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ABSTRACT: Cultured human fibroblasts have been used for soft-tissue augmentation in the face. However, if cultured cells are to be used clinically, the approval of the Food and Drug Administration and time-consuming culturing procedures are required. For this reason, we investigated adipose-derived stromal vascular fraction (SVF) cells, which could be obtained in large quantities without cell culture. However, unlike fibroblasts, SVF cells are a heterogenic cell population. Therefore, it was hypothesized that a SVF cell graft may possibly form various tissues. This study was performed to determine what tissue would form after a graft of SVF cells. Stromal vascular fraction cells were isolated from liposuctioned human adipose tissue. For a test group, SVF cells were suspended in hyaluronic acid filler. For a control group, no cells were included in the filler. These implants were subcutaneously injected into the backs of 4 nude mice. After 16 weeks, the injection areas were excised, and histologic examination was performed including immunohistochemistry to confirm the presence of human collagen. The test group specimens revealed fibrous connective tissues infiltrating into and surrounding the hyaluronic acids. Collagen fibers and fibroblasts were found around newly formed vascular structures. In contrast, the control group did not show cells or hyaluronic acid particles. Immunohistochemistry of the test group displayed strong expression of human collagen. However, the control group exhibited negative staining. This suggests that transplanted uncultured human SVF cells combined with hyaluronic acid filler generate fibrovascular tissue.
The Journal of craniofacial surgery 03/2013; 24(2):636-9. · 0.81 Impact Factor
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ABSTRACT: Oncostatin M (OSM) is a multifunctional cytokine found in a variety of pathologic conditions, which leads to excessive collagen deposition. Current studies demonstrate that OSM is also a mitogen for fibroblasts and has an anti-inflammatory action. It was therefore hypothesised that OSM may play an important role in healing of chronic wounds which usually involve decreased fibroblast function and persist in the inflammatory stage for a long time. In a previous in vitro study, the authors showed that OSM increased wound healing activities of diabetic dermal fibroblasts. However, wound healing in vivo is a complex process involving multiple factors. Thus, the purpose of this study was to evaluate the effect of OSM on diabetic wound healing in vivo. Five diabetic mice were used in this study. Four full-thickness round wounds were created on the back of each mouse (total 20 wounds). OSM was applied on the two left-side wounds (n = 10), and phosphate-buffered saline was applied on the two right-side wounds (n = 10). After 10 days, unhealed wound areas of the OSM and control groups were compared using the stereoimage optical topometer system. Also, epithelialisation, wound contraction, and reduction of wound volume in each group were compared. The OSM-treated group showed superior results in all of the tested parameters. In particular, the unhealed wound area and the reduction of wound volume demonstrated statistically significant differences (P < 0·05). The results of this study indicate that topical application of OSM may have the potential to accelerate healing of diabetic wounds.
International Wound Journal 11/2012; · 1.46 Impact Factor
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ABSTRACT: Selecting a proper reconstruction method is the key to success in skin cancer management, especially for lesions involving the face. Using a skin graft is usually straightforward when covering a skin defect; however, major concerns in skin grafting include a poor color match in the recipient-site and donor-site morbidity. To overcome these limitations, the authors have developed a dermis graft, which utilizes a de-epithelialized split-thickness skin graft method. The purpose of this retrospective study was to report reliability of dermis grafts after removal of basal cell carcinomas (BCCs) on the face by presenting our clinical experience with them. This study included 38 patients who were treated for facial defects created by resection of BCCs. The locations of the defects were as follows: nose (n = 17), orbital area (n = 14), cheek (n = 4), temple area (n = 2), and forehead (n = 1). The defects ranged in size from 3.3 to 6.5 cm. Functional and cosmetic outcomes, postoperative complications, and patient satisfaction were assessed. The patients were followed up for 12 to 36 months. The entire dermis graft re-epithelialized after grafting within 17 to 27 days. Most of the patients had satisfactory results in both functional and cosmetic matters with high-quality skin characteristics. There were no significant complications and no recurrences were observed during the follow-up period. Patient satisfaction with the dermis graft was also excellent. The dermis graft may be used reliably for covering defects after removal of BCCs on the face.
