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Background: Mobile smartphone thermal imaging (MTI) devices correlate with blood flow, which makes them appealing adjuncts during reconstructive surgery. MTI was assessed in the setting of deep inferior epigastric artery perforator (DIEAP) free flaps. We hypothesized that MTI can be a surrogate for blood flow to identify microvascular flow insufficiencies., Methods: Nineteen patients underwent 30 DIEAP flaps for breast reconstruction. Images were obtained preoperatively, intraoperatively, and at instances of concern for flap viability. Three groups were evaluated: normal DIEAP flaps (NDFs), flaps with arterial insufficiency (AI), and flaps with venous congestion (VC)., Results: All flaps were successful. There were significant temperature increases from max ischemia (24.5 ± 2.1°C) to 1 min after anastomosis (27.2 ± 1.6°C, P < 0.001). NDFs continued to warm until the final MTI was taken when leaving the operating room. There were no differences between MTI flap temperatures before transfer to the chest and after completion of microanastomosis. With questionable flap viability, VC and AI temperatures were found to be significantly colder than the NDF group (28.3 ± 1.9°C versus 32.2 ± 1.8°C, P = 0.003) in the VC group and (27.2 ± 0.7°C versus 32.2 ± 1.8°C, P = 0.001) in the AI group. After correction of the identified flow insufficiency, VC and AI rewarmed and temperatures were no different compared with NDF., Conclusions: MTI recognizes microanastomotic failure and is a practical adjunct in the evaluation of free flap perfusion., (Published by Elsevier Inc.)

Background: Reduction mammoplasty requires significant tissue dissection, which may impact the interpretation of future mammograms used in breast cancer surveillance. The aim of this study was to define the incidence of abnormal mammography after reduction mammoplasty and to assess the impact of substantial tissue remodeling on interpreting mammography., Methods: We conducted a single-center retrospective case-control study examining results of postoperative mammography after reduction mammoplasty over a 5-year period., Results: Between 2001 and 2005, 87 patients underwent breast reduction and had available postoperative mammography. A control group of 30 patients were identified who underwent consultation for breast reduction but did not have surgery. The median time to postoperative mammography was 52 weeks. The incidence of abnormal first postoperative mammogram (Breast Imaging-Reporting and Data System [BIRADS] 0, 3-6) was not significantly different between reduction mammoplasty patients and controls (n = 23, 26% vs 8, 27%, respectively, P = 1.00). Age, postoperative complications, tissue pathology, history of previous breast biopsy, and abnormal preoperative mammography did not significantly predict abnormal postoperative mammogram. Postoperative mammography led to additional imaging in 20 patients (23%) and breast biopsy in 1 patient (1.1%)., Conclusions: Despite the substantial tissue mobilization performed during reduction mammoplasty, postoperative screening mammography does not lead to significantly more imaging or diagnostic interventions when compared with nonoperative controls. This small case-control study suggests that oncoplastic closure techniques should not adversely impact subsequent mammography., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Standard use of preoperative mammography is controversial in patients considering reduction mammoplasty. The aim of this study was to determine the utility of mammography before breast reduction., Methods: The authors conducted a single-center, retrospective chart review examining preoperative mammography in reduction mammoplasty candidates., Results: Between 2001 and 2005, 207 women with recent screening mammography were evaluated for reduction mammoplasty. Thirty-two patients (16%) were found to have abnormal preoperative mammographic results, all of which were false-positives. Previously, reported risk factors including body mass index, decreasing age, previous breast procedure, and lack of comparative mammogram did not predict abnormal mammographic findings. Abnormal imaging results did not influence the decision to proceed with surgery but did have a trend toward delaying surgery., Conclusions: Mammography before reduction mammoplasty can result in a high number of false-positive results, and surgeons should counsel their patients as to the possibility of subsequent studies., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: Reduction mammaplasty is the fifth most common reconstructive surgical procedure in the United States. The incidence of invasive breast cancer in breast reduction specimens is between 0.06 and 0.4 percent. However, the incidence of atypical hyperplasia and other precancerous lesions is not well described., Methods: The authors conducted a single-center retrospective chart review examining the incidence of benign and precancerous lesions in breast reduction specimens over a 5-year period., Results: Of the 562 patients who underwent reduction mammaplasty, 52.7 percent had nonproliferative or proliferative breast lesions. Twenty-five patients (4.4 percent) had a specimen containing atypical ductal or lobular hyperplasia. Six patients (1.1 percent) had ductal carcinoma in situ and four patients (0.7 percent) had lobular carcinoma in situ. No occult invasive breast cancer was identified in the breast reduction specimens, but one patient with ductal carcinoma in situ was found to have invasive breast cancer on completion mastectomy (0.2 percent)., Conclusion: This study demonstrates the importance of systematic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty.

