Evaluating Revascularization and Flap Survival Using Vascular Endothelial Growth Factor in an Irradiated Rat Model [Original Article]

Published online January 17, 2011. Arch Facial Plast Surg May/Jun 2011 2011;13(3):185-189. Objective To evaluate the role of vascular endothelial growth factor (VEGF) plasmid DNA (pDNA) in improving flap revascularization in a previously developed rat model. Our hypothesis was that the uptake and expression of VEGF pDNA in the wound bed would improve revascularization and flap viability.

Design Twenty-eight male Sprague-Dawley rats received a total dose of 40 Gy electron beam radiation to the ventral abdominal wall. After a recovery period, they underwent a ventral fasciocutaneous flap procedure with a 2-hour ischemia period. Group 1 (n = 14) received topical VEGF pDNA, in vivo cationic polymer, and fibrin sealant. Group 2 (n = 14) received topical cationic polymer and fibrin sealant only. Seven of the rats from each group underwent pedicle ligation at 8 or 14 days. The primary outcome measure was percentage of flap revascularization 5 days after pedicle ligation.

Results Rats receiving VEGF pDNA had a significantly higher rate of flap revascularization (90.8% vs 79.8%) after pedicle ligation at 14 days (P = .045). At 8 days, rats receiving VEGF pDNA (group 1) had an increased rate of flap revascularization (58.2% vs 42.8%) that approached significance (P = .11).

Conclusion This study demonstrates the potential of VEGF pDNA to improve revascularization and flap viability in previously irradiated tissue.

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Serial Excision of Facial Hemangiomas [Original Article]

Arch Facial Plast Surg May/Jun 2011 2011;13(3):199-202. Jonathan Kulbersh, MD; Marcelo Hochman, MD

Author Affiliations: American Academy of Facial Plastic and Reconstructive Surgery Fellowship, Los Angeles, California (Dr Kulbersh); and Hemangioma International Treatment Center, Charleston, South Carolina (Dr Hochman). Objective To present the technique of and indications for serial excision of facial hemangiomas.

Methods Clinical review of patients cared for by the senior author (M.H.) in a private-practice specialty center.

Results Forty-six patients underwent serial excision of facial infantile hemangiomas. The average number of excisions was 3 (range, 2-5), with a mean interoperative period of 4 months (range, 3-7 months). One patient sustained a traumatic dehiscence of the surgical wound, and 6 others had minor wound problems that had no impact on the final result. Two “final” scars underwent surgical revision. All results were ultimately deemed acceptable by the parents and surgeons.

Conclusion Serial excision is a practical and reliable technique for treatment of facial hemangiomas which due to size and location are not feasibly excised and repaired in a single setting without the use of complex adjunctive reconstructive techniques.

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Undifferentiated Human Adipose Tissue-Derived Stromal Cells Induce Mandibular Bone Healing in Rats [Original Article]

Undifferentiated Human Adipose Tissue–Derived Stromal Cells Induce Mandibular Bone Healing in Rats

Claudio Parrilla, MD, PhD; Nathalie Saulnier, PhD; Camilla Bernardini, PhD; Riccardo Patti, MS; Tommaso Tartaglione, MD; Anna Rita Fetoni, MD, PhD; Enrico Pola, MD, PhD; Gaetano Paludetti, MD; Fabrizio Michetti, MD; Wanda Lattanzi, MD, PhD

Arch Otolaryngol Head Neck Surg. 2011;137(5):463-470. doi:10.1001/archoto.2011.61

Objective  To test the osteo-regenerative potential of adipose tissue–derived stromal cells (ATSCs), an attractive human source for tissue engineering, in a rat model of mandibular defect. Human dermal fibroblasts (HDFs) were used as a differentiated cellular control in the study.

Design  The ATSCs and HDFs were isolated from human lipoaspirate and skin biopsy specimens, respectively. Cells were characterized in vitro and then adsorbed on an osteo-conductive scaffold to be transplanted in a mandibular defect of immunosuppressed rats. Naked unseeded scaffold was used as a negative control.

Main Outcome Measures  Bone healing was studied by computerized tomography and histologic analysis after 4, 8, and 12 weeks.

Results  Computed tomography showed that undifferentiated ATSCs induced successful bone healing of the mandible defect when transplanted in animals, compared with HDFs and negative controls. Histologic analysis demonstrated that the newly formed tissue in the surgical defect retained the features of compact bone.

Conclusion  Undifferentiated human ATSCs are suitable for cell-based treatment of mandibular defects, even in the absence of previous osteogenic induction in vitro.

Author Affiliations: Departments of Otolaryngology (Drs Parrilla, Fetoni, and Paludetti), Internal Medicine (Dr Saulnier), Radiology (Dr Tartaglione), Orthopaedics (Dr Pola), and Institute of Anatomy and Cell Biology (Drs Bernardini, Michetti, and Lattanzi and Mr Patti), Universit? Cattolica del Sacro Cuore, School of Medicine A. Gemelli, Rome, Italy; INSERM, Paris, France (Dr Saulnier); and Latium Muscular Skeletal Tissue Bank, Rome, Italy (Dr Michetti).

