*Corresponding author: José M Lasso, Plastic Surgery, Hospital General Universitario Gregorio Mar... more *Corresponding author: José M Lasso, Plastic Surgery, Hospital General Universitario Gregorio Marañón, Área 3400, C/ Dr Esquerdo 46, 28007 Madrid, Spain, E-mail: josemaria.lasso@salud.madrid.org Citation: Lasso JM (2015) Reconstruction of the Facial Nerve in Pigs with Facial Nerve Allografts Wrapped in A Fibrin Scaffold Containing Fibroblasts Transduced with Adenovirus Encoding VEGF 156. Enliven: Surg Transplant 1(1): 009. Copyright: @ 2015 Dr. Jose M Lasso. This is an Open Access article published and distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Received Date: 9th June 2015 Accepted Date: 22nd June 2015 Published Date: 27th June 2015 Research Article Enliven: Surgery and Transplantation ISSN: 2379-5719
Aims: Women undergoing breast conservation therapy (BCT) for breast cancer are often left with co... more Aims: Women undergoing breast conservation therapy (BCT) for breast cancer are often left with contour defects and few acceptable reconstructive options. RESTORE-2 is the first prospective clinical trial using autologous adipose-derived regenerative cell (ADRC)-enriched fat grafting for reconstruction of such defects. This single-arm, prospective, multi-center clinical trial enrolled 71 patients post-BCT with defects 150 mL. Methods: Adipose tissue was collected via syringe lipoharvest and then processed during the same surgical procedure using a closed automated system that isolates ADRCs and prepares an ADRC-enriched fat graft for immediate re-implantation. ADRC-enriched fat graft injections were performed in a fan-shaped pattern to prevent pooling of the injected fat. Overall procedure times were less than 4 h. The RESTORE-2 protocol allowed for up to two treatment sessions and 24 patients elected to undergo a second procedure following the six month follow-up visit. Results: Of the 67 patients treated, 50 reported satisfaction with treatment results through 12 months. Using the same metric, investigators reported satisfaction with 57 out of 67 patients. Independent radiographic core laboratory assessment reported improvement in the breast contour of 54 out of 65 patients based on blinded assessment of MRI sequence. There were no serious adverse events associated with the ADRC-enriched fat graft injection procedure. There were no reported local cancer recurrences. Injection site cysts were reported as adverse events in ten patients. Conclusion: This prospective trial demonstrates the safety and efficacy of the treatment of BCT defects utilizing ADRC-enriched fat grafts.
Cirugía Plástica Ibero-Latinoamericana, Dec 1, 2013
Presentamos el caso de una adolescente africana de 16 años de edad afectada por albinismo óculo-c... more Presentamos el caso de una adolescente africana de 16 años de edad afectada por albinismo óculo-cutáneo, que desarrolló un carcinoma epidermoide en pabellón auricular derecho que requirió escisión radical y reconstrucción con colgajo TRAM libre. El albinismo es un trastorno metabólico genético que consiste en la incapacidad hereditaria para sintetizar melanina. Tiene dos variantes clínicas: el albinismo ocular y el albinismo óculo-cutáneo. En determinados países africanos, los pacientes afectos por esta enfermedad son socialmente rechazados y por ello no se les presta un control sanitario adecuado. Por esta razón el tumor llevaba varios años de evolución y cuando la paciente fue vista en nuestro centro, existía una infiltración profunda con afectación severa de la base del cráneo. La compleja anatomía de las estructuras vitales en esta región hace que la resección quirúrgica de los tumores sea complicada. Comentamos las peculiaridades en la reconstrucción de casos complejos en la base lateral del cráneo con proyección a la zona temporal.
Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.
Hairline is a crucial landmark in facial aesthetics. Its restoration in terms of position, contin... more Hairline is a crucial landmark in facial aesthetics. Its restoration in terms of position, continuity and hair growth is of a paramount importance in facial plastic aesthetic and reconstructive surgery. The purpose of the paper is to demonstrate the effectiveness of using local tissue only in the restoration of skin and soft tissue defects affecting the hairline. A brief retrospective analysis of clinical cases with defects engaging the hairline was made. The majority of the patients (20 out of 22) were operated because of skin lesions of different entities. In 7 of the cases the direct closure technique was applied as a surgical tool for hairline restoration and in 15 of them rotational fl aps were the best reconstructive option. A special emphasis is put on the defect size in regards of choosing the right surgical technique for defect closure in order to achieve the best aesthetic outcome in the hairline restoration.
