• Archives of Plastic Surgery
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• v.48 no.5
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• pp.549-552
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• 2021

Clinical applications of stromal cells obtained mechanically from adipose tissue are quite popular methods. However, generally accepted protocols still do not exist. In this study, three new delivery methods using different protocols are presented as innovative methods in accordance with an approach called "Indication-based protocols." In mechanical methods, before cutting the fat tissue with ultra-sharp blades, which we define as "Adinizing," mixing it with different liquids such as saline or plasma provides the stromal cells in liquid form with high number and viability as a final product. At the same time, since stromal cells and extracellular matrix are preserved by mechanical methods, it was deemed appropriate to use the term total stromal cells (TOST) instead of stromal vascular fraction for this final product, unlike the product obtained with the enzyme. TOST can be combined with plasma and used for dermal filling in "solid" form. In addition to this filling effect, it will also cause a change in the tissue regeneratively. Finally, the stromal cells obtained from liquid can be applied clinically in aerosol form with the help of nebulizer. We believe that three innovative delivery methods can be used successfully in the treatment of many clinical situations in the future.

• Archives of Plastic Surgery
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• v.48 no.4
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• pp.433-439
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• 2021

Acellular dermal matrices (ADM) are a novel graft. The goal of this systematic review is to evaluate the evidence behind differences in human and porcine ADM, irrelevant of manufacturing method, and to determine if there is enough of an evidence base to change clinical practice. An extensive literature search was performed through MEDLINE and Embase with search terms defining a population, intervention and outcome. Title and abstract exclusion were performed with other exclusion criteria. In 191 articles were found after exclusion of duplicates, with only 29 remaining following exclusions. Ten studies were found to have level I and II evidence (I=3, II=8), of which two were histopathological, one was an animal model, one was a systematic review, and six were clinical. The remaining studies were reviewed and considered for discussion, but did not hold high enough standards for medical evidence. Strong clinical evidence already exists for the use of human ADM, but questions of access, cost, and ethics require consideration of a xenograft. Histopathologically, evidence suggests minimal long-term differences between human and porcine ADM, although there is a short acute immune response with porcine ADM. Clinically, there is limited difference in outcomes, with a small range in effect of different ADM preparations. Considering the effectiveness of ADM in wound healing, more high-level research with appropriate statistical analysis to facilitate a future meta-analysis is recommended to justify a transition from human to porcine ADM.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.233-240
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• 2011

Purpose: To apply a computer assisted navigation system to orthognathic surgery, a simple and efficient measuring algorithm calculation based on affine transformation was designed. A method of improving accuracy and reducing errors in orthognathic surgery by use of an optical tracking camera was studied. Methods: A total of 5 points on one surgical splint were measured and tracked by the Polaris $Vicra^{(R)}$ (Northern Digital Inc Co., Ontario, Canada) optical tracking system in two cases. The first case was to apply the transformation matrix at pre- and postoperative situations, and the second case was to apply an affine transformation only after the postoperative situation. In each situation, the predictive measuring value was changed to the final measuring value via an affine transformation algorithm and the expected coordinates calculated from the model were compared with those of the patient in the operation room. Results: The mean measuring error was $1.027{\pm}0.587$ using the affine transformation at pre- and postoperative situations and the average value after the postoperative situation was $0.928{\pm}0.549$. The farther a coordinate region was from the reference coordinates which constitutes the transform matrixes, the bigger the measuring error was found which was calculated from an affine transformation algorithm. Conclusion: Most difference errors were brought from mainly measuring process and lack of reproducibility, the affine transformation algorithm formula from postoperative measuring values by using of optic tracking system between those of model surgery and those of patient surgery can be selected as minimizing the difference error. To reduce coordinate calculation errors, minimum transformation matrices must be used and reference points which determine an affine transformation must be close to the area where coordinates are measured and calculated, as well as the reference points need to be scattered.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.199-209
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• 2011

Purpose: Osteoporosis, is a major health problem for the elderly and post-menopausal women and shown to alter the properties of bone as well as impair bone healing around titanium implants in both human and animals. The objective of this study was to examine the effect of LIPUS with adipose-derived stem cells on the healing process around a titanium implant in rats with osteoporosis. Methods: Sixteen osteoporosis-induced rats were divided into two groups: an adipose-derived stem cell injected with Low Intensity Pulsed Ultrasound (LIPUS) application group and a control group. Titanium screw implants (diameter, 2.0 mm: length, 3.5 mm, Cowell Medi, Korea) were placed into both tibia of 16 rats, on 8 rats as the control group and the other 8 rats as the experimental group. Rats were sacrificed at different intervals from 1, 2, 4 and 8 weeks after implantation for histopathologic and immunohistochemical analyses. Results: Histopathological analysis revealed newly formed bone in experimental group earlier than that in control group. Especially at 1 week after implantation, more amounts of new bone matrix and collagen around the implant in the experimental group were seen compared with the control group. Immunohistochemical analysis showed that the levels of osteoprotegerin (OPG) expression in the experimental group were increased at early stages compared with that of control group until 2 weeks after implantation. But after 2 weeks, the expression level of OPG similar in both groups. The expression levels of receptor activator of nuclear factor kB ligand (RANKL) were stronger in the experimental group than the control group until 2 weeks after implantation. After 4 weeks, expression of RANKL in experimental group was similar to the control group. Conclusion: The results of this study suggest that LIPUS with Adipose-Derived Stem Cells in implantation could promote bone healing around titanium implants in rats with osteoporosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.497-503
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• 2010

