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Evaluation eines neuen Biomaterials aus Carboxymethylcellulose zur Augmentation von Weichteilgewebe – eine Pilotstudie in Minipigs

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Background: Breast cancer is the most common noncutaneous malignancy among women worldwide. After a breast cancer removal procedure, women are asked to decide about breast reconstruction, mainly to improve their life quality, and they can choose from among many options. Broadly, there are two different types of breast reconstruction procedures: prosthetic implant-based reconstruction and autologous tissue-based reconstruction. Methods: Implant-breast reconstruction is a minimally invasive procedure compared with autologous breast reconstruction. It is associated with fewer short- and long-term complications. Results: The ideal candidates for implant-based reconstruction are patients with non-redundant soft tissue coverage, who desire a moderate sized non-ptotic breast and have not been previously irradiated. Conclusion: The state of the art for implant-breast reconstruction is briefly described in this article.
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Background: Soft tissue tumours of the abdominal wall account for approximately 10% of all soft tissue tumours. Tumours at this site comprise a heterogeneous group of pathologies with distinct clinical behaviours and responses to treatment. The management of these tumours has largely been extrapolated from studies of soft tissue tumours at other sites. This review aims to summarise the existing data relating to abdominal wall tumours and suggest principles for managing soft tissue tumours at this site. Methods: Relevant articles were retrieved from a comprehensive literature search using the PubMed database. Key words included abdominal wall, soft tissue tumours, surgery, radiotherapy and chemotherapy. No restrictions on publication date were used. Results: The most common pathologies presenting in the abdominal wall are desmoid tumours, soft-tissue sarcoma and dermatofibrosarcoma protuberans (DFSP). Desmoid tumours should be managed with an initial period of observation, with surgery reserved for progressive lesions. Surgery should be the primary treatment for soft-tissue sarcomas and DFSP, with radiotherapy reserved for large-high grade tumours and preferentially given pre-operatively. Conclusions: Abdominal wall tumours are rare and should be managed in centres with experience in the management of soft tissue tumours. Management should be tailored to the biological behaviour of specific pathologies.
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As the science and engineering of biomaterials continues to expand with increased emphasis on the development of nanomaterials and tissue engineering scaffolds, emphasis also must be placed on appropriate and adequate approaches to the in vivo and in vitro evaluation of biomaterial biocompatibility/biological response evaluation. This article presents six topic areas that should be addressed by investigators as they move forward in the development of new systems for regenerative medicine. Most certainly, there are other areas that require attention to detail and a more complete understanding of the strengths and weaknesses of various experimental approaches to biomaterial/biological response evaluation. The small number of issues addressed in this article is only meant to bring to the attention of prospective investigators and authors, the importance of the development of adequate and appropriate evaluation techniques that address the unique features of biomaterials utilized in the development of new medical devices.
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This study was conducted for evaluation of the ability to maintain efficacy and biocompatibility of cross-linked dextran in hydroxypropyl methylcellulose (DiHM) and cross-linked dextran mixed with PMMA in hydroxypropyl methylcellulose (PDiHM), compared with hyaluronic acid (HA) filler. Saline and HA solution was administered in the negative and positive control groups, and DiHM and PDiHM were administered in the test groups (n = 10 in each group). The site of cranial subcutaneous injection was the mid-point of the interpupillary line, and the site of intraoral submucosal injection was the ridge crest 2 mm below the cervical line of the mandibular left incisor. Before and immediately after filler injection, intraoral photos and lateral cephalometric radiographs were taken for analysis and comparison of the effect of the filler on the injection sites. The filler injected areas were converted into sequential size changes (%) of the baseline. Histomorphologic examination was performed after 12 weeks. The smallest value in the filler injected area was observed during the experimental period in the normal saline group (p < 0.001), which was almost absorbed at 4 weeks (7.19% ± 12.72%). The HA group exhibited a steady decrease in sequential size and showed a lower value than the DiHM and PDiHM groups (saline < HA < DHiM, PDHiM, p < 0.001). DiHM and PDiHM tended to increase for the first 4 weeks and later decreased until 12 weeks. In this study on DiHM and PDiHM, there was no histological abnormality in cranial skin and oral mucosa. DiHM and PDiHM filler materials with injection system provide an excellent alternative surgical method for use in oral and craniofacial fields.
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A liquid collagen has been developed that fibrilizes upon injection. Rapid polymerizing collagen (RPC) is a type I porcine collagen that undergoes fibrillization upon interaction with ionic solutions, such as physiological solutions. The ability to inject liquid collagen would be beneficial for many soft tissue augmentation applications. In this study, RPC was synthesized and characterized as a possible dermal filler. Transmission electron microscopy, ion induced RPC fibrillogenesis tests, collagenase resistance assay, and injection force studies were performed to assess RPC's physicochemical properties. An in vivo study was performed which consisted of a 1, 3, and 6 month study where RPC was injected into the ears of miniature swine. The results demonstrated that the liquid RPC requires low injection force (<7N); fibrillogenesis and banding of collagen occurs when RPC is injected into ionic solutions, and RPC has enhanced resistance to collagenase breakdown. The in vivo study demonstrated long-term biocompatibility with low irritation scores. In conclusion RPC possesses many of the desirable properties of a soft tissue augmentation material. This article is protected by copyright. All rights reserved.
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Radiesse(®) (Calcium hydroxylapatite [CaHA]) is a biocompatible, injectable gel for facial soft tissue augmentation. It is a completely biodegradable filler and this is well documented, but objective imaging methods to confirm this property are scarce. We present a case report in which CaHA was injected into the midface of a 50-year-old woman for volume restoration and shaping of the cheek region. On the right side of the face, 1.6 mL CaHA was injected as several (5-7) small depots (0.1-0.2 mL) using a 28G 3/4 inch needle and the vertical supraperiosteal depot technique. On the contralateral side of the face, the subject received 1.6 mL CaHA over three entry points using a 27G 1 1/2 inch blunt cannula and the fanning technique. CaHA location and degradation were assessed using magnetic resonance imaging (MRI). CaHA appears as low-to-intermediate signal intensity on MRI images taken immediately after injection for malar enhancement with a symmetrical distribution. On MRI images taken 2.5 years after injection, no CaHA was visible but tissue volume remained increased, indicating a collagen-stimulating effect. The treatment was well tolerated. In addition to producing long-lasting aesthetic and collagen-stimulating effects, MRI images confirm that CaHA is completely biodegradable with no product remaining 2.5 years after injection.
