Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment.
Παρασκευή 21 Σεπτεμβρίου 2018
Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol
Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea.
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Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea.
Clin Cosmet Investig Dermatol. 2018;11:421-429
Authors: Hernandez-Pigeon H, Garidou L, Galliano MF, Delga H, Aries MF, Duplan H, Bessou-Touya S, Castex-Rizzi N
Abstract
Background: Rosacea is a chronic facial skin disorder characterized by inflammation and vascular abnormalities. The pathophysiology of rosacea involves increased activation of the capsaicin receptor, TRPV1, the vascular endothelial growth factor (VEGF) pathway, and cathelicidin LL-37, MMP-9, and KLKs. We evaluated the activity of four compounds (dextran sulfate, 4-t-butylcyclohexanol [BCH; TRP-regulin®], pongamia oil, and hesperidin methyl chalcone [HMC]) on inflammatory and vascular responses implicated in rosacea.
Materials and methods: The anti-inflammatory activity of dextran sulfate was evaluated on PGE2 production after PMA stimulation of NCTC-2544 keratinocytes, and on normal human epidermal keratinocytes (NHEKs) after proinflammatory stimulation to mimic a rosacea environment. The anti-angiogenic activity of dextran sulfate was measured by analyzing pseudotube formation in co-cultured human microvascular endothelial cells/normal human dermal fibroblasts. HMC modulation of vascular responses and IL-8 cytokine production after SP stimulation was evaluated in human skin explants. We also assessed the effect of BCH on TRPV1 activation, and the effect of combined BCH and pongamia oil on the inflammatory response of NHEKs.
Results: Dextran sulfate strongly and significantly inhibited PMA-induced PGE2 production, inhibited KLK5 and MMP-9 mRNA expression, and IL-8, IL-1α and VEGF production, and displayed a highly significant inhibitory effect on VEGF-induced pseudotube formation. In SP-stimulated human skin explants, HMC significantly decreased the proportion of dilated vessels, total vessel area, and IL-8 production. BCH significantly and dose-dependently inhibited TRPV1 activation, and BCH and pongamia oil inhibited CXCL1 and CXCL6 mRNA expression and IL-8 production in NHEKs. Combined BCH/pongamia oil inhibited IL-8 production synergistically.
Conclusion: These in vitro results showed that dextran sulfate, BCH, pongamia oil and HMC, possess complementary soothing and anti-redness properties, supporting their combination in Avène redness-relief cosmetic products for sensitive skin prone to redness, and for topical adjunctive rosacea treatment.
PMID: 30233225 [PubMed]
European research trends in nuclear medicine
Abstract
Written by associate editors of the Annals of Nuclear Medicine, this invited review article is intended to offer our readers a condensed global view on the high-quality research work that has been published in Europe last year. We have divided this article into five sections. The first three sections from the oncology category include "[18F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) for therapy monitoring in malignant lymphoma", "[18F]fluoromisonidazole (FMISO) PET for hypoxia", and "lymphoscintigraphy update". It is followed by a section on "amyloid PET for Alzheimer's disease" using [11C]Pittsburgh Compound B (PiB) and [18F]florbetapir from the neurology category. The final section reviews three original articles in the field of "basic and translational molecular imaging" regardless of the category, which investigated new PET tracers such as L-4-borono-2-[18F]fluoro-phenylalanine (FBPA), O-(2-[18F]fluoroethyl)-L-tyrosine (FET) and 64Cu-NOTA-pertuzumab in small animals. We hope that this review article will arouse greater interest in our readers in recent European research trends in the field of nuclear medicine.
Transcutaneous oximetry and laser Doppler flowmetry values in patients with chronic skin ulcers treated with platelet rich plasma and stromal vascular fraction cells: a pilot study
Abstract
Background
Stromal vascular fraction cells (SVFs) hold great promise for use in regenerative medicine applications, as a result of their ability to promote the healing process through in situ differentiation and the secretion of paracrine factors. The aim of this paper was to evaluate whether and how the topical application of SVF with platelet-rich plasma (PRP) for the treatment of chronic skin ulcers modified the cutaneous perfusion of the treated areas.
