BACKGROUND: Random type small V-Y advancement flap is widely used for facial reconstruction with advantages including good color and texture match. However, the flap is not as widely used in the extremities and back as in the face because of apprehension of the relatively poor vascularity as a risk factor of flap necrosis. We used a small bilateral V-Y advancement flap for the repair of extremity and back defects from various causes. Competent clinical outcomes are described. METHODS: Between 2007 and 2014, 24 patients (48 flaps) with skin defects in the upper or lower extremities and back were enrolled. The site of the defect was on back (n=6), forearm (n=7), upper arm (n=2), lower leg (n=5), thigh (n=3), and axilla (n=1). RESULTS: Among the 48 flaps, 47 survived (no event: 42 flaps, total necrosis: 1 flap, partial necrosis: 5 flaps). All partial necrotized flaps healed in 3–4 weeks with conservative care. However, debridement and skin grafting was required for the total necrosis flap. One total necrosis and two partial necroses occurred on the anterolateral side of the lower leg. Two partial necroses occurred on the paraspinal area. CONCLUSIONS: Contour deformities including central depression and the dog-ear deformity were not observed. Small bilateral V-Y advancement in the extremity and back could be a safe and useful flap, if thick subcutaneous fat and subcutaneous plexus were saved. But areas with thin subcutaneous fat layer, such as the anterolateral lower leg, are poor candidates and carry the increased risk of improper subcutaneous pedicle circulation.
Arm ; Axilla ; Congenital Abnormalities ; Debridement ; Depression ; Extremities* ; Forearm ; Humans ; Leg ; Lower Extremity ; Necrosis ; Reconstructive Surgical Procedures ; Risk Factors ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Surgical Flaps ; Thigh

BACKGROUND: Medium-sized congenital melanocytic nevi (CMN) require surgical excision because of the risk of malignant transformation and aesthetic concerns. There are various possible reconstruction methods after excision, such as primary repair, skin graft, local flap, and composite graft. In this study, we used skin-fat composite grafts for reconstructing full-thickness skin defects and assessed the aesthetic outcomes. METHODS: Facial nevi excision plus skin-fat composite grafts were performed in 11 children (range, 3-16 years old). All grafts were harvested from the preauricular area on one or both sides; they included the epidermis, full-thickness dermis, and subcutaneous fat. All procedures were performed simultaneously. Standardized photographs were taken preoperatively and at a mean follow-up of 10.5 months. Viewing the photographs, four plastic surgeons rated the aesthetic outcomes of all patients using the following scale: 1, poor; 2, fair; 3, good; 4, very good; and 5, excellent. RESULTS: No patient was diagnosed with malignancy. There were no complications, such as graft loss, infection, or aesthetic problems that required surgical revision. All donor sites healed well and exhibited only minimal scarring. The aesthetic outcomes of skin-fat composite grafts were outstanding with a mean score of 4.2 +/- 0.4. Most patients and parents were highly satisfied with the results. CONCLUSIONS: Skin-fat composite grafts provide good color match, texture, and contour. They are more tolerable, especially in children, because the technique involves simpler procedures and shorter operation times than local flaps. They may be the ideal option for facial defects after excision of medium-sized melanocytic nevi.
Child* ; Cicatrix ; Dermis ; Epidermis ; Follow-Up Studies ; Humans ; Nevus ; Nevus, Pigmented* ; Parents ; Reoperation ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Surgical Flaps ; Tissue Donors ; Transplants*

BACKGROUND: As harvesting techniques have improved the viability of transposed adipose tissue, autologous fat transfer is increasingly utilized for facial augmentation. Conventional techniques involve placing harvested fat deep in subcutaneous tissue through skin punctures. Trans-oral fat injections at the buccal and labial sulci and through the mucosa of the oral commissures obviate external scars. We report experience with this technique for augmentation of the cheeks, zygomatic arch, nasolabial folds, upper and lower lips, and chin in 130 patients over a 14-year period. METHODS: We report an observational case series of 147 procedures performed in 130 patients (118 women and 12 men, 19-69 years of age) in which 10 to 60 mL autologous fat supernatant harvested from the hips, buttocks, or abdomen were injected through the oral mucosa for augmentation. Single preoperative doses of antibiotic and methylprednisolone were administered in all cases. Fat frozen and banked during initial treatments was used for additional augmentation 3 to 6 months after initial treatments in 46% of cases. Outcomes were assessed clinically with physical exams and photographs. RESULTS: Mucosal puncture wounds healed uneventfully. Most patients tolerated the procedures well and recovered rapidly compared to historical experience with conventional percutaneous techniques. One patient developed a sterile seroma 3 weeks after facial augmentation that responded to needle aspiration. CONCLUSIONS: Transmucosal, intra-oral autologous fat grafting was associated with minimal visible scarring, swelling, or infection at the recipient site. This technique may be considered an alternative to percutaneous transfer for proximate peri-oral facial augmentation.
Abdomen ; Adipose Tissue ; Buttocks ; Cheek ; Chin ; Cicatrix ; Cosmetic Techniques ; Female ; Hip ; Humans ; Lip ; Male ; Methylprednisolone ; Mouth Mucosa ; Mucous Membrane ; Nasolabial Fold ; Needles ; Punctures ; Reconstructive Surgical Procedures ; Rejuvenation ; Seroma ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Tissue Transplantation ; Transplants ; Wounds and Injuries ; Zygoma

