Abdominal Wall Allograft: Preclinical Biomechanical Investigation of a Novel Reconstructive Adjunct.

Introduction: Acellular dermal matrices have revolutionized abdominal wall reconstruction; however, device failure and hernia recurrence remain significant problems. Fascia grafts are a reconstructive adjunct with increased tensile strength compared with acellular dermal matrices; however, clinical use is limited by insufficient donor material and donor site morbidity. To this end, we investigate the biomechanical properties of human abdominal wall allografts (AWAs) consisting of the anterior rectus sheath from xiphoid to pubis.

Evaluation of Sidestream Darkfield Microscopy for Real-Time Imaging Acellular Dermal Matrix Revascularization.

Background: Acellular dermal matrices (ADMs) serve as a regenerative framework for host cell integration and collagen deposition to augment the soft tissue envelope in ADM-assisted breast reconstruction-a process dependent on vascular ingrowth. To date noninvasive intra-operative imaging techniques have been inadequate to evaluate the revascularization of ADM.

Methods: We investigated the safety, feasibility, and efficacy of sidestream darkfield (SDF) microscopy to assess the status of ADM microvascular architecture in 8 patients at the time of tissue expander to permanent implant exchange during 2-stage ADM-assisted breast reconstruction.

Syndactyly Web Space Reconstruction Using the Tapered M-to-V Flap: A Single-Surgeon, 30-Year Experience.

Purpose: To describe the technique and results of the tapered M-to-V flap for syndactyly web space construction.

Methods: We reviewed a single-surgeon, single-institution experience of all syndactyly reconstructions performed between 1982 and 2013. Demographic data and patient characteristics were recorded.

Acquired digital fibrokeratoma: a case report.

Acquired digital fibrokeratomas are benign, rare tumors that develop most commonly on the fingers. They can have an appearance of a rudimentary supernumerary digit or be misdiagnosed as a more common condition, such as verruca vulgaris. There are no case reports described in the plastic surgery literature.

Postoperative outcomes and reliability of "sensation-sparing" sural nerve biopsy.

Sural nerve biopsy is a valuable tool for the diagnosis of neuropathic disorders. However, concerns of persisting pain and numbness resulting from traditional whole sural nerve biopsy have led to interfascicular dissection techniques with inconsistent benefits over whole nerve biopsy. In this study we describe a novel technique of atraumatic anterior fascicular sural nerve biopsy designed to preserve calcaneal sensation while maintaining diagnostic benefit, without requiring significant interfascicular dissection.

Hypothenar hammer syndrome in a computer programmer: CTA diagnosis and surgical and endovascular treatment.

Finger ischemia due to embolic occlusion of digital arteries resulting from trauma to the palmar ulnar artery has been termed hypothenar hammer syndrome (HHS). In HHS, arterial thrombosis and/or aneurysm formation with embolization to the digital arteries causes symptoms of ischemia. We describe a patient in whom the initial diagnosis was made on multidetector computed tomographic angiography (CTA), as well as his endovascular and surgical management.

Effects of perivascular Botulinum Toxin-A application on vascular smooth muscle and flap viability in the rat.

Botulinum toxin-A (BTX) has become a widely used pharmacologic agent for esthetic surgeons and those who treat neuromuscular and gastrointestinal conditions. Until recently, there has been very little basic science research related to how this powerful agent may be useful when applied to vessels. The mechanism of action of this agent suggests that it may be useful in treating vasospastic conditions and ischemic tissues.

Modification of blood vessel diameter following perivascular application of botulinum toxin-A.

The purpose of this study was to demonstrate that perivascularly applied botulinum toxin-A (BTX) increases the diameter of treated blood vessels in a rat femoral vessel exposure model. Six adult Sprague-Dawley rats were used and bilateral femoral artery and vein exposures were performed. Five units of BTX were applied to the experimental side and an equal volume of sterile saline was applied to the control side.

Special considerations in the management of pediatric upper extremity and hand burns.

Pediatric patients account for approximately one third of all burn patients in the United States, with upper extremity or hand involvement in most admitted burn patients. Specialized management and care of pediatric burn patients optimizes functional outcomes. Common mechanisms of injury are discussed.

Topical poloxamer-188 improves blood flow following thermal injury in rat mesenteric microvasculature.

Microvascular changes of sludging and stasis are indications of thermal injury in tissue. This study investigates whether microvascular thermal injury can be decreased via topical application of poloxamer-188. Rat mesenteric microvessels were thermally injured and topically suffused with either Ringer's solution (control) or 5% poloxamer-188 in Ringer's solution (experiment).

Plastic surgery at the University of Virginia: a 50-year retrospective.