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Soft tissue augmentation is a process of implanting tissues or materials to treat wrinkles or soft tissue defects in the body. Over the years, various materials have evolved to correct soft tissue defects, including a number of tissues and polymers. Autogenous dermis, autogenous fat, autogenous dermis-fat, allogenic dermis, synthetic implants, and fillers have been widely accepted for soft tissue augmentations. Tissue engineering technology has also been introduced and opened a new venue of opportunities in this field. In particular, a long-lasting filler consisting of hyaluronic acid filler and living human mesenchymal cells called "injectable tissue-engineered soft tissue" has been created and applied clinically, as this strategy has many advantages over conventional methods. Fibroblasts and adipose-derived stromal vascular fraction cells can be clinically used as injectable tissue-engineered soft tissue at present. In this review, information on the soft tissue augmentation method using the injectable tissue-engineered soft tissue is provided. Graphical Abstract
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Objectives To ascertain by MRI the presence of filler injected into facial soft tissue and characterize complications by contrast enhancement. Methods Nineteen volunteers without complications were initially investigated to study the MRI features of facial fillers. We then studied another 26 patients with clinically diagnosed filler-related complications using contrast-enhanced MRI. TSE-T1-weighted, TSE-T2-weighted, fat-saturated TSE-T2-weighted, and TIRM axial and coronal scans were performed in all patients, and contrast-enhanced fat-suppressed TSE-T1-weighted scans were performed in complicated patients, who were then treated with antibiotics. Patients with soft-tissue enhancement and those without enhancement but who did not respond to therapy underwent skin biopsy. Fisher’s exact test was used for statistical analysis. Results MRI identified and quantified the extent of fillers. Contrast enhancement was detected in 9/26 patients, and skin biopsy consistently showed inflammatory granulomatous reaction, whereas in 5/17 patients without contrast enhancement, biopsy showed no granulomas. Fisher’s exact test showed significant correlation (p 10 mm) was found in 16 complicated patients (65 %; levels IA/IB/IIA/IIB). Conclusions MRI is a useful non-invasive tool for anatomical localization of facial dermal filler; IV gadolinium administration is advised in complicated cases for characterization of granulomatous reaction. Key Points • MRI is a non-invasive tool for facial dermal filler detection and localization. • MRI-criteria to evaluate complicated/non-complicated cases after facial dermal filler injections are defined. • Contrast-enhanced MRI detects subcutaneous inflammatory granulomatous reaction due to dermal filler. • 65 % patients with filler-related complications showed lymph-node enlargement versus 31.5 % without complications. • Lymph node enlargement involved cervical levels (IA/IB/IIA/IIB) that drained treated facial areas.
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Background: Lip augmentation with injectable materials is a popular aesthetic procedure. When complications occur, patients often ignore which material was implanted, thus making subsequent treatments difficult. This study aims to present the diagnosis and management of dermal filler complications in the perioral region. Study design: The Medical charts of 26 patients with filler complications in the oral region were reviewed. All patients were submitted to High Frequency Ultrasound, often complemented by Magnetic Resonance Imaging (MRI) and White Blood Cell Scintigraphy, to evaluate filler characteristics and complication types. Antibiotic, corticosteroid or surgical treatment was therefore planned. Results: Imaging always identified dermal fillers in the oral region, distinguishing among infections, fibrosis, granulomatous inflammation and product migration. Nine patients received surgery, ten received medical treatments, six received both, and one refused treatment. Eighty percent of the patients presented an improvement after three- year follow-up. Conclusions: Complications of oral region fillers are similar in clinical presentation but differ in etiology, therefore necessitating different clinical approaches. Imaging techniques add useful information for treatment planning.
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Soft tissue filler products have become very popular in recent years, with ever-increasing medical and aesthetic indications. While generally considered safe, the number of reported complications with tissue fillers is growing. Nevertheless, there is no specific animal model that is considered as the gold standard for assessing safety or efficacy of tissue fillers, and there are very little data on interspecies differences in reaction to these products. Here, we report on interspecies differences in reaction to a subcutaneous injectable co-polyester, composed of castor oil and citric acid. Comparison of the histopathological local tissue changes following 1-month postimplantation, indicated that in rats the reaction consisted of cavities, surrounded by relatively thin fibrotic enveloping capsule. In contrast, an unexpected severe inflammatory granulomatous reaction was noticed in Sinclair minipigs. To our knowledge, this is the first report on significant interspecies differences in sensitivity to tissue fillers. It emphasizes the importance of using the appropriate animal model for performing preclinical biocompatibility assays for biodegradable polymers, tissue fillers, and implanted medical devices in general. It also makes the Sinclair minipig subject for scrutiny as an animal model in future biocompatibility studies.
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Progression of lipodystrophy syndrome is a big challenge in HIV treatment. Nowadays, fat loss at the lower part of buttocks has become another problem as patients have started to complain that it is painful to be seated for a long time and/or on hard surfaces. We developed a method for buttock lipoatrophy treatment with PMMA-microspheres, as silicone prostheses and autologous fat transplant were not completely efficient. The treatment consisted of net-crossed injections, in the subcutaneous layer, of a 30% PMMA-microspheres solution on the atrophic areas of the buttock. One hundred and fifty-four patients were included. The amount of PMMA-microspheres used to treat buttock lipoatrophy depended on the degree of atrophy and size of the area to be treated. Patients were satisfied with this treatment and reported to be more comfortable to be seated for longer period of time. We demonstrated that soft tissue augmentation with PMMA-microspheres is safe and efficient for the treatment of buttock lipoatrophy associated with HIV lipodystrophy.
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Characteristics of the aging face include soft tissue atrophy, loss of skin elasticity resulting in excess facial skin, and gravitational descent or ptosis of facial soft tissues. Poly-L-lactic acid (PLLA) is a synthetic biodegradable polymer that provides soft tissue augmentation through stimulation of an inflammatory tissue response with subsequent collagen deposition. The authors discuss the special considerations inherent in facial aging, describe the mechanism of action and indications for a new PLLA filler under consideration for Food and Drug Administration (FDA) approval (Sculptra Aesthetic, sanofi-aventis US, Bridgewater, New Jersey), and detail the results of a two-year off-label pilot study with the product. The senior author (LAC) treated 106 patients with PLLA in an off-label indication, as part of a pilot study while Sculptra Aesthetic was being evaluated for FDA approval for cosmetic indications. All patients were followed up for two years to help develop a protocol for injection technique. The age range of patients in this series was 40 to 78 years. Three patients were male and 103 were female. Patients received an average injection of 1.6 vials per session, over an average of 2.3 sessions, to achieve volume restoration in the tear trough, midface, malar region, nasolabial folds, prejowl area, mandibular border, and mandibular angle. The authors we achieved 100% follow-up with 99.1% patient satisfaction. The rate of nodule formation was 4.7% at a minimum follow-up of two years. Because of its unique mechanism of action, PLLA for nonsurgical facial rejuvenation requires meticulous injection technique with special considerations for optimizing outcomes and minimizing adverse events.
