Faculty Bibliography

Several histologic studies regarding peri-implant soft tissues and biological width around dental implants have been done in animals. However, these findings in human peri-implant soft tissues are very scarce. Therefore, the aim of this case series was to compare the biological width around unloaded one- and two-piece implants retrieved from human jaws. Eight partially edentulous patients received 2 test implants in the posterior mandible: one-piece (solid implants that comprise implant and abutment in one piece) and two-piece (external hexagon with a healing abutment) implants. After 4 months of healing, the implants and surrounding tissue were removed for histologic analysis. The retrieved implants showed healthy peri-implant bone and exhibited early stages of maturation. Marginal bone loss, gaps, and fibrous tissue were not present around retrieved specimens. The biologic width dimension ranged between 2.55 +/- 0.16 and 3.26 +/- 0.15 to one- and two-piece implants, respectively (P < 0.05). This difference was influenced by the connective tissue attachment, while sulcus depth and epithelial junction presented the same dimension for both groups (P > 0.05). Within the limits of this study, it could be shown that two-piece implants resulted in the thickening of the connective tissue attachment, resulting in the increase of the biological width, when compared to one-piece implants.

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.

BACKGROUND: Fat grafting is used to restore breast defects after surgical resection of breast tumors. Supplementing fat grafts with adipose tissue-derived stromal/stem cells (ASCs) is proposed to improve the regenerative/restorative ability of the graft and retention. However, long term safety for ASC grafting in proximity of residual breast cancer cells is unknown. The objective of this study was to determine the impact of human ASCs derived from abdominal lipoaspirates of three donors, on a human breast cancer model that exhibits early metastasis. METHODOLOGY/PRINCIPAL FINDINGS: Human MDA-MB-231 breast cancer cells represents "triple negative" breast cancer that exhibits early micrometastasis to multiple mouse organs [1]. Human ASCs were derived from abdominal adipose tissue from three healthy female donors. Indirect co-culture of MDA-MB-231 cells with ASCs, as well as direct co-culture demonstrated that ASCs had no effect on MDA-MB-231 growth. Indirect co-culture, and ASC conditioned medium (CM) stimulated migration of MDA-MB-231 cells. ASC/RFP cells from two donors co-injected with MDA-MB-231/GFP cells exhibited a donor effect for stimulation of primary tumor xenografts. Both ASC donors stimulated metastasis. ASC/RFP cells were viable, and integrated with MDA-MB-231/GFP cells in the tumor. Tumors from the co-injection group of one ASC donor exhibited elevated vimentin, matrix metalloproteinase-9 (MMP-9), IL-8, VEGF and microvessel density. The co-injection group exhibited visible metastases to the lung/liver and enlarged spleen not evident in mice injected with MDA-MB-231/GFP alone. Quantitation of the total area of GFP fluorescence and human chromosome 17 DNA in mouse organs, H&E stained paraffin sections and fluorescent microscopy confirmed multi-focal metastases to lung/liver/spleen in the co-injection group without evidence of ASC/RFP cells. CONCLUSIONS: Human ASCs derived from abdominal lipoaspirates of two donors stimulated metastasis of MDA-MB-231 breast tumor xenografts to multiple mouse organs. MDA-MB-231 tumors co-injected with ASCs from one donor exhibited partial EMT, expression of MMP-9, and increased angiogenesis.

The concept that epinephrine-based local anesthetics cannot be injected in terminal appendages has been perpetuated for decades. The hypothesis that the vasoconstrictive effect of epinephrine will result in finger necrosis has been accepted as fact, often preventing its use in hand surgery. To scientifically challenge this hypothesis, a systematic review of the literature was performed, and a survey of ASPS members reported to highlight the lack of evidence-based opinions. A systematic literature review performed using Medline, Embase, PubMed, and Cochrane databases identified all published studies evaluating use of epinephrine/adrenaline in hand, finger or digit surgery. Each study was independently evaluated by three reviewers for inclusion or exclusion from the systematic review. Additionally, a survey (E-survey link) was distributed to all ASPS members and data were collected over a 5-month period through SurveyMonkey®. A total of 568 articles published prior to December 2012 were identified. After elimination of 151 duplicates, 417 articles remained. Fifty-five articles were selected and full examination of the texts was performed. Forty-five studies matched the selection criteria and were included in the analysis. The ASPS member survey demonstrated a 13 % overall questionnaire response rate (5,299 questionnaires/687 responses). Of all respondents, 37.4 % felt it was unsafe to inject local anesthesia mixed with epinephrine into the fingers/thumb, respectively. Critical literature review validated the safety and efficacy of utilizing epinephrine-based local anesthetics. The author's survey elucidates the pervasive concern of employing epinephrine in hand surgery. Level of Evidence: Not ratable.