Purpose: The purpose of this study is to induce artificial arthritis on rabbit TMJ by injecting collagenase. Materials and Methods: An experimental animal model of arthritis induced by surgical method or intraarticular injection of chemical agent like LDH, papain, ketorolac. Surgical method is complex and needs a long time in inducing arthritis. Intra-articular injection of chemical agent like LDH, papain, ketorolac is simple. But chemical agent like LDH, papain, ketololac needs multiple injections to induce arthritis and mechanism inducing arthritis was known. Collagenase destroys helical domain of type II collagen in extracellular matrix produced by chondrocyte and then induces arthritis. We injected collagenase (0.5, 1.0, 2.0 mg) into the temporomandibular joint of rabbit. In the control group saline was intra-articularly injected. The condylar cartilage, disk and synovia were histologically examined at 1, 2, 4, 6 weeks after the initiation of collagenase injections. Results: Four weeks after injection of 2.0 mg collagenase, we could see histologic change like arthritis. In other groups, we couldn't see arthritis-like change. Conclusion: In our study, we produce arthritis on temporomandibular joint of rabbit by using injection of collagenase in temporomandibular joint of rabbit. And this experimental osteoarthritis is a useful animal model.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.2
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• pp.103-111
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• 2011

Purpose: Choukroun's platelet-rich-fibrin (PRF) is composed of platelets, white blood cells and fibrin matrix. It does not induce enough bone formation by itself but it can improve bone formation with calcium. Silk fibroin does not cause inflammatory reactions because it is bio-compatible and degradable. The purpose of this study was to exam the bone formation when a combination of Choukroun's PRF and silk fibroin was used. Methods: In this study, cell reactions to silk powder with differing molecular weights was first tested to select the appropriate silk powder. Then we applied these bone graft materials on defects of skull and in a peri-implant bony defect model in New Zealand rabbits. The results between the experimental and control s (non-grafted) group were analyzed. Results: The small sized silk fibroin powder showed increased cellular proliferation for bone-regeneration. There was no statistically significant difference between the experimental group and the control group at 6 weeks, but more new bone formation was observed in the combination graft group at 12 weeks (P<0.05). And in the dental implant model, the combination bone graft group showed much improved torque test results, which was statistically significant. Histomorphometric analysis showed more regenerated cortical bone and a higher mean bone to implant in the experimental group. Both were statistically significant. Conclusion: The combination graft of Choukroun's platelet-rich-fibrin (PRF) and silk fibroin powder can successfully restore the bony defects in a skull defected model and a peri-implant bony defects model.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.47.1-47.10
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• 2019

Background: Hyaluronic acid (HA) has been applied as a primary biomaterial for temporary soft tissue augmentation and as a carrier for cells and the delivery of growth factors to promote tissue regeneration. Although HA derivatives are the most versatile soft tissue fillers on the market, they are resorbed early, within 3 to 12 months. To overcome their short duration, they can be combined with cells or growth factors. The purpose of this study was to investigate the stimulating effects of human fibroblasts and basic fibroblast growth factors (bFGF) on collagen synthesis during soft tissue augmentation by HA hydrogels and to compare these with the effects of a commercial HA derivative (Restylane^®). Methods: The hydrogel group included four conditions. The first condition consisted of hydrogel (H) alone as a negative control, and the other three conditions were bFGF-containing hydrogel (HB), human fibroblast-containing hydrogel (HF), and human fibroblast/bFGF-containing hydrogel (HBF). In the Restylane^® group (HGF), the hydrogel was replaced with Restylane^® (R, RB, RF, RBF). The gels were implanted subdermally into the back of each nude mouse at four separate sites. Twelve nude mice were used for the hydrogel (n = 6) and Restylane^® groups (n = 6). The specimens were harvested 8 weeks after implantation and assessed histomorphometrically, and collagen synthesis was evaluated by RT-PCR. Results: The hydrogel group showed good biocompatibility with the surrounding tissues and stimulated the formation of a fibrous matrix. HBF and HF showed significantly higher soft tissue synthesis compared to H (p < 0.05), and human collagen type I was well expressed in HB, HF, and HBF; HBF showed the strongest expression. The Restylane^® filler was surrounded by a fibrous capsule without any soft tissue infiltration from the neighboring tissue, and collagen synthesis within the Restylane^® filler could not be observed, even though no inflammatory reactions were observed. Conclusion: This study revealed that HA-based hydrogel alone or hydrogel combined with fibroblasts and/or bFGF can be effectively used for soft tissue augmentation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.16-23
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• 2005

