Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review

Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.

Adipose Tissue Transplant Impregnated with Collagen Increases Engraftment by Promoting Cell Proliferation, Neovascularization, and Macrophage Activity in a Rat

Objectives: To clarify the effect of impregnating transplanted adipose tissue with collagen on angiogenesis, cell proliferation, and tissue remodeling process and to reveal whether collagen impregnation contributes to improving the engraftment of transplanted adipose tissue in rats.Methods: Adipose tissue was harvested from the inguinal and injected into the back of the rat, in addition to collagen. Engraftment tissue was harvested, semi-quantitatively evaluated and underwent HE or Perilipin staining. Moreover, we evaluated viable adipocyte counts and neovascularization. Macrophages were evaluated using flow cytometry, and the adiponectin or VEGF mRNA was detected using real-time PCR. Results: By impregnating transplanted adipose tissue with collagen, higher engraftment rate semi-quantitatively and a greater number of new blood vessels histologically were identified. Perilipin staining revealed a higher adipocyte number. The total cell, M1 macrophage, and M2 macrophage count were higher. There was increased adiponectin mRNA significantly at week 4 compared to that at week 1 after transplantation. Note that the expression levels of VEGF mRNA increased.Discussion: In rats, collagen impregnation enhanced cell proliferation, induced M2 macrophages, which are involved in wound healing, and promoted adipocytes and neovascularization. Therefore, impregnating transplanted adipose tissue with collagen could increase the engraftment rate of adipose tissue.

Combating the illegal transplantation as a prerequisite for the sustainable development of regions (on the example of Sverdlovsk region)

The text of this article emphasizes that the history of transplantation as an independent medical industry originated in the Union of Soviet Socialist Republics, the first successful operation to transplant human organs and tissues was performed there by the surgeon Yuri Voronoy. Today Russia is one of the world-leading powers where human organ and tissue transplant operations are performed. Among all the subjects of Russia where transplant operations are carried out, Sverdlovsk region occupies a special place: doctors in this region conduct successful operations on organ and tissue transplantation and make discoveries that are significant for Russian transplantology. The study of Russian laws and regulations regulating relations in the field of transplantology conducted by authors, as well as an analysis of the scientific literature showed that relations in the field of transplantology are not fully regulated by Russian legislation, including criminal law. On the territory of Sverdlovsk region in particular, as well as on the territory of Sverdlovsk region as a whole, it is possible, for example, to carry out transactions for the sale and purchase of human organs and tissues with impunity, if such transactions are not related to causing harm to the life and health of the victim. These deals are illegal, but not punishable. As the analysis of the practice carried out in the framework of this study has shown, the inhabitants of Sverdlovsk region suffered from the imperfection of the norms of Russian legislation regulating relations in the field of transplantology. While the residents of Sverdlovsk region are suffering from illegal transplantation, one cannot speak of the sustainable development of this region. The authors of the study, in order to combat illegal transplantation in Sverdlovsk region, propose that the regional authorities strengthen measures to improve the general legal literacy of the population, introduce a register of citizens' opinions on the posthumous transplantation of their organs and tissues, and introduce mandatory registration of transactions made in Sverdlovsk region, a subject of which are human organs and tissues.

Case report - a cornea donor with a positive SARS-CoV-2 finding

The safety of the patient is the highest priority when providing a recipient with a tissue transplant. When screening a potential donor, the presence of infectious diseases is therefore also considered, which requires special attention in view of the current SARS-CoV-2 pandemic. Reliable test systems for the detection of the novel virus and its determination during all phases of infection are a prerequisite for a reliable statement on the risk of transmission of the virus through a corneal transplant. The case of a 70-year-old cornea donor with a positive SARS-CoV-2 result, which is documented here, demonstrates the difficulty of a meaningful donor test.

