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Physiologic surgical options, including vascularized lymph node transplant and lymphovenous bypass are becoming increasingly popular interventions for the treatment of lymphedema of both the upper and lower extremities. Many different lymph node donor sites have been described, including submental, lateral thoracic, superficial groin, supraclavicular, and various intraabdominal sites. This paper describes a step-by-step approach to the harvest of vascularized lymph nodes from the supraclavicular area, which is the preferred donor site for most patients with both upper and lower extremity lymphedema. LESS      Full article

Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades. While techniques for ulnar nerve repair have been well-documented, more recent techniques for median and radial nerve branch reinnervation are still being explored. This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves. LESS      Full article

Aim: Skin firmness is one of the key parameters to define skin quality and facial aging. Among the minimally invasive anti-aging strategies, hyaluronic acid (HA) injection is widely accepted to improve skin quality. While most of the available HA injectables are designed and intended for intradermal injection, a novel HA/sorbitol composition containing 2.6% high molecular weight hyaluronic acid stabilized by sorbitol was recently developed to be specifically injected into the adipose tissue to improve the quality of all skin layers, especially the skin firmness.Methods: The HA/sorbitol composition was investigated versus product comparators in terms of biophysical properties, tolerance in subcutaneous tissue with in vivo implantation study, and skin firmness assessment on human skin explants.Results: The HA/sorbitol composition was characterized by unique and differentiated biophysical properties, proper distribution and high tolerance of the gel composition into the adipose tissue, and the ability to efficiently improve skin firmness.Conclusion: The HA/sorbitol composition represents a new attractive solution to treat facial skin aging with an injection strategy specifically targeting the adipose tissue instead of the dermis, to improve the quality of the skin. LESS      Full article

This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate, showing a left alveolar cleft, lateral deviation of the major segment of the maxilla, and palatal transposition of the lateral incisor. Preoperatively, the midline of the upper central incisors was shifted by 7.0 mm to the right, the right lateral incisor showed palatal transposition, and the residual alveolar cleft was 6.5 mm. Segmental Le Fort I osteotomy of the major segment, and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age. Thus, midline correction, alignment of the right lateral incisor, and cleft closure were achieved; no further prosthetic treatment was required. LESS      Full article

Aim: Dermal fillers are increasingly popular procedures. Inadvertent intraarterial injection of fillers, particularly with calcium hydroxylapatite (CaHA), can result in devastating consequences. A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications.Methods: The methodology of this review was derived from The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). In addition, this paper presents a previously unreported case of a CaHA-associated vascular complication. Results: There were 32 articles describing 42 cases, plus our case included in this review. There were 15 cases of vision complications, 23 cases of non-vision complications, and 5 experimental studies. The most common injection sites reported were nasal region for vision complications (45%) and nasolabial folds for non-vision complications (40%). Of the 38 human cases, the most prevalent treatment choice was steroids (24 cases, 63%). Complete or near complete improvement was reported in 83% of non-vision complications and 40% of vision complications. There was no noticeable homogeneity in the management strategies and outcomes of the patients. Of the 5 experimental studies, no clear consensus on treatments was found.Conclusion: Vascular complications of CaHA are seemingly uncommon, but it is widely suspected that this is due to underreporting. While best management is prevention, preparation for a potential complication is equally important. Derived from CaHA literature, hyaluronic acid filler complication protocols, findings of this review, and personal experiences, this report proposes management strategies for CaHA-associated vascular complications. We hope these strategies provide a much-needed framework for injectors to refer to and utilize as needed. LESS      Full article

Collagen-based supplements have become a keystone in the management of the ageing process, with proven ability to repair skin damage, bestowing a youthful and healthy appearance sought in the pursuit of beauty. Collagen is an essential scaffold protein that gives smoothness and elasticity to skin, but its production declines with age. Finding ways to tackle this problem is now strongly promoted as an effective way to transform skin and hair, repairing age-related deterioration. A growing number of scientific studies show exciting evidence that it is possible to rejuvenate ageing or damaged skin, improve function of worn joints, and support personal wellbeing and vitality. In recent times, research on the mechanisms which impact the production of collagen in skin and the ideal organization into functional fibres which give skin its characteristic elasticity and firmness has provided new insights into how this bio-scaffold can support cells, tissues and organs. The factors which influence collagen production over a lifetime (e.g., puberty, pregnancy, menopause, andropause), intrinsic factors (e.g., genetics, age, ethnicity) and extrinsic factors (e.g., UV-radiation, pollution, smoking) and the potential for new technologies, ingredients and devices to restore collagen and matrix components to their optimal condition are improving the ability to deliver anti-aging strategies with unprecedented results. This paper will review skin collagen production, structure and function throughout the lifestages, emphasizing its relationship with health, appearance and beauty. LESS      Full article

Inflammation is a key phase in the cutaneous wound repair process. The activation of inflammatory cells is critical for preventing infection in contaminated wounds and results in the release of an array of mediators, some of which stimulate the activity of keratinocytes, endothelial cells, and fibroblasts to aid in the repair process. However, there is an abundance of data suggesting that the strength of the inflammatory response early in the healing process correlates directly with the amount of scar tissue that will eventually form. This review will summarize the literature related to inflammation and cutaneous scar formation, highlight recent discoveries, and discuss potential treatment modalities that target inflammation to minimize scarring. LESS      Full article

The extracellular matrix (ECM) occupies the space between cell and cell, and serves as a sort of intranet which connects the whole organism. Current research is focused on the ECM and, it is now possible to develop increasingly effective strategies for the prevention and treatment of degenerative diseases and even, cutaneous ageing. In fact, the most advanced anti-aging treatments are those that regenerate the ECM, which is now regarded as the main player in the physical support of, and exchange with and between cells of nutrients, cellular mediators and growth factors. LESS      Full article

Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability. LESS      Full article