It is commonly acknowledged that bone morphogenic protein (BMP-2) functions as a potential osteogenic inducer in bone formation. Recently, several papers reported that bone marrow-derived stem cell (BMSC) from human is not responsive to BMP-2 in comparison to high capacity of BMP-2 in the osteoinduction of stromal cell derived from bone marrow of rodent animals such as rat or mouse. In this study, we characterized BMSC derived from 11 years old donor for the responsiveness to rhBMP-2, dexamethasone (Dex) and 1,25-dihydroxyvitamin D (vitamin D), in order to analyze their function in the early osteogenesis. The effect of over mentioned agents was evaluated by means of assessing alkaline phosphatase (ALP) activity/staining, RT-PCR analysis and von Kossa staining. In addition, we analyzed the meaning of expressed several osteoblastic markers such as alkaline phosphatase, collagen typeI, osteopontin, bone sialoprotein and osteocalcin with relation to either differentiation or mineralization. Only in the presence of Dex, human BMSC could commit osteoblastic differentiation and matrix mineralization, and either BMP-2 or vitamin D treatment was not able to induce. But BMP-2 or Vitamin D showed potential synergy effect with Dex. ALP and bone sialoprotein were clearly expressed in response of Dex treatment compared to weak expression of osteopontin in early osteogenesis. Therefore, we expect that this study will contribute partly to elucidiating early osteogenesis mechanism in human, but variations among bone marrow donors must be considered through further study.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.459-466
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• 2011

Purpose: This study evaluated the capability of bone formation with silk fibroin/nano-hydroxyapatite/corn starch composite scaffold as a bone defect replacement matrix when grafted in a calvarial bone defect of rabbits $in$ $vivo$. Methods: Ten New Zealand white rabbits were used for this study and bilateral round-shaped defects were formed in the parietal bone (diameter: 8.0 mm). The silk fibroin 10% nano-hydroxyapatite/30% corn starch/60% composite scaffold was grafted into the right parietal bone (experimental group). The left side (control group) was grafted with a nano-hydroxyapatite (30%)/corn starch (70%) scaffold. The animals were sacrificed at 4 weeks and 8 weeks. A micro-computerized tomography (${\mu}CT$) of each specimen was taken. Subsequently, the specimens were decalcified and stained with Masson's trichrome for histological and histomorphometric analysis. Results: The average ${\mu}CT$ and histomorphometric measures of bone formation were higher in the control group than in the experimental group at 4 weeks and 8 weeks after surgery though not statistically significant ($P$ >0.05). Conclusion: The rabbit calvarial defect was not successfully repaired by silk fibroin/nano-hydroxyapatite/corn starch composite scaffold and may have been due to an inflammatory reaction caused by silk powder. In the future, the development of composite bone graft material based on various components should be performed with caution.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.1
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• pp.38-50
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• 2013

Purpose: The aim of this study is to evaluate the effect and potential of electron beam (E-beam) irradiation treatment to the synthetic bony mixtures composed of hydroxyapatite (HA; Bongros$^{(R)}$, Bio@ Co., Korea) and tricalcium phosphate (${\beta}$-TCP, Sigma-Aldrich Co., USA), mixed at various ratios and of type I collagen (Rat tail, BD Biosciences Co., Sweden) as an organic matrix. Methods: We used 1.0~2.0 MeV linear accelerator and 2.0 MeV superconductive linear accelerator (power 100 KW, pressure 115 kPa, temperature $-30{\sim}120^{\circ}C$, sensor sensitivity 0.1~1.2 mV/kPa, generating power sensitivity 44.75 mV/kPa, supply voltage $5{\pm}0.25$ V) with different irradiation dose, such as 1, 30 and 60 kGy. Structural changes in this synthetic bone material were studied in vitro, by scanning electron microscopy (SEM), elementary analysis and field emission scanning electron microscope (FE-SEM), attenuated total reflection (ATR), and electron spectroscopy for chemical analysis (ESCA). Results: The large particular size of HA was changed after E-beam irradiation, to which small particle of TCP was engaged with organic collagen components in SEM findings. Conclusion: The important new in vitro data to be applicable as the substitutes of artificial bone materials in dental and medical fields will be able to be summarized.