Background: We reviewed our experience with 3 operative techniques for abdominal panniculectomies to determine differences in complication rates and levels of patient satisfaction., Methods: This retrospective study included 92 consecutive patients who underwent abdominal panniculectomies over a 9-year period. Patients underwent one of 3 panniculectomy techniques: fleur-de-lis (n = 25), transverse incisions with minimal undermining (n = 30), or transverse incisions with extensive undermining (n = 37). Postoperatively, patient satisfaction surveys were completed., Results: Median pannus weight was 4.4 kg (range, 1.6-20.5). Sixty-eight patients (73.9%) had a previous gastric bypass. Median body mass index (BMI) was 38 kg/m2 (range, 22-66.9). Median follow-up for complications was 8.1 week (range, 1-235). Forty of 92 patients (43%) suffered wound complications. The reoperation rate was 13%. Postoperative complication rates were higher among hypertensive patients (61% vs. 36%; P = 0.04). There was a trend towards increased complications among those with higher BMI and pannus weights. There was not a significant relationship between operative technique and overall complication rate. Mean length of follow-up for patient questionnaire completion was 2 years, 11 months (range, 1-9 years). Eighty-one percent of those responding to the mailed questionnaire were satisfied with their operative results. There were no statistically significant differences between the technique used and patient satisfaction level. Concomitant hernia repair was performed in 47% of patients without increased wound complications., Conclusions: Patients were satisfied with the results of their panniculectomy, although complications were common. Higher BMI, larger pannus size, and hypertension were correlated with increased complication rates. The minimal undermining, extensive undermining, and the fleur-de-lis panniculectomy techniques result in similar patient satisfaction rates and complication rates.

Background: In thin patients or in those with prior surgery that precludes the use of abdominal tissue for autologous breast reconstruction, the skin and fat of the lower buttock, perfused by perforating branches of the inferior gluteal artery, has been proposed as an alternative., Methods: This study reviewed 19 reconstructions based on the inferior gluteal artery that were performed between July 2001 and March 2007. Patient characteristics, cancer stage and treatment, indications for use of gluteal tissue, surgical time, length of hospitalization, and complications were recorded., Results: Our average patient age was 49 years, with early stage breast cancer, and low body mass index. The average surgical time was 9 hours and 7 minutes, and the average hospitalization time was 4 days. Complications included 2 complete flap losses, seromas, and delayed donor site healing., Conclusions: We conclude that tissue from the lower buttock, perfused by branches of the inferior gluteal artery, is a useful alternative for autologous breast reconstruction.

Background: Free tissue transfer for coverage of complex wounds in the ischial and sacral area can be limited by the lack of adequate recipient vessels., Methods: We reviewed the records of 3 patients seen between August 2002 and December 2005 who underwent free tissue transfer to ischiosacral defects., Results: Two patients were quadriplegic, and 1 patient was ambulatory. The gluteal vessels were used as recipients in 2 patients, and 1 patient had an arteriovenous loop to the femoral vessels. All flaps were successful and all wounds healed., Conclusions: A free latissimus flap to the ischiosacral area can be effective, and both local (gluteal) and regional (femoral) vessels can serve as recipient vessels.

