Publications by authors named "Daniel F Kalbermatten"

114 Publications

Reply: Adipose tissue grafts survival and bioactivity in relation to space and internal pressure of the recipient site: a transversal topic in plastic surgery.

Plast Reconstr Surg 2022 Jul 12. Epub 2022 Jul 12.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000009415DOI Listing
July 2022

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies.

J Clin Med 2022 Jun 25;11(13). Epub 2022 Jun 25.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.

Background: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes.

Method: A systematic review of pubmed, EMBASE, Cochrane library, and Web of Science was conducted, aiming at articles comparing the outcomes of free versus pedicled flaps in lower limb reconstruction. A pooled analysis with the Mantel and Haenszel methods and random effect analysis provided results as a risk ratio with a 95% confidence interval.

Results: 10 retrospective studies were selected. While the flap necrosis rate did not differ significantly between techniques (RR 1.35, 95%CI 0.76-2.39, = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22-0.91, = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64-1.07, = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55-3.50, = 0.49) did not differ significantly. No significant difference was found in the high aesthetic satisfaction rate (RR 1.76, 95%CI 0.57-5.41, = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55-1.33, = 0.48).

Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies for lower limb reconstruction with similar surgical outcomes.
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http://dx.doi.org/10.3390/jcm11133672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267676PMC
June 2022

Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap.

Plast Reconstr Surg Glob Open 2022 May 16;10(5):e4329. Epub 2022 May 16.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.
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http://dx.doi.org/10.1097/GOX.0000000000004329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187201PMC
May 2022

Rintala Flap and Posterior Perichondrial Cutaneous Graft: A Combined Approach for Nasal Tip Reconstruction.

Plast Reconstr Surg Glob Open 2022 May 6;10(5):e4316. Epub 2022 May 6.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Nasal tip reconstruction requires a meticulous approach due to the complexity of the nasal anatomy and its aesthetic importance. Many procedures have been described to restore this aesthetic unit, including the paramedian forehead flap, which is one of the workhorse flaps. However, despite excellent final outcomes, this procedure may be refused by patients, due to its temporary conspicuous appearance possibly associated with serious psychological implications, and the need of multiple interventions. We aimed to present an approach combining the Rintala flap and the posterior perichondrial cutaneous graft as a valuable alternative to treat large nasal tip defects.
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http://dx.doi.org/10.1097/GOX.0000000000004316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9076444PMC
May 2022

Defining the Ideal Breast Reconstruction Procedure After Mastectomy From the Patient Perspective: A Retrospective Analysis.

Breast Cancer (Auckl) 2022 19;16:11782234221089597. Epub 2022 Apr 19.

Division of Plastic, Reconstructive and Esthetic Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Background: An increasing number of breast cancer patients undergo immediate or secondary breast reconstruction, but the ideal method in terms of patient satisfaction remains ambiguous. We compared the 3 most common breast reconstruction techniques to determine patient satisfaction and objective outcomes.

Methods: Retrospective study of 184 patients with breast cancer who underwent a reconstructive procedure between 1993 and 2011 at our institution. Procedures evaluated were implant-based reconstruction (IBR) alone, latissimus dorsi (LD) flap reconstruction with/without implant, and deep inferior epigastric perforator (DIEP) free flap reconstruction. A retrospective patient satisfaction questionnaire was sent to all women. Twenty patients from each subgroup were matched to conduct a standardized objective assessment of the sensitivity of their reconstructed breast. A blinded photographic evaluation was also performed by 3 independent observers to assess the esthetic aspect and symmetry.

Results: DIEP obtained significantly higher average scores regarding the esthetic outcome, immediate reconstruction impact, and overall score in the questionnaire evaluation. The IBR had the best results in the somatosensory evaluation, with DIEP scoring better than LD. DIEP received higher scores on average than LD for the criteria of size and symmetry in the esthetic evaluation. No statistically significant differences were observed between IBR and DIEP.

Conclusions: Good results were reported overall for all breast reconstruction procedures, with more reserved scores for LD. The DIEP reconstruction appeared to be the most satisfactory and best experienced reconstruction method for patients, despite the complexity of the intervention. Clinicians should be encouraged to consider DIEP as the principal choice for breast reconstruction.
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http://dx.doi.org/10.1177/11782234221089597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021510PMC
April 2022

Head and Neck Porocarcinoma: SEER Analysis of Epidemiology and Survival.

