Development and assessment of a cutaneous tissue stretch device as a novel scar therapy

Aim:Scar prevention and reduction is an area of therapeutic opportunity and unmet medical need.With no current effective scar therapy,patients are often disappointed in their appearance post surgery and re-present to surgeons,only to be turned away.The purpose of this study was to develop and test a device that produces intermittent parallel stretch on new scars and to analyze its potential to reduce scarring.Methods:Mice were randomized into 5 scar stretch treatment groups:1 control,1 sham,and 3 stretch models(0.5×,1×,or 2×device strength)and treated for 10 days.Scars were scored using the Vancouver Scar Scale.Scar tissue samples were compared by histology and transforming growth factor beta 1(TGF-β1)expression between control and treatment groups.Results:Scar scores of 0.5×and 1×groups were significantly lower than the control group(P<0.05).Scar scores from the 1×treatment group were also significantly lower than the 0.5×group(P<0.05).Sham,control scar and 2×groups showed more collagen deposition and a thicker dermal scar than the 0.5×and 1×groups.Unstretched scars had fewer fibroblasts with more collagen deposition than the 0.5×and 2×groups.TGF-β1 levels were significantly lower in the 0.5×(342.1±9.2)and 1×(254.1±3.1)groups than in the control group(P<0.05).TGF-β1 levels in the 1×treatment group were also significantly lower than the 0.5×treatment group(P<0.05).Conclusion:Intermittent cutaneous tissue stretch parallel to scars during the proliferative phase of wound healing decreases fibrosis on a macroscopic,microscopic and biochemical level.

Fat injection to correct contour deformities of the reconstructed breast:a single surgeon experience

Aim:Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction.The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction.Methods:A single surgeon,prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was reviewed.Patient characteristics,breast history,type of breast reconstruction,volume of fat injected,and complications were analyzed.Results:One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013,for a total of 187 treated breasts.The patients were on average 49.3 years old(±8.9 years).Fat was harvested from the medial thighs(20.5%),flanks(39.1%),medial thighs and flanks(2.9%),trochanters(13.3%),medial knees(2.7%),and abdomen(21.9%).An average of 49.25 mL of fat was injected into each reconstructed breast.A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast reconstruction.Thirteen breasts(in 12 separate patients)were injected several years after having undergone lumpectomy and radiotherapy.Of the 187 treated breasts,118 were reconstructed with expanders to implants,45 with deep inferior epigastric perforator flaps,9 with latissimus dorsi flaps with implants,4 with transverse rectus abdominis myocutaneous flaps,and 13 had previously undergone lumpectomy and radiotherapy.Six complications were noted in the entire series,for a rate of 3.2%.All were in previously radiated breasts.Average follow-up time was 12 months(range:2-36 months).Conclusion:Fat injection continues to grow in popularity as an adjunct to breast reconstruction.Our experience demonstrates a low complication rate as compared to most surgical interventions of the breast and further supports its safety in breast reconstruction.However,caution should be used when treating previously radiated breasts.