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Background: Since the first reports on microsurgery in children, there has been an evolution in the reconstruction of soft tissue defects as evidenced by a shift to free flaps as the first-line treatment. Methods: The primary objective of this systematic review was to compare the complication rate of free perforator/fasciocutaneous flaps with free muscular/myocutaneous flaps in pediatric lower limb soft tissue reconstructions. The secondary objective was to evaluate the frequency and severity of complications for both reconstructive options. A search was performed in the databases PubMed, Web of Science, Embase, Scopus, and Cochrane Library depending on predefined inclusion criteria. Results: The evolution to perforator flaps from muscular and myocutaneous flaps is reflected in this systematic review as demonstrated by the anterolateral thigh (ALT) flap, which is the most common reconstructive option with a very low complication rate (11.3%) and flap loss. The latissimus dorsi (LD) flap was the second most frequently reported reconstruction with a complication rate comparable with that of the thoracodorsal artery perforator (TDAP) flap (32% vs. 39%, respectively), but the former suffers few failures. The radial forearm (RFA) fasciocutaneous flap can be considered a good alternative for ALT and TDAP flaps with a very low complication rate (16%) and no flap loss. Conclusions: The ALT flap is considered the best reconstructive method for pediatric lower limb soft tissue defects. More adequate prospective studies specifically concerning free flap reconstructions for lower limb defects in children are necessary in the future to provide guidelines for treatment and optimize outcomes in the long term.
Soft tissue reconstruction of head and neck ablative defects is a broad, challenging, and subjective topic. The authors outline goals to keep in mind when deciding on a primary reconstructive option for defects created by oncologic resection. Factors considered in local, regional, and distant flap selection are discussed. Based on the goals of reconstruction and factors involved in flap selection, a defect-based reconstructive algorithm is developed to help choose the ideal reconstructive option. The authors also discuss indications, pearls, pitfalls, and challenges in the harvest and inset of commonly used soft tissue flaps for head and neck reconstructive surgery.
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The U.S. Food and Drug Administration Center for Devices and Radiological Health (FDA/CDRH) has recently published several in vivo test guidance documents that mention refinements, reductions, or replacement animal testing strategies to facilitate the leveraging of data from large animal safety tests for conventional rodent testing. In response to the recently enacted Food and Drug Administration Safety and Innovation Act Section 907, which facilitates expedited access to novel therapies commonly described as Breakthrough Therapy Designation, FDA/CDRH has discussed efficient regulatory strategies for first-in-human investigation, including early feasibility study guidance. Large gains in humane care and translational research could also be attained by examples in FDA’s Guidance for the Use of International Organization for Standardization 10993-1, which states that large animal safety studies may be considered as replacement rodent tests if the scientific principles, methods, and end points (SPME) are considered and applied. This article discusses SPME for the replacement of conventional rodent testing by the inclusion and integration of clinical, diagnostic, and pathologic data obtained from well-designed large animal studies. The recommendations include consideration for study designs that utilize methods for an overall more comprehensive interrogation of animal systems.
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Injectable fillers and neuromodulators are used for a range of indications pertaining to the correction of facial aging and disfigurement. Fillers can correct soft tissue loss, depressed scars, and atrophy or asymmetry induced by systemic or local disease. Neuromodulators correct muscle-mediated skin creases, reshape the face, and address right–left functional asymmetry. Among the prepackaged injectable fillers approved by the US Food and Drug administration are hyaluronic acid derivatives, calcium hydroxylapatite, and poly-L-lactic acid; neuromodulators include three types of botulinum toxin type A and one type of type B. Adverse events associated with injections are typically mild, easily managed injection pain, followed by redness, swelling, and bruising. Asymmetry, nodules, ptosis, and intravascular occlusion are less common. Filler and toxin injections are part of a complete treatment plan. Reinjection is typically required to maintain the clinical effect, and combination treatment with laser and energy devices can enhance the aggregate effect.
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| BACKGROUND |: Autologous fat transfer (AFT), also known as fat grafting or lipofilling, has already become part of clinical practice for treating contour deformities of the breast, even though evidence regarding its efficacy is still lacking. This is the first meta-analysis on the subject, aimed to facilitate intuitive interpretation of the available data by clinicians, guideline committees and policy makers. | METHODS |: A literature search was performed on September 1st, 2017 in PubMed, Embase and the Cochrane Library to identify all relevant studies. A rigorous data extraction and standardisation process allowed pooling of clinical outcome data into a meta-analysis. | RESULTS |: Eighty-nine studies consisting of 5,350 unique patients were included. The mean follow-up was 1.9 years. Meta-analysis revealed a very high overall patient and surgeon satisfaction rate of 94.3% and 95.7%, respectively, which was also confirmed by high satisfaction scores and Breast-Q scores. Overall, only 1.5 sessions were needed to achieve the desired result. Though evidence on the long-term volume retention is lacking, based on the current data it was calculated to be 52.4% at one year. Only 5.0% of procedures resulted in clinical complications and 8.6% of breasts required biopsy due to abnormal clinical or radiological findings. | CONCLUSIONS |: Autologous fat transfer seems to be an effective procedure in breast reconstruction, reflected by the high patient and surgeon satisfaction and low incidence of clinical and radiological complications. Future research should focus on evaluating the technical and patient factors influencing the rate of fat resorption as well as its oncological safety.
Article
| IMPORTANCE |: The use of autologous fat transfer (AFT) or lipofilling for correcting contour deformities is seen as one of the major breakthroughs in reconstructive plastic surgery. Its applications in facial reconstructive surgery have been of particular interest owing to the prospect of achieving autologous reconstruction by a minimally invasive approach. However, its unpredictability and variable degree of resorption have limited its utility and much skepticism still exists regarding its efficacy. Furthermore, more than 2 decades of clinical research have produced a highly fragmented body of evidence that has not been able to provide definite answers. | OBJECTIVE |: To investigate the safety and efficacy of AFT in facial reconstruction through a systematic review and meta-analysis. | DATA SOURCES |: A literature search was performed in PubMed, Embase, and the Cochrane Library from inception to October 11, 2017. | STUDY SELECTION |: All published studies investigating the efficacy and safety of AFT in facial reconstructive surgery. | DATA EXTRACTION AND SYNTHESIS |: Two independent reviewers performed data extraction systematically, adhering to the PRISMA guidelines. Summary measures were pooled in a random-effects model meta-analysis. | MAIN OUTCOMES AND MEASURES |: The patient and surgeon satisfaction, graft survival, number of AFT sessions, and the incidence of AFT-related complications were the main outcomes of interest in this meta-analysis. | RESULTS |: This systematic review resulted in the inclusion 52 relevant studies consisting of 1568 unique patients. These included 4 randomized clinical trials, 11 cohort studies, and 37 case series. The overall follow-up averaged 1.3 years after AFT. Meta-analysis revealed a very high overall patient satisfaction rate of 91.1% (95% CI, 85.1%-94.8%) and overall surgeon satisfaction rate of 88.6% (95% CI, 83.4%-92.4%). The number of AFT sessions required to achieve the desired result was 1.5 (95% CI, 1.3-1.7) and 50% to 60% of the injected volume was retained at 1 year. Only 4.8% (95% CI, 3.3%-6.9%) of procedures resulted in clinical complications. | CONCLUSIONS AND RELEVANCE |: To our knowledge, this study provides the first overview of the current knowledge about AFT in facial reconstructive surgery. Our results confirm that AFT is an effective technique for treating soft-tissue deformities in the head and neck, with low rate of minor complications.