Nerve grafts are used to repair segmental defects in peripheral nerves. However, autografts and e... more Nerve grafts are used to repair segmental defects in peripheral nerves. However, autografts and even allografts are limited for clinical use. Xenotransplantation offers a potentially unlimited source for tissue transplantation. We have conducted a systematic review of the literature, aiming to clarify the latest and more appealing proposals and discoveries in nerve xenotransplantation. A total of 22 articles were retrieved, all of them experimentally controlled studies in animals. There are no current studies in humans. Fresh xenografts provoke an immune response that leads to graft rejection. Immunosuppressive drugs or pretreatment of the grafts are the preferred methods against immune rejection. Recently, investigative groups have proposed the use of acellular nerve xenografts, which do not elicit immune rejection while they do allow and promote axonal regeneration. The addition of human stem cells increases nerve growth. Limits to the analyzed studies are the absence of trials in humans and the short length of the nerve defects that have been successfully repaired. Further investigations and clinical trials are needed before nerve xenografting is accepted as a valid method of nerve repair.
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract... more Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose. The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment. Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse. The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result. Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.
Anatomical record (Hoboken, N.J. : 2007), Jan 16, 2018
The extrapetrous course of the facial nerve has been a matter of study and debate since XIX centu... more The extrapetrous course of the facial nerve has been a matter of study and debate since XIX century. Two different classifications have been classically proposed and widely accepted by most of the authors. Nevertheless, there are reported cases which do not fit in any of those. The aim of this study is to propose a new and useful classification. We have used 23 embalmed Caucasian adult cadavers (11 male and 12 female) belonging to the Bodies Donation and Dissecting Rooms Centre of the University Complutense of Madrid. The extra-petrous facial nerve was dissected in the possible specimens resulting in 38 facial nerves. The studied parameters were length, diameter of divisions, terminal branches, and nerve connections. In every specimen two main divisions were found, temporofacial and cervicofacial. They divided into five terminal branches from cranial to caudal: temporal, zygomatic, buccal, marginal or mandibular, and cervical. Based on the comparison with previous proposed classific...
Background context: Sacral chordoma is a rare entity with high local recurrence rates when comple... more Background context: Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. Till date, there are not any series available in literature combining surgery and intraoperative radiotherapy (IORT). Purpose: To report the experience of our Centre in the management of sacral chordoma combining radical resection with both external radiotherapy and intraoperative radiotherapy (IORT). Study Design: Retrospective case series. Patients sample: 15 patients with sacral chordoma resected in our centre from 1998 to 2015. Outcome measures: Overall survival (OS), Disease free survival and rates of local and distant recurrence. Methods: We retrospectively revised the records of all the patients with sacral chordoma resected in our centre from 1998 to December 2015. Overall survival (OS), Disease free survival and rates of local and distant recurrence were calculated. Results between patients treated with or without IORT were compared. Results: A total of 15 patients were identified: 8 males and 7 females. Median age was 59 years (range 28-77). IORT was applied in 9 patients and 6 were treated with surgical resection without IORT. In 13 patients we performed the treatment of the primary tumor and in 2 patients we performed the treatment of recurrence disease. A posterior approach was used in 4 patients. Wide surgical margins (R0) were achieved in 6 patients, marginal margins (R1) in 7 patients and there were not any patient with intralesional (R2) margins. At a median follow up of 38 months (range 11-209 months), the 5 years OS in the IORT group was 100% versus 53% in the group of non-IORT (p=0.05). The median DFS in the IORT group was 85 months versus 41 months in the non-IORT group. In the group without IORT, two patients died and nobody died during the follow up in the group treated with IORT. High sacrectomy treated patients had a median survival of 41 months versus 90 months in low sacrectomy treated patients. DFS in patients without gluteal involvement was 100% at 5 years, and 40% in patients with gluteal involvement (fig ). All patients with a recurrence in our study had gluteal involvement. Conclusions: Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in overall survival and diseasefree survival. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed in order to confirm the utility of IORT.