Orthotopic Bone Formation by Streamlined Engineering and Devitalization of Human Hypertrophic Cartilage

Most bones of the human body form and heal through endochondral ossification, whereby hypertrophic cartilage (HyC) is formed and subsequently remodeled into bone. We previously demonstrated that HyC can be engineered from human mesenchymal stromal cells (hMSC), and subsequently devitalized by apoptosis induction. The resulting extracellular matrix (ECM) tissue retained osteoinductive properties, leading to ectopic bone formation. In this study, we aimed at engineering and devitalizing upscaled quantities of HyC ECM within a perfusion bioreactor, followed by in vivo assessment in an orthotopic bone repair model. We hypothesized that the devitalized HyC ECM would outperform a clinical product currently used for bone reconstructive surgery. Human MSC were genetically engineered with a gene cassette enabling apoptosis induction upon addition of an adjuvant. Engineered hMSC were seeded, differentiated, and devitalized within a perfusion bioreactor. The resulting HyC ECM was subsequently implanted in a 10-mm rabbit calvarial defect model, with processed human bone (Maxgraft®) as control. Human MSC cultured in the perfusion bioreactor generated a homogenous HyC ECM and were efficiently induced towards apoptosis. Following six weeks of in vivo implantation, microcomputed tomography and histological analyses of the defects revealed an increased bone formation in the defects filled with HyC ECM as compared to Maxgraft®. This work demonstrates the suitability of engineered devitalized HyC ECM as a bone substitute material, with a performance superior to a state-of-the-art commercial graft. Streamlined generation of the devitalized tissue transplant within a perfusion bioreactor is relevant towards standardized and automated manufacturing of a clinical product.

Organizing a microsurgery workshop for residents

Microsurgery represents an important branch in Plastic and Reconstructive Surgery. It involves fine skills which doctors need to repair nerves, vessels and thus being able to perform replantation and transplantation of different types of tissue. After traumatic injuries, a plastic surgeon is capable of either coverage of the exposed noble tissue or can perform the replantation of the amputated limb using microsurgery. This field can be very challenging at the beginning, but very rewarding in the end. The utility microsurgery is quite vast; however, the skills to perform such surgery require a lot of training beforehand. Before doing any replantation or other tissue transplant in humans, it would be recommended that a surgeon should have a basic microsurgical course completed and afterwards several hours of practice in front of the microscope. Last but not least, one should also test the skills acquired in vivo, in order to improve and perform the correct manoeuvres from the beginning. In order to do this, a plastic surgery trainee must therefore have a dedicated laboratory where he/she can practice this art. This place should be quiet, equipped with microscopes and microsurgery instruments and authorized to perform experiments on live animals.

Impact of human visceral and glutealfemoral adipose tissue transplant on glycemic control in a mouse model of diet-induced obesity

Regional distribution of adipose tissue is an important factor in conferring cardiometabolic risk and obesity-related morbidity. We tested the hypothesis that human visceral adipose tissue (VAT) impairs glucose homeostasis, whereas subcutaneous glutealfemoral adipose tissue (GFAT) protects against the development of impaired glucose homeostasis in mice. VAT and GFAT were collected from patients undergoing bariatric surgery and grafted onto the epididymal adipose tissue of weight- and age-matched severe, combined immunodeficient mice. SHAM mice underwent surgery without transplant of tissue. Mice were fed a high-fat diet after xenograft. Energy homeostasis, glucose metabolism, and insulin sensitivity were assessed 6 wk later. Xenograft of human adipose tissues was successful, as determined by histology, immunohistochemical evaluation of collagen deposition and angiogenesis, and maintenance of lipolytic function. Adipose tissue transplant did not affect energy expenditure, food intake, whole body substrate partitioning, or plasma free fatty acid, triglyceride, and insulin levels. Fasting blood glucose was significantly reduced in GFAT and VAT compared with SHAM, whereas glucose tolerance was improved only in mice transplanted with VAT compared with SHAM mice. This improvement was not associated with differences in whole body insulin sensitivity or plasma insulin between groups. Together, these data suggest that VAT improves glycemic control and GFAT does not protect against the development of high-fat diet-induced glucose intolerance. Hence, the intrinsic properties of VAT and GFAT do not necessarily explain the postulated negative and positive effects of these adipose tissue depots on metabolic health.