Nerve Wrap for Local Delivery of FK506/Tacrolimus Accelerates Nerve Regeneration.

Peripheral nerve injuries (PNIs) occur frequently and can lead to devastating and permanent sensory and motor function disabilities. Systemic tacrolimus (FK506) administration has been shown to hasten recovery and improve functional outcomes after PNI repair. Unfortunately, high systemic levels of FK506 can result in adverse side effects.

An Analysis of Specialty-Specific Microsurgical Head and Neck Reconstruction: A Look at a Single Institution and National Trends Over a Decade.

Introduction: Head and neck free flap (HNFF) reconstructions have historically utilized a multidisciplinary approach between otolaryngology head and neck surgery (OHNS) and plastic surgery (PS). However, there seems to be a trend toward both the extirpative and reconstructive portions being performed by OHNS. We aimed to elucidate the volume trend in HNFF reconstruction over the last decade.

Does Size Matter: Evaluating the Difference between Right and Left Internal Mammary Veins in Free Flap Breast Reconstruction.

Background:  Venous congestion in breast free flap reconstruction continues to be a major reason for flap compromise requiring reoperative exploration and possible flap failure. We aim to investigate whether size of the internal mammary vein (IMV) (1) varies between the left and right sides, (2) changes with certain patient demographics or preoperative factors, and (3) correlates with postoperative complications.

Methods:  We performed a retrospective cohort study examining all patients undergoing free flap breast reconstruction from September 2005 to March 2016 using internal mammary recipient veins.

Fat Grafting to the Breast: Clinical Applications and Outcomes for Reconstructive Surgery.

This article is a review of fat grafting for breast reconstruction. The use of small volume fat grafting for the correction of step-off deformities, intrinsic deformities, and extrinsic deformities of the breast, and the uses of large volume fat grafting for total breast reconstruction, correction of implant complications with simultaneous implant exchange with fat, and correction of noncancer chest wall deformities is reviewed. Cancer monitoring and the risks of cancer recurrence following fat-grafting to the breast is also reviewed.

Lateral thigh perforator flap for breast reconstruction: Computed tomographic angiography analysis and clinical series.

Purpose: Although abdominal-based flaps remain the first choice for autologous breast reconstruction, alternative donor sites are necessary when the abdomen is unavailable. Abdominal donor site suitability is determined, at times, according to deep inferior epigastric perforator (DIEP)-protocol computed tomographic angiography (CTA) results. CTA provides information about the pelvis/upper thigh that can be used to evaluate the suitability of other donor sites.

Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis.

Background: Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty.

Abnormal Vessel Architecture Persists in the Microvasculature of the Massive Weight Loss Patient.

Background: Research demonstrates a link between obesity and increased circulating inflammatory cytokines, which lead to changes in the microvasculature. Massive weight loss patients often experience delayed wound healing after body-contouring procedures; however, no studies exist to explore the inflammatory response of massive weight loss on microvasculature. This study hypothesized that massive weight loss patients who undergo body-contouring procedures maintain persistently elevated inflammatory markers in the microvasculature that delay wound healing.

Speech Outcomes After Clinically Indicated Posterior Pharyngeal Flap Takedown.

Background: Velopharyngeal insufficiency affects as many as one in three patients after cleft palate repair. Correction using a posterior pharyngeal flap (PPF) has been shown to improve clinical speech symptomatology; however, PPFs can be complicated by hyponasality and obstructive sleep apnea. The goal of this study was to assess if speech outcomes revert after clinically indicated PPF takedown.

Fat Grafting for Facial Filling and Regeneration.

Plastic surgeons have come to realize that fat grafting can rejuvenate an aging face by restoring or creating fullness. However, fat grafting does much more than simply add volume. Grafted fat can transform or repair the tissues into which it is placed.

The influence of preexisting lower extremity edema and venous stasis disease on body contouring outcomes.

Background: While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-body contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease.

Methods: Fifty-five patients who had undergone body contouring surgery were identified from our prospective registry.

Facial bone density: effects of aging and impact on facial rejuvenation.

Background: Facial bone aging has recently been described as primarily resulting from volume loss and morphologic changes to the orbit, midface, and mandible.

Objective: The authors demonstrate how the facial skeleton bone mineral density (BMD) changes with age in both men and women and compare these changes to those of the axial skeleton. They also explore the aesthetic implications of such changes in bone density.

The impact of Smad3 loss of function on TGF-β signaling and radiation-induced capsular contracture.

Background: Capsular contracture remains a major problem following prosthetic breast implantation, especially in patients undergoing irradiation. Recent studies suggest that such radiation injuries are a cascading process of cytokine activation, with transforming growth factor (TGF)-β acting as the "master switch." Because TGF-β signals through phosphorylation of Smad3, a plausible approach to abate TGF-β-induced capsular contracture would be to interrupt Smad3 signaling.

A novel animal model for studying silicone gel-related capsular contracture.

Background: Capsular contracture remains one of the major problems following prosthetic implantation of the breast, especially in postmastectomy breast reconstruction patients receiving radiation therapy. Advances in this area have been hampered by the absence of an acceptable animal model. This study evaluates a new murine model with which to facilitate research into the cellular and molecular pathways underlying capsular contracture and provides a surrogate for evaluating potential therapies.

Aging of the facial skeleton: aesthetic implications and rejuvenation strategies.

Background: Facial aging is a dynamic process involving the aging of soft-tissue and bony structures. In this study, the authors demonstrate how the facial skeleton changes with age in both male and female subjects and what impact these structural changes may have on overall facial aesthetics.

Methods: Facial bone computed tomographic scans were obtained from 60 female and 60 male Caucasian subjects.

Impact of Smad3 loss of function on scarring and adhesion formation during tendon healing.

Studies were performed evaluating the role of Smad3, a transcription factor mediating canonical TGF-β signaling, on scarring and adhesion formation using an established flexor digitorum longus (FDL) tendon repair model. In unoperated animals the metatarsophalangeal (MTP) range of motion (ROM) was similar in Smad3(-/-) and wild-type (WT) mice while the basal tensile strength of Smad3(-/-) tendons was significantly (39%) lower than in WT controls. At 14 and 21 days following repair Smad3(-/-) MTP ROM reached approximately 50% of the basal level and was twice that observed in WT tendon repairs, consistent with reduced adhesion formation.

Treatment of plagiocephaly with helmet molding therapy: do actual results mimic perception?

Purpose: Actual and perceived improvements from helmet molding therapy for deformational plagiocephaly are demonstrated here. Effective communication of these data by craniofacial teams can help avoid unrealistic expectations and inform parents of expected outcomes.

Methods: Parents of 61 patients with plagiocephaly were asked to rate their children's head shape and ear position before and after helmet therapy (a score of 1 being abnormal and 10 being normal).

Aging of the mandible and its aesthetic implications.

Background: Facial aging is a dynamic process involving the aging of soft-tissue and bony structures. In this study, the authors demonstrate how specific bony aspects of the mandible change with age in both genders and what impact these structural changes may have on overall facial aesthetics.

Methods: Facial bone three-dimensional computed tomographic scans were obtained from 120 Caucasian subjects (60 women and 60 men).

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

Background: The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery.

Methods: All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients.