Plasma Radiofrequency Ablation for Scar Treatment

Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.

Toxic shock syndrome complicated with symmetrical peripheral gangrene after liposuction and fat transfer: a case report and literature review

Background Liposuction is one of the most commonly performed aesthetic procedures. Toxic shock syndrome(TSS) is a rare, life-threatening complication. The incidence rate of TSS is very low in the plastic surgery field, especially after liposuction and fat transfer. Case presentation A 23-year-old female patient was transferred to our emergency department from an aesthetic clinic with sepsis shock features after received liposuction and fat transfer. The patient underwent TSS, disseminated intravascular coagulation(DIC), multiple organ dysfunction syndrome (MODS), symmetrical peripheral gangrene (SPG), and necrotizing soft tissue infection of the buttocks in the next 10 days. Authors used a series of debridement and reconstructive surgery including vacuum sealing drainage (VSD) treatment, artificial dermis grafts,split-thickness skin grafts, amputation surgeries when her vital signs were stable. The patient experienced desquamation of the hand on the 26th day. The skin grafts survived and the function of both fingers and toes recovered. She was discharged 2 months after admission and was in good health. Conclusion TSS is extremely rare in the field of liposuction and autologous fat transfer. The mortality rate of TSS is very high. Early diagnosis and operative treatment, as well as correction of systemic abnormalities, are the important keys to save a patient's life.

Standardized Anatomic and Regenerative Facial Fat Grafting: Objective Photometric Evaluation From 1-19 Months After Injectable Tissue Replacement and Regeneration (ITR2)

Background A standardized technique for facial fat grafting, Injectable Tissue Replacement and Regeneration (ITR 2), was developed to address both anatomic volume losses in superficial and deep fat compartments as well as skin aging, incorporating newer regenerative approaches. Objectives The authors sought to track the short and long terms effects of a new standardized technique for facial fat grafting in the midfacial zone across a 19-month time period. Methods Twenty-nine female were analyzed for mid-facial volume changes after autologous fat transfer with ITR 2. Across 19 months, volumes were evaluated using the Vectra XT 3D Imaging System to calculate differences between a predefined, 3-dimensional mid-facial zone measured preoperatively and serially after fat grafting with novel approach using varying fat parcel sizes. Results Patient data was analyzed collectively as well as separately by age (< and > 55 years). Collective analysis revealed a trend of initial volume loss within the first 1-7 months followed by an increase within the 8–19-month range, averaging 56.6% postoperative gain and ending at an average of 52.3% gain in volume by 14-19 months. A similar trend was observed for patients <55 years of age, but to a greater extent, with a 54.1% average postoperative gain and final average of 75.2%. Conversely, patients above 55 years of age revealed a linear decay beginning at 60.6% and steadily declining to 29.5%. Multiple regression analysis revealed no statistically significant influence of weight change during the study duration. Conclusions Preliminary evidence shows a dynamic change in facial volume, with an initial decrease in facial volume followed by a rebound effect that demonstrated improvement of facial volume regardless of patient weight change or amount of fat injected 19 months after treatment. Volume improvement occurred to a greater extent in patients under 55 years old, whereas in patients older than 55 volume gradually decreased. To our knowledge, this study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment with a new standardized technique of fat grafting.

Oncological Safety of Lipofilling in Patients with Breast Cancer: A Metaanalysis

Background Lipofilling is an increasingly popular technique for breast reconstruction following both mastectomy and breast-conserving surgery (BCS). Autologous fat transfer (Lipofilling), is a technique which has been used for many years in the setting of aesthetic breast surgery. Although gaining popularity in this setting, there are still questions regarding its oncological safety when used in patients being treated for breast cancer. Objective To systematically evaluate the current literature regarding the oncological safety of lipofilling in patients who underwent surgical treatment for breast cancer by performing a metaanalysis to investigate the recurrence rates and the incidence of complications after lipofilling. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materi als available in the Internet till 2019. Data Extraction All the studies which did not fulfill the inclusion criteria were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Through this analysis, no evidence that lipofilling significantly increases the risk of locoregional recurrence when used as part of a breast reconstruction procedure after either mastectomy or BCS for breast cancer was found. Therefore, it can be considered an oncologically safe procedure in suitable patients with careful oncological follow-up. In the future, more longterm, adequately powered, multicentre controlled studies are needed. Additionally, more research should be carried out on the incidence of complications following lipofilling so that efforts can be made to prevent them and optimise fat graft survival.

CASE REPORT: COMPLICATION AT BOTH RECEIVING AND DONOR SITES IN FACIAL AUTOLOGOUS FAT TRANSFER

Autologous fat grafting is a technique that has been used for a long time in the field of plastic surgery. Besides many advantages, the complications, which can range from mild such as hematoma, infection, calcification, necrosis... even death is a big problem. The article presents a case of using autologous fat taken from the abdomen to graft onto the facial area with complications of severe infection in both the receiving and donor sites, causing necrosis of fat and skin in both areas. The treatment takes a long time with different procedures, but the consequences for the patient are still very serious both in terms of aesthetics and function. The objective of this study was to evaluate the safety and efficacy of fat grafting to the facial region for the reconstruction and aesthetic enhancement of facial contour.

BREAST trial study protocol: evaluation of a non-invasive technique for breast reconstruction in a multicentre, randomised controlled trial

IntroductionPioneers have shown that it is possible to reconstruct a full breast using just autologous fat harvested by liposuction or autologous fat transfer (AFT). This study describes the first multicentre randomised study protocol to thoroughly investigate the effectiveness of AFT to reconstruct full breasts following mastectomy procedures (primarily and delayed).Methods and analysisThis study is designed as a multicentre, randomised controlled clinical superiority trial with a 1:1 allocation ratio. A total of 196 patients (98 patients per treatment arm) are aimed to be included. Patients who wish to undergo breast reconstruction with either one of the two techniques are randomly allocated into the AFT group (intervention) or the tissue-expander/prosthesis group (control). The primary outcome measure for the quality of life is measured by the validated BREAST-Q questionnaire.Ethics and disseminationApproval for this study was obtained from the medical ethics committee of Maastricht University Medical Centre/Maastricht University; the trial has been registered at ClinicalTrials.gov. The results of this randomised controlled trial will be presented at scientific meetings as abstracts for poster or oral presentations and published in peer-reviewed journals.Trial statusEnrolment into the trial has started in October 2015. Data collection and data analysis are expected to be completed in December 2021.Trial registration numberNCT02339779.