The Journal of craniofacial surgery 11/2012; 23(6):1895-7. · 0.81 Impact Factor
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ABSTRACT: A large number of silver-based dressings are commonly used in the management of chronic wounds that are at risk of infection, including diabetic foot ulcers. However, there are still controversies regarding the toxicity of silver dressings on wound healing. The purpose of this study was to objectively test the cytotoxicity of silver dressings on human diabetic fibroblasts. Human diabetic fibroblasts were obtained from the foot skin of four diabetic foot ulcer patients and cultured. The effect of five silver-containing dressing products (Aquacel Ag, Acticoat*Absorbent, Medifoam Ag, Biatain Ag and PolyMem Ag) and their comparable silver-free dressing products on morphology, proliferation and collagen synthesis of the cultured human diabetic fibroblasts were compared in vitro. In addition, extracts of each dressing were tested in order to examine the effect of other chemical components found in the dressings on cytotoxicity. The diabetic fibroblasts cultured with each silver-free dressing adopted the typical dendritic and fusiform shape. On the other hand, the diabetic fibroblasts did not adopt this typical morphology when treated with the different silver dressings. All silver dressings tested in the study reduced the viability of the diabetic fibroblasts and collagen synthesis by 54-70 and 48-68%, respectively, when compared to silver-free dressings. Silver dressings significantly changed the cell morphology and decreased cell proliferation and collagen synthesis of diabetic fibroblasts. Therefore, silver dressings should be used with caution when treating diabetic wounds.
International Wound Journal 04/2012; · 1.46 Impact Factor
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ABSTRACT: Although various commercially available filler materials are now commonly used, their variable degrees of resorption require repeated percutaneous injections. To overcome these drawbacks, a new injectable in vitro differentiated adipocyte filler has been developed, and animal studies have demonstrated that implantation of the filler successfully enhances in vivo adipose tissue formation. This study was undertaken to evaluate the clinical efficacy of this method, particularly in soft tissue augmentation.
Autologous adipose-derived stromal cells were isolated, cultured, and differentiated to adipocytes in vitro. The differentiated adipocytes were suspended in Dulbecco's modified Eagle medium and injected into the lesion requiring soft tissue augmentation. Eight patients were treated with this tissue-engineered filler. Long-term follow-up for longer than 1 year was possible in all patients.
Two or 3 weeks after the injection, volume increment of subcutaneous tissue was observed around the injection area in the ensuing 1 to 5 weeks. Thereafter, additional volume augmentation was not found and the augmentation effect was well-maintained. All patients agreed on the clinical effectiveness of the procedure, and no complications occurred.
The results obtained indicate that this method is well tolerated and may be an effective means of achieving soft tissue augmentation. The authors have indicated no significant interest with commercial supporters.
Dermatologic Surgery 06/2011; 37(6):760-7. · 1.80 Impact Factor
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ABSTRACT: To obtain a wide and clean operative field for anatomic reconstruction of medial orbital blowout fractures, an alternative method called the subcaruncular approach has been performed. Between March 2008 and June 2010, this method was applied to the orbits of 41 patients with isolated pure medial orbital blowout fractures. A medial half conjunctival incision was made and extended meticulously to the subcaruncular area through preseptal plane under direct vision. Pre- and postoperative computed tomographic scans and ophthalmic examinations were performed, and clinical results were assessed. Postoperatively, computed tomographic scans revealed anatomic reduction of orbital soft tissues and the reconstructed medial orbital wall to be in proper position in all cases, and diplopia and eyeball motility limitation were resolved in most patients. There were no complications except severe chemosis in one case. We believe that this method can be a useful alternative option for the anatomic reconstruction of medial orbital blowout fractures.