Adipose tissue stem cells (ADSCs) would be an attractive autologous cell source. However, ADSCs require invasive procedures, and has potential complications. Recently, urine stem cells (USCs) have been proposed as an alternative stem cell source. In this study, we compared USCs and ADSCs collected from the same patients on stem cell characteristics and capacity to differentiate into various cell lineages to provide a useful guideline for selecting the appropriate type of cell source for use in clinical application. The urine samples were collected via urethral catheterization, and adipose tissue was obtained from subcutaneous fat tissue during elective laparoscopic kidney surgery from the same patient (n = 10). Both cells were plated for primary culture. Cell proliferation, colony formation, cell surface markers, immune modulation, chromosome stability and multi-lineage differentiation were analyzed for each USCs and ADSCs at cell passage 3, 5, and 7. USCs showed high cell proliferation rate, enhanced colony forming ability, strong positive for stem cell markers expression, high efficiency for inhibition of immune cell activation compared to ADSCs at cell passage 3, 5, and 7. In chromosome stability analysis, both cells showed normal karyotype through all passages. In analysis of multi-lineage capability, USCs showed higher myogenic, neurogenic, and endogenic differentiation rate, and lower osteogenic, adipogenic, and chondrogenic differentiation rate compared to ADSCs. Therefore, we expect that USC can be an alternative autologous stem cell source for muscle, neuron and endothelial tissue reconstruction instead of ADSCs.
Adult Stem Cells/*cytology/*immunology/transplantation ; Biomarkers/metabolism ; Cell Differentiation ; Cell Lineage ; Cell Proliferation ; Cell Separation ; Chromosomal Instability ; Colony-Forming Units Assay ; Humans ; Karyotyping ; Multipotent Stem Cells/cytology/immunology/transplantation ; Subcutaneous Fat, Abdominal/*cytology ; Transplantation, Autologous ; Urine/*cytology

We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited widespread retinal whitening with visible emboli in several retinal arterioles. Diffusion-weighted magnetic resonance imaging of the brain showed a hyperintense lesion at the left insular cortex. Therefore, we diagnosed ophthalmic artery obstruction and left middle cerebral artery infarction due to fat emboli. The patient was managed with immediate ocular massage, carbon dioxide, and oxygen therapy. Following treatment, dysarthria improved considerably but there was no improvement in visual acuity.
Adult ; Arterial Occlusive Diseases/diagnosis/*etiology ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Infarction, Middle Cerebral Artery/*complications/diagnosis ; Magnetic Resonance Imaging ; *Ophthalmic Artery ; Orbit ; Subcutaneous Fat/*transplantation ; Transplantation, Autologous/adverse effects ; Visual Acuity

BACKGROUND: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. MATERIAL AND METHOD: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and NH4Cl et al, and these components were cultured by non-induction media-DMEM media containing 10% FBS and inducted by none, 3 micromol/L, 6 micromol/L, and 9 micromol/L 5-azacytidine after the 1st and 2nd subculture. After 4 weeks incubation, the cell blocks were made, immunostaining was done with the antibodies of CD34, heavy myosin chain, troponin T, and SMA. RESULT: Immunostaining of the transformed cells for troponin T was positive in the 6 micromol/L & 9 micromol/L 5-azacytidine of Group 1 & 2, but CD34 and heavy myosin chain antibodies were negative and SMA antibody was positive in the 3 micromol/L & 6 micromol/L 5-azacytidne of Group 2. CONCLUSION: These observations confirm that adult mesenchymal stem cells isolated from the abdominal subcutaneous adipose tissues and intra-abdominal adipose tissues can be chemically transformed into cardiomyocytes. This can potentially be a source of autologous cells for myocardial repair.
Adipose Tissue ; Adult* ; Animals ; Antibodies ; Azacitidine* ; Bone Marrow ; Cardiomyoplasty ; Cell Transplantation ; Cicatrix ; Collagenases ; Fibroblasts ; Heart Failure ; Heart Transplantation ; Heart, Artificial ; Heart-Assist Devices ; Humans ; Intra-Abdominal Fat ; Mesenchymal Stromal Cells* ; Myocardial Infarction ; Myocytes, Cardiac* ; Myosins ; Omentum ; Rats* ; Subcutaneous Fat, Abdominal ; Transplants ; Troponin T

