BACKGROUND:In 2001, Zuk et al found adipose-derived stem cels (ASCs) from the aspirate of liposuction for the first time, which launched a new era of stem cel research. In recent years, stem cels have been proved to widely exist in many tissues and organs. ASCs are always in the spotlight of plastic and reconstructive surgery, tissue engineering and regenerative medicine because of extensive sources and simple isolation.
OBJECTIVE: To review the fat tissue harvesting and ASCs isolation, purification, expansion, and cryopreservation, to discuss the main factors which influence the yield, proliferation capacity and differentiation potential of ASCs, and to predict the future research interests based on current issues.
METHODS:On September 10th, 2015, relevant articles were searched in PubMed using the folowing format: (adipose stem cels[Title]) OR (adipose-derived stem cels[Title]) OR (adipose-derived mesenchymal stem cels[Title]) and in SinoMed using the folowing format in Chinese: (“adipose-derived stem cels” [Title])or(“adipose-derived mesenchymal stem cels”[Title]). Finaly, 81 representative articles were included according to their titles and abstracts. In this review, we also introduced relevant experience about the aforementioned procedures from the Department of Plastic Surgery and Tissue Regeneration and Molecular Cel Engineering Lab of University of Texas, MD Anderson Cancer Center, USA.
RESULTS AND CONCLUSION:The widely dispersed fat tissues potentialy provide abundant stem cels for tissue engineering and regenerative medicine. Liposuction is a mini-invasive approach for harvesting fat tissues. Colagenase digestion is the major method for ASCs isolation due to its simplicity and high yield in basic research. However, clinical fat transplantation without ASCs isolation or non-colagenase isolation of stromal vascular fraction or ASCs is preferred. The phenotype, proliferation and differentiation capacity of ASCs may be affected by several factors during the fat tissue harvesting and ASCs isolation. Therefore, a standard protocol for ASCs isolation is needed.

OBJECTIVETo investigate the blood supply patterns of the anteriorlateral thigh adipofascial flap for clinical applications.

METHODSTo investigate the blood supply patterns of the anteriorlateral thigh (ALT) adipofascial flap, 16 fresh cadavers were anatomically examined by intraarterial injection of colored latex. Three-dimensional analysis of the vasculature of the subcutaneous adipofascial tissue was performed. Sixteen patients underwent microsurgical correction with the ALT adipofascial flap. Among them, there were fifteen with hemifacial atrophy, one with micromastia.

RESULTSThe three-dimensional arterial structures of the ALT adipofascial flap were the same in all the cadaver specimens. Each layer of the adipofascial tissue was supplied by several blood vessels of the axial pattern, especially in the deep layer. Sixteen patients were successfully treated with this flap. The postoperative follow-up ranged from six months to eleven years. There was not postoperative flap necrosis or absorption of the fatty tissue. Stable restoration of the facial contour or the breast was achieved. The donor-site morbidity was minimal.

CONCLUSIONThe blood supply of the ALT adipofascial flap is reliable. A considerable amount of the fatty layer of the flap can be removed primarily. It is a preferable procedure for reconstructing soft tissue defects.

Adipose Tissue ; Adolescent ; Adult ; Breast ; surgery ; Female ; Humans ; Male ; Mammaplasty ; methods ; Surgical Flaps ; blood supply ; Thigh

OBJECTIVETo compare cricothyroid membrane puncture directed tracheostomy (CMPDT) with conventional surgical tracheostomy (ST) and cricothyroidotomy (CT) and to evaluate the feasibility, efficacy and safety of this novel technique.

METHODS15 minipigs were divided randomly into 3 groups, 5 in each. After general anesthesia, CMPDT, ST and CT were performed respectively according to the established techniques when SPO₂reached 80% (T0). Procedure duration, ECG and arterial blood gas results were recorded. Complications were recorded and scored according to an established score scale by an observer blinded to the grouping.

RESULTSAirway was successfully established in all animals (15/15). ECG monitor showed T-wave decreased and Q-T shortened after seasing of oxygen supply and both recovered rapidly to normal levels after reoxygenation. There were no significant differences between 3 groups in HR, BP, SPO2, SaO₂, PaO₂, PaCO₂and pH at pre-apnea, T0 or post-operation, but with significant intragroup variation in the parameters before and after operation. The time for CMPDT, ST and CT was (174 ± 34) s, (619 ± 128) s and (86 ± 12) s respectively. Three of 5 minipigs in ST group experienced hypotension due to longer time of hypoxia. 1 and one had minor bleeding and stoma infection after surgery. One of 5 animals in CT group had minor laryngeal cartilage injury leading to difficult decannulation, postoperative fiber bronchoscopy showed no subglottic stenosis. The complication scores were 13, 9, and 3 for ST, CT and CMPDT, respectively.

CONCLUSIONSAll 3 methods can provide with effective airway access with no significant differences in ventilation effect, however CMPDT has short recovery time for SpO2 and other vital signs with the lowest complication score. The animal experiment suggests that CMPDT is a fast, safe and effective surgical technique for emergency airway.

Anesthesia, General ; Animals ; Blood Gas Analysis ; Bronchoscopy ; Emergency Treatment ; methods ; Hypoxia ; Larynx ; surgery ; Swine ; Swine, Miniature ; Tracheostomy ; methods

OBJECTIVETo search for an ideal method to repair large facial defects.

METHODSOne or two soft tissue expanders were implanted at the clavicular-pectoral region. After fully expansion, a clavicular-pectoral skin flap was designed and created with similar color, texture, and size to the facial defect. The flap would pass over the neck and transfer to the face to repair a large defect.

RESULTS10 cases were treated with this method. All have been followed up for 12-18 months with satisfactory results.

CONCLUSIONThe large facial defects could be repaired by the expanded clavicular-pectoral skin flap without damaging the natural neck contour and donor site abnormality was avoided. The patients get an aesthetic look and good function.

Adolescent ; Adult ; Child ; Clavicle ; Face ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Pectoralis Muscles ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo search for the applications of the dermal vault in mammaplasty.

METHODSThe dermal vault was planned as large as possible according to the degree of the macromastia and mammaptosis. The residual gland was sculptured and fixed with the dermal vault in order to reconstruct the protrude, pliable and living breasts.

RESULTSThe 27 cases (53 breast) were performed with this technique. The result is satisfactory and there are no complications.

CONCLUSIONIt is a good method to use the dermal vault as a sculpturing and fixing material in mammaplasty. The breasts formed are projecting, pliable and moveable. The scar is not apparent and the result is persistent.

Adult ; Breast ; pathology ; Female ; Humans ; Mammaplasty ; methods

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h,