Methods
Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO2) values were recorded for a 3-month period in 15 patients with chronic skin ulcers of various etiologies, who had been previously treated with single co-administered perilesional and intralesional injections of SVF+PRP.
Results
No significant differences were found between pretreatment, 1 month, and 3 month posttreatment values regarding both LDF values (basal: p = 0.10 and declivous: p = 0.0976) and declivous tcpO2 levels (p = 0.0804). The only significant difference reported was between pretreatment and 3-month posttreatment basal tcpO2 levels (p = 0.0466).
Conclusions
These results may reflect improved subcapillary circulation of the treated areas at 3 months postinjection, without a significant improvement in capillary perfusion.
Level of Evidence: Level IV, therapeutic study.
The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones
Abstract
Background
Accurate knowledge of the fracture of cranial bone can provide insight into the prevention of skull fracture injuries and help aid the design of energy-absorbing head protection systems and safety helmets. When cranial bone needs to be removed or is lost, subsequent reconstruction of the defect is necessary to protect the underlying brain, or correct esthetic deformities, or both. Ideal reconstruction of defected bone is possible utilizing a biocompatible implant with a bone-like design individualized for the specific patient. The purpose of this study is to investigate the anatomical and mechanical characteristics of fresh frozen human parietal bones and determine compliance of polylactic acid-based personalized three-dimensional implants in terms of mechanical properties in order to replace such defective bones.
Methods
Parietal bone specimens were extracted from 19 fresh frozen cadavers. Morphological parameters of individual bone specimens were measured using Image J software. Three-point bend tests were performed to extract Young's modulus and tensile strength of the specimens from the measured force and displacement data by modeling the bone specimens as curved linear elastic beams. Also, three-point bend tests were performed to polylactic acid-based three-dimensional replicas mimicking geometry of the bone specimens in order to determine whether the material's Young's modulus and tensile strength properties comply with parietal bones.
Results
Entire fresh parietal specimens were observed to be comprised of a three-layered structure: external layers consisting of compact, high-density cortical bone and the central layer consisting of low-density, irregularly porous bone structure. Mean thickness of three-layered structure was 6.25 ± 1.46 mm. Mean Young's modulus and tensile strength of the specimens were 1.40 ± 1.34 GPa and 44.56 ± 21.94 MPa, respectively where no statistically significant differences among genders were detected (p > 0.05). Mean Young's modulus and tensile strength of the polylactic acid-based three-dimensional implants mimicking geometry of the bone specimens were 1.8 ± 0.7 GPa and 72.8 ± 2.5 MPa, respectively.
Conclusions
Polylactic acid-based three-dimensional implants can be considered as acceptable candidates for temporary replacement of parietal defects in terms of mechanical properties.
Level of Evidence: Not ratable.
Poly Implant Prothèse silicone breast implants: implant dynamics and capsular contracture
Abstract
Background
The Poly Implant Prothèse (PIP) implants were withdrawn from the market in 2010 due to the use of low-grade silicone, causing a high risk for implant rupture. The aim of this study was to investigate the implant dynamics of PIP breast implants, as well as to determine the rate and predictors of implant gel bleeding, rupture, and capsular contracture in PIP implants.
Methods
Eighty women with a total of 152 PIP implants who underwent a reoperation in 2012 were enrolled in this study. Physical investigation included assessing the Baker score and demographics were retrospectively traced in medical records. The pre- and post-operative volumes of the implants were calculated and their state was determined intraoperatively by the surgeon.
Results
The implants were removed after a mean implant duration of 11 ± 2.1 years. Gel bleed and implant rupture occurred in respectively 42 and 25% of the implants. Intact implants had post-operative volume increase as well as decrease. There was a correlation between gel bleeding and more post-operative implant volume increase (P ≤ 0.05). Capsular contracture had a protective effect against post-operative implant volume increase (P ≤ 0.05), while a post-operative implant volume increase provided a protective influence in developing capsular contracture (P ≤ 0.05). Additionally, implant rupture led to a higher risk of capsular contracture (P ≤ 0.05).
