Search Results (101)

Background: Severe burn injuries involving the face and scalp have profound physical and psychosocial consequences, and represent the greatest reconstructive challenge in plastic surgery. One comprehensive solution involves the sequential application of autologous fat grafting, follicular unit excision (FUE) hair transplantation, and scalp micropigmentation (SMP); however, the long-term outcomes of this approach have rarely been documented. Methods: A male patient sustained catastrophic methane explosion burns at age 27, involving 79% total body surface area (TBSA) with full-thickness involvement of the face and scalp (Revised Baux Score 123; estimated mortality risk 50–80%). Following 65 reconstructive procedures at external institutions over six years, he was referred to our center at age 30. He presented with extensive facial and scalp scarring, complete absence of eyebrow, beard, and mustache hair, and widespread scalp alopecia. Over an eight-year period, the patient received 11 sessions of autologous FUE hair transplantation (7180 follicular units to the eyebrows, beard, and scalp), four sessions of structural fat grafting using the Coleman technique, and five sessions of SMP. Results: The patient achieved complete reconstruction of facial hair, a natural scalp hairline, and significant scar quality improvement. Conclusions: Our findings demonstrate that systematic, long-term multimodal reconstruction, i.e., combining fat grafting, FUE transplantation, and SMP, can yield clinically meaningful esthetic and psychosocial outcomes, even after the most catastrophic burn injuries. Full article

Background and Objectives: Autologous fat transplantation using fat alone can lead to postoperative complications. Laminin–alginate beads have been investigated as carriers for adipose mesenchymal stem cells (ASCs), with the potential to modulate cell release kinetics, influence macrophage responses, and thereby affect the maintenance of graft volume. We hypothesized that encapsulating ASCs in laminin–alginate beads would allow gradual ASC release into the transplantation site and influence the macrophage-related microenvironment during fat graft maturation. Materials and Methods: ASCs were isolated from two female enhanced green fluorescent protein (eGFP) transgenic rats. For SC (ASC + fat) grafts, ASCs were freely mixed with 1 mL of mature adipose tissue. For bead-encapsulated cell (BEC) (laminin–alginate + ASC + fat) grafts, ASCs were first encapsulated in laminin–alginate beads and subsequently mixed with 1 mL of fat tissue. The fat graft was subcutaneously injected into the backs of the rats, which were subsequently euthanized at weeks 4, 6, and 8. The grafts were then harvested for histological and immunofluorescence analyses. Results: The histological analysis indicated that the number of eGFP-ASCs in the BEC grafts gradually increased between weeks 4 and 8, whereas that in the SC grafts decreased over the same period. The BEC grafts also exhibited a numerically higher degree of M2 macrophage infiltration. Conclusions: Laminin–alginate bead encapsulation was associated with prolonged persistence of eGFP-ASCs within the graft area. Although the macrophage-related findings were not statistically significant, they suggest a potential interaction between gradual ASC release and the local graft microenvironment. Full article