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Postmastectomy breast reconstruction (PMBR) has evolved dramatically since it was first described by Vincent Czerny in 1895. The increasing numbers of mastectomy procedures and improved patient survival have placed an increasing emphasis on the aesthetic and psychosocial outcomes, prompting surgeons to develop more sophisticated methods to reconstruct the breast mound. Significant improvements have been made to existing implant and autologous methods of PMBR in recent decades in an effort to reduce donor site morbidity and complication rates and improve cosmesis. The limitations of contemporary methods of PMBR have directed research toward more novel techniques such as autologous fat grafting and adipose tissue engineering. The present review discusses recent advances in the evolution of contemporary approaches to breast reconstruction and the future directions of PMBR using adipose tissue engineering strategies.
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Collagen soft tissue fillers suffer from fast reabsorption, which minimizes their use as a tissue engineered construct. Extensive cross-linking can be utilized to extend longevity, but changes in microstructure and biomechanics can have deleterious effects. To enhance longevity while still achieving a natural microstructure, gold nanoparticles (AuNPs) were conjugated to fibrilized collagen and homogenized into an injectable form for use as a soft tissue filler. A long-term animal study in Yucatan swine was conducted to assess biocompatibility and longevity. Two formulations of the AuNP-collagen were compared to porcine cross-linked collagen and commercially available hyaluronic acid (HA). The results of the study demonstrated that the AuNPs may provide enhanced longevity over the six month compared to hyaluronic acid and cross-linked collagen. Irritation scores indicated that the AuNP-collagen construct demonstrated low irritation compared to the cross-linked collagen and HA while histology scores demonstrated good biocompatibility. Overall, it may be possible to utilize AuNPs to stabilize and increase the longevity of collagen constructs while still achieving biocompatibility.
Article
Background: The number of procedures involving dermal filler injection is still on the rise. Although their safety is improving, not all complications can be avoided. The late complications manifesting as nodules or granulomas pose a particular diagnostic and therapeutic challenge, due to the lack of uniform standards or guidelines. High-frequency, ultrasound imaging appears to be a useful method for distinguishing between granulomas and nodular dermal filler deposits. Aim: The aim of the paper was to evaluate the utility of high frequency ultrasound imaging for distinguishing between foreign body granulomas and nodular dermal filler deposits. Material and methods: Eleven females aged 21-66 years (mean age of 43.6 years old) who had soft tissue fillers injected were enrolled. All patients had a high-frequency ultrasound scan of the involved skin area performed. The shape, margins, area, location and echogenicity of the lesions were assessed. Additionally, the lesions were evaluated histologically and photographs were taken. Results: The analysis indicated differences between the ultrasound image of granulomas and dermal filler deposits. Characteristic ultrasound features of granulomas include oval shape and blurred, irregular outer edges. Small hyperechoic areas were seen inside the granulomas. The deposits were anechogenic, with sharp, regular borders. Conclusions: High-frequency ultrasound imaging enables distinguishing between granulomas and nodules-dermal filler deposits, which form after dermal filler injections.
Article
Soft-tissue augmentation and implants are increasingly seen by the radiologist as more techniques emerge for a variety of indications and locations. Some surgical and implant procedures are performed for purely cosmetic reasons in otherwise healthy patients seeking to improve their body image, and some are performed for reconstruction after cancer or other chronic illnesses. Abdominoplasty, liposuction, and autologous fat grafting can be performed for abdominal and gluteal contouring. Injection of liquid injectable silicone has historically been fraught with legal issues, although it continues to be used for augmentation in a variety of anatomic locations. Newer solid silicone implants have revolutionized cosmetic and reconstructive muscular contouring. Subdermal implants placed by non-medical professionals are relatively new and unrecognized within the medical establishment, although such implants have been described in the popular culture. Perhaps the most rapidly increasing segment of cosmetic procedures, however, is minimally invasive cosmesis in the form of soft-tissue fillers in the hands and face. Finally, the major principles of breast augmentation and penile implants are also reviewed. Regardless of the location and the type of implant, complications of plastic surgery and soft-tissue implants can generally be classified into the following categories: seroma, he-matoma, infection, migration, vascular or nerve compression, fibrosis, foreign-body reaction, and rupture or breakdown. Key concepts include knowing the appropriate anatomic location and the normal postoperative appearance so that complications can be properly detected. A broad range of approved, off-label, and illicit plastic surgical and implant procedures are described and their complications illustrated with cases with classic imaging findings.
Article
The treatment of sequelae after conservative breast cancer treatment can be a challenge. Lipomodeling, although controversial in the beginning, is a safe technique that can help in the treatment of these deformities, without an important impact on the imaging surveillance. Depending on the severity of the deformity, one or several sessions of fat transfer can be required. The technique is easy and reproducible, but before obtaining satisfying results with a low complication rate, a learning curve should be completed. The final result is natural, with normal breast consistency, with no additional scars.
Article
Background: Radiesse(®) , or calcium hydroxylapatite (CaHA), is a biodegradable, biostimulatory soft tissue filler suitable for deeper folds and wrinkles. In the literature, good results have been documented with the use of CaHA and patient satisfaction scores are high. This study reviews the current literature on safety and complications of CaHA. Methods: A literature search in MEDLINE/PubMed electronic database was conducted. A total of 21 articles were included and screened for reports of adverse events (AEs). Results: Twenty-one peer-reviewed articles, published between 2004 and 2015, were included. A total of 5081 treatments with CaHA were performed on 2779 patients. A total of 173 (3%) AEs were reported. The assessed types of AEs consisted of nodules (n=166, 96%), persistent inflammation/swelling (n=4, 2%), persistent erythema (n=2, 1%), and overcorrection (n=1, 1%). Conclusion: Based on the results in this study, CaHA appears to have a good safety profile. Nodules are by far the most common AE. Of the reported nodules, 49% occurred in "dynamic" areas currently known for having a higher tendency for nodules. Several treatment approaches exist for managing CaHA nodules; however, in most cases, CaHA nodules are not visible and resolve without intervention.