Conclusions
We managed to illustrate that PIP implant shells were too permeable and that there is a correlation between gel bleeding and the increase of the post-operative implant volume. Implant rupture led to a higher risk for developing capsular contracture.
Level of evidence: Level III, risk / prognostic study.
Split-thickness skin grafting using grafts of different thickness
Abstract
Background
Split-thickness skin grafting (STSG) is the most commonly used technique in the treatment of traumatic, post-burn, and post-operative wounds, when direct wound edge closure is unavailable. There is currently no general agreement on the optimal thickness of skin grafts. We aimed to analyze the early results of recipient wound healing after STSG, using grafts of different thicknesses.
Methods
This randomized, controlled, and parallel-group pilot clinical trial included 98 adult patients who underwent STSG transplantation surgery for post-burn, post-traumatic, or post-operative skin defects. Patients were randomized into three groups to receive a skin graft of 0.2, 0.3, or 0.4-mm thickness. After skin transplantation, the healing parameters of the recipient wounds were evaluated after 3 days, 7 days, 2 weeks, and 1 month. At each time, epithelialization and pain parameters were evaluated.
Results
Our study showed that thinner split-thickness skin grafts had better epithelialization scores at the second post-operative week. However, thinner split-thickness skin grafts caused greater pain to the patients.
Conclusions
Thickness of the skin graft is a significant factor affecting recipient wound healing parameters. It is necessary to evaluate healing of the donor wound, as well as distant treatment outcomes, such as scarring, pigmentation, and esthetic results of skin grafting with different thickness grafts.
Level of Evidence: Level I, therapeutic study.
A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery
Abstract
Background
NSAIDs are used extensively in the perioperative period, for analgesia, or for preexisting conditions. However, potential risks of NSAID-induced haemorrhage have raised concerns regarding their use. NSAIDs inhibit platelet aggregation and have been shown to significantly increase bleeding time. In the available literature, there is an apparent lack of consensus regarding the use of NSAIDs and their clinical effects. A systematic review was undertaken to collate all relevant published data to provide a combined measure of the overall risk of serious complications when using NSAIDs in the perioperative period.
Methods
The search for potentially relevant studies was undertaken in PubMed for all publications up to August 2016, using appropriate medical subject (MeSH) headings. There were no restrictions on publication date or status. This was conducted in concordance with and adherence to the 2009 PRISMA guidance. Data harvested relevant papers was tabulated and analysed utilising Review Manager software to calculate a risk ratio (Mantel-Haenszel method, random effects).
Results
Twelve articles were included in the analysis, comprising 6581 patients, of which 1785 received an NSAID and 4796 were controls. Within the 1785 patients receiving NSAIDs, a total of 102 (5.7%) experienced moderate to severe complications, compared with 108 (2.2%) in the control groups.
Conclusions
Based on the assembled data, the authors conclude that the use of perioperative NSAIDs in plastic surgical procedures increases the risk of postoperative bleeding complications. Despite this, the rate of bleeding complications remains low.
Level of Evidence: Not ratable.
Surgical management of giant congenital melanocytic nevus of face in the adult—outcomes and experience
Abstract
Background
Congenital melanocytic nevi (CMN), especially those of the face, cause great psychological stress to the patient. Giant-sized lesions coupled with the complex anatomy and functional demands of the region complicate treatment, more so in adults. We present our outcomes and our experience in the treatment of such lesions in the adult.
Methods
A retrospective review was carried out of all patients over the age of 14 years undergoing surgical treatment for giant CMN of the face at a tertiary care hospital. This three-year study focuses on nevi of the face; nevi elsewhere are not included. Surgical techniques employed, and complications and esthetic outcome are discussed.
