Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps represent increasingly popular options for breast reconstruction. Although several retrospective, small-scale studies comparing these flaps have been published, most have failed to find a significant difference in flap complication rates or donor-site morbidity. We systematically reviewed the current literature, and subsequently pooled and analyzed data from included studies. Included studies reported flap complications and/or donor site morbidities for both flap types. Eight studies met the inclusionary criteria. For flap complications, there was a statistically significant difference between deep inferior epigastric perforator and free transverse rectus abdominis myocutaneous flaps in fat necrosis rates (25.5 +/- 0.49 vs. 11.3% +/- 0.41%, P < 0.001) and total necrosis rates (4.15 +/- 0.08 vs. 1.59% +/- 0.08%, P = 0.044). Partial necrosis rates were not statistically significant (3.54 +/- 0.07 vs. 1.60% +/- 0.07%, P = 0.057). For donor-site morbidity, there was no statistically significant difference in abdominal bulge (8.07 +/- 0.23 vs. 11.25% +/- 0.29%, P = 0.28). Multicenter, prospective studies are needed to further investigate differences between these flap options.

BackgroundNon-healing foot ulcers are the most common cause of non-traumatic amputation and hospitalization amongst diabetics in the developed world. Impaired wound neovascularization perpetuates a cycle of dysfunctional tissue repair and regeneration. Evidence implicates defective mobilization of marrow-derived progenitor cells (PCs) as a fundamental cause of impaired diabetic neovascularization. Currently, there are no FDA-approved therapies to address this defect. Here we report an endogenous PC strategy to improve diabetic wound neovascularization and closure through a combination therapy of AMD3100, which mobilizes marrow-derived PCs by competitively binding to the cell surface CXCR4 receptor, and PDGF-BB, which is a protein known to enhance cell growth, progenitor cell migration and angiogenesis.Methods and ResultsWounded mice were assigned to 1 of 5 experimental arms (n = 8/arm): saline treated wild-type, saline treated diabetic, AMD3100 treated diabetic, PDGF-BB treated diabetic, and AMD3100/PDGF-BB treated diabetic. Circulating PC number and wound vascularity were analyzed for each group (n = 8/group). Cellular function was assessed in the presence of AMD3100. Using a validated preclinical model of type II diabetic wound healing, we show that AMD3100 therapy (10 mg/kg; i.p. daily) alone can rescue diabetes-specific defects in PC mobilization, but cannot restore normal wound neovascularization. Through further investigation, we demonstrate an acquired trafficking-defect within AMD3100-treated diabetic PCs that can be rescued by PDGF-BB (2 μg; topical) supplementation within the wound environment. Finally, we determine that combination therapy restores diabetic wound neovascularization and accelerates time to wound closure by 40%.ConclusionsCombination AMD3100 and PDGF-BB therapy synergistically improves BM PC mobilization and trafficking, resulting in significantly improved diabetic wound closure and neovascularization. The success of this endogenous, cell-based strategy to improve diabetic wound healing using FDA-approved therapies is inherently translatable.

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Radiomorphometrically, absorbable collagen sponge and hydroxyapatite-tricalcium phosphate scaffolds induced more bone formation than untreated controls. The rhBMP-2 added a small but significant histomorphometric osteogenic advantage to the hydroxyapatite-tricalcium phosphate scaffold.

Current preservation methods for interval cranioplasty do not maintain bone graft viability. Subcutaneous storage appears to provide a small advantage compared with freezing.

described as a landmark for MRI staging of pelvic organ prolapse. Fresh cadaver data has established the midpubic line as a reliable indicator of the clinical hymen, which is the landmark used for clinical scoring [4].Previous studies have shown MRI to demonstrate a more advanced degree of prolapse; however, none have attempted to establish POP-Q equivalent MRI scoring. The merging of clinical and radiological reference points would allow detailed compartmental comparison between clinical and MRI evaluation. AbstractObjective: To compare the degree of pelvic organ prolapse (POP) as measured by the pelvic organ prolapse quantification (POP-Q) system to the degree of prolapse as measured by magnetic resonance imaging (MRI) defecography and to merge clinical and radiologic terminology in reference to POP.Methods: A retrospective analysis of 29 patients who presented with POP and defecatory complaints and underwent MRI defecography (2008)(2009)(2010)(2011). POP-Q scores were recorded by two attending urogynecologists. A radiologist, blinded to the clinical POP-Q scores, measured the maximum prolapse of the anterior vagina, posterior vagina, and vaginal apex/cervix on each subject's MRI.Results: Prolapse as measured by MRI defecography was significantly more advanced as compared to the clinical POP-Q measurements in all three compartments studied. The differences were both statistically significant and potentially, clinically relevant. A mean difference of 2.0 centimeters ± 1.5 SD, 2.3 centimeters