Background/Objectives: We aimed to describe clinical phenotypes, imaging distribution, treatment time window, and short-term outcomes of ophthalmic–cerebral artery embolic stroke caused by cosmetic facial injections or fillers in a tertiary neurology-referred cohort. Methods: This single-center retrospective observational case series included 33 consecutive eligible patients with ophthalmic artery embolism complicated by cerebral infarction or optic nerve ischemia after cosmetic facial injections. All 33 patients had cerebral infarction. Demographic, clinical, imaging, treatment-timing, and discharge-outcome data were extracted from medical records and analyzed descriptively. Results: Mean age was 31.1 ± 7.5 years (median 30.0, IQR 25.0–37.0); 29 (87.9%) were female. The injected materials were as follows: hyaluronic acid (24, 72.7%), autologous fat (8, 24.2%), and unknown (1, 3.0%). Anterior circulation involvement occurred in 32 patients (97.0%), posterior in 16 (48.5%) (an exploratory observation of uncertain mechanism; 15/16 co-occurred with anterior involvement), both in 15 (45.5%), multifocal/multi-territorial infarction in 24 (72.7%), and hemorrhagic transformation in six (18.2%). Optic nerve ischemia co-occurred in 25/33 patients (75.8%); no patient had isolated optic nerve ischemia without cerebral infarction. Median time from onset to intervention was 25.4 h (IQR 9.0–34.5); only two of 28 (7.1%) received intervention within 6 h. Within our cohort, earlier intervention was not associated with visual improvement (≤24 h 3/10 vs. >24 h 2/14; Fisher’s p = 0.61). At discharge, as a within-patient change between admission and discharge (not a controlled treatment-effect estimate), ocular motility abnormalities improved (17/26, 65.4%, p < 0.001), skin abnormalities improved (17/27, 63.0%, p < 0.001), and severe visual impairment improved (6/29, 20.7%, p = 0.031). Conclusions: Cosmetic facial injection/filler-related stroke is a specific type of iatrogenic embolic stroke caused by the dissemination of exogenous materials through facial–orbital–intracranial anastomotic pathways. Because the cohort was ascertained through a tertiary neurology department, the phenotype reflects the severe, brain-involved end of the spectrum and the distribution estimates are not generalizable to the full spectrum of filler-related vascular events. For patients presenting with acute blindness accompanied by skin ischemia, ocular muscle abnormalities, or neurological symptoms following cosmetic injections, early referral to both the stroke green channel and emergency ophthalmology for multidisciplinary evaluation is recommended, primarily to limit cutaneous necrosis, support extraocular muscle recovery, and monitor and control infarct progression and hemorrhagic transformation rather than to restore vision. Full article

The deep inferior epigastric perforator (DIEP) flap holds its place as the gold standard approach for autologous tissue breast reconstruction given the strong durability, favorable donor site morbidity, and high patient satisfaction overall. With the reliability and safety of microsurgical reconstruction of the breasts being well-established over these last decades, the goals of DIEP flap reconstruction have expanded beyond flap survival toward optimization of aesthetic, patient-reported, and quality-of-life outcomes. Achieving ideal cosmesis requires thoughtful decision-making across the reconstructive continuum, including of radiation timing, mastectomy incision design, nipple–areolar complex management, reconstructive sequencing, flap shaping and inset, abdominal closure, neurotization, and the potential role of any revision or adjunctive procedures. Modern techniques including delayed-immediate reconstruction, nipple delay, free nipple grafting, fat grafting, and abdominal wall reinforcement have expanded the availability of personalized care in breast reconstruction. This narrative review integrates a targeted literature search with consensus-driven expert opinion informed by our senior authors’ extensive cumulative experience performing DIEP flap breast reconstruction. It discusses principles, technical strategies, and evolving evidence for optimizing aesthetic outcomes in DIEP flap breast reconstruction while preserving safety and minimizing morbidity. Full article

Adipose-derived stem cells (ADSCs) are widely used in regenerative medicine and are considered key effectors underlying the therapeutic efficacy of autologous fat grafting for scarring and skin fibrosis, yet clinical outcomes remain variable. This review examines how obesity alters the adipose microenvironment through chronic inflammation and metabolic dysfunction, resulting in epigenetic changes, mitochondrial impairment, oxidative stress, and premature cellular senescence in ADSCs. ADSCs from obese individuals exhibit reduced stemness, impaired differentiation, and a pro-inflammatory secretome with diminished regenerative capacity. While weight loss may partially reverse these effects, persistent epigenetic and functional memory limits full recovery. This review argues that donor metabolic status is a determinant of ADSC therapeutic potency and discusses key challenges and opportunities for improving regenerative outcomes. Full article