J Clin Med 2022 Apr 14;11(8). Epub 2022 Apr 14.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Porocarcinoma is a rare malignant adnexal tumor. Little is known about the location of the disease in the head and neck. Our aim is to offer the largest analysis of demographic, pathological, and treatment patterns of head and neck porocarcinoma in comparison with other locations of the neoplasm from an epidemiologically representative cohort.

Method: The Surveillance, Epidemiology, and End Results program of the National Cancer Institute was searched for all cases of porocarcinomas diagnosed between 2000 and 2018. This database is considered representative of the US population. Demographic, pathological, and treatment variables were compared between the head and neck and other regions. Overall and disease-specific survival was calculated and compared between groups.

Results: 563 porocarcinomas were identified, with 172 in the head and neck. The mean age was 66.4 years. Males were more affected in the head and neck. Regional and distant invasion rates were low (2.9 and 2.3%, respectively). Local excision and Mohs surgery were the most frequent therapies. Five-year overall survival was 74.8%. Five-year disease-specific survival was 97%.

Conclusions: Head and neck porocarcinoma affects more males than females. Regional or distant metastatic rates are low and overestimated in previous literature. Disease-specific mortality is low. Surgery remains the mainstay of treatment.
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http://dx.doi.org/10.3390/jcm11082185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024621PMC
April 2022

Muscle vs. Fasciocutaneous Microvascular Free Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies.

J Clin Med 2022 Mar 11;11(6). Epub 2022 Mar 11.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

(1) Background: Lower extremity microvascular reconstruction aims at restoring function and preventing infection while ensuring optimal cosmetic outcomes. Muscle (M) or fasciocutaneous (FC) free flaps are alternatively used to treat similar conditions. However, it is unclear whether one option might be considered superior in terms of clinical outcomes. We performed a meta-analysis of studies comparing M and FC flaps to evaluate this issue. (2) Methods: The PRISMA guidelines were followed to perform a systematic search of the English literature. We included all articles comparing M and FC flap reconstructions for lower limb soft tissue defects following trauma, infection, or tumor resection. We considered flap loss, postoperative infection, and donor site morbidity as primary outcomes. Secondary outcomes included minor recipient site complications and the need for revision surgery. (3) Results: A total of 10 articles involving 1340 patients receiving 1346 flaps were retrieved, corresponding to 782 M flaps and 564 FC flaps. The sizes of the studies ranged from 39 to 518 patients. We observed statistically significant differences ( < 0.05) in terms of donor site morbidity and total flap loss with better outcomes for FC free flaps. Moreover, the majority of authors preferred FC flaps because of the greater aesthetic satisfaction and lesser rates of postoperative infection. (4) Conclusion: Our data suggest that both M and FC free flaps are safe and effective options for lower limb reconstruction following trauma, infection, or tumor resection, although FC flaps tend to provide stronger clinical benefits. Further research should include larger randomized studies to confirm these data.
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http://dx.doi.org/10.3390/jcm11061557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951471PMC
March 2022

Intramuscular Stem Cell Injection in Combination with Bioengineered Nerve Repair or Nerve Grafting Reduces Muscle Atrophy.

Plast Reconstr Surg 2022 05 11;149(5):905e-913e. Epub 2022 Mar 11.

From Plastic and Reconstructive Surgery, University Hospital of Lausanne; Departments of Integrative Medical Biology and Surgical and Perioperative Sciences, Umeå University; and Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Basel.

Background: Peripheral nerve injuries represent a clinical challenge, especially when they are accompanied by loss of neural tissue. In this study, the authors attempted to attain a better outcome after a peripheral nerve injury by both repairing the nerve lesion and treating the denervated muscle at the same time.

Methods: Rat sciatic nerves were transected to create 10-mm gaps. Repair was performed in five groups (n = 5 rats for each), as follows: group 1, nerve repair using poly-3-hydroxybutyrate strips to connect the proximal and distal stumps, in combination with control growth medium injection in the gastrocnemius muscle; group 2, nerve repair with poly-3-hydroxybutyrate strip seeded with Schwann cell-like differentiated adipose stem cells (differentiated adipose stem cell strip) in combination with growth medium intramuscular injection; group 3, differentiated adipose stem cell strip in combination with intramuscular injection of differentiated adipose stem cells; group 4, repair using autograft (reverse sciatic nerve graft) in combination with intramuscular injection of growth medium; and group 5, autograft in combination with intramuscular injection of differentiated adipose stem cells. Six weeks after nerve injury, the effects of the stem cells on muscle atrophy were assessed.

