Searched for: Department/Unit:Plastic Surgery
Fabrication and in vivo microanastomosis of vascularized tissue-engineered constructs
Hooper, Rachel Campbell; Hernandez, Karina A; Boyko, Tatiana; Harper, Alice; Joyce, Jeremiah; Golas, Alyssa R; Spector, Jason A
Tissue engineering endeavors to create replacement tissues and restore function that may be lost through infection, trauma, and cancer. However, wide clinical application of engineered scaffolds has yet to come to fruition due to inadequate vascularization. Here, we fabricate hydrogel constructs using Pluronic((R)) F127 as a sacrificial microfiber, creating microchannels within biocompatible, biodegradable type I collagen matrices. Microchannels were seeded with human umbilical vein endothelial cells (HUVEC) or HUVEC and human aortic smooth muscle cells (HASMC) in co-culture, generating constructs with an internal endothelialized microchannel. Histological analysis demonstrated HASMC/HUVEC-seeded constructs with a confluent lining after 7 days with preservation and further maturation of the lining after 14 days. Immunohistochemical staining demonstrated von Willebrand factor and CD31(+) endothelial cells along the luminal surface (neointima) and alpha-smooth muscle actin expressing smooth muscle cells in the subendothelial plane (neomedia). Additionally, the deposition of extracellular matrix (ECM) components, heparan sulfate and basal lamina collagen IV were detected after 14 days of culture. HUVEC-only- and HASMC/HUVEC-seeded microchannel-containing constructs were microsurgically anastomosed to rat femoral artery and vein and perfused, in vivo. Both HUVEC only and HUVEC/HAMSC-seeded constructs withstood physiologic perfusion pressures while their channels maintained their internal infrastructure. In conclusion, we have synthesized and performed microvascular anastomosis of tissue-engineered hydrogel constructs. This represents a significant advancement toward the generation of vascularized tissues and brings us closer to the fabrication of more complex tissues and solid organs for clinical application.
PMCID:4195524
PMID: 24712390
ISSN: 1937-335x
CID: 2654532
The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study
Kim, Paul J; Attinger, Christopher E; Steinberg, John S; Evans, Karen K; Powers, Kelly A; Hung, Rex W; Smith, Jesse R; Rocha, Zinnia M; Lavery, Larry
BACKGROUND: Negative-pressure wound therapy with instillation is a novel wound therapy that combines negative pressure with instillation of a topical solution. METHODS: This retrospective, historical, cohort-control study examined the impact of negative-pressure wound therapy with and without instillation. RESULTS: One hundred forty-two patients (negative-pressure wound therapy, n = 74; therapy with instillation, 6-minute dwell time, n = 34; and therapy with instillation, 20-minute dwell time, n = 34) were included in the analysis. Number of operative visits was significantly lower for the 6- and 20-minute dwell time groups (2.4 +/- 0.9 and 2.6 +/- 0.9, respectively) compared with the no-instillation group (3.0 +/- 0.9) (p = 0.05). Hospital stay was significantly shorter for the 20-minute dwell time group (11.4 +/- 5.1 days) compared with the no-instillation group (14.92 +/- 9.23 days) (p = 0.05). Time to final surgical procedure was significantly shorter for the 6- and 20-minute dwell time groups (7.8 +/- 5.2 and 7.5 +/- 3.1 days, respectively) compared with the no-instillation group (9.23 +/- 5.2 days) (p = 0.05). Percentage of wounds closed before discharge and culture improvement for Gram-positive bacteria was significantly higher for the 6-minute dwell time group (94 and 90 percent, respectively) compared with the no-instillation group (62 and 63 percent, respectively) (p = 0.05). CONCLUSION: The authors' results suggest that negative-pressure wound therapy with instillation (6- or 20-minute dwell time) is more beneficial than standard negative-pressure wound therapy for the adjunctive treatment of acutely and chronically infected wounds that require hospital admission. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
PMID: 24572860
ISSN: 1529-4242
CID: 2447882
Utility of indocyanine green fluorescence lymphography in identifying the source of persistent groin lymphorrhea
Maddox, John S; Sabino, Jennifer M; Buckingham, E Bryan; Mundinger, Gerhard S; Zelken, Jonathan A; Bluebond-Langner, Rachel O; Singh, Devinder P; Holton, Luther H 3rd
SUMMARY: Surgical manipulation of the groin can result in lymphatic injury in a significant number of patients leading to poor wound healing or infectious complications. Surgical repair of lymphatic injury is greatly aided by the precise and prompt intraoperative localization of the injured lymphatic vessels. We assessed and identified lymphatic leaks in 2 cases of surgical wound lymphorrhea occurring after instrumentation of the groin using laser-assisted indocyanine green lymphography paired with isosulfan blue injection. Both cases healed without complication, and no lymphatic leak recurrence was observed during postoperative follow-up. Laser-assisted indocyanine green lymphography is a useful adjunct in the management of lymphatic leaks after surgery of the groin and may have potential for prophylactic evaluation of high-risk groin wounds.