Results
Seventeen patients were included in the study. Primary reconstructive procedures included tissue expansion (TE), split-thickness skin graft (STSG), full-thickness skin graft (FTSG), and free tissue transfer (FTT). Additionally, secondary procedures were required in 15 patients. Esthetic outcomes were superior with TE and FTT.
Conclusions
Size and location of the lesion, and compliance of the patient are the primary determinants of the choice of procedure. However, potential for malignant transformation and optimal esthetic results have to be also borne in mind. Treatment should be prompt, reconstruction should be individualized and follow-up should be prolonged.
Level of Evidence: Level IV, therapeutic study.
Reconstruction of abdominal wall defects using extended trilobed rectus abdominis musculocutaneous flap
Abstract
Reconstruction of extensive abdominal wall defects is difficult in many cases. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. Firstly, the peritoneum is closed by free fascia lata transplantation. Then, the rectus abdominis musculocutaneous flap is prepared adjacent to the abdominal wall defect and centering on the rectus abdominis muscle body on the contralateral side. The rectus abdominis musculocutaneous flap is elevated with the first flap toward the xiphoid process on the cranial side, the second flap toward the middle axillary line on the lateral side, and the third flap toward the lower abdominal region on caudal side as an extended trilobed rectus abdominis musculocutaneous flap with a deep inferior epigastric arteriovenous pedicle and transposed to the abdominal wall defect. This method was applied to a full-thickness abdominal wall defect produced by colon cancer resection in two patients. Case 1 was a 10 × 15-cm full-thickness right abdominal wall defect, and case 2 was an 8 × 14-cm full-thickness left abdominal wall defect. The postoperative course was favorable, and no complication, such as abdominal incisional hernia, developed. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. By preparing a trilobed flap, the flap-donor region could also be easily closed. This method may be useful for reconstruction of extensive full-thickness abdominal wall defects.
Level of Evidence: Level V, therapeutic study.
A case of important weight loss after a prepectoral breast reconstruction
Abstract
The submuscular implant-based breast reconstruction is the most common reconstructive technique following mastectomy. Recently, subcutaneous implant positioning, together with acellular dermal matrix, has become a promising technique in selected patients. We present the case of a 42-year-old woman who underwent left nipple-sparing mastectomy with prepectoral acellular dermal matrix (ADM) assisted direct-to-implant (DTI) breast reconstruction and contralateral mastopexy. The implant was completely wrapped around by Braxon®, a preshaped porcine ADM. A few months after surgery, she experienced a severe weight loss resulting in the aesthetic deterioration of both breasts. The patient showed a migration of the left implant inferiorly and laterally, and deflation of the contralateral breast. In order to improve the left breast, a lateral capsulectomy was performed to reduce the prepectoral pocket size and lift the implant. Subsequently, a modified donut mastopexy was performed to obtain an upward migration of the nipple-areolar complex. One of the limiting factors of prosthetic reconstruction, as compared to autologous reconstruction, is the aesthetic deterioration determined by any weight change. Differently from submuscular implant reconstruction, the prepectoral implant reconstruction follows body changes after weight changes and ageing. In fact, Braxon's integration determines the formation of a capsule adhering to the mastectomy flap which makes the implant more sensible to dermatochalasis. The greater thickness of the mastectomy flap due to the larger representation of the subcutaneous tissue makes the reconstruction more sensitive to weight changes. A tailored partial capsulectomy combined with a donut mastopexy can be a solution in these patients after an important weight loss.
Level of Evidence: Level V, therapeutic study.
Reconstruction with artificial dermis of oncological surgical defects in the craniofacial district—Matriderm® versus Integra®: a non-randomized, unblinded single-operator case series
Abstract
Background
The use of dermal templates after oncologic surgery, such as Matriderm® and Integra®, allows the reconstruction of wide defects without the use of flaps or tissue expanders, minimizing the operative time and the hospital stay. In this study, we aim to analyze the results of Matriderm® and Integra®, both used in the reconstruction of oncological surgical defects in the craniofacial. Our evaluation takes into account the location of the surgical defect, the type of dermal template, and the surgical technique employed.