Results: Poly-3-hydroxybutyrate strips seeded with differentiated adipose stem cells showed a high number of βIII-tubulin-positive axons entering the distal stump and abundant endothelial cells. Group 1 animals exhibited more muscle atrophy than all the other groups, and group 5 animals had the greatest muscle weights and muscle fibers size.

Conclusion: Bioengineering nerve repair in combination with intramuscular stem cell injection is a promising technique to treat nerve lesions and associated muscle atrophy.

Clinical Relevance Statement: Nerve injuries and resulting muscle atrophy are a clinical challenge. To optimize functional recovery after a nerve lesion, the authors treated the nerve and muscle at the same time by using regenerative medicine with adipose stem cells and obtained encouraging results for future clinical applications.
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http://dx.doi.org/10.1097/PRS.0000000000009031DOI Listing
May 2022

Survival outcomes and epidemiology of Merkel cell carcinoma of the lower limb and hip: A Surveillance, Epidemiology, and End Results analysis 2000-2018.

JAAD Int 2022 Jun 23;7:13-21. Epub 2022 Feb 23.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Background: Merkel cell carcinoma of lower limb and hip skin is a rare skin tumor that has a high recurrence rate.

Objective: To assess epidemiology and survival outcomes of the lower limb and hip Merkel cell carcinoma, which are less addressed in the literature.

Methods: The Surveillance, Epidemiology, and End Results database was searched for all cases of skin Merkel cell carcinoma between 2000 and 2018. Demographic and clinicopathologic features were compared between lower limb and other skin localizations using the test or χ test. The overall survival (OS) of lower limb Merkel cell carcinoma was calculated using the Kaplan-Meier method. Subgroups were compared using the log rank test. Multivariate cox regression was used to identify independent prognostic factors.

Results: In total, 976 patients were identified. The mean age was 72.7 years. The median OS was 68 months, better than that of other localizations. Older age, regional lymph node, and distant metastasis were associated with low OS. Surgery with >1-cm margins, when associated with radiotherapy, had the best OS. Age, tumor size, lymph node status, presence of metastasis, and treatment sequence were identified as independent prognostic factors.

Conclusion: Lower limb and hip Merkel cell carcinomas have better OS than tumors in other skin localizations. In this dataset, the best OS was ensured using surgery with >1-cm margins and adjuvant radiotherapy.
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http://dx.doi.org/10.1016/j.jdin.2021.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873923PMC
June 2022

Squamous Cell Carcinoma of the Vulva: A Survival and Epidemiologic Study with Focus on Surgery and Radiotherapy.

J Clin Med 2022 Feb 16;11(4). Epub 2022 Feb 16.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Vulvar squamous cell carcinoma (SCC) is the most frequent vulvar neoplasia. While the primary role of surgery is widely accepted, large population studies are needed to compare survival between diverse treatment modalities and to identify independent prognostic factors to help council patients and guide oncological treatment. The U.S. National Cancer Index, Surveillance, Epidemiology and End Results (SEER) program data between 2000 and 2018 was screened for all squamous cell carcinoma affecting the vulva. Raw data was processed with IBM SPSS. Demographic, clinical-pathological and treatment data were studied. Overall survival (OS) was calculated using the Kaplan-Meier method and subgroups were compared using the log rank test. A multivariate cox regression was conducted to identify independent prognostic factors. A total of 11,360 patients were identified with a median age of 65. Median overall survival was 101 months. Surgery as a primary treatment is the therapeutic sequence associated with the best overall survival. Multivariate cox-regression did not meet proportional hazard assumption. Age, pathological grade, stage at diagnosis, treatment sequence and the use of chemotherapy were identified as independent prognostic factor. Surgery alone is the treatment sequence offering the best overall survival. Surgery should be offered to all eligible patients.
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http://dx.doi.org/10.3390/jcm11041025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880528PMC
February 2022

Sacral Chordoma: A Population-based Analysis of Epidemiology and Survival Outcomes.

Anticancer Res 2022 Feb;42(2):929-937

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland;

Background/aim: Sacral chordoma is a rare primary bone neoplasm associated with high morbidity. The aim of this study is to identify demographic and clinicopathological characteristics of this tumor and evaluate their impact on survival outcomes.