Background: The ability of the immature skull to spontaneously heal large bony defects created after craniofacial procedures was examined over a 25-year period of craniofacial surgery at the Children's Hospital of Philadelphia., Methods: Only patients who underwent frontal orbital advancement and reconstruction, had at least 1 year of documented follow-up, and had the presence or absence of a bony defect documented on clinical examination were included. The sex, age at operation, diagnosis, history of a prior craniectomy, and presence or absence of a postoperative infection were determined for each patient. A variety of statistics were applied to the data., Results: Eighty-one patients met the inclusion criteria. A statistically significant association between age at operation and closure of bony defect was demonstrated. Children who closed a bony defect after frontal orbital advancement and reconstruction were significantly younger than those children who had a persistent bony defect. Iterative regression analyses demonstrated that a transition point between closure and the inability to close bony defects occurred between 9 and 11 months of age. Closure of bony defects was not statistically associated with sex, prior craniectomy, an FGFR mutation, or a postoperative infection in the regression analysis., Conclusions: Healing of bony defects after frontal orbital advancement and reconstruction is significantly related to age at initial operation, with a mean age for closure of less than 12 months. Between 9 and 11 months of age, a change occurs that results in an increasingly lower probability of bony defect closure; thus, all other considerations being equal, initial frontal orbital advancement and reconstruction would ideally take place before this occurs.

The purpose of our retrospective review is to examine our method and outcomes for the application of octyl-2-cyanoacrylate for the repair of primary and revision cleft lips in both pediatric and adult patients. Records and photographs were reviewed and analyzed for patient age, type of cleft, revision or primary repair, complications, length of follow-up, and aesthetic outcomes. Eighteen patients, both children and adults, who underwent cleft lip repairs using tissue adhesive performed by a single surgeon between 1999 and 2003 were included. Twelve patients underwent primary repair and 6 patients underwent revision repair. Repairs were performed using the Millard rotation advancement technique and the Mohler variant. The lateral advancement flap was kept long and redundant in its transverse dimension to create a pressure fit everting the skin edges with minimal sutures to set up the closure for application of the tissue adhesive. Seventeen of eighteen patients had excellent cosmetic outcomes. One patient had minor necrosis of the tip of the advancement flap. No allergic reactions, wound infections, or dehiscences occurred. The use of octyl-2-cyanoacrylate for the skin closure of primary and revision cleft lip repairs in both children and adults results in excellent cosmetic outcomes. Employing our pressure-fit technique for skin eversion prior to application of the tissue adhesive may be advantageous. The lack of suture removal in the pediatric population and decreased operative time are additional benefits.

The tumescent technique has been shown to be efficacious in reducing both operative and postoperative bleeding without significant deleterious side effects in suction lipectomy. In this study, the effects of the tumescent technique on postoperative complications in transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction are investigated. All women who underwent a TRAM flap breast reconstruction by the senior author (J.B.) at the Emory Clinic during the years 1990 to 1996 were pooled (n = 386). Any woman who had a preincision infiltration of 0.25% epinephrine-containing saline solution (>200 cc) around the donor site was included in the tumescent group (n = 59). Medical records were reviewed, and rates of partial flap loss, fat necrosis (> or =10 percent flap volume), flap full-thickness skin loss, donor-site complication (skin loss, hernia, or infection), and blood transfusion were determined. Group rates were compared. The infiltrated group had a significantly lower transfusion rate as compared with the control group (0.34 units versus 1.32 units, p < 0.001). The rates of partial flap loss and fat necrosis were less in the tumescent group, but not significantly (0 percent versus 4 percent, p = 0.232; and 1.7 percent versus 10.4 percent, p = 0.058). There were no significant differences in the incidence of full-thickness skin loss or donor-site complications. Donor-site infiltration before incision with a 0.25% epinephrine-containing saline solution significantly reduced the transfusion requirement in TRAM flap breast reconstruction patients without adversely affecting either breast mound or abdominal donor-site complication rates.

