Publications by authors named "G Lemperle"

113 Publications

Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation.

Aesthetic Plast Surg 2020 08;44(4):1348-1360

, Frankfurt, Germany.

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lackexperimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances- resorbable or nonresorbable-appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances.
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http://dx.doi.org/10.1007/s00266-020-01827-7DOI Listing
August 2020

2020 Update on 2003 Article "Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation".

Aesthetic Plast Surg 2020 08;44(4):1361-1363

Division of Plastic Surgery, University of California, San Diego, 200 West Arbor Drive, San Diego, CA, 92103-8890, USA.

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http://dx.doi.org/10.1007/s00266-020-01776-1DOI Listing
August 2020

Keloids: Which Types Can Be Excised without Risk of Recurrence? A New Clinical Classification.

Plast Reconstr Surg Glob Open 2020 Mar 27;8(3):e2582. Epub 2020 Mar 27.

Institut für Pathologie, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany.

A surgical team from Interplast-Germany removed 387 keloids in 302 patients during 4 visits to Goma, Democratic Republic of the Congo, from 2015-2018. Preoperative and postoperative photographs and a thorough anamnesis of keloids were done for all patients. In addition, 18 selected biopsies from 4 types of keloids were histologically examined in Germany.

Methods: Treatment options were tested and keloid recurrence rates were compared with data from questionnaires, photographs, and histology.

Results: Keloids were classified accordingly as follows: (1) fresh nodular (continuously growing) keloids had a 30% recurrence rate after surgery: no common adjuvant therapy but triamcinolone acetonide (TAC) injections on onset, only; (a) earlobe keloids had the lowest recurrence rate after complete excision with negative resection margins; (2) superficial spreading (or butterfly) keloids were treated with TAC injections only; (3) mature (nongrowing or burned-out) keloids had also a low recurrence rate of 4.5%, which were then treated with TAC on onset, only; and (4) multiple keloids comprise various types in different stages.

Conclusions: According to this classification, about 50% of keloids may be removed surgically without risk of recurrence in the examined patient population in Africa, where only TAC injections, but no radiation, are available. Adjuvant TAC or radiation should be started at the onset of recurrence and not generally.
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http://dx.doi.org/10.1097/GOX.0000000000002582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253266PMC
March 2020

Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy?

Intern Emerg Med 2020 Aug 26;15(5):801-812. Epub 2020 May 26.

Department of Medical-Surgery Sciences and Translational Medicine, University of Rome Sapienza, Rome, Italy.

Of huge importance now is to provide a fast, cost-effective, safe, and immediately available pharmaceutical solution to curb the rapid global spread of SARS-CoV-2. Recent publications on SARS-CoV-2 have brought attention to the possible benefit of chloroquine in the treatment of patients infected by SARS-CoV-2. Whether chloroquine can treat SARS-CoV-2 alone and also work as a prophylactic is doubtful. An effective prophylactic medication to prevent viral entry has to contain, at least, either a protease inhibitor or a competitive virus ACE2-binding inhibitor. Using bromhexine at a dosage that selectively inhibits TMPRSS2 and, in so doing, inhibits TMPRSS2-specific viral entry is likely to be effective against SARS-CoV-2. We propose the use of bromhexine as a prophylactic and treatment. We encourage the scientific community to assess bromhexine clinically as a prophylactic and curative treatment. If proven to be effective, this would allow a rapid, accessible, and cost-effective application worldwide.
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http://dx.doi.org/10.1007/s11739-020-02383-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249615PMC
August 2020

Minimal Scar Formation After Orthopaedic Skin Incisions Along Main Folding Lines.

J Bone Joint Surg Am 2019 Mar;101(5):392-399

Division of Plastic Surgery, University of California San Diego, San Diego, California.

Background: Patients, particularly those who are young, often develop noticeable orthopaedic scars. In order to achieve minimal scarring, surgeons should attempt to place incisions in skinfolds or skin creases.

Methods: Optimal incision lines can be determined from the direction of stretch marks (striae distensae), which develop perpendicular to lines of tension or main folding lines. A composite diagram of photographs of 213 individuals with striae distensae was created and compared with 276 images of incisions and scars derived from the Internet.

Results: Classically described Langer cleavage lines often run counter to real tension lines and poorly predict the optimal direction for skin incisions.

Conclusions: Whenever possible, main folding lines should be utilized as a guide in planning surgical incisions for young patients as well as for correction of problem scars.
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http://dx.doi.org/10.2106/JBJS.18.00331DOI Listing
March 2019
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