Background: Autologous fat grafts are widely used for skull base reconstruction following endoscopic endonasal surgery. However, uncertainty regarding their postoperative volumetric evolution may complicate the distinction between expected postoperative changes and residual or recurrent disease on imaging. Methods: We performed a retrospective volumetric imaging analysis of patients undergoing endoscopic endonasal skull base surgery with reconstruction using autologous fat and the 3F technique between 2013 and 2023. Fat graft volumes were measured on postoperative day 1 CT scans and on 3-, 9-, and 15-month postoperative MRI using standardized volumetric segmentation analysis (method described in detail in the main text). It should be noted that baseline measurements were derived from CT, whereas follow-up assessments were performed using MRI. Resorption rates were correlated with demographic, pathological, surgical, and postoperative variables. Results: Thirty-four patients met inclusion criteria. Mean initial fat graft volume was 3.01 ± 2.65 cm³. Overall, fat graft volume demonstrated a consistent temporal decline, with mean reductions of 56.8% at 3 months, 75.3% at 9 months, and 81.8% at 15 months. In subgroup analysis, differences in resorption were observed according to surgical approach, with higher resorption following transsellar compared with transtuberculum approaches (87.4% vs. 74.8% at 15 months, p = 0.042). These findings were closely related to graft compartment, although compartment and surgical approach showed substantial overlap in this cohort. No significant associations were detected between resorption rate and age, sex, comorbidities, postoperative CSF leak, extent of resection, or adjuvant radiotherapy. Conclusions: Autologous fat grafts used for skull base reconstruction demonstrate substantial early postoperative resorption followed by slower progressive volume loss. Recipient anatomical compartment was associated with differences in observed resorption patterns, although this relationship should be interpreted in the context of overlap with surgical approach and limited sample size. These findings may assist in improving interpretation of postoperative imaging by clarifying the expected temporal pattern of fat graft evolution after endoscopic skull base reconstruction. Full article

Background/Objectives: Radiotherapy following mastectomy induces persistent structural alterations in the chest wall, including fibrosis, extracellular matrix disorganization, and vascular changes that compromise reconstructive outcomes. Although autologous fat grafting is widely used to improve tissue quality in irradiated breasts, direct human histological evidence remains limited. The aim of this prospective pilot study was to evaluate intra-patient histological remodeling in irradiated postmastectomy breast tissue before and 4 months after autologous fat grafting using paired core needle biopsies. This study should be considered a hypothesis-generating histological pilot study. Methods: Five female patients with prior mastectomy and adjuvant radiotherapy underwent Tru-Cut core needle biopsy of irradiated chest wall tissue before lipofilling and at approximately four months (range between 3 and 12 months) post-procedure. Specimens were processed using formalin fixation, paraffin embedding, and hematoxylin and eosin staining. Histological assessment focused on collagen density, stromal organization, vascular structures, inflammatory infiltrate, and adipocyte integration. Comparative intra-patient analysis was performed descriptively. Results: Baseline biopsies demonstrated consistent post-radiation alterations, including collagen compaction, stromal disorganization, perivascular fibrosis, and variable inflammatory infiltrate. Post-lipofilling specimens showed heterogeneous remodeling characterized by focal collagen fiber insertion between adipocytes, areas of immature connective tissue formation, and variable preservation of adipose architecture. The extent and pattern of remodeling differed among patients. Inflammatory activity decreased or remained mild in most cases. Conclusions: Autologous fat grafting in irradiated postmastectomy tissue is associated with measurable histological remodeling. Structural adaptation appears heterogeneous and patient-specific, suggesting a dynamic multi-stage process rather than uniform regeneration. Further studies incorporating quantitative and molecular analyses are required to clarify the mechanisms underlying these changes. Full article

