2,285 research outputs found
The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate-Severe Vulvar Lichen Sclerosus Who were Non-responders to Topical Clobetasol Propionate: A Randomized Pilot Study
No full textA Meta-Analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars
No full textThe role of structured training in learning microsurgery: a narrative review
No full textBackground and introduction. Microsurgery has transformed reconstructive surgery, offering superior aesthetic and functional outcomes, particularly in complex cases. Mastery of microsurgery is challenging due to the intricate nature of procedures and the precision required, leading to a steep learning curve. Various training methods, including traditional animal models and emerging synthetic alternatives, have been developed to enhance skill acquisition. Structured training programs, supported by national and international societies, are crucial for improving competency, with emphasis on both objective and subjective measures of performance.
Material and methods. This review utilized the PubMed database to analyze literature on microsurgery training, employing search terms like “Microsurgery” AND “training resident”. After systematic filtering, 15 relevant articles were included, encompassing studies evaluating improvements in anastomosis time and patency rates, along with resident confidence.
Results. Key findings included a 2022 study revealing a 41% patency rate among 1.792 anastomoses performed by residents after a 7-month training course with Wistar rats. Training duration significantly influenced performance. A virtual training program in low-resource settings demonstrated improved confidence in microsurgical skills, although statistical significance was limited by sample size. An Italian study indicated that structured long-term training led to significant improvements in Global Rating Scale (GRS) scores and reduced procedure times.
Discussion and conclusions. The findings emphasize the effectiveness of structured, hands-on training in enhancing microsurgical skills. While remote training offers valuable introductory knowledge, in-person practice remains essential for developing the precision required in microsurgery. An integrated training approach combining both methods could improve global access to microsurgical education, equipping practitioners with necessary skills for success in the field. Overall, structured training enhances residents’ confidence and technical competence
Levator alae nasi muscle V-Y island flap for nasal tip reconstruction
No full textNasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian
Striae distensae : évaluation d’un nouveau traitement combiné : étude in vitro et in vivo
No full textStretch marks or Striae Distensae (SD) appear clinically as parallel streaks, perpendicular tothe lines of tension in the skin. SD evolves into two clinical phases, an initial inflammatoryphase or striae rubrae (SR) and a chronic phase or striae albae (SA). Fibroblasts appear toplay a key role in the pathogenesis of stretch marks. The results of studies explaining theetiology of SD are discordant, which is why we have tried to analyze the phenotype andfunction of fibroblasts in initial and old lesions and compare them with those in healthy skin(NS) of the same patient. Currently, there is no cure for SA. The non-ablative fractional lasercan achieve satisfactory results, but only on the initial lesions (SRs). The goals of this studywere: to describe and analyze fibroblasts from stretch marks and the differences between SRFand SAF compared to fibroblasts from healthy tissue from the same donor (NSF); to testinnovative treatments (sodium ascorbate and PrP) on cell cultures of fibroblasts from SA(SAF) in vitro; performing an in vivo study using PRP + nanofat combined treatment.Material and methodsIn order to characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA)was investigated. Type I collagen expression was measured in SAF, before and after addingdifferent PrP concentrations and sodium ascorbate in the culture medium. The products testedwere: Standard PrP 1% and 5%, PrP concentrated 1% and 5%, sodium ascorbate (100μg / M),PrP standard 1% and 5% + sodium ascorbate (100μg / M), PrP concentrated 1% and 5% +sodium ascorbate (100μg / M), no treatment (control). For the in vivo study, the productstested were: PRP, PRP 20% + nanofat 80%, nanofat. Results were processed throughstatistical analysis models using the Student’s t-test.ResultsA significant increase in alpha SMA (P <0.001) was observed in SRF. SAF treatedwith PrP and sodium ascorbate showed a resumption of their metabolic activity by an increasein collagen type I production and cell proliferation. After 24 hours of incubation with PrP 1%and PrP 5% + Sodium ascorbate, cell viability was increased by 140% and 151% and by 156and 178% after 48 hours respectively compared to the control. Regarding the in vivo study:the PrP and the nanofat contributed to increasing the biosynthesis of collagen in the treatedareas significantly compared to the control. A greater effect was observed for AS treated withthe combined PrP-Nanofat treatment (p <0 .0001).ConclusionOur study shows that a biologically mediated improvement of SMF metabolicactivity is possible. Our promising results require further trials to be able to confirm thereproducibility of these combined treatments, particularly in vivo.Les Vergetures ou Striae distensae (SD) se manifestent cliniquement sous forme de stries parallèles, perpendiculaires aux lignes de tension de la peau. Les SD évoluent en deux phases cliniques, une phase inflammatoire initiale ou striae rubrae (SR) et une phase chronique ou striae albae (SA). Les fibroblastes semblent jouer un rôle clé dans la pathogenèse des vergetures. Les résultats des études expliquant l’étiologie des SD sont discordants, c’est pourquoi nous avons essayé d’analyser le phénotype et la fonction des fibroblastes dans des lésions initiales et anciennes, et les comparer à ceux de la peau saine (PS) du même patient. Actuellement, il n'y a pas de traitement curatif pour les SA. Le laser fractionné non ablatif permet d’obtenir des résultats satisfaisants, mais seulement sur les lésions initiales (les SR). Les buts de cette étude étaient : décrire et analyser les fibroblastes des vergetures et les différences entre les fibroblastes issues des SR et des SA en comparaison aux fibroblastes de tissus sain du même donneur ; tester des traitements innovants (ascorbate de sodium et PrP) sur des cultures cellulaires de fibroblastes issues des SA in vitro ; la réalisation d’une étude in vivo utilisant la combinaison de PRP + nanofat