Patients And Methods: The Surveillance, Epidemiology and End Results (SEER) database collecting data between 2000 and 2018 was searched for all cases of sacral chordoma. We analyzed demographic aspects, cancer stage and treatment patterns. Overall survival was calculated using the Kaplan-Meier method and compared between subgroups using the log-rank test. A multivariate Cox hazard regression analysis was conducted to identify independent predictors of overall survival.

Results: Four hundred and forty-two patients were identified with a mean age of 62.7 years. Most tumors presented regional invasion at diagnosis (43.2%). Mean overall survival was 124.7 months. No significant difference in terms of overall survival was found between surgery alone and surgery associated with radiotherapy. Both options provided a significantly increased survival than radiotherapy alone. Age of less than 50 years or between 50 and 69 correlated significantly with improved survival.

Conclusion: Age and stage at diagnosis impact significantly survival outcomes. Surgery remains the mainstay treatment with the highest overall survival. Its association with radiotherapy is currently questionable and needs further research.
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http://dx.doi.org/10.21873/anticanres.15552DOI Listing
February 2022

Sternocleidomastoid Muscle Transfer for Treatment of Longstanding Facial Paralysis: Long-term Outcomes and Complications.

In Vivo 2022 Jan-Feb;36(1):501-509

Plastic and Reconstructive Surgery Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China;

Background/aim: The use of sternocleidomastoid muscle (SCM) flap for facial reanimation was established in the 1980s by the senior author of this paper. We aimed to analyze long-term outcome and complications of this procedure.

Patients And Methods: We conducted a retrospective chart review of all patients undergoing SCM reanimation for longstanding facial palsy between January 2009 and December 2015. Patients with follow-up longer than 12 months (range=12-96) were included in the study. Facial muscle function was evaluated before and at each follow-up after the surgery with the House-Brackmann (HB) scale-facial nerve grading system and Facegram analysis. Donor site morbidity and overall complication rates were documented and analyzed.

Results: Forty-two patients aged 18-66 years (mean age=37) with a mean duration of facial palsy of 5 years (range=2-48) met the inclusion criteria. The HB score 2 years after surgery improved significantly (p<0.05) in comparison to the pre-operative condition (3.6 vs. 4.7). Twelve months after surgery, oral commissure excursion improved by mean 8.95 mm. No flap necrosis occurred, nor compromise of neck and shoulder function despite an obvious contour defect in the SCM donor site. None of the patients presented head posture or movement issues.

Conclusion: The SCM flap transfer is a reliable and effective procedure to achieve moderate improvement of the oral commissure excursion using a local method with moderate donor site morbidity. It can be regarded as a valuable option for dynamic facial reanimation in case of longstanding facial palsy.
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http://dx.doi.org/10.21873/invivo.12731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765154PMC
January 2022

Complications of Nonpermanent Facial Fillers: A Systematic Review.

Plast Reconstr Surg Glob Open 2021 Oct 22;9(10):e3851. Epub 2021 Oct 22.

Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.

Background: A variety of complications after injection of nonpermanent fillers for facial rejuvenation have been reported so far. However, to date, the overall complication rate is still a matter of debate. The aim of this study was to perform a systematic review of literature to assess the type and severity of associated complications following injections in different anatomical regions of the face.

Methods: The entire PubMed/Medline database was screened to identify case reports and clinical studies describing complications that have occurred after injection of nonpermanent fillers in the face. These complications have been reviewed and analyzed according to their occurrence in different anatomical regions of the face.

Results: Forty-six articles including a total of 164 patients reported on a total of 436 complications during the time period between January 2003 and February 2020. The majority of the complications were reported after injections to the nose and the nasolabial fold (n = 230), the forehead and the eyebrows (n = 53), and the glabellar region (n = 36). Out of 436 complications, 163 have been classified as severe or permanent including skin necrosis (n = 46), loss of vision (n = 35), or encephalitis (n = 1), whereas 273 complications were classified as mild or transient, such as local edema (n = 74), skin erythema (n = 69), and filler migration (n = 2). The most severe complications were observed in treatments of nose, glabella, and forehead.

Conclusions: Nonpermanent facial fillers are associated with rare but potentially severe complications. Severity and impact of complications depend on the anatomical region of the face and eventually require profound knowledge of facial anatomy.
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http://dx.doi.org/10.1097/GOX.0000000000003851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542164PMC
October 2021

Reduction Mammoplasty: A Ten-Year Retrospective Review of the Omega Resection Pattern Technique.