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Mandibular Distraction Osteogenesis in Infants Younger Than 3 Months [Original Article]

Published online January 17, 2011. Arch Facial Plast Surg May/Jun 2011 2011;13(3):173-179. Andrew R. Scott, MD; Robert J. Tibesar, MD; Timothy A. Lander, MD; Daniel E. Sampson, DDS, MD; James D. Sidman, MD

Author Affiliations: Department of Otolaryngology–Head & Neck Surgery, Tufts University School of Medicine, and Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts (Dr Scott); Pediatric ENT Associates (Drs Tibesar, Lander, and Sidman) and Department of Oral Surgery (Dr Sampson), Children's Hospitals and Clinics of Minnesota, Minneapolis; Department of Otolaryngology, University of Minnesota Medical School, Minneapolis (Drs Tibesar, Lander, and Sidman); and OMS Specialists, Anthony, Minnesota (Dr Sampson). Objectives To examine the long-term outcomes and complications in infants with upper airway obstruction and feeding difficulty who underwent bilateral mandibular distraction osteogenesis (MDO) within the first 3 months of life and to identify any preoperative characteristics that may predict the long-term outcome following early MDO intervention for airway obstruction.

Methods An institutional, retrospective medical chart review was performed. Inclusion criteria were bilateral MDO performed at an age younger than 3 months, with a minimum follow-up of 3 years. A quantitative outcome measures scale was developed, and patients were scored based on long-term postoperative complications as well as airway and feeding goals. Factors such as need for an additional surgical procedure were also considered.

Results Nineteen children were identified as having undergone MDO before 3 months of age and having more than 3 years of follow-up data. The mean age at distraction was 4.8 weeks (range, 5 days-12 weeks); the mean length of follow-up was 5.6 years (range, 37-122 months). Of these 19 patients, 14 had isolated Pierre Robin sequence (PRS) and 5 had syndromic PRS. All patients with isolated PRS had a good or intermediate long-term result. Infants with comorbidities such as developmental delay, seizures, or arthrogryposis had the poorest outcomes.

Conclusions Bilateral MDO is a relatively safe and effective means of treating airway obstruction and feeding difficulty in infants with PRS. The effects of this procedure, which carries a relatively low morbidity, persist through early childhood in most patients.

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The Spectrum of Isolated Congenital Nasal Deformities Resembling the Cleft Lip Nasal Morphology [Original Article]

Arch Facial Plast Surg May/Jun 2011 2011;13(3):152-160. Travis T. Tollefson, MD; Clinton D. Humphrey, MD; Wayne F. Larrabee Jr, MD; Robert T. Adelson, MD; Kian Karimi, MD; J. David Kriet, MD

Author Affiliations: Divisions of Facial Plastic and Reconstructive Surgery, Departments of Otolaryngology–Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento (Dr Tollefson), Otolaryngology–Head and Neck Surgery, University of Kansas School of Medicine, Kansas City (Drs Humphrey and Kriet), and Otolaryngology, University of Florida, Gainesville (Drs Adelson and Karimi); and The Larrabee Center, Seattle, Washington (Dr Larrabee). Objective To define the intrinsic (hypoplasia) and extrinsic (deformational) contributions to congenital nasal deformities and the potential of a carrier state for orofacial clefting.

Methods Retrospective case series.

Results The factors affecting 4 congenital nasal deformities are postulated after contrasting the patient's characteristics.

Conclusions The spectrum of congenital nasal deformities includes those that resemble the cleft lip nasal deformity, but careful inspection is needed for proper classification. Classifying congenital nasal deformities can be difficult in part due to the highly variable normal range. The most minor form of the typical unilateral cleft lip nasal deformity is the microform cleft. The potential of an isolated cleft lip nasal deformity without obvious cleft lip has been previously suggested to represent a carrier state for orofacial clefting. Definitive genetic studies and continued anthropometric documentation in relatives of patients with orofacial clefts are needed if we are to uncover previously unidentified associations, and a potential carrier state.

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Improving Aesthetic Outcomes in Pediatric Free Tissue Oromandibular Reconstruction [Original Article]

Published online January 17, 2011. Arch Facial Plast Surg May/Jun 2011 2011;13(3):180-184. Yadranko Ducic, MD, FRCSC; Lindsay Young, MD

Author Affiliations: Department of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth (Dr Ducic), Otolaryngology and Facial Plastic Surgery Associates, Fort Worth (Dr Ducic), and Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas (Drs Ducic and Young), Texas. Objective To review our substantial favorable experience with oromandibular free tissue reconstruction in pediatric patients, emphasizing technical pearls, which seem to be associated with favorable long-term aesthetic and functional outcomes.

Methods Retrospective review of a consecutive series of all free tissue transfers performed from 1997 to 2010 by the senior author (Y.D.) in patients younger than 18 years. Demographic data, techniques used, and complications were examined.

Results A total of 51 patients were identified, and their data were available for collection. Twenty-eight were female, and 23 were male; the mean age was 10 years (range, 4-17 years). Flaps performed included 43 fibula free flaps and 8 radial forearm free flaps with successful transplantation in each case. Twenty-six patients had temporomandibular joint reconstruction as part of their initial repair. The reasons for reconstruction were trauma (in 18 cases) and oncologic (in 33 cases). Functional and aesthetic results were improved with minimal access, maximal exposure approaches as outlined.

Conclusions Pediatric free tissue oromandibular reconstruction is associated with excellent outcomes in most patients. Specific technical modifications allowing for minimal visible scarring and improved function, particularly at the level of the joint, allow for rewarding results in young patients.

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