Article
Background: Hyaluronic acid is a widely available, biocompatible, polysaccharide with distinguishing physiochemical properties which inspire its application throughout several fields of medicine. Objective: We aim to investigate the application of hyaluronic acid and its effectiveness throughout several fields of medicine, including several therapies administered and prescribed by general health practitioners. Methods: We conducted a systematic review on randomized controlled trials about the physiochemical properties of hyaluronic acid and its application through primary care. Studies included in this review were peer reviewed and met our inclusion criteria. Findings: Factors were clustered into the following: uses throughout several fields of medicine, physiochemical properties, bioavailability, tolerance, effectiveness, and adverse effects. Therapies with hyaluronic acid provided long-lasting, pain relieving, moisturizing, lubricating, and dermal filling effect. Tissue hydration, elasticity, and durability improved. Conclusions: Adjunct therapy with hyaluronic acid provides longer-lasting therapeutic effect when compared to the use of glucocorticosteroids and NSAIDs in osteoarthritic chronic diseases, is well-established in ophthalmology due to its lubricating properties for the corneal endothelium, and improves tissue hydration and cellular resistance to mechanical damage in aesthetic dermatology, and has marginal adverse effects. Several trials indicated its role in tumor markers, liver diseases, and in pharmaceuticals, but further research would be necessary to draw conclusive results in those fields.
Article
Background: A polymethylmethacrylate-collagen filler is generally believed to give long-term benefits, but the risk of granuloma formation over time remains unclear. Objective: To determine the incidence of granuloma formation and response to treatment and assess the degree of patient satisfaction over 5 years. Materials and methods: Adults seeking correction of nasolabial folds underwent up to 3 injection sessions over 2 months. Subjects were then queried regularly for the development of signs and symptoms of a granuloma. Any positive responses were evaluated, and lesions suspicious for granulomas were confirmed by biopsy. Granulomas were treated at the discretion of the investigator. Subjects also completed regular satisfaction questionnaires. Results: A total of 1,008 subjects were enrolled and 871 completed the full 5 years of the study. A biopsy-confirmed granuloma developed in 1.7% of subjects. Almost all granulomas responded to treatment. At study exit, 0.9% of subjects had an unresolved granuloma. Patient satisfaction remained high throughout the duration of the study. Conclusion: The incidence of granuloma formation with a polymethylmethacrylate-collagen dermal filler is low, and almost all lesions are manageable with simple therapeutic measures. Patient satisfaction remains durable over 5 years. Polymethylmethacrylate-collagen offers a well-characterized and very favorable risk/benefit profile.
Article
Background: Physicochemical properties and performance in nonclinical animal models can provide insights into soft tissue filler performance. Objective: To evaluate the in vivo performance of fillers with different compositions and physicochemical properties. Materials and methods: Physicochemical properties were measured in vitro. Rat models were developed and used to compare lift capacity, resistance to deformation, and tissue integration. Four homogeneous hyaluronic acid (HA) fillers, 2 nonanimal stabilized HA (NASHA) fillers, and 1 calcium hydroxylapatite/carboxymethyl cellulose (CaHA/CMC) filler were evaluated. Results: Filler lift capacity correlated better with filler composition/type (homogeneous > NASHA > CaHA/CMC) than with specific rheological properties. The CaHA/CMC filler had high initial resistance to deformation relative to other groups; all HA fillers exhibited lower initial resistance to deformation, which increased over time. Homogeneous HA fillers were integrated with surrounding tissue, whereas integration within particle-based fillers (NASHA and CaHA/CMC) was variable, with some areas void of tissue. Conclusion: The animal models provide a platform to make comparative evaluations among fillers. The results indicated that biological interaction plays an important role in how the filler performs. Rheology alone was not sufficient to understand filler performance but was most useful when comparing within fillers of similar composition.
Article
Background: About 8000 breast reconstructions after mastectomy are per - formed in Germany each year. It has become more difficult to advise patients because of the wide variety of heterologous and autologous techniques that are now available and because of changes in the recommendations about radiotherapy. Methods: This article is based on a review of pertinent articles (2005-2014) that were retrieved by a selective search employing the search terms "mastectomy" and "breast reconstruction." Results: The goal of reconstruction is to achieve an oncologically safe and aestically satisfactory result for the patient over the long term. Heterologous, i.e., implant-based, breast reconstruction (IBR) and autologous breast reconstruction (ABR) are complementary techniques. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. If post-mastectomy radiotherapy (PMRT) is not indicated, implant-based reconstruction with or without a net/acellular dermal matrix (ADM) is a common option. Complications such as seroma formation, infection, and explantation are significantly more common when an ADM is used (15.3% vs. 5.4% ). If PMRT is performed, then the complication rate of implant-based breast reconstruction is 1 to 48% ; in particular, Baker grade III/IV capsular fibrosis occurs in 7 to 22% of patients, and the prosthesis must be explanted in 9 to 41% . Primary or, preferably, secondary autologous reconstruction is an alternative. The results of ABR are more stable over the long term, but the operation is markedly more complex. Autologous breast reconstruction after PMRT does not increase the risk of serious complications (20.5% vs. 17.9% without radiotherapy). Conclusion: No randomized controlled trials have yet been conducted to compare the reconstructive techniques with each other. If radiotherapy will not be performed, immediate reconstruction with an implant is recommended. On the other hand, if post-mastectomy radiotherapy is indicated, then secondary autol ogous breast reconstruction is the procedure of choice. Future studies should address patients' quality of life and the long-term aesthetic results after breast reconstruction.
Article
Soft tissue ischemia is a devastating and unpredictable complication following dermal filler injection. Multiple mechanisms to explain this complication have been proposed, including vascular compression, vessel damage, and intraarterial filler emboli. To elucidate the mechanism of injury, the authors introduce a mouse model, imaged with optical microangiography and laser speckle contrast imaging technologies, to demonstrate in vivo microvascular response to soft tissue and intravascular filler injection. To determine the effect of external vascular compression on distal perfusion, the authors attempted to occlude vessels with subcutaneous hyaluronic acid gel (HAG) bolus injections into the pinna of hairless mice. The authors also performed suture ligation of a major vascular bundle. Following these interventions, laser speckle and optical microangiography were performed serially over 1 week follow up. To determine the effect of intravascular HAG injection, the authors devised and validated a novel method of cannulating the mouse external carotid artery for intraarterial access to the pinna vasculature. Using this model, the authors performed intraarterial HAG injections and completed optical microangiography and laser speckle contrast imaging. Despite large HAG bolus injections directly adjacent to vascular bundles, the authors were unable to induce compressive occlusion of the mouse pinna vessels. Vascular occlusion was successfully performed with suture ligation, but optical microangiography and laser speckle contrast imaging confirmed undisturbed distal capillary bed perfusion. With intravascular HAG injection, large segments of pinna showed distinct perfusion reduction along a vascular distribution when compared with preinjection images, most noticeably at the capillary level. The novel mouse pinna model combining intravascular access and in vivo microvascular perfusion imaging has furthered the understanding of the mechanism of filler-induced tissue ischemia. Distal capillary perfusion was maintained despite external vascular compression. Intraarterial HAG filler injection, however, resulted in large areas of capillary nonperfusion and is the most likely etiology for filler-induced tissue necrosis that is observed clinically.