Children with metopic synostosis have a well-described clinical picture of trigonocephaly, often with hypotelorbitism. The craniofacial disorder itself is well recognized; however, objective prognostic factors for predicting the risk of reoperation are not well known. In 39 children with metopic synostosis, measurements of the cranial length, cranial width, anterior intercoronal distance, anterior interorbital distance (intercanthal distance), lateral orbital distance, and interzygomatic buttress distance were taken from preoperative computed tomographic (CT) scans and were normalized relative to each child's age. To separate overall facial hypoplasia from regional hypoplasia, a ratio of intercanthal distance to interzygomatic buttress distance was determined. These prognostic factors were analyzed with respect to reoperation rate. A stepwise logistic regression analysis was used to determine the interrelationships between the prognostic factors. Twenty-eight percent of the children underwent reoperation (N=11, 1 total reoperation and 10 minor recontouring). All of the reoperations occurred in children with a decreased intercanthal distance (p=0.30). The ratio of intercanthal distance to midfacial width was related to reoperation rate, with those children who had a ratio < or =0.80 having a reoperation rate of 44% (8 of 18 total children with an intercanthal-to-zygomatic ratio < or =0.8, p=0.07). This relationship was significant in children younger than the age of 12 months (6 of 13 total children with an intercanthal-to-zygomatic ratio < or =0.8, 46% reoperation rate, p=0.006). This study suggests that preoperative CT measurements can be used as a means of risk stratification in outcome analyses of the surgical treatment of craniosynostosis. In children treated for metopic suture synostosis, a foreshortened intercanthal distance compared with the interzygomatic buttress distance was related to reoperation rate, especially in children younger than 12 months of age.

This study represents an initial investigation into the adult psychological functioning of individuals born with craniofacial disfigurement. A total of 24 men and women born with a craniofacial anomaly completed paper and pencil measures of body image dissatisfaction, self-esteem, quality of life, and experiences of discrimination. An age- and gender-matched control group of 24 non-facially disfigured adults also completed the measures. As expected, craniofacially disfigured adults reported greater dissatisfaction with their facial appearance than did the control group. Craniofacially disfigured adults also reported significantly lower levels of self-esteem and quality of life. Dissatisfaction with facial appearance, self-esteem, and quality of life were related to self-ratings of physical attractiveness. More than one-third of craniofacially disfigured adults (38 percent) reported experiences of discrimination in employment or social settings. Among disfigured adults, psychological functioning was not related to number of surgeries, although the degree of residual facial deformity was related to increased dissatisfaction with facial appearance and greater experiences of discrimination. Results suggest that adults who were born with craniofacial disfigurement, as compared with non-facially disfigured adults, experience greater dissatisfaction with facial appearance and lower self-esteem and quality of life; however, these experiences do not seem to be universal.

A large series of women who had undergone bilateral, pedicled TRAM flap reconstructions were compared with women who had had unilateral, unipedicled TRAM flap procedures to determine whether a bilateral TRAM flap breast reconstruction had significant additional morbidity. The records of all women who underwent either a bilateral or unilateral pedicled TRAM flap breast reconstruction through the Emory Clinic from 1987 to 1994 (n = 257) were retrospectively analyzed with respect to general, breast (fat necrosis, flap loss, and cellulitis), and abdominal (hernia, skin loss, and cellulitis) complications. By using logistic regression, risk factors for these complications were determined. The incidence of fat necrosis and partial flap loss was not significantly different among bilateral patients compared with patients with unilateral TRAM reconstructions (10.0 percent versus 12.6 percent, p = 0.64 and 3.8 percent versus 5.5 percent, p = 0.74, respectively). The rate of hernia formation in the bilateral TRAM flap patients (5.4 percent) was similar to that of unilateral patients (3.9 percent, p = 0.80). Significant factors for any complication in both patient populations included obesity, smoking, and prior irradiation. The type of breast reconstruction was not a significant factor for any breast or donor-site complication. A bilateral TRAM reconstruction showed a weak association with general complications. Review of the Emory Clinic experience with unilateral and bilateral pedicled TRAM flap reconstructions from 1987 to 1994 was able to detect no significant additional rate of complications for bilateral pedicled TRAM flap breast reconstructions compared with unilateral unipedicled TRAM flap procedures.