Breast-conserving therapy (BCT), consisting of lumpectomy followed by adjuvant radiation, provides oncologic outcomes equivalent to mastectomy for many patients with breast cancer. As survivorship increases, the demand for aesthetic restoration after BCT has grown; however, reconstructive strategies in this setting remain less standardized than those following mastectomy. Reconstruction after BCT presents distinct challenges due to partial tissue loss, nonuniform radiation injury, progressive fibrosis, and wide variability in patient expectations and tolerance for revision surgery. Consequently, mastectomy-based reconstructive algorithms are often insufficient for guiding care in this population. This review synthesizes contemporary reconstructive options following BCT through a personalized medicine framework, emphasizing patient-specific risk factors that influence technique selection, timing, and long-term outcomes. Key determinants include radiation exposure, breast morphology, comorbid conditions, prior breast surgery, and psychosocial preferences. Oncoplastic volume displacement, implant-based augmentation, fat grafting, and autologous reconstruction each demonstrate distinct risk profiles in the post-BCT tissue environment and require individualized application. Timing of reconstruction and willingness to undergo staged procedures play a central role in outcome durability and patient satisfaction. Across reconstructive strategies, revision burden emerges as a clinically meaningful, patient-centered outcome that is not adequately captured by traditional short-term complication metrics. A risk-informed approach that integrates individualized risk assessment with transparent counseling and shared decision-making may improve alignment between reconstructive planning and patient goals. Personalized reconstruction after BCT requires moving beyond technique-driven paradigms toward flexible, longitudinal care pathways. Future efforts should focus on developing BCT-specific predictive models and incorporating patient-reported outcomes to advance personalized reconstructive care. Full article

Background: Autologous fat grafting is widely used in reconstructive, aesthetic and regenerative surgery and often requires repeated applications. Cryopreservation of lipoaspirate enables autologous fat banking and off-the-shelf availability; however, its clinical implementation is limited by freezing-induced tissue injury, regulatory requirements and uncertainties regarding the optimal preservation protocol. Glycerol is a biocompatible cryoprotective agent with promising preliminary data. Nevertheless, the optimal concentration for lipoaspirate cryopreservation remains unknown. The aim of this study was to determine the optimal glycerol concentration for preservation of adipose tissue processed according to the Cell-Enriched Lipotransfer (CELT) protocol in clinically relevant volumes under GMP-compatible conditions. Methods: Lipoaspirates from 10 patients were processed by centrifugation according to the CELT protocol and allocated into experimental groups: fresh unfrozen control, frozen samples without cryoprotectant, frozen samples with PBS, and frozen samples supplemented with glycerol in concentrations ranging from 10% to 60%. Samples were cryopreserved using a controlled freezing rate at a temperature of −80 °C for 24 h. Large-volume cryopreservation was additionally performed with the best concentration of glycerol. Post-thaw tissue quality was assessed by resazurin assay of whole tissue, stromal vascular fraction (SVF) cell live/dead counting, and resazurin assay after short-term cell culture. Results: Glycerol supplementation improved post-thaw tissue viability compared with cryopreservation without cryoprotectant or with PBS alone. An optimal concentration range between 10% and 30% glycerol was identified, with highest preservation of metabolic activity and surviving cell yield observed at 20%. Higher glycerol concentrations resulted in a marked decline in tissue quality. Cryopreservation in large volume was feasible and did not impair post-thaw viability compared with small-volume samples. Conclusions: Glycerol-based cryopreservation allows effective and GMP-compatible preservation of human lipoaspirate. An optimal glycerol concentration range was identified, enabling large-volume fat banking without compromising tissue quality. This protocol provides a clinically applicable strategy for autologous fat storage and may facilitate repeated reconstructive and regenerative treatments. Full article

Radiation-associated soft tissue fibrosis represents a progressive structural remodeling process characterized by extracellular matrix accumulation, septal thickening, and reduced tissue compliance, which complicates reconstructive interventions. Reliable longitudinal experimental frameworks capable of non-invasive structural monitoring remain limited. This study aimed to develop and implement a standardized ultrasonographic protocol for the evaluation of bleomycin-induced subcutaneous fibrosis and to assess remodeling dynamics following autologous fat grafting in a rat model. Twenty-two adult female Wistar rats were included. Subcutaneous fibrosis was induced using submaximal bleomycin administration (1 mg/kg/day for three consecutive days). High-frequency ultrasonography (12 MHz) was performed at baseline (Day 0), post-bleomycin (Day 17), and post-lipofilling (Day 31). A predefined semi-quantitative 0–3 scoring system was applied to characterize global echogenicity, septal thickening, and architectural organization. At Day 17, all animals demonstrated structural alteration with a mean score of 2.15 ± 0.58. At Day 31, the mean score decreased to 1.50 ± 0.50, with complete disappearance of high-grade architectural disorganization (score 3). Focal hypoechoic areas consistent with graft integration were observed in 88.9% of animals without ultrasonographic signs of necrosis or fluid collection. This standardized imaging-based framework enables reproducible longitudinal monitoring of early-stage subcutaneous fibrotic remodeling and provides a non-invasive tool for evaluating regenerative interventions in translational soft tissue engineering research. Full article