BACKGROUND: Beauty lies in the eyes of the beholder, but influenced by the individual's geographic, ethnic, and demographic background and characteristics. In plastic surgery, objective measurements are used as a foundation for aesthetic evaluations. This study assumes interdependence between variables such as country of residence, sex, age, occupation, and aesthetic perception. METHODS: Computerized images of a model's face were generated with the ability to alter nasal characteristics and the projection of the lips and chin. A survey containing these modifiable images was sent to more than 13,000 plastic surgeons and laypeople in 50 different countries, who were able to virtually create a face that they felt to be the aesthetically "ideal" and most pleasing. Demographic information about the interviewees was obtained. RESULTS: Values of various aesthetic parameters of the nose were described along with their relationship to geography, demography, and occupation of the respondents. Interregional and ethnic comparison revealed that variables of country of residence, ethnicity, occupation (general public vs surgeon), and sex correlate along a 3-way dimension with the ideal projection of the lips and the chin. Significant interaction effects were found between variables of country of residence or ethnicity with occupation and sex of the respondents. CONCLUSIONS: What are considered the "ideal" aesthetics of the face are highly dependent on the individual's cultural and ethnic background and cannot simply and solely be defined by numeric values and divine proportions. As confirmed with this study, ethnic, demographic, and occupational factors impact peoples' perception of beauty significantly.

BACKGROUND:Recently, a strategy for treating stroke directly at the emergency site was developed. It was based on the use of an ambulance equipped with a scanner, a point-of-care laboratory, and telemedicine capabilities (Mobile Stroke Unit). Despite demonstrating a marked reduction in the delay to thrombolysis, this strategy is criticized because of potentially unacceptable costs. METHODS:We related the incremental direct costs of prehospital stroke treatment based on data of the first trial on this concept to one year direct cost savings taken from published research results. Key parameters were configuration of emergency medical service personnel, operating distance, and population density. Model parameters were varied to cover 5 different relevant emergency medical service scenarios. Additionally, the effects of operating distance and population density on benefit-cost ratios were analyzed. RESULTS:Benefits of the concept of prehospital stroke treatment outweighed its costs with a benefit-cost ratio of 1.96 in the baseline experimental setting. The benefit-cost ratio markedly increased with the reduction of the staff and with higher population density. Maximum benefit-cost ratios between 2.16 and 6.85 were identified at optimum operating distances in a range between 43.01 and 64.88 km (26.88 and 40.55 miles). Our model implies that in different scenarios the Mobile Stroke Unit strategy is cost-efficient starting from an operating distance of 15.98 km (9.99 miles) or from a population density of 79 inhabitants per km2 (202 inhabitants per square mile). CONCLUSION/CONCLUSIONS:This study indicates that based on a one-year benefit-cost analysis that prehospital treatment of acute stroke is highly cost-effective across a wide range of possible scenarios. It is the highest when the staff size of the Mobile Stroke Unit can be reduced, for example, by the use of telemedical support from hospital experts. Although efficiency is positively related to population density, benefit-cost ratios can be greater than 1 even in rural settings.

The proper management of complex pediatric mandibular fractures remains a topic of debate because of the relatively uncommon presentation of these fractures, combined with concerns related with deciduous teeth, tooth buds, and growth inhibition. In this current study, we present a novel approach to the repair of bilateral condylar fractures with concomitant symphyseal fracture in a 4-year-old girl. Manual closed reduction was first obtained, followed by placement of a transfacial Steinman pin through the angles of the mandible and placement of circummandibular wires. Maxillomandibular fixation remained for 2 weeks and the Steinman pin was removed after 11 weeks. At 3 months of postsurgical follow-up, the patient displayed class I occlusion, facial symmetry, full range of jaw motion, and absence of deviation or pain on full oral excursion. Radiographic findings also revealed complete resolution of the symphyseal fracture with appropriate condylar healing and alignment.