This study evaluates the feasibility of growing tissue-engineered cartilage in the shape of a human ear using chondrocytes seeded onto a synthetic biodegradable polymer fashioned in the shape of a 3-year-old child's auricle. A polymer template was formed in the shape of a human auricle using a nonwoven mesh of polyglycolic acid molded after being immersed in a 1% solution of polylactic acid. Each polyglycolic acid-polylactic acid template was seeded with chondrocytes isolated from bovine articular cartilage and then implanted into subcutaneous pockets on the dorsa of 10 athymic mice. The three-dimensional structure was well maintained after removal of an external stent that had been applied for 4 weeks. Specimens harvested 12 weeks after implantation and subjected to gross morphologic and histologic analysis demonstrated new cartilage formation. The overall geometry of the experimental specimens closely resembled the complex structure of the child's auricle. These findings demonstrate that polyglycolic acid-polylactic acid constructs can be fabricated in a very intricate configuration and seeded with chondrocytes to generate new cartilage that would be useful in plastic and reconstructive surgery.

Endoscopically assisted surgery has gained wide popularity in plastic surgery. Its major uses have been in aesthetic procedures. In this article we demonstrate the safety and utility of these techniques to a pediatric population. All patients younger than 20 years who underwent an endoscopically assisted plastic surgical procedure by one of the authors were pooled and their medical records reviewed. Complications were determined. For those children having an excision of a forehead mass, the duration of the procedure, length of incision, specimen size, and length of hospital stay were determined. Additionally, parents of these children were contacted by telephone after the excisions to determine satisfaction with the procedures. Sixteen patients' records were reviewed. Patients' ages ranged from 6 months to 15 years (mean, 5.8 years). The procedures performed included removal of forehead mass (n = 9), placement of tissue expanders (n = 5), excision of gynecomastia (n = 1), and malar soft tissue elevation (n = 1). All procedures were completed with endoscopic assistance. One procedure had to be converted to an open technique. No hematomas were observed. For forehead mass excisions, the average duration of the procedure was 46.9 min. Incision length was 1.1 cm, and specimen volume was 0.5 cm3. Parent satisfaction with the endoscopic procedures was high, with 100% responding favorably. No significant complications were observed. Many of the procedures were performed as outpatients. Parental acceptance of and satisfaction with the endoscopic techniques was high. Our experience supports the use of endoscopic techniques in the pediatric plastic surgical patient.

These studies investigated the utility of calcium alginate as a biocompatible polymer matrix within which large numbers of chondrocytes could be held successfully in a three-dimensional structure and implanted. Further, the ability of chondrocyte-calcium alginate constructs to engraft and generate new cartilage was examined. Chondrocytes isolated from calf shoulders were mixed with a 1.5% sodium alginate solution to generate cell suspensions with densities of 0, 1.0, 5.0, and 10.0 x 10(6) chondrocytes/ml. The cell suspensions were gelled to create disks that were placed in subcutaneous pockets on the dorsums of nude mice. The alginate concentration and CaCl2 concentration used to make the disks also were varied. A total of 20 mice were implanted with 67 bovine chondrocyte-calcium alginate constructs. Samples with an initial cellular density of at least 5.0 x 10(6) chondrocytes/ml demonstrated gross cartilage formation 12 weeks after implantation. Cartilage formation was observed microscopically in specimens with a cellular density as low as 1.0 x 10(6) chondrocytes/ml. The histoarchitecture of the new cartilage closely resembled that of native cartilage. Cartilage formation was independent of CaCl2 concentration (15 to 100 mM) or alginate concentration (0.5% to 4.0%) used in gel polymerization.