OBJECTIVE: Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes. MATERIALS AND METHODS: The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated. RESULTS: Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm²/m² demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = −0.54, p < 0.001) and intensive care unit (ICU) stay (R = −0.33, p = 0.021). CONCLUSION: Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.
Adult ; Body Composition ; Body Mass Index ; Cohort Studies ; Follow-Up Studies ; Humans ; Intensive Care Units ; Lung ; Lung Transplantation ; Male ; Mortality ; Muscles ; Retrospective Studies ; Risk Factors ; Sarcopenia ; Spine ; Subcutaneous Fat ; Thorax ; Tomography, X-Ray Computed ; Transplant Recipients ; Ventilators, Mechanical

A 49-year-old female patient suffered a suspicious scalding burn in her right hand and forearm during a seizure, and visited the clinic 16 hours after injury without appropriate initial treatment. The wound was covered with multiple bullae, was cold and pale, and the extension and flexion functions were decreased. The intrafascial pressure was measured as 19~95 mmHg (mean 46.9), confirming compartment syndrome. The pressure was improved following fasciotomy to 23~32 mmHg (mean 27); escharectomy, split thickness skin grafting and partial ostectomy was then performed, and an abdominal flap operation was conducted. The patient underwent a delayed procedure 14 days after the operation, and on the 18th day, subcutaneous fat and fascia tissues from the subcutaneous layer were removed from the skin; after sculpturing, split thickness skin grafting was performed. On the 21st day after flap separation, stump revisions were performed. The patient is currently undergoing rehabilitation; the metacarpophalangeal joint exhibits a normal range of motion, and the proximal interphalangeal joint has a range of motion of 30~45°. The abdominal flap operation was performed for soft tissue defects in the extensor tendon and bone exposure. Thus, various long-term processes were avoided, and by implementing a short operation time and low-cost surgery, relatively quick rehabilitation treatment could be initiated.
Burns* ; Compartment Syndromes ; Fascia ; Female ; Fingers* ; Forearm ; Hand ; Humans ; Joints ; Metacarpophalangeal Joint ; Middle Aged ; Range of Motion, Articular ; Reference Values ; Rehabilitation ; Seizures ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Tendons ; Wounds and Injuries

Therapeutic angiogenesis is an important strategy to rescue ischemic tissues in patients with critical limb ischemia having no other treatment option such as endovascular angioplasty or bypass surgery. Studies indicated so far possibilities of therapeutic angiogenesis using autologous bone marrow mononuclear cells, CD34⁺ cells, peripheral blood mononuclear cells, adipose-derived stem/progenitor cells, and etc. Recent studies indicated that subcutaneous adipose tissue contains stem/progenitor cells that can give rise to several mesenchymal lineage cells. Moreover, these mesenchymal progenitor cells release a variety of angiogenic growth factors including vascular endothelial growth factor, fibroblast growth factor, hepatocyte growth factor and chemokine stromal cell-derived factor-1. Subcutaneous adipose tissues can be harvested by less invasive technique. These biological properties of adipose-derived regenerative cells (ADRCs) implicate that autologous subcutaneous adipose tissue would be a useful cell source for therapeutic angiogenesis in humans. In this review, I would like to discuss biological properties and future perspective of ADRCs-mediated therapeutic angiogenesis.
Angioplasty ; Bone Marrow ; Extremities ; Fibroblast Growth Factors ; Hepatocyte Growth Factor ; Humans ; Intercellular Signaling Peptides and Proteins ; Ischemia ; Mesenchymal Stromal Cells ; Stem Cell Transplantation ; Stem Cells ; Subcutaneous Fat ; Vascular Endothelial Growth Factor A