PMCID:4229269
PMID: 25426393
ISSN: 2169-7574
CID: 2244042
Novel technique for innervated abdominal wall vascularized composite allotransplantation: a separation of components approach
Singh, Devinder P; Mavrophilipos, Vasilios D; Zapora, Jeffrey A; Berli, Jens; Broyles, Justin; Chopra, Karan; Sabino, Jennifer; Matthews, Jamil; Buckingham, E Bryan; Maddox, John S; Bluebond-Langner, Rachel; Silverman, Ronald P
OBJECTIVE: Applications for Abdominal Wall Vascularized Composite Allotransplantation may expand if a functional graft with decreased immunosuppressive requirements can be designed. We hypothesize that it is anatomically feasible to prepare a functional, innervated, and vascularized abdominal composite graft using a multilayered component separation technique. Including vascularized bone in the graft design may decrease the immunosuppressive requirements by inducing immunologic chimerism. METHODS: Two cadaver torsos were used. Adipocutaneous flaps were elevated from the midaxillary lines, preserving deep inferior epigastric artery perforators. A 2-layered component separation through the external and internal oblique fasciae was carried out, exposing segmental intercostal thoracolumbar nerves. Superiorly directed muscle release over the subcostal margin provided for a 3-rib segment with attached rectus abdominis muscle. The remainder of the full-thickness allograft was harvested with its vasculature. Flap inset into the recipient cadaver abdomen, with osteosynthesis fixation between donor and recipient ribs, was achieved. RESULTS: The harvested grafts had an average size of 845 +/- 205 cm(2) with a total procurement time of 110 minutes. On one cadaver, 4 thoracolumbar nerves were isolated bilaterally, while the other cadaver yielded 3 nerves. The nerves were transected with an average length of 5.7 +/- 1.2 cm. The graft vasculature was transected with a length of 4.40 +/- 0.10 cm. CONCLUSION: Using the principles of component separation technique, we demonstrated a novel approach to harvest and transfer a neurotized osteomyofasciocutaneous abdominal wall allotransplant as a multipedicled, single functional unit.
PMCID:4171836
PMID: 25328567
ISSN: 1937-5719
CID: 2244052
A global update on breast implants
Cohen, Leslie E; Ascherman, Jeffrey A
PMID: 24938688
ISSN: 1432-5241
CID: 2162432
Litigation and legislation. Separate but equal [Editorial]
Jerrold, Laurance
PMID: 25432263
ISSN: 1097-6752
CID: 1991932
Litigation and legislation. How to write an expert opinion letter
Jerrold, Laurance
PMID: 24975007
ISSN: 1097-6752
CID: 1991982
Litigation and legislation. Swell [Case Report]
Jerrold, Laurance
PMID: 24703293
ISSN: 1097-6752
CID: 1992012
Litigation and legislation. Considering consideration
Jerrold, Laurance
PMID: 25439219
ISSN: 1097-6752
CID: 1991942
Practicing what you preach-or not [Editorial]
Jerrold, Laurance
PMID: 24785935
ISSN: 1097-6752
CID: 1992002