The University of Virginia recently celebrated 50 years of plastic surgery history. Past and present chairmen were honored by the department and previous residents. Accomplishments by our department, faculty, and residents have come in areas of national leadership, education, research, and patient care.

Silicone gel implants in breast augmentation and reconstruction.

Silicone gel implants have been widely used for breast augmentation and reconstruction since the 1960s. Several alterations to both elastomer shell and filler gel have been made over the years to improve their ability to replicate the natural breast and to decrease the incidence of capsular contracture. The latter is a pathologic process involving the periprosthetic tissues formed in response to the presence of the implant.

BMP-9-transduced prefabricated muscular flaps for the treatment of bony defects.

Autologous bone grafting techniques involve the use of tissues that need to be extracted from healthy sites. This can lead to significant donor site morbidity that causes a one-site defect to become a two-site defect. Bone grafts can be especially difficult to manipulate, because bone is a relatively nonmoldable tissue.

Lidocaine metabolism pathophysiology, drug interactions, and surgical implications.

A thorough understanding of the pathophysiology of lidocaine metabolism is an important prerequisite to minimizing the risk of morbidity and mortality associated with lipoplasty. Although the tumescent technique has greatly improved the safety of large-volume lipoplasty through decreased blood loss and reduced anesthetic needs, it has introduced the possibility for lidocaine toxicity. Because lidocaine is metabolized by the cytochrome P450 system, the potential for drug interactions is heightened.

Ex vivo fat graft preservation: effects and implications of cryopreservation.

There are a variety of recommended methods for harvesting, treating, and utilizing autologous fat grafts. Previous work with the MTT assay illustrated that various preimplantation handling techniques had minimal effect on the viability of fat samples. This assay was used to test the viability of harvested fat samples after being stored for up to 8 days in a variety of conditions.

Aberrant bony vasculature associated with activating fibroblast growth factor receptor mutations accompanying Crouzon syndrome.

Fibroblast growth factor receptor mutations are associated with and, in fact, cause most syndromes presenting with craniosynostosis. This knowledge has resulted in a shift in the paradigm of suture fusion causation; it was thought previously that abnormal tensional forces arising in the cranial base caused fusion of the vault sutures, but it is now understood that aberrant intercellular signaling in the developing skull leads to abnormal suture morphogenesis. Although the mutations associated with these syndromes are known and the phenotypic consequences are well documented, the pathway from mutation to phenotype has yet to be elucidated.

Human adipocyte viability testing: a new assay.

Background: Surgical experience and anecdotal data on the most effective method of harvesting, preparing, and injecting autologous fat grafts are inconsistent and conflicting. Because the limitation of fat grafting is its resorption, understanding how various handling techniques affect adipocyte survival is crucial to optimizing its long-term survival.

Objective: We sought to develop a method for assaying fat viability in its clinically used form and then to test several common techniques used in fat grafting for their effects on the viability of the fat.

Surgical management of the hand in Freeman-Sheldon syndrome.

Freeman-Sheldon syndrome is a rare form of distal arthrogryposis characterized by craniofacial anomalies, a rheumatoid-appearing hand, and pedal deformities. The hand deformities include ulnar deviation of the fingers, camptodactyly, first web space contracture, and hypoplasia of the thumb. Because of clinical variability and rarity, there is no standard management protocol.

Vascular anomalies: hemangiomas.

Mulliken and Glowacki categorized vascular anomalies as either hemangiomas or malformations, with the former being the most common tumor of infancy. Despite distinct clinical, radiologic, and histologic findings, the two major types of vascular lesions are often confused. This complicates both patient care and interpretation of the medical literature.

Modified Z-plasty repair of webbed neck deformity seen in Turner and Klippel-Feil syndrome.

Objective: Webbed neck deformity exists in many syndromes including Turner's or Klippel-Feil syndrome. Multiple problems are encountered with existing techniques to correct a webbed neck deformity. In Turner's syndrome, a subcutaneous band of thickened fascia and a low neck hairline present a challenge to the surgeon when designing a repair.

Beneficial effect of hyperbaric oxygen on island flaps subjected to secondary venous ischemia.

The potential for hyperbaric oxygen therapy (HBO) to decrease the untoward effects of a secondary ischemic event was studied in the rat superficial epigastric flap model. The secondary venous ischemic flap was created by cross-clamping the vascular pedicles for 2 h. Twenty-four hours later, the flap was reelevated and the venous pedicle was occluded for 5 h.

Shur-clens: an agent to remove silicone gel after breast implant rupture.

Removal of silicone gel from surrounding tissues after implant rupture is difficult. Local inflammation, infection, and silicone granulomas warrant thorough removal of the silicone gel. Shur-Clens (20% solution of the surfactant poloxamer 188), povidone-iodine, and saline are agents that are used to aid in the removal of silicone gel from tissue.