Article
Cosmetic fillers are frequently used these days for enhancing beauty and to treat wrinkles or sagging skin. However, information on the history of injections may be difficult to obtain, and there is a growing number of reports on complications with these agents. In contrast to other imaging techniques, sonography has been successfully used for detecting and identifying common types of cosmetic fillers and has become the first-line imaging modality to deal with these exogenous components. © 2015 by the American Institute of Ultrasound in Medicine.
Article
Background Fat grafting for primary breast augmentation is growing in popularity due to its autologous properties and its side benefit of removing unwanted fat from other areas, although volume gain is unpredictable and patient safety remains unclear. Objective The aim of this study was to provide an evidence-based overview of autologous fat grafting to healthy breast tissue with focus on volume gain, safety, and complications. Design A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data sources The MEDLINE, Cochrane Library, and EMBASE database were searched for clinical studies on autologous fat grafting to healthy breast tissue within the last 30 years. Data extraction Clinical articles were evaluated for indication, pre- and postoperative work-up, surgical technique, volume gain (efficacy), complications, radiographic changes, and oncological safety. Level of evidence was assessed according to the Oxford Centre for Evidence-based Medicine 2011. Results Thirty six articles with 1453 patients with a mean follow-up of 16.3 months (1-156 months) were included. No randomized controlled studies were found. Six percent of the patients undergoing fat grafting to healthy breast tissue experienced major complications requiring a surgical intervention or hospitalisation. Two patients with breast cancer (0.1%) after fat grafting for cosmetic purposes were reported. Average breast volume gain ranged from 55 to 82% relative to the grafted fat volume. Conclusions The prevalence of complications and reoperations in fat grafting to healthy breast tissue compared favourably to implant-based breast augmentation. Although no increased incidence of breast cancer was found, long-term breast cancer screening and the implementation of publicly accessible registries are critically important to proving the safety of fat grafting.
Article
The purpose of this study was to present new rheologic data for hyaluronic acid filler products, correlate them with recent tissue integration studies, and provide a scientific rationale for selecting appropriate products for volume replacement within different tissue levels and anatomical zones. A brief overview of the methodology of filler rheology studies and data analysis is provided. Seven U.S. Food and Drug Administration-approved, cross-linked, nonanimal derived hyaluronic acid filler products were studied: one cohesive polydensified matrix hyaluronic acid (Belotero Balance, also known as Belotero Basic), three Hylacross hyaluronic acids (Juvéderm Ultra, Juvéderm Ultra Plus, and Juvéderm Voluma), and three nonanimal stabilized hyaluronic acids (Perlane, Restylane, and Restylane SubQ). The elastic modulus, complex viscosity, and viscous modulus of each filler gel were quantified. Tan delta for each filler gel and also for calcium hydroxylapatite filler (Radiesse) was calculated at 0.7 Hz. Cohesive polydensified matrix hyaluronic acid (Belotero Balance) has the lowest elasticity and viscosity and the highest tan delta. This predicts its soft, flowing qualities and correlates with its homogeneous pattern of tissue integration after intradermal implantation. Nonanimal stabilized hyaluronic acid (Perlane and Restylane) has the highest elasticity and viscosity and low tan delta. This predicts its firm, less flowing qualities and correlates with a bolus-like pattern of tissue integration. Hylacross hyaluronic acid (Juvéderm) has intermediate elasticity, viscosity, and tan delta, correlating with its intermediate pattern of tissue integration. Rheologic evaluation reliably predicts tissue integration patterns and appropriate clinical applications of the studied fillers. Paradigms of layered filler placement can be designed to optimally address individual patient need.
Article
Background: No human model has emerged as an accepted standard to evaluate tissue filler longevity. Objectives: To validate a human model adequate to compare soft tissue filler degradation and tissue reaction. Materials and methods: We evaluated in 18 patients the persistence of hyaluronic acid (HA) filler injected into labial tissue analyzing hyaluronidase (HYAL) activity by means of in vitro and in vivo tests, MRI and histological and ultra-structural examination at 3 and 6 months postop. Results: MRI examination revealed the presence of HA filler in a clear hyperintense area. Histology demonstrated fibroblast activation. The amount and the degradation rate of HYAL and HA did not show a linear correlation. Conclusion: MRI demonstrated the presence of HA in lip tissue even after 6 months. Biopsies at 3 months revealed tissue maturation and at 6 months confirmed the ability of HA to reorganize and integrate the extracellular matrix. The absence of linear correlation between HYAL and HA revealed that the result clinically is probably dependent on systemic factors which can determine HYAL activity and therefore HA longevity.
Article
This study demonstrated a chitosan (CS)/polyglutamate (PG) polyelectrolyte complex (PEC) hydrogel combined with spherical hydroxyapatite (HAp) particles as an injectable dermal filler for soft-tissue augmentation. The CS/PG PEC hydrogel with oppositely charged ionic cross-linking, a high gel content, and low degradation rate was introduced as a carrier to achieve high shape and volume stability. An MTT assay indicated that the CS/PG PEC had satisfactory cell biocompatibility. This PEC/HAp hydrogel showed good structural integrity in a PBS solution for up to 60 days. Clinical manageability was indexed by an injection force measurement through sterile 27-gauge needles using a texture analyzer. In an animal study, 0.2 mL of the PEC and PEC/hydroxyapatite (HAp) were implanted within the dorsal dermis of a swine ear. Injected tissue areas were biopsied 2 weeks, and 2 and 6 months after the injection. According to the histomorphometric results, the PEC and PEC/HAp groups showed percentages of retention of the maximum height of the cross-section of about 44% and 73% at 6 months. New collagen was observed in the central position indicating a possible collagenesis effect. These results suggest that this PEC/HAp system can be used as an alternative for soft-tissue augmentation.
Article
Background: An increasing number of persons seek medical solutions for esthetic indications and for diverse pathological conditions, such as malformations, trauma, or cancer. Despite manufacturers' and different authors' claims that fillers are non-immunogenic or that complications are uncommon, unwanted adverse reactions do occur. Objectives: To review the literature regarding the multiple types of immune-mediated adverse reactions related to medical dermal filler injections/prosthesis. Methods: A comprehensive MEDLINE, PubMed, and Google Scholar electronic database search was performed (2000-January 2012). Selected articles published before 2000 referring to general concerns regarding the studied topic were also included. The search provided almost 300 articles. Finally, 235 studies were selected and included. Results: All known fillers present in the market have been shown to be able to provoke early- and late-onset inflammatory adverse reactions. Their true prevalence is unknown but appears to be significant. The majority of the late-onset adverse effects are inflammatory and immune-mediated in nature. Edema, granulomas, sarcoid-like disorders, and panniculitis are the findings most commonly seen. Rarely, systemic granulomatous and autoimmune diseases, and to lesser extent acute hypersensitivity reactions can be seen. Conclusions: All implanted, injected, and blood-contact biomaterials trigger a wide variety of adverse reactions that may appear early or late and range from local to systemic. Most fillers act more as adjuvants than as direct T-cell activators, on a background of genetic predisposition. Their treatment has not been the subject of well-designed studies. Management of both acute and systemic reactions is often difficult and requires anti-inflammatory and occasionally immunosuppressive therapy.
Article
Background Numerous hyaluronic acid (HA) fillers seem to have similar characteristics, although manufacturers insist that monophasic and biphasic HA fillers are different in many ways. Little information regarding this is available in the literature. Objectives To determine characteristics of monophasic fillers vs. biphasic fillers. Material and methodsWe tested three different (two biphasic and one monophasic) HA fillers both in vitro and in vivo. In the in vitro assay, cell toxicity, resistance to enzyme degradation, syringeability and morphology of particles were tested. In vivo, the efficacy and safety were investigated in the dorsal skin of hairless mice. ResultsThere was no cell toxicity in any of the three HA fillers. Resistance to enzymatic degradation and syringeability were better in the two biphasic HA fillers than in the monophasic filler. In particle morphology test, gel type monophasic HA filler was also found as a particle type, although there was a slight difference. Volume assessment in animal skin was superior with the monophasic than with the two biphasic HA fillers. Conclusion Biphasic HA fillers have some advantages in hyaluronidase resistance, syringeability and lower risk for overcorrection, while monophasic HA fillers may be more suitable for volume augmentation due to swelling capacity.
Article
Background: Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer device that stimulates collagen production, leading to gradual volume restoration. It has been used worldwide for more than a decade to treat the lines and wrinkles of the aging face and in individuals with the human immunodeficiency virus for treatment of facial lipoatrophy. Objective: To provide an overview of the experience with injectable PLLA in Europe and the United States and the practices that have improved product use. Materials and methods: A review of the literature was conducted, and the authors' clinical experience was included detailing the evolution of the use of injectable PLLA for facial restoration. Results: Although relatively high rates of nodule and papule formation were reported during early use of injectable PLLA, updated methods have led to better safety and efficacy, including patient selection, preparation, and instruction; product preparation; timing of injections and avoidance of overcorrection; an updated understanding of the anatomy of the aging face; and site-specific injection techniques. Conclusion: Important lessons have been learned that have enhanced the safety and efficacy of injectable PLLA and have made it a desirable product for restoring facial volume.
Article
Contemporary management of the axilla in breast cancer surgery remains in evolution. Axillary lymph node status in breast cancer is a major prognostic factor and remains integral to guiding adjuvant treatment decisions. There remains controversy regarding the management of the node-positive axilla in clinically node-negative primary breast cancer. Trials to date have suggested re-evaluation of the historical therapeutic strategy that a positive sentinel node requires axillary node dissection. However, further evidence is required before modern clinical management of the axilla should be altered. As patient awareness and technical expertise grow, national rates of breast reconstruction after mastectomy continue to rise. Oncoplastic techniques continue to evolve and many patients are suitable for a plethora of reconstructive options. Despite the widespread practice of breast reconstruction globally, there is limited randomised evidence comparing the optimal type and/or timing of breast reconstruction on which to base practice. Breast reconstruction type is either purely autologous, implant-based or a combination of these two techniques. We explore the benefits and limitations of these techniques and some of the key findings of the National Mastectomy and Breast Reconstruction Audit. The timing of reconstruction after mastectomy is either immediate (a single procedure) or delayed (for an indefinite period after mastectomy). The ideal reconstruction is one that is best aligned to the patient's expectations, as this will achieve the highest levels of long-term patient satisfaction. Selecting the optimal type of breast reconstruction at the right time for the right patient remains the key challenge in breast reconstruction.
Article
Over the past 3 decades minipigs have moved from being an obscure alternative to dogs and nonhuman primates to being a standard animal model in regulatory toxicity studies. This article covers the use of minipigs as a model in the context of nonclinical drug safety and provides an overview of the minipig's developmental history and relates minipigs to other animal species commonly used in toxicology; and the minipig's translational power is supported by 43 case studies of marketed drug products covered. Special focus is given to criteria for selecting minipigs in nonclinical programs supporting the development of new medicines; the use of swine in the assessment of food additives, agrochemicals, and pesticides; as well as a regulatory perspective on the use of minipigs in Food and Drug Administration (FDA)-regulated products. This article presents the main points conveyed at a symposium held at the 2010 American College of Toxicology meeting in Baltimore, Maryland.
Article
Background: Fat grafting has emerged as a useful method for breast contouring in aesthetic and reconstructive patients. Advancements have been made in fat graft harvest and delivery, but the ability to judge the overall success of fat grafting remains limited. The authors applied three-dimensional imaging technology to assess volumetric fat graft survival following autologous fat transfer to the breast. Methods: Fat grafting surgery was performed using a modified Coleman technique in breast reconstruction. Patients undergoing the procedure were entered into the study prospectively and followed. Three-dimensional imaging was performed using the Canfield Vectra system and analyzed using Geomagic software. Breasts were isolated as closed objects, and total breast volume was calculated on every scan. Results: The data stratified patients into three groups with statistically significant parameters based on the volume of fat injected. The largest injected group (average volume, 151 cc) retained a volume of 86.9 percent (7 days postoperatively), 81.1 percent (16 days), 57.5 percent (49 days), and 52.3 percent (140 days). The smallest group (average, 51 cc) retained a volume of 87.9 percent (7 days postoperatively), 75.8 percent (16 days), 56.6 percent (49 days), and 27.1 percent (140 days). The intermediate group (average, 93 cc) retained 90.3 percent (7 days postoperatively), 74 percent (16 days), 45.7 percent (49 days), and 38.1 percent (140 days). Of note, irradiation or prior breast procedure type did not seem to affect the volume retention rate. Conclusions: The authors' data suggest that fat retention is volume and time dependent. Patients receiving higher volumes of injected fat had slower volume loss and greater total volume retention.