Annals of plastic surgery 05/2011; 68(6):588-93. · 1.29 Impact Factor
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ABSTRACT: We report a case of 2-staged reconstruction of flexor tendons ruptured spontaneously by attrition. A 49-year-old man presented with inability to flex the ring and little fingers of his left hand. Preoperative computed tomographic scans revealed fracture of the hamate hook. At the time of the operation, both the flexor superficialis and profundus of the little finger and the flexor profundus tendon of the ring finger were ruptured adjacent to the fracture site of the hamate. Because the flexor tendon rupture secondary to the fracture of the hamate is extremely rare, and surgical outcomes of previous reports are not satisfactory, a decision was made to perform 2-staged reconstruction of ruptured flexor tendons. The surgical result was excellent with complete restoration of full range of motion. This report describes for the first time to our knowledge, the technique, and rehabilitation of 2-staged tendon reconstruction in a patient with hook of hamate fracture.
Annals of plastic surgery 05/2011; 69(2):157-60. · 1.29 Impact Factor
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ABSTRACT: BACKGROUND Although various commercially available filler materials are now commonly used, their variable degrees of resorption require repeated percutaneous injections. To overcome these drawbacks, a new injectable in vitro differentiated adipocyte filler has been developed, and animal studies have demonstrated that implantation of the filler successfully enhances in vivo adipose tissue formation. This study was undertaken to evaluate the clinical efficacy of this method, particularly in soft tissue augmentation. MATERIALS AND METHODS Autologous adipose-derived stromal cells were isolated, cultured, and differentiated to adipocytes in vitro. The differentiated adipocytes were suspended in Dulbecco's modified Eagle medium and injected into the lesion requiring soft tissue augmentation. Eight patients were treated with this tissue-engineered filler. Long-term follow-up for longer than 1 year was possible in all patients. RESULTS Two or 3 weeks after the injection, volume increment of subcutaneous tissue was observed around the injection area in the ensuing 1 to 5 weeks. Thereafter, additional volume augmentation was not found and the augmentation effect was well-maintained. All patients agreed on the clinical effectiveness of the procedure, and no complications occurred. CONCLUSIONS The results obtained indicate that this method is well tolerated and may be an effective means of achieving soft tissue augmentation. The authors have indicated no significant interest with commercial supporters.
Dermatologic Surgery 04/2011; · 1.80 Impact Factor
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ABSTRACT: Percutaneous transluminal angioplasty (PTA) has been performed as an alternative to bypass surgery for improving tissue oxygenation in ischemic diabetic feet because the former is less invasive than the latter. The purpose of this study was to evaluate the effect of PTA on tissue oxygenation in ischemic diabetic feet. This study included 29 ischemic diabetic feet, as determined by a transcutaneous oxygen pressure (TcPO(2) )<30 mmHg. The PTA was carried out in 29 limbs. The PTA procedure was considered successful, acceptable, and failed when residual stenosis was<30%, between 30 and 50%, and>50%, respectively. For evaluation of tissue oxygenation, the foot TcPO(2) was measured before PTA and weekly for 6 weeks after PTA. Immediately after PTA, 26 feet were evaluated as being successful and the remaining three as acceptable. Before PTA, the average foot TcPO(2) was 12.7 ± 8.9 mmHg. The TcPO(2) values were increased to 43.6 ± 24.1, 51.0 ± 22.6, 58.3 ± 23.0, 61.3 ± 24.2, 59.0 ± 22.2, and 53.8 ± 21.0 mmHg 1, 2, 3, 4, 5, and 6 weeks after PTA, respectively (p<0.01). The PTA procedure significantly increases tissue oxygenation in ischemic diabetic feet. The maximal level of tissue oxygenation was measured on the fourth week following PTA.
