to 300 mOsm/L. Increased osmolarities resulted in transient (nuclear DNA and actin reorganisation) and non-transient, long-term morphological changes (vesicle formation, increase in cell area, and culture morphology), as well as reduced proliferation in monolayer cultures. Increased osmolarities diminished acid proteoglycan production and compactness of chondrogenically induced pellet cultures, indicating decreased chondrogenic potential. Viability of hASC was strongly dependent on the type of culture, with hASC in monolayer culture being more tolerant to increased osmolarity compared to hASC in suspension, alginate-agarose hydrogel, and pellet cultures, thus emphasizing the importance of choosing relevant in vitro conditions according to the specifics of clinical application.
In our tertiary Plastic surgery unit the number of breast reconstruction patients is rapidly increasing due to better patient education provided by general practitioners, oncologist surgeons and enhanced media coverage. The yet unfinished trend presents us with a high volume of cases seen at a joint meeting of oncology and reconstruction surgeons where treatment options in terms of reconstruction are discussed. We have noticed that more and more patients have rather firm inclination towards certain type of reconstruction, many decidable decline free tissue transfer. We usually inform the patient on other treatment options but try to endorse their original decision when clinically sound. Along with cases not feasible for autologous reconstruction (unsuitable donor area, inconvenient general condition) the proportion of reconstruction with expander and breast implant versus autologous reconstruction is approximately 60 percent. We present our experience with expanders McGhan style 133 and expander prosthesis style 150.
Pareza obraznega živca ima lahko za bolnika hude posledice, ki se kažejo kot iznakaženost obraza, in funkcionalne motnje, ki kot take vplivajo tudi na duševno zdravje. Zdravljenje pareze je odvisno od vzroka zanjo. Ob ugotovitvi, da je pareza dokončna in izboljšanja ni pričakovati, se v plastični in rekonstruktivni kirurgiji poslužujemo različnih tehnik reanimacije obraza.
Za katere posege se bomo odločili, je ključnega pomena obdobje trajanja pareze, ki ga delimo na akutno, intermediarno in kronično. Glede na ta podatek se odločamo, kateri rekonstruktivni poseg je za bolnika najbolj primeren in pri katerem lahko pričakujemo najboljši rezultat. V članku so tehnike reanimacije za vsako obdobje natančno opisane.
Pri nas je bilo v obdobju med letoma 2008 in 2017 na Kliničnem oddelku za plastično, rekonstruktivno in estetsko kirurgijo in opekline UKC Ljubljana zaradi pareze obraznega živca obravnavanih 66 bolnikov, pri katerih so bili opravljeni opisani posegi. V članku je tudi predstavljena naša dosedanja statistika.
Poleg pravilne izbire in izvedbe kirurškega posega je pri parezi obraznega živca potrebno poudariti predvsem pomembnost zgodnje prepoznave in napotitve bolnikov v usmerjene specialistične centre, kjer so deležni individualne in celostne obravnave.
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