Hydrogel-based products are used in many areas of biomedicine and healthcare. Recently, the incorporation of cellulose nanocrystals (CNC), a renewable and functional nanomaterial, into hydrogels has enhanced their functionality, particularly by imparting mechanical strength and structural integrity. This scoping review aims to appraise the types of biomedical models and assays that have been utilised to investigate the effects of CNC incorporation into hydrogels in tissue engineering, wound healing, medical implantation and drug delivery applications, and reports on the rationale for including these models and assays. A structured literature search was undertaken in major scientific databases (PubMed Central, PubMed, BioMed Central, ScienceDirect, Wiley and EBSCOhost), focusing on identifying primary research published between 2016 and 2024. From this process, fifteen studies providing biomedical analyses met the inclusion criteria. Most of these investigations employed in vitro cell-line models (n = 12), with a smaller number utilising in vivo experimental systems (n = 5). Across the included studies, CNC incorporation typically yielded measurable performance gains: reported compressive or storage modulus improvements of 20–40% over hydrogel-only controls, consistently high cell viability (>85%) across multiple human and murine cell types for up to 21 days, and sustained drug release profiles (days–weeks) in stent and antitumour contexts. Where quantified, functional outcomes in vivo included preserved graft volume (autologous fat grafts) and reduced intimal hyperplasia signals in vascular graft models. Critical gaps included heterogeneous CNC sources and surface chemistries, inconsistent reporting of CNC concentration and hydrogel formulation parameters, the limited duration and scope of biocompatibility testing, and minimal alignment with standard evaluation protocols, constraining reproducibility and cross-study comparability. To date, there are no human clinical trials of CNC-hydrogels. Translational readiness will require standardised ISO-compliant biocompatibility evaluations. Large-animal studies under relevant mechanical and physiological conditions, and rigorous long-term degradation and immunogenicity assessments to de-risk progression to human trials. We recommend standardised CNC sources and surface functionalisation reporting, concentration (wt%) ranges, hydrogel rheological characterisation (G′, G″, swelling), and consistent biological endpoints (viability, differentiation, inflammation panels) to enable robust meta-analyses and translational benchmarking. Distinct from prior nanocellulose reviews that emphasise material synthesis and properties, this analysis centres on the biomedical models and assays applied to CNC-incorporated hydrogels, identifying the methodological convergence and divergence that directly impact translational pathways. Full article

Background: Autologous fat grafting is increasingly used in irradiated postmastectomy tissues, but objective imaging-based data describing structural remodeling remain limited. Objective: This pilot study aimed to evaluate ultrasound detectable structural changes following autologous fat grafting in irradiated postmastectomy chest wall tissues. Methods: This prospective pilot study included five female patients with prior radical mastectomy and adjuvant chest wall radiotherapy who underwent a single-session of autologous fat grafting. High-resolution ultrasound was performed preoperatively and at 3–5 months postoperatively using a 12 MHz linear probe. Parameters evaluated included hypodermal thickness, echogenicity (hyperechoic versus hypoechoic patterns), fascial definition, and fibrotic patterns. Results: All patients demonstrated a consistent postoperative increase in hypodermal thickness. Preoperative compact, hyperechogenic architecture transitioned to heterogeneous hypoechogenic patterns suggestive of viable adipose tissue integration consistent with viable adipose tissue. Fascial planes became more clearly defined in four patients. No necrosis, oil cysts, or fluid collections were detected. Conclusions: In this pilot cohort, ultrasound detected consistent postoperative changes in hypodermal thickness, echogenicity, and fascial definition following autologous fat grafting. These findings support the feasibility of ultrasound for the non-invasive assessment of post-radiotherapy structural tissue changes. Full article

Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively assess neovascularization and vascular structure in breasts reconstructed with AFG. Methods: In this retrospective, cross-sectional study, data from eight patients who underwent PAI of both reconstructed and contralateral breasts at least three months after their final AFG procedure for total breast reconstruction were used. Excluding the nipple–areola complex and skin markings, four 3 × 3 cm regions of interest (one per quadrant) were selected in the periareolar region. Vascular density in terms of depth from the skin surface was analyzed in five cases with adequate contact between the device and the skin. Visible vessel diameters within the regions of interest were manually measured and categorized as small, medium, or large to assess distribution patterns. Results: PAI successfully enabled visualization of vascular structures on the reconstructed side in all cases, even at depths greater than 10 mm. In five cases, vascular density in the superficial layer (0–2.5 mm) was higher on the reconstructed side than on the contralateral side. A longer postoperative interval was associated with a higher proportion of small vessels and fewer large vessels. Conclusions: PAI enabled noninvasive visualization of vascular structures consistent with neovascularization on the reconstructed side after AFG. Temporal changes in vessel diameter distribution suggest ongoing vascular remodeling, supporting the potential utility of PAI in assessing vascular structural changes in grafted tissue over time. Full article

Background/Objectives: Hybrid breast reconstruction (HBR), which combines implant-based reconstruction with autologous fat grafting (lipofilling), has emerged as a promising approach for improving both aesthetic and functional outcomes following mastectomy. This study aimed to evaluate patient-reported outcomes using the BREAST-Q questionnaire before and after lipofilling, focusing on aesthetic satisfaction, physical well-being, and quality of care. Methods: This before–after study included patients who underwent prepectoral implant-based reconstruction followed by one session of lipofilling between November 2024 and May 2025. The BREAST-Q questionnaire was administered preoperatively and at three months postoperatively. Statistical analyses were conducted to compare changes across aesthetic, functional, and care-related domains. Results: A total of 96 patients completed both pre- and postoperative questionnaires. Statistically significant improvements (p < 0.01) were observed in most aesthetic and psychosocial parameters, including satisfaction with breast appearance (Q1), psychosocial well-being (Q2), sexual well-being (Q4), and satisfaction with surgical outcomes (Q5). Physical symptoms such as discomfort (Q3) decreased significantly postoperatively. Satisfaction with medical care remained high, with minor improvements noted. No oncologic recurrences were reported. Conclusions: Hybrid breast reconstruction using fat grafting after implant placement offers significant benefits in terms of aesthetics, symptom relief, and patient satisfaction. It is a safe and effective procedure that can be widely integrated into clinical practice, provided that patient selection and technique are carefully considered. Full article

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical data focused on patient-reported symptoms remain limited. The objective of this study was to describe symptomatic and clinical changes after autologous fat grafting in irradiated postmastectomy chest wall tissue. Methods: This pilot observational study included five female patients with a history of mastectomy followed by adjuvant chest wall radiotherapy. All patients underwent a single session of standard autologous fat grafting without adipose derived stem cell enrichment. Patient-reported symptoms, including pruritus, local discomfort, burning sensation and erythema, were recorded preoperatively and at six months using a standardized 0 to 5 scale. Scar pliability was assessed by two experienced physicians using the same scale. Only descriptive statistical analysis was performed. Results: All patients demonstrated lower postoperative symptom scores at six months. Mean reductions were observed for erythema (71.4 percent), burning sensation (61.1 percent) and pruritus (57.1 percent). Local discomfort decreased by 33.3 percent. Mean scar pliability scores increased from 2.2 to 3.2. No postoperative complications, such as infection, fat necrosis or oil cyst formation, were recorded. All patients completed the six month follow up. Conclusions: In this small pilot observational study, autologous fat grafting was well tolerated and associated with descriptive improvement of patient-reported symptoms and scar pliability in irradiated postmastectomy chest wall tissue. These findings suggest a potential symptomatic benefit of fat grafting, while larger studies with objective imaging and histological correlation are required to confirm efficacy and durability. Full article