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Background: Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration., Methods: In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography., Results: Cell yield for application and cell viability were 55.9 ± 28.5 × 10 6 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density., Conclusions: It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal-dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Fat necrosis within a deep inferior epigastric artery perforator flap reconstructed breast is considered a minor complication from reconstructive point of view, but one that can induce anxiety, inconvenience and concerns about cancer recurrence to the oncologist and the patient. A series of 100 consecutive unilateral deep inferior epigastric artery perforator flap breast reconstructions were reviewed to identify the institutional incidence as well as potential risk and predictor factors of fat necrosis. Examination revealed 37 reconstructed breasts with palpable firmnesses (described as clinical fat necrosis) and ultrasonography and mammography confirmed signs of fat necrosis in 30 reconstructed breasts. Flaps harvested on a single perforator, obese patients with body mass index > or = 30 and revision operations were all statistically significant predictors in our statistical model. Postoperative radiotherapy, a reconstructed breast volume over 500 mL and a pedicle raised on a single row of perforators were statistically significant only after univariate analysis and their statistical strength was lost after introducing them with multivariate model. This study helped us to further clarify criteria for selection of patients undergoing breast reconstruction with flaps from the abdomen.

Reconstruction of a large upper lip defect is a demanding procedure and can be performed by a variety of local flaps or by microvascular free tissue transfer. We present our experience in reconstructing near total or total upper lip defects by free tissue transfer. In 11-year period seven patients underwent microvascular reconstruction of upper lip, six with non-innervated radial forearm flap and one with non-innervated anterolateral thigh flap. In all patients good functional and acceptable aesthetic results, with oral competence at rest and during eating and speaking, were achieved. Deglutition and articulation were not affected in any patient. Sensory evaluation of reconstructed upper lips was performed in four patients and in three a reasonable recovery of sensation was recorded. In our opinion subtotal or total upper lip reconstructions with folded thin fascio-cutaneous free flaps produce very good functional and aesthetically acceptable results and avoid additional scars on lower lip and cheek. Further, because the size of the mouth is not altered, microstomia is avoided, which is especially important for patients using dentures. The remaining disadvantage of this method is non-competence of orbicularis oris muscle sphincter.

Construction of a prognostic model is presented for the long-term outcome after femoral neck fracture treatment with implantation of hip endoprosthesis. While the model is induced from the follow-up data, we show that the use of additional expert knowledge is absolutely crucial to obtain good predictive accuracy. A schema is proposed where domain knowledge is encoded as a hierarchical decision model of which only a part is induced from the data while the rest is specified by the expert. Although applied to hip endoprosthesis domain, the proposed schema is general and can be used for the construction of other prognostic models where both follow-up data and human expertise is available.