*Corresponding author: José M Lasso, Plastic Surgery, Hospital General Universitario Gregorio Mar... more *Corresponding author: José M Lasso, Plastic Surgery, Hospital General Universitario Gregorio Marañón, Área 3400, C/ Dr Esquerdo 46, 28007 Madrid, Spain, E-mail: josemaria.lasso@salud.madrid.org Citation: Lasso JM (2015) Reconstruction of the Facial Nerve in Pigs with Facial Nerve Allografts Wrapped in A Fibrin Scaffold Containing Fibroblasts Transduced with Adenovirus Encoding VEGF 156. Enliven: Surg Transplant 1(1): 009. Copyright: @ 2015 Dr. Jose M Lasso. This is an Open Access article published and distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Received Date: 9th June 2015 Accepted Date: 22nd June 2015 Published Date: 27th June 2015 Research Article Enliven: Surgery and Transplantation ISSN: 2379-5719
Aims: Women undergoing breast conservation therapy (BCT) for breast cancer are often left with co... more Aims: Women undergoing breast conservation therapy (BCT) for breast cancer are often left with contour defects and few acceptable reconstructive options. RESTORE-2 is the first prospective clinical trial using autologous adipose-derived regenerative cell (ADRC)-enriched fat grafting for reconstruction of such defects. This single-arm, prospective, multi-center clinical trial enrolled 71 patients post-BCT with defects 150 mL. Methods: Adipose tissue was collected via syringe lipoharvest and then processed during the same surgical procedure using a closed automated system that isolates ADRCs and prepares an ADRC-enriched fat graft for immediate re-implantation. ADRC-enriched fat graft injections were performed in a fan-shaped pattern to prevent pooling of the injected fat. Overall procedure times were less than 4 h. The RESTORE-2 protocol allowed for up to two treatment sessions and 24 patients elected to undergo a second procedure following the six month follow-up visit. Results: Of the 67 patients treated, 50 reported satisfaction with treatment results through 12 months. Using the same metric, investigators reported satisfaction with 57 out of 67 patients. Independent radiographic core laboratory assessment reported improvement in the breast contour of 54 out of 65 patients based on blinded assessment of MRI sequence. There were no serious adverse events associated with the ADRC-enriched fat graft injection procedure. There were no reported local cancer recurrences. Injection site cysts were reported as adverse events in ten patients. Conclusion: This prospective trial demonstrates the safety and efficacy of the treatment of BCT defects utilizing ADRC-enriched fat grafts.
Cirugía Plástica Ibero-Latinoamericana, Dec 1, 2013
Presentamos el caso de una adolescente africana de 16 años de edad afectada por albinismo óculo-c... more Presentamos el caso de una adolescente africana de 16 años de edad afectada por albinismo óculo-cutáneo, que desarrolló un carcinoma epidermoide en pabellón auricular derecho que requirió escisión radical y reconstrucción con colgajo TRAM libre. El albinismo es un trastorno metabólico genético que consiste en la incapacidad hereditaria para sintetizar melanina. Tiene dos variantes clínicas: el albinismo ocular y el albinismo óculo-cutáneo. En determinados países africanos, los pacientes afectos por esta enfermedad son socialmente rechazados y por ello no se les presta un control sanitario adecuado. Por esta razón el tumor llevaba varios años de evolución y cuando la paciente fue vista en nuestro centro, existía una infiltración profunda con afectación severa de la base del cráneo. La compleja anatomía de las estructuras vitales en esta región hace que la resección quirúrgica de los tumores sea complicada. Comentamos las peculiaridades en la reconstrucción de casos complejos en la base lateral del cráneo con proyección a la zona temporal.
Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.
Hairline is a crucial landmark in facial aesthetics. Its restoration in terms of position, contin... more Hairline is a crucial landmark in facial aesthetics. Its restoration in terms of position, continuity and hair growth is of a paramount importance in facial plastic aesthetic and reconstructive surgery. The purpose of the paper is to demonstrate the effectiveness of using local tissue only in the restoration of skin and soft tissue defects affecting the hairline. A brief retrospective analysis of clinical cases with defects engaging the hairline was made. The majority of the patients (20 out of 22) were operated because of skin lesions of different entities. In 7 of the cases the direct closure technique was applied as a surgical tool for hairline restoration and in 15 of them rotational fl aps were the best reconstructive option. A special emphasis is put on the defect size in regards of choosing the right surgical technique for defect closure in order to achieve the best aesthetic outcome in the hairline restoration.