J Clin Med 2021 Sep 27;10(19). Epub 2021 Sep 27.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Reduction mammoplasty is the gold standard procedure for symptomatic breast hypertrophy and it is also used for contralateral breast symmetrisation following breast cancer surgery. We aim at introducing a new procedure, which uses an omega resection pattern to simplify the inferior pedicle breast resection technique. A retrospective review of all patients who underwent the omega resection reduction mammoplasty at the University Hospital of Basel between 2010 and 2020 was carried out. We collected patient demographics, surgical outcomes, operation time, type and frequency of complications at 12 months follow-up. Outcomes were compared with the most commonly used techniques. Additionally, we assessed if patients' and clinical characteristics augmented/diminished the complication rate. During the study period, 67 reduction mammaplasties were performed by a senior plastic surgeon (M = 42.5, SD = 15.6; M = 27.28, SD = 3.4; 20% smokers). The average tissue removed was 826 g (ranging from 15 to 2307 g). In 10 breasts (15%) occurred minor complications. No major complications were reported. Operation time (M = 149 min; ranging from 87 to 270 min) was significantly shorter than the inferior, superomedial, and superior pedicle techniques. Univariate Odd Ratios showed that no-smoker status, a BMI in a normal range, resection weight between 500 g to 1500 g, NTN distance < 30 cm, removal of drains one day after the operation, ASA index of 2, inpatient clinic hospitalisation, and not undergoing other concomitant surgical operations were protective factors against the risk to develop complications. The omega resection pattern technique demonstrated to be an effective, safe, and fast mammoplasty reduction procedure for bilateral macromastia and unilateral symmetrizing procedures, even for large breasts, able to be adopted as a new valid alternative to the existing ones.
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http://dx.doi.org/10.3390/jcm10194418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509280PMC
September 2021

Systematic investigation and comparison of US FDA-approved immunosuppressive drugs FK506, cyclosporine and rapamycin for neuromuscular regeneration following chronic nerve compression injury.

Regen Med 2021 11 11;16(11):989-1003. Epub 2021 Oct 11.

Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland.

To compare therapeutic benefits of different immunophilin ligands for treating nerve injuries. Cyclosporine, FK506 and rapamycin, were evaluated first on a serum-free culture of embryonic dorsal root ganglia followed by a new model of chronic nerve compression. Outcomes of the study have shown a potent effect of cyclosporine and FK506, on dorsal root ganglia axonal outgrowth, comparable to the effect of nerve growth factor. Rapamycin exhibited only a moderate effect. The study revealed the beneficial effects of cyclosporine, FK506 and rapamycin for neuromuscular regeneration. Cyclosporine showed the better maintenance of the tissues and function. Cyclosporine, FK506 and rapamycin drugs showed potential for treating peripheral nerve chronic compression injuries.
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http://dx.doi.org/10.2217/rme-2020-0130DOI Listing
November 2021

A new model of chronic peripheral nerve compression for basic research and pharmaceutical drug testing.

Regen Med 2021 10 23;16(10):931-947. Epub 2021 Sep 23.

Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.

To develop a consistent model to standardize research in the field of chronic peripheral nerve neuropathy. The left sciatic nerve of 8-week-old Sprague-Dawley rats was compressed using a customized instrument leaving a defined post injury nerve lumen (400 μm, 250 μm, 100 μm, 0 μm) for 6 weeks. Sensory and motor outcomes were measured weekly, and histomorphology and electrophysiology after 6 weeks. The findings demonstrated compression depth-dependent sensory and motor pathologies. Quantitative measurements revealed a significant myelin degeneration, axon irregularities and muscle atrophy. At the functional level, we highlighted the dynamics of the different injury profiles. Our novel model of chronic peripheral nerve compression is a useful tool for research on pathophysiology and new therapeutic approaches.
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http://dx.doi.org/10.2217/rme-2020-0129DOI Listing
October 2021

The Butterfly Technique: A Retrospective Study for Labia Minora Reduction Using an Integrated Approach.

Plast Reconstr Surg Glob Open 2021 Sep 13;9(9):e3810. Epub 2021 Sep 13.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals (HUG), University of Geneva, Geneva, Switzerland.

In recent years, the demand for genital plastic procedures has increased. Of those, the reduction of the labia minora has become very popular. Several techniques are described, with all its advantages and disadvantages. The aim of this study is to introduce a novel approach combining de-epithelialization with wedge resection.