Wound Repair and Regeneration 01/2011; 19(1):19-24. · 2.91 Impact Factor
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ABSTRACT: Although various methods for reconstruction of burn alopecia have been described in case reports and small case series, a comprehensive comparison of these methods has not been performed. The purpose of this study was to assess the appropriateness of the clinical indications for the various reconstructive methods for burn alopecia and suggest an algorithm for individualized reconstruction. A review of 83 patients who underwent reconstruction for burn alopecia between 1995 and 2007 was conducted. Demographics, associated injuries, preoperative findings, surgical techniques, and postoperative complications were collected. From these data, we classified reconstructive methods based on the area, the scar quality, and the location of the burn alopecia, and investigated the clinical outcomes. Reconstructive methods included hair grafting (n = 13), scalp reduction (n = 21), scalp extension (n = 14), and scalp expansion (n = 37). Hair grafting was mainly performed for reconstruction of small, good-quality burn alopecia located in the frontal or parietal area. Scalp reduction was primarily used in small or medium burn alopecia in which scar quality was good or moderate. Scalp extension was mainly performed for reconstruction of medium- and moderate-quality burn alopecia; scalp extension was particularly successful in the vertex region. Scalp expansion was the reconstructive procedure of choice for large, poor-quality burn alopecia. Twenty-eight (33.7%) patients experienced surgical complications and most of the complications were related to alloplastic implants used in scalp extension and expansion. The reconstructive method should be tailored to the conditions of the burn alopecia. Because scalp extension and expansion are associated with a high rate of complications, the authors recommend the use of these methods for large, poor-quality burn alopecia. On the other hand, hair grafting and scalp reduction are more appropriate treatment options for relatively small, good-quality burn alopecia.
Annals of plastic surgery 09/2010; 65(3):330-7. · 1.29 Impact Factor
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ABSTRACT: Many clinical trials have shown the effectiveness of platelet releasate on chronic wound healing, but large volumes of blood must be aspirated from patients and a platelet separator is required. Moreover, in the case of using homologous platelets, time and effort are needed to locate a suitable donor, and the donor's blood sample must be tested for a history of infectious disease. The current study was undertaken to evaluate the effect of a straightforward method using a blood bank platelet concentrate in treating diabetic foot ulcers.
Fifty-two patients with diabetic foot ulcers were treated using a blood bank platelet concentrate. A control treatment (i.e., treatment with topical fibrinogen and thrombin) was performed on 48 patients. Twelve weeks after treatment, the percentage of complete healing, mean healing time, percentage of wound shrinkage, and patient satisfaction were compared.
Complete wound healing was achieved in 79 percent of the blood bank platelet concentrate-treated group and 46 percent of the control group (p < 0.05). The times required for complete healing were 7.0 +/- 1.9 and 9.2 +/- 2.2 weeks in the blood bank platelet concentrate-treated and control groups, respectively (p < 0.05). The degrees of wound shrinkage were 96.3 +/- 7.8 and 81.6 +/- 19.7 percent for the treated and control groups, respectively (p < 0.05). Patient satisfaction with the blood bank platelet concentrate treatment yielded better results than the control method (mean score, 7.6 +/- 1.6 and 5.3 +/- 1.4, respectively; p < 0.05). No adverse events related to the study treatment occurred.
Treatment of diabetic foot ulcers using a blood bank platelet concentrate showed results superior to control treatment. A blood bank platelet concentrate offers a simple and effective treatment for diabetic foot ulcers.
Plastic and reconstructive surgery 03/2010; 125(3):944-52. · 2.74 Impact Factor
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Plastic and reconstructive surgery 01/2010; 125(1):32e-33e. · 2.74 Impact Factor
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ABSTRACT: Studies regarding nasal bone fractures have mainly focused on esthetic aspects, but the nose also plays an important role as an airway. The purpose of this study was to evaluate the influence of nasal bone fractures and the treatment of nasal bone fractures on nasal obstruction. Nasal bone fractures were classified by fracture site and septal displacement. Nasal airways were investigated at 3 time points: before reduction (n = 84), 6 days postreduction (n = 84), and 1-year postreduction (n = 27). Airway changes were based on minimal cross-sectional area measurements. The severity of airway obstruction following fracture differed according to the fracture site and the presence of septal displacement. Bilateral fractures caused more profound airway obstruction than unilateral or tip fractures and septal displacement was the most important parameter in nasal obstruction. Airway obstruction improved immediately after reduction by 21% and deteriorated by 4% 1-year postreduction.
Annals of plastic surgery 08/2009; 63(1):63-6. · 1.29 Impact Factor
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ABSTRACT: Various types of allogenic skin substitutes composed of cryopreserved keratinocytes, fibroblasts, or both have been used for treatments of diabetic foot ulcers, but the effects have generally not been dramatic because cryopreservation impairs cell activities. The purpose of the study was to evaluate the use of non-cryopreserved fresh human fibroblast allografts in treating diabetic foot ulcers.