Article
Background and Objective Monopolar radiofrequency (RF) treatment is used by physicians to heat skin and promote tissue tightening and contouring. Cosmetic fillers are used to soften deep facial lines and wrinkles. Patients who have had dermal fillers implanted may also benefit from or are candidates for monopolar RF skin tightening. This study examined the effect of RF treatment on various dermal filler substances. This is the second part of a two-part study.Study Design/Materials and MethodsA juvenile farm pig was injected with dermal fillers including cross-linked human collagen (Cosmoplast™), polylactic acid (PLA) (Sculptra™), liquid injectable silicone (Silikon™ 1000), calcium hydroxylapatite (CaHA) (Radiesse™), and hyaluronic acid (Restylane®). Skin injected with dermal fillers was RF-treated using a 1.5-cm2 treatment tip and treatment levels typically used in the clinical setting. Fillers were examined histologically 5 days, 2 weeks, or 1 month after treatment. Histological specimens were scored for inflammatory response, foreign body response, and fibrosis in order to assess the effect of treatment on early filler processes, such as inflammation and encapsulation.ResultsEach filler substance produced a characteristic inflammatory response. No immediate thermal effect of RF treatment was observed histologically. RF treatment resulted in statistically significant increases in the inflammatory, foreign body, and fibrotic responses associated with the filler substances.Conclusions Monopolar RF treatment levels that are typically used in the clinical setting were employed in this animal study. RF treatment resulted in measurable and statistically significant histological changes associated with the various filler materials. Additional clinical and histological studies are required to determine the optimal timing of monopolar RF treatment and filler placement for maximal potential aesthetic outcome. Lasers Surg. Med. 38:211–217, 2006. © 2006 Wiley-Liss, Inc.
Article
Rigorous preclinical testing of soft tissue fillers has been lacking. No animal model has emerged as an accepted standard to evaluate tissue filler longevity. To validate a small animal model to compare soft tissue filler degradation and tissue reaction. Preliminary experiments compared caliper with magnetic resonance imaging volumetric analysis. Next, four hyaluronic acid (HA) fillers were injected into the dermis of Sprague-Dawley rats. The three dimensions of the implants were measured at day 0, day 1, and monthly for 1 year or complete resorption of the filler. Volumetric, histologic, and statistical analyses were performed. Magnetic resonance imaging results validated caliper-based volumetric measurements. Histology demonstrated injections in the subcutaneous space just deep to the dermis and panniculus carnosus. High- and very high-concentration HA fillers maintained significantly greater volumes and volume ratios than low-concentration HA fillers throughout the duration of the study. The rat subcutis model demonstrated the ability to differentiate between HA fillers with different residence times. The caliper-based rat-subcutis method demonstrated consistent volumetric analysis and correlated with human residence times of HA fillers. These quantitative results validate the rat subcutis model as an expedited preclinical model for HA fillers.
Article
Recent studies directed toward developing a better understanding of the molecular and cellular biology basis of monocyte-derived multinucleated giant cell formation, function, and biologic activity are presented. In addition, HIV-1-infected T-lymphocyte syncytia and the significance of adhesion molecule/ligand interactions in the formation of these syncytia are described. Interleukin-4 or interleukin-13 induction of monocyte-macrophage fusion provides a model for foreign body giant cell formation. On the other hand, interferon-gamma induction of monocyte-macrophage fusion provides a model for Langhans' giant cell formation. Variations in monocyte-macrophage adhesion and fusion to form foreign body giant cells are provided by substrates with different surface chemistries. Recent advances in osteoclast biology have identified the role of tumor necrosis factor-alpha in regulating osteoclast bone resorption and receptor-ligand interactions and signal pathways for osteoclast activation. Although foreign body giant cells, Langhans' giant cells, and osteoclasts are derived from monocytes or monocyte progenitor cells, the ways in which they are formed, whether induced by cytokines, receptors, or biologic activity, are markedly different.
Article
Aim of this study is to describe the use of high-frequency ultrasound to ascertain the site, quantity, and type of filler injected in the soft tissue of the face, with respect to reliability of the procedure and the analysis costs. Between December 2006 and August 2010, 80 subjects aged 25 to 65 years, who underwent facial filler augmentation, were submitted to high-frequency sonography. Of total, 42 patients (22 after temporary filler and 20 after permanent filler) were healthy and satisfied of the treatment, and 38 patients sought consultation for filler-related problems. The nature of the injected filler was known in 86.25% of the patients, whereas it was unknown in 13.75% of the patients. Besides 4 patients, previously treated with temporary products, in which no foreign material was detected, high-frequency sonography was able to identify and quantify the presence of filler in the soft tissue of 97% of patients. Moreover, it was possible to detect inflammatory reaction (that were often silent), granulomas, and recognize the presence of diverse fillers in the same area. Ultrasonography has proved to be a useful, inexpensive, noninvasive tool for the identification of the site, quantity, and often even nature of the filler injected.
Article
The monocyte-derived macrophage is recognized as a critical determinant in biocompatibility, but its appearance in the chronic inflammatory phase is accompanied by the presence of lymphocytes, which have been much less studied in this regard. Here, we first present an overview of the physiologic continuum comprising host reactions to the surgical implantation of biomaterial. Secondly, we describe our collective research efforts, which indicate that lymphocytes are additional and key cellular determinants of biocompatible outcome. Thus, bioengineering advances will require that lymphocyte responses be regarded as integral components of innate inflammatory and immune/immunotoxic cell interactions at sites of biomaterial implantation.
Article
Autologous fat injection for breast augmentation has been disputed with regard to its complications for many years, especially regarding calcifications, most of which present with benign features. In previous studies, clustered microcalcifications were not observed after fat injection for breast augmentation, which are usually regarded as malignant calcifications. From July of 1999 to December of 2009, autologous fat injection for breast augmentation was performed for both breasts in 48 patients. Eight patients with clustered microcalcifications found by mammography after surgery were analyzed retrospectively. For the nonpalpable breast lesions in three patients, the clustered microcalcifications were resected with the help of needle localized breast biopsy. The palpable lump, including clustered microcalcifications, was resected 1 cm away from its border in the other patients. All of the specimens were submitted to pathologic examination. The digitized mammographic films of eight of 48 patients (16.7 percent) showed clustered microcalcifications after autologous fat injection, which were highly suspected of being breast carcinoma microcalcifications, whereas all pathologic examinations indicated fat necroses. Clustered microcalcifications can be found after autologous fat injection for breast augmentation, which cannot be distinguished from malignancy. The mammographic confusion constitutes the problem rather than the success of the procedure itself, and the method should continue to be prohibited.