Methods: In this retrospective study, we included patients seen between September 2011 and April 2014 with hypertrophic labia minora. The surgical technique consisted in an integrated approach of de-epithelialization and wedge excision. Patients were examined for early and late postoperative complications. Furthermore, patient satisfaction was evaluated at the final follow-up.

Results: A total of 17 labioplasties (Franco type II-IV) in 10 patients with a mean age of 29 ± 12 years (range 20-62 y) were performed. Three patients experienced wound-healing problems, requiring surgical revision. After a median follow-up of 39 ± 6 months (range 28-48 mo), a high overall patient satisfaction has been achieved (8.6 ± 1.1). No dyspareunia, hypertrophic scarring, or micturition problems have been reported.

Conclusions: By using our integrated approach, hereby called the "butterfly technique," the neurovascular supply remains preserved, and an efficient volume reduction can be achieved with a concealed scar. Nevertheless, suture techniques and suture materials have to be tested to reduce the incidence of wound dehiscence rate.
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http://dx.doi.org/10.1097/GOX.0000000000003810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432638PMC
September 2021

Abdominal-based adipocutaneous advancement flap for reconstructing inguinal defects with contraindications to standard reconstructive approaches: a simple and safe salvage reconstructive option.

Arch Plast Surg 2021 Jul 15;48(4):395-403. Epub 2021 Jul 15.

Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Background: Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity.

Methods: This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed.

Results: Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years.

Conclusions: Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.
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http://dx.doi.org/10.5999/aps.2019.01795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342256PMC
July 2021

Soft-tissue reconstruction in lower-leg fracture-related infections: An orthoplastic outcome and risk factor analysis.

Injury 2021 Nov 16;52(11):3489-3497. Epub 2021 Jul 16.

Center for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, Basel CH-4031 Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Switzerland.

Introduction Fracture-related infection (FRI) is a severe post-traumatic complication which is occasionally accompanied by a deficient or even avital soft-tissue envelope. In these cases, a thoroughly planned orthoplastic approach is imperative as a vital and intact soft-tissue envelope is mandatory to achieve fracture union and infection eradication. The aim of this study was, to analyse if soft-tissue reconstruction (STR) without complications is associated with a better long-term outcome compared to FRI patients with STR complications. In particular, it was investigated if primary flap failure represented a risk factor for compromised fracture union and recurrence of infection. Patients and Methods Patients with a lower leg FRI requiring STR (local, pedicled and free flaps) who were treated from 2010-18 at the University Hospital Basel were included in this retrospective analysis. The main outcome measure was the success rate of STR, further outcome measures were fracture nonunion and recurrence of infection. Results Overall, 145 patients with lower leg FRI were identified, of whom 58 (40%) received STR (muscle flaps: n = 38, fascio-cutaneous flaps: n=19; composite osteo-cutaneous flap: n = 1). In total seven patients required secondary STR due to primary flap failure. All failures and flap-related complications occurred within the first three weeks after surgery. Secondary STR was successful in all cases. A high Charlson Comorbidity Index Score was a significant risk factor for flap failure (p = 0.011). Out of the 43 patients who completed the 9-month follow-up, 11 patients presented with fracture nonunion and 12 patients with a recurrent infection. Polymicrobial infection was a significant risk factor for fracture nonunion (p = 0.002). Primary flap failure was neither a risk factor for compromised fracture consolidation (p = 0.590) nor for recurrence of infection (p = 0.508). Conclusion: A considerable number of patients with lower-leg FRI required STR. This patient subgroup is complex and rich in complications and the long-term composite outcome demonstrated a high rate of compromised fracture consolidation and recurrent infections. It appears that secondary STR should be performed, as primary flap failure was neither a risk factor for compromised fracture consolidation nor for recurrence of infection. We propose to monitor these patients closely for three weeks after STR.
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http://dx.doi.org/10.1016/j.injury.2021.07.022DOI Listing
November 2021

[Management of symptomatic breast hypertrophy and reduction mammaplasty].

Rev Med Suisse 2021 Jun;17(743):1177-1181

Service de chirurgie plastique, reconstructive et esthétique, Département de chirurgie, HUG, 1211 Genève 14.

Breast hypertrophy (macromastia) can cause various symptoms correlated with excessive breast volume and is usually associated with breast ptosis. Symptomatic macromastia can constitute a heavy burden on patient's global health. While conservative therapy does not allow for long term relief, breast reduction mammaplasty is an effective and safe treatment. Multiple techniques have been described, but all rely on common principles. Measures can be taken to lower surgical complications rates and implemented by primary care physicians in collaboration with the plastic surgery approach.
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June 2021

The "purse-string-suture technique" for scar improvement in vertical scar mammaplasty.