Nerve grafts are used to repair segmental defects in peripheral nerves. However, autografts and e... more Nerve grafts are used to repair segmental defects in peripheral nerves. However, autografts and even allografts are limited for clinical use. Xenotransplantation offers a potentially unlimited source for tissue transplantation. We have conducted a systematic review of the literature, aiming to clarify the latest and more appealing proposals and discoveries in nerve xenotransplantation. A total of 22 articles were retrieved, all of them experimentally controlled studies in animals. There are no current studies in humans. Fresh xenografts provoke an immune response that leads to graft rejection. Immunosuppressive drugs or pretreatment of the grafts are the preferred methods against immune rejection. Recently, investigative groups have proposed the use of acellular nerve xenografts, which do not elicit immune rejection while they do allow and promote axonal regeneration. The addition of human stem cells increases nerve growth. Limits to the analyzed studies are the absence of trials in humans and the short length of the nerve defects that have been successfully repaired. Further investigations and clinical trials are needed before nerve xenografting is accepted as a valid method of nerve repair.
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract... more Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose. The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment. Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse. The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result. Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.
Anatomical record (Hoboken, N.J. : 2007), Jan 16, 2018
The extrapetrous course of the facial nerve has been a matter of study and debate since XIX centu... more The extrapetrous course of the facial nerve has been a matter of study and debate since XIX century. Two different classifications have been classically proposed and widely accepted by most of the authors. Nevertheless, there are reported cases which do not fit in any of those. The aim of this study is to propose a new and useful classification. We have used 23 embalmed Caucasian adult cadavers (11 male and 12 female) belonging to the Bodies Donation and Dissecting Rooms Centre of the University Complutense of Madrid. The extra-petrous facial nerve was dissected in the possible specimens resulting in 38 facial nerves. The studied parameters were length, diameter of divisions, terminal branches, and nerve connections. In every specimen two main divisions were found, temporofacial and cervicofacial. They divided into five terminal branches from cranial to caudal: temporal, zygomatic, buccal, marginal or mandibular, and cervical. Based on the comparison with previous proposed classific...
Background context: Sacral chordoma is a rare entity with high local recurrence rates when comple... more Background context: Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. Till date, there are not any series available in literature combining surgery and intraoperative radiotherapy (IORT). Purpose: To report the experience of our Centre in the management of sacral chordoma combining radical resection with both external radiotherapy and intraoperative radiotherapy (IORT). Study Design: Retrospective case series. Patients sample: 15 patients with sacral chordoma resected in our centre from 1998 to 2015. Outcome measures: Overall survival (OS), Disease free survival and rates of local and distant recurrence. Methods: We retrospectively revised the records of all the patients with sacral chordoma resected in our centre from 1998 to December 2015. Overall survival (OS), Disease free survival and rates of local and distant recurrence were calculated. Results between patients treated with or without IORT were compared. Results: A total of 15 patients were identified: 8 males and 7 females. Median age was 59 years (range 28-77). IORT was applied in 9 patients and 6 were treated with surgical resection without IORT. In 13 patients we performed the treatment of the primary tumor and in 2 patients we performed the treatment of recurrence disease. A posterior approach was used in 4 patients. Wide surgical margins (R0) were achieved in 6 patients, marginal margins (R1) in 7 patients and there were not any patient with intralesional (R2) margins. At a median follow up of 38 months (range 11-209 months), the 5 years OS in the IORT group was 100% versus 53% in the group of non-IORT (p=0.05). The median DFS in the IORT group was 85 months versus 41 months in the non-IORT group. In the group without IORT, two patients died and nobody died during the follow up in the group treated with IORT. High sacrectomy treated patients had a median survival of 41 months versus 90 months in low sacrectomy treated patients. DFS in patients without gluteal involvement was 100% at 5 years, and 40% in patients with gluteal involvement (fig ). All patients with a recurrence in our study had gluteal involvement. Conclusions: Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in overall survival and diseasefree survival. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed in order to confirm the utility of IORT.
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