Methods
Data were collected retrospectively from our database from Jan 2012 to Aug 2016. The patients with a craniofacial skin cancer treated with a dermal template were identified. Preoperative, intraoperative, and postoperative data were recorded.
Results
In the period from Jan 2012 to Aug 2016, a total of 50 patients were operated for craniofacial skin cancer excision and reconstruction with a dermal template. Both Integra® and Matriderm® were used in 25 patients. The complete healing was generally achieved in 5 weeks for the one-step reconstructions and in 8 weeks for the two-step reconstructions. The global rate of complications was of 20%, and therefore, most of them were resolved with conservative therapy.
Conclusions
We observed that Integra® has a better integration on poorly vascularized surfaces, such as the skull bones; however, the thickness of the dermis obtained is lower than the one obtained with Matriderm®. The latter, when used with the two-step technique, allows complete restoration of the thickness gap obtaining a better cosmetic result.
Level of Evidence: Level III, therapeutic study.
How to avoid common errors in writing scientific manuscripts
Abstract
When writing scientific manuscripts, many important details are left a side which many times causes the rejection of the manuscript from high impact journals. Scientific writing is a combination of a comprehensive literature search and study, collection of statistical data, and a clear and concise structured writing, while avoiding common and known errors. The knowledge and implementation of basic rules of style, structure, and presentation when writing a scientific paper increase the chances of success and ultimately publication. This article aims to contribute with the existing information on how to recognize and avoid common errors for a successful scientific writing and consequently being published.
Level of Evidence: Not ratable.
Prominent nose, its modalities and their treatment
Abstract
Background
Size of the nose varies in the different parts of the world, and perception of what is the aesthetically acceptable nose shows large differences depending on the ethnic background, type of the society, gender and age. Nose which is generally larger than the average nose in a given society, particularly regarding the height of its nasal bridge, could be defined as a prominent nose.
Methods
Photographs of the 414 consecutive patients who underwent rhinoplasty by the author during the years 2014 and 2015 were reviewed. Attention was directed to the following outer features: overall length, height and width of the nose, nasofrontal angle, nasolabial angle, nose-lip and nose-chin relations, shape and position of the chin and the evaluation of the respiratory function. Among determinants was formula of Goode, which delineates the approximate relationship between tip projection and nasal length.
Results
A total of 144 patients, 112 females and 31 males, who fulfilled criteria of prominent nose were selected for the further analysis. A total of 70% of the patients were of Middle-Eastern origin. The following four types of prominent nose were recognised: (1) short prominent nose, or tension nose was present in 38 patients. It has overprojecting dorsum, which usually forms a hump. Nasolabial angle is obtuse, and nasal spina is frequently overgrown. The rate of functional problems is quite high due to the overdevelopment and subsequent deviation of the septal cartilage. (2) Long prominent nose, present in 96 patients, usually has an arched dorsum, sharp NL angle and drooping tip. (3) Long nose depending on the height of the dorsum in the lateral projection can be the low long nose and it was seen in four patients, or when the nose is both long and the tip is overprojecting, it is called Pinocchio nose and it was present in eight patients. (4) Rhinomegaly is the term describing nose which is very large in all dimensions, the height, length and width and was also seen in eight patients.
Conclusions
Prominent nose has several modalities and each of them requires different techniques applied during the surgical intervention. Both aesthetic and functional topics are frequently present, and multiple nasal structures, both external and internal, are commonly involved. In the aesthetically pleasing Caucasian nose, Goode's ratio should equal 0.55 to 0.60. If there is before operation unrecognised deviation from this norm, which is also persistent after the rhinoplasty, the final result will be substandard.
Level of Evidence IV, risk / prognostic study.