J Plast Reconstr Aesthet Surg 2021 06 14;74(6):1355-1401. Epub 2020 Dec 14.

Millpark Hospital, 9 Guild Road, Parktown West, 2193, Suite F PO Box 650051, Benmore, 2010, South Africa.

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http://dx.doi.org/10.1016/j.bjps.2020.12.013DOI Listing
June 2021

Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning with External Volume Expansion.

Plast Reconstr Surg 2021 01;147(1):158e-159e

Department of Plastic, Reconstructive, and Aesthetic Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000007445DOI Listing
January 2021

Schwann Cell-Like Cells: Origin and Usability for Repair and Regeneration of the Peripheral and Central Nervous System.

Cells 2020 08 29;9(9). Epub 2020 Aug 29.

Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.

Functional recovery after neurotmesis, a complete transection of the nerve fiber, is often poor and requires a surgical procedure. Especially for longer gaps (>3 mm), end-to-end suturing of the proximal to the distal part is not possible, thus requiring nerve graft implantation. Artificial nerve grafts, i.e., hollow fibers, hydrogels, chitosan, collagen conduits, and decellularized scaffolds hold promise provided that these structures are populated with Schwann cells (SC) that are widely accepted to promote peripheral and spinal cord regeneration. However, these cells must be collected from the healthy peripheral nerves, resulting in significant time delay for treatment and undesired morbidities for the donors. Therefore, there is a clear need to explore the viable source of cells with a regenerative potential similar to SC. For this, we analyzed the literature for the generation of Schwann cell-like cells (SCLC) from stem cells of different origins (i.e., mesenchymal stem cells, pluripotent stem cells, and genetically programmed somatic cells) and compared their biological performance to promote axonal regeneration. Thus, the present review accounts for current developments in the field of SCLC differentiation, their applications in peripheral and central nervous system injury, and provides insights for future strategies.
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http://dx.doi.org/10.3390/cells9091990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565191PMC
August 2020

Arteriovenous Loops Enable Free Tissue Transfer With Otherwise Inadequate Local Donor and Recipient Vessels.

In Vivo 2020 Sep-Oct;34(5):2543-2548

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Background/aim: Free flap reconstruction with damaged or diseased vessels is a challenging problem. We describe our case series using an arteriovenous loop or bypass surgery with free flaps for complex defect reconstructions at the lower extremity and the pelvic region.

Patients And Methods: In this single-center retrospective cohort study 11 consecutive patients (mean age=73 years, range=53-88 years) were operated on, between June 2016 and August 2018. Patients were reconstructed with free gracilis flaps (n=8), free latissimus dorsi flap (n=1) and chimeric scapular flap (n=1), respectively.

Results: The mean loop length was 30 cm (range=12-40 cm). The loop/bypass revision rate was 27% (3/11), and the overall flap loss rate was 20% (2/10). After a mean follow-up time of 17 months (range=12-24 months), the limb salvage rate was 75% (6/8).

Conclusion: We successfully reconstructed complex defects with poor recipient vessels using arteriovenous loops or bypass surgery and free flaps.
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http://dx.doi.org/10.21873/invivo.12071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652518PMC
June 2021

Modulation of Human Adipose Stem Cells' Neurotrophic Capacity Using a Variety of Growth Factors for Neural Tissue Engineering Applications: Axonal Growth, Transcriptional, and Phosphoproteomic Analyses In Vitro.

Cells 2020 08 21;9(9). Epub 2020 Aug 21.

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4021 Basel, Switzerland.