Slowly polymerizing calcium alginate gels were investigated as a means of delivering large numbers of isolated chondrocytes by means of injection to determine if these gels would promote engraftment and could provide three-dimensional templates for new cartilage growth. Chondrocytes isolated from the articular surface of calf forelimbs were added to a 1% sodium alginate dissolved in a 0.1 M potassium phosphate buffer solution (pH 7.4) to generate a final cellular density of 10 x 10(6)/ml (representing approximately 10 percent of the cellular density of human juvenile articular cartilage). The calcium alginate-chondrocyte mixture was injected through a 22-gauge needle in 100-microliters aliquots under the panniculus carnosus on the dorsum of nude mice and incubated for 6 (n = 4), 8 (n = 11), and 12 (n = 12) weeks in vivo. Time-zero specimens (n = 10) consisting of 100-microliters aliquots of the calcium alginate-chondrocyte mixture were used to calculate initial weight. At harvest, all calcium alginate-chondrocyte specimens exhibited a pearly opalescence and were firm to palpation as early as 6 weeks after injection. By 12 weeks of in vivo incubation, the specimens weighed 0.15 +/- 0.04 gm, significantly more than the initial weight of 0.11 +/- 0.01 gm (p < 0.05). Specimens stained with hematoxylin and eosin demonstrated lacunae within a basophilic ground-glass substance. Control specimens of calcium alginate without chondrocytes (n = 4) had a doughy consistency 12 weeks after injection and had no histologic evidence of cartilage formation.(ABSTRACT TRUNCATED AT 250 WORDS)

One approach to tissue-engineering combines isolated cells with polymer scaffolds for the purpose of generating new tissue or tissue equivalents. It has met with much success when applied to the formation of new cartilage (neo-cartilage). In this review, we will examine the development of polyglycolic acid fiber meshes and calcium alginate gels that when combined with chondrocytes generate new cartilage. Animal models designed to mimic clinical problems will also be discussed. Using the chondrocyte-polymer systems as paradigms, we will attempt to extract some principles of tissue engineering.

Injection of polytetrafluoroethylene (Teflon) or collagen has been used in the endoscopic treatment of vesicoureteral reflux. Although the principle of an endoscopic treatment is valid, there are concerns regarding the long-term safety and effectiveness of these substances. In search of a different injectable material we conducted experiments using chondrocytes in a biodegradable polymer solution for the treatment of vesicoureteral reflux in an animal model. Reflux was created in 4 mini-pigs and confirmed with a cystogram. Cartilage was obtained from the auricular surface of each animal. Chondrocytes were harvested and expanded in vitro. The cells were individually quantitated and concentrated to 40 million cells per cc. The cell suspensions were mixed with a sodium alginate and calcium sulfate solution. Each pig was injected unilaterally in the subureteral region with the autologous chondrocyte suspension. The opposite ureter served as an internal control in all animals. Cystograms showed resolution of reflux in the treated side and persistence of reflux in the opposite untreated side in each instance. Excretory urograms revealed no evidence of obstruction. Histological examination of the subureteral region demonstrated cartilage. Autologous chondrocytes can be readily harvested, expanded in vitro and injected cystoscopically. The cells survive and form a cartilage nidus that is nonantigenic. This system is able to correct reflux without any evidence of obstruction.