Correction of eyelid retraction using a half-thickness tarsal flap for lengthening of the eyelid following ptosis surgery
Abstract
Various surgical procedures for correction of upper eyelid retraction have been reported, many of which have had favorable results. However, most of these reports are concerned with the correction of upper eyelid retraction in patients with thyroid ophthalmopathy, and few have focused on upper eyelid retraction caused by overcorrection during ptosis surgery. Corrective surgery for upper eyelid retraction resulting from ptosis surgery is often difficult because of the extensive irregular contracture caused by scar tissue. However, as this is a repeat surgery following ptosis surgery, it is important to ensure good postoperative evaluation indices, particularly favorable symmetry, appropriate palpebral fissure width, appropriate crease height, and natural-looking parabolic eyelid margins. Here, we report the lengthening of the upper eyelids using a half-thickness tarsal flap to address upper eyelid retraction secondary to ptosis surgery. By using a half-thickness tarsal flap, the anatomy of the levator insertion onto the tarsal plate is retained, so that good eyelid contour can be obtained, and the results are quantitatively reproducible. Therefore, this technique can be considered for the treatment of upper eyelid retraction and has a potentially wide range of applications.
Level of Evidence: Level V, therapeutic study.
Quality of life before and after rhinoplasty surgery measured with SF-36, RSES, and WHOQOL-BREF
Abstract
Background
Rhinoplasty continues to be among the most popular surgical cosmetic treatments around the world. This is often a reflection of the significance of nose shapes in sociocultural, ethnic, and psychological contexts. Despite developments in the therapeutic field of cosmetic surgery, there is scarce information available within current literature concerning the effects of cosmetic procedures on quality of life (QOL), particularly in Iran. The purpose of this study was to survey QOL among Iranian adults before and after rhinoplasty.
Methods
From July 2015 to July 2016, 83 patients over 16 years of age seeking cosmetic rhinoplasty were included in this study. Demographic information such as age, sex, marital status, education, occupation, and monthly income of patients were recorded. SF-36 version 2, Rosenberg self-esteem scale (RSES), and WHOQOL-BREF questionnaires were completed by a single trained interviewer for all patients, before and 6 months after rhinoplasty. Data analysis was conducted using SPSS ver. 16. Results before and after surgery were compared.
Results
The mean age of the subjects was 24.87 ± 5.8 years, with a median of 24 years. The female-to-male ratio was 4.53:1. In all cases and all questionnaires, QOL was improved after rhinoplasty. Significant differences were observed on six subscales of SF-36 comprised bodily pain (p = 0.003), general health (p = 0.002), vitality (p = 0.005), social functioning (p < 0.001), emotional role (p = 0.02), and mental health state (p = 0.012). According to RSES and WHOQOL-BREF questionnaires, self-esteem (p = 0.002), psychological health (p < 0.001), social relationships (p < 0.001), and general quality of life (p = 0.011) indicated significant differences.
Conclusions
Our data suggest that QOL can be improved after rhinoplasty in Iranian adult patients. With proper patient selection and a successful operation, improvement of QOL can be expected.
Level of Evidence: Level III, risk / prognostic study
Introduction
It is truly an honor to be invited to be the guest editor of an issue of Operative Techniques in Otolaryngology Head and Neck Surgery. What's more, the issue focusses on one of my favorite subjects: salivary gland pathology and surgery. When considering parotid tumors alone, the incidence is approximately 4/100,000 in the United States. The current census of the United States is 324 million and approximately 25% of whom are children1. If one assumes that 243 million Americans over the age 18 are at risk for developing these tumors, then approximately 10,000 parotid tumors will occur and potentially present each year.
Increased expression of aquaporin-1 in dermal fibroblasts and dermal microvascular endothelial cells possibly contributes to skin fibrosis and edema in patients with systemic sclerosis
Aquaporin-1 (AQP1), a water channel protein controlling the water contents of cells and tissues, exerts pleiotropic effects on various biological activities, including inflammation, angiogenesis, and extracellular matrix remodeling, by regulating cell behaviors and tissue water balance.
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