Human dermal fibroblasts from healthy teenagers were cultured and applied over the foot ulcers of 37 patients with diabetes. Control treatment was performed in 18 patients. Eight weeks after treatment, the percentages of complete healing, mean healing times, and patient satisfaction were compared, with follow-up ranging from 6 to 40 months.
Our study showed that 83.8% of the treated group and 50.0% of the control group experienced complete healing. The times required for complete healing were 30.9+/-10.1 and 47.2+/-7.8 days in the treated and control groups, respectively. Patient satisfaction with fresh fibroblast treatment was also superior to satisfaction with the conventional method (mean scores: 8.0+/-1.0 and 4.9+/-1.4, respectively). No adverse events related to the study treatment occurred.
The use of fresh human fibroblast allografts was found to be a safe and effective treatment for diabetic foot ulcers. The authors have indicated no significant interest with commercial supporters.
Dermatologic Surgery 07/2009; 35(9):1342-8. · 1.80 Impact Factor
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ABSTRACT: In previous pilot studies, the authors reported that bone marrow stromal cells (BSCs) have a superior effect on healing of acute wounds compared with fibroblasts in vitro and in vivo. The present study was designed to compare the effect of allograft of normal BSCs with that of normal fibroblasts on the activity of diabetic fibroblasts in vitro. Diabetic fibroblasts were cultured in 24-well culture plates. Three groups were evaluated: group I, diabetic fibroblasts only; group II, diabetic fibroblasts co-cultured with normal fibroblasts; group III, diabetic fibroblasts co-cultured with normal BSCs. After 3-day incubation, cell proliferation and collagen synthesis, which are the major contributing factors in wound healing, were measured. Group III showed the highest level in both cell proliferation and collagen synthesis, followed by group II and group I (p<0.05). These results demonstrate that BSCs are superior to fibroblasts in stimulating the activity of diabetic fibroblasts.
Journal of Plastic Reconstructive & Aesthetic Surgery 05/2009; 63(6):1030-5. · 1.49 Impact Factor
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Plastic and reconstructive surgery 03/2009; 123(2):88e-89e. · 2.74 Impact Factor
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Plastic and reconstructive surgery 06/2008; 121(5):334e-335e. · 2.74 Impact Factor
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ABSTRACT: Posttraumatic nasal deformities may not be adequately corrected by conventional osteotomy techniques when the configuration of the nasal bone has been changed as a result of malunion. The purpose of this study is to present an osteotomy technique, including refracture along malunion sites and anatomic reduction of a malformed nasal bone, for the correction of a posttraumatic deviated nose. From March 2003 to May 2004, 27 patients, who underwent corrective rhinoplasty for the correction of bony pyramid deviation, were included in this study. Postoperative results were evaluated regarding nasal midline location, nasal symmetry, and nasal contour. All patients were also evaluated subjectively for cosmetic improvement, changes in breathing, and overall satisfaction. Objective results of the technique were excellent and patients' satisfaction levels were also very positive. The osteotomy technique presented in this study is simple, effective, and safe for correcting posttraumatic nasal deviation and also produces consistent results.
Journal of Craniofacial Surgery 04/2008; 19(2):476-81. · 0.82 Impact Factor
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Plastic & Reconstructive Surgery 01/2008; 121(2):684-685. · 3.38 Impact Factor
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ABSTRACT: In a previous in vitro study, the authors reported that bone marrow stromal cells (BSCs) have better wound-healing activities than fibroblasts. The purpose of this study was to evaluate the effect of BSCs and fibroblasts on wound-healing activity in vivo. Cultured human BSCs and dermal fibroblasts taken from the same patients were tested to compare collagen synthesis and epithelization in a rat wound model. No-cell-treated animals were used as controls. The BSC group showed the highest collagen level, followed by the fibroblast group, and then the no-cell group (P < 0.05). In addition, the best epithelization was observed in the BSC group. These results demonstrate that BSCs better stimulate wound healing than fibroblasts in vivo and in vitro.
Annals of Plastic Surgery 12/2007; 59(6):713-9. · 1.32 Impact Factor