This study compares artifact from craniomaxillofacial internal fixation devices in magnetic resonance images and examines heating and magnetic deflection effects on these devices. Stainless steel wires, microfixation plates of vitallium and titanium, and minifixation and mandibular reconstruction plates of stainless steel, vitallium, and titanium were evaluated. The plates were mounted on a dry skull and submerged in dilute copper sulfate solution. All images were obtained in duplicate by two independent, nonblinded teams of observers with a 1.5-T Signa magnetic resonance system. Each team ranked artifact size for each material by computerized measurement. The rank order of artifact size for each material within each fixation system group and between fixation groups was identical between the two teams. Bath and plate temperatures were recorded before and after imaging. Artifact production was related to hardware size and composition. Titanium hardware caused the least amount of "black-hole" artifact. Vitallium and stainless steel fixation devices of similar size produced significantly more artifact. No significant heating or magnetic deflection effects were seen with any of the fixation devices.

The authors tested the feasibility of using tissue-engineered cartilage, grown in the shape of cylinders, for replacing large circumferential defects of the cervical trachea in rats. Chondrocytes obtained from the shoulder of newborn calves were seeded onto a synthetic nonwoven mesh, 100 microns thick, of polyglycolic acid fibers 15 microns in diameter, cut into pieces of 2.5 x 4 cm. Twenty cell-polymer constructs were wrapped around silastic tubes and implanted into 10 nude mice for 4 weeks. Specimens were then excised and evaluated grossly and histologically for the presence of new cartilage, and biomechanically for their ability to resist collapse upon application of negative pressure. Six cylinders of tissue-engineered cartilage were then sutured into large circumferential defects created in the cervical tracheas of nude rats to replace the excised trachea. Implantation of cell-polymer constructs resulted in the formation of cylinders of hyaline cartilage. When placed within the lumen of a segment of bowel denuded of its mucosal lining, the hollow cylinders resisted collapse in all instances upon administration of negative 200 mm Hg pressure. The cartilage was grossly and histologically identical to that from which the cells had been initially isolated. Four of the six animals receiving these cartilage cylinders as tracheal replacements survived the procedure and were able to breathe in an unassisted fashion. Three of these animals never recovered fully from the anesthetic and the operation, and expired at 24, 48, and 72 hours. The fourth animal fully recovered from the procedure, and breathed spontaneously for 1 week, with no apparent limitations. Increasing respiratory distress then developed, and the animal died.(ABSTRACT TRUNCATED AT 250 WORDS)

Injection of polytetrafluoroethylene (Teflon) or collagen has been used in the endoscopic treatment of vesicoureteral reflux. Although the principle of an endoscopic treatment is valid, there are concerns regarding the long-term safety and effectiveness of these substances. The goal of several investigators has been to find alternate implant materials that would be safe for human use. Toward this goal we conducted a study to determine the effect of chondrocytes using a biodegradable polymer solution as a template. Hyaline cartilage was obtained from the articular surfaces of calf shoulders and chondrocytes were harvested. Chondrocyte suspensions were concentrated to 20, 30 and 40 x 10(6) cells per cc and mixed with dry alginate powder (a biodegradable polymer) to form a gel. Twelve athymic mice were injected subcutaneously with a chondrocyte-alginate solution. Each mouse had 4 injection sites, consisting of control, 10, 15 and 20 x 10(6) chondrocyte cells (48 injection sites). Mice were sacrificed at 2, 4, 6 and 12 weeks after injection. Histological examination of the injection sites demonstrated evidence of cartilage formation in 34 of the 36 experimental injection sites. Gross examination of the injection sites with increasing time showed that the polymer gels were progressively replaced by cartilage. The ultimate size of the cartilage formed was related to the initial chondrocyte concentration injected, and appeared to be uniform and stable within each category. There was no evidence of cartilage formation in the 12 controls. Histological analyses of distant organs showed no evidence of cartilage or alginate gel migration, or granuloma formation. In conclusion, chondrocyte-alginate gel suspensions are injectable, appear to be nonmigratory and are able to conserve their volume. In addition, the use of autologous cartilage cells would preclude an immunological reaction. These preliminary studies indicate that autologous cartilage-polymer gel solutions may be potentially useful in the endoscopic treatment of reflux.