We report on a potential strategy involving the exogenous neurotrophic factors (NTF) for enhancing the neurotrophic capacity of human adipose stem cells (ASC) in vitro. For this, ASC were stimulated for three days using NTF, i.e., nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT3), NT4, glial cell-derived neurotrophic factor (GDNF), and ciliary neurotrophic factor (CNTF). The resulting conditioned medium (CM) as well as individual NTF exhibited distinct effects on axonal outgrowth from dorsal root ganglion (DRG) explants. In particular, CM derived from NT3-stimulated ASC (CM-NT3-ASC) promoted robust axonal outgrowth. Subsequent transcriptional analysis of DRG cultures in response to CM-NT3-ASC displayed significant upregulation of STAT-3 and GAP-43. In addition, phosphoproteomic analysis of NT3-stimulated ASC revealed significant changes in the phosphorylation state of different proteins that are involved in cytokine release, growth factors signaling, stem cell maintenance, and differentiation. Furthermore, DRG cultures treated with CM-NT3-ASC exhibited significant changes in the phosphorylation levels of proteins involved in tubulin and actin cytoskeletal pathways, which are crucial for axonal growth and elongation. Thus, the results obtained at the transcriptional, proteomic, and cellular level reveal significant changes in the neurotrophic capacity of ASC following NT3 stimulation and provide new options for improving the axonal growth-promoting potential of ASC in vitro.
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http://dx.doi.org/10.3390/cells9091939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565501PMC
August 2020

A Changing Paradigm: The Brazilian Butt Lift Is Neither Brazilian Nor a Lift-Why It Needs to Be Called Safe Subcutaneous Buttock Augmentation.

Plast Reconstr Surg 2020 10;146(4):502e-503e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000007200DOI Listing
October 2020

Ex-Vivo Stimulation of Adipose Stem Cells by Growth Factors and Fibrin-Hydrogel Assisted Delivery Strategies for Treating Nerve Gap-Injuries.

Bioengineering (Basel) 2020 May 5;7(2). Epub 2020 May 5.

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4021 Basel, Switzerland.

Peripheral nerve injuries often result in lifelong disabilities despite advanced surgical interventions, indicating the urgent clinical need for effective therapies. In order to improve the potency of adipose-derived stem cells (ASC) for nerve regeneration, the present study focused primarily on ex-vivo stimulation of ASC by using growth factors, i.e., nerve growth factor (NGF) or vascular endothelial growth factor (VEGF) and secondly on fibrin-hydrogel nerve conduits (FNC) assisted ASC delivery strategies, i.e., intramural vs. intraluminal loading. ASC were stimulated by NGF or VEGF for 3 days and the resulting secretome was subsequently evaluated in an in vitro axonal outgrowth assay. For the animal study, a 10 mm sciatic nerve gap-injury was created in rats and reconstructed using FNC loaded with ASC. Secretome derived from NGF-stimulated ASC promoted significant axonal outgrowth from the DRG-explants in comparison to all other conditions. Thus, NGF-stimulated ASC were further investigated in animals and found to enhance early nerve regeneration as evidenced by the increased number of β-Tubulin III+ axons. Notably, FNC assisted intramural delivery enabled the improvement of ASC's therapeutic efficacy in comparison to the intraluminal delivery system. Thus, ex-vivo stimulation of ASC by NGF and FNC assisted intramural delivery may offer new options for developing effective therapies.
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http://dx.doi.org/10.3390/bioengineering7020042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357460PMC
May 2020

Human platelet lysate stimulated adipose stem cells exhibit strong neurotrophic potency for nerve tissue engineering applications.

Regen Med 2020 03 20;15(3):1399-1408. Epub 2020 Apr 20.

Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.

We investigated a potential strategy involving human platelet lysate (HPL) as a media additive for enhancing the neurotrophic potency of human adipose stem cells (ASC). Dorsal root ganglion explants, ASC and Schwann cells were used for axonal outgrowth experiments. Remarkably, HPL-supplemented ASC promoted robust axonal outgrowth, in other words, four-times higher than fetal bovine serum-supplemented ASC and even matched to the level of Schwann cells. Further, analysis of regime of growth medium additive supplementation revealed the critical play of HPL in dorsal root ganglion and stem cells co-culture system for mounting effective axonal growth response. HPL supplementation significantly improved the neurotrophic potency of ASC as evidenced by the robust axonal outgrowth; these findings hold significance for nerve tissue engineering applications.
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http://dx.doi.org/10.2217/rme-2020-0031DOI Listing
March 2020

Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction.

Arch Plast Surg 2021 Mar 10;48(2):224-230. Epub 2020 Apr 10.

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Background: Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation.

Methods: Thirteen consecutive patients with a median age of 55 years (range, 21-70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed.

Results: All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10-51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C).

Conclusions: Finer sensation could be partially restored. However, thermal sensation remained poor.
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http://dx.doi.org/10.5999/aps.2019.00584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007463PMC
March 2021

Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model.

Plast Reconstr Surg 2020 03;145(3):657e-658e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000006574DOI Listing
March 2020
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