Striae distensae : évaluation d’un nouveau traitement combiné : étude in vitro et in vivo
No full textStretch marks or Striae Distensae (SD) appear clinically as parallel streaks, perpendicular tothe lines of tension in the skin. SD evolves into two clinical phases, an initial inflammatoryphase or striae rubrae (SR) and a chronic phase or striae albae (SA). Fibroblasts appear toplay a key role in the pathogenesis of stretch marks. The results of studies explaining theetiology of SD are discordant, which is why we have tried to analyze the phenotype andfunction of fibroblasts in initial and old lesions and compare them with those in healthy skin(NS) of the same patient. Currently, there is no cure for SA. The non-ablative fractional lasercan achieve satisfactory results, but only on the initial lesions (SRs). The goals of this studywere: to describe and analyze fibroblasts from stretch marks and the differences between SRFand SAF compared to fibroblasts from healthy tissue from the same donor (NSF); to testinnovative treatments (sodium ascorbate and PrP) on cell cultures of fibroblasts from SA(SAF) in vitro; performing an in vivo study using PRP + nanofat combined treatment.Material and methodsIn order to characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA)was investigated. Type I collagen expression was measured in SAF, before and after addingdifferent PrP concentrations and sodium ascorbate in the culture medium. The products testedwere: Standard PrP 1% and 5%, PrP concentrated 1% and 5%, sodium ascorbate (100μg / M),PrP standard 1% and 5% + sodium ascorbate (100μg / M), PrP concentrated 1% and 5% +sodium ascorbate (100μg / M), no treatment (control). For the in vivo study, the productstested were: PRP, PRP 20% + nanofat 80%, nanofat. Results were processed throughstatistical analysis models using the Student’s t-test.ResultsA significant increase in alpha SMA (P <0.001) was observed in SRF. SAF treatedwith PrP and sodium ascorbate showed a resumption of their metabolic activity by an increasein collagen type I production and cell proliferation. After 24 hours of incubation with PrP 1%and PrP 5% + Sodium ascorbate, cell viability was increased by 140% and 151% and by 156and 178% after 48 hours respectively compared to the control. Regarding the in vivo study:the PrP and the nanofat contributed to increasing the biosynthesis of collagen in the treatedareas significantly compared to the control. A greater effect was observed for AS treated withthe combined PrP-Nanofat treatment (p <0 .0001).ConclusionOur study shows that a biologically mediated improvement of SMF metabolicactivity is possible. Our promising results require further trials to be able to confirm thereproducibility of these combined treatments, particularly in vivo.Les Vergetures ou Striae distensae (SD) se manifestent cliniquement sous forme de stries parallèles, perpendiculaires aux lignes de tension de la peau. Les SD évoluent en deux phases cliniques, une phase inflammatoire initiale ou striae rubrae (SR) et une phase chronique ou striae albae (SA). Les fibroblastes semblent jouer un rôle clé dans la pathogenèse des vergetures. Les résultats des études expliquant l’étiologie des SD sont discordants, c’est pourquoi nous avons essayé d’analyser le phénotype et la fonction des fibroblastes dans des lésions initiales et anciennes, et les comparer à ceux de la peau saine (PS) du même patient. Actuellement, il n'y a pas de traitement curatif pour les SA. Le laser fractionné non ablatif permet d’obtenir des résultats satisfaisants, mais seulement sur les lésions initiales (les SR). Les buts de cette étude étaient : décrire et analyser les fibroblastes des vergetures et les différences entre les fibroblastes issues des SR et des SA en comparaison aux fibroblastes de tissus sain du même donneur ; tester des traitements innovants (ascorbate de sodium et PrP) sur des cultures cellulaires de fibroblastes issues des SA in vitro ; la réalisation d’une étude in vivo utilisant la combinaison de PRP + nanofat
Necrotizing Fasciitis of the Upper Limb: Optimizing Management to Reduce Complications
No full textBackground: Necrotizing fasciitis (NF) is a severe, potentially life-threatening condition. The aim of this study is to identify strategies aimed at reducing complications in patients with NF of the upper limb. Methods: We conducted a retrospective study on patients admitted to our Unit for suspected NF of the upper limb. The analyzed data included patient characteristics, delay before primary care, clinical and biological signs upon arrival, pathogens involved, and the rate of amputations and mortality. Results: A total of 21 patients presented with confirmed necrotizing bacterial dermohypodermitis-NBDH with NF (NBDH-NF) affecting the upper limb. The mean delay between the onset of symptoms and the clinical examination in the Emergency Dermatology Unit was 48 h (range: 6 to 72 h). The mean delay between admission and primary surgery was 150 min (range: 60 min to 280 min). No amputations were performed. All patients were alive one year after the first surgical procedure. Conclusions: Our study demonstrated that it is possible to reduce mortality and morbidity rates in NF of the upper limb. Timely diagnosis and early treatment and a multidisciplinary medico-surgical dedicated team providing care can significantly modify the outcomes. Early surgical debridement is the most important factor affecting the prognosis of these infections
Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands
No full textIntroduction: Determining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors' approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure. Material and methods: A preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05). Results: The preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low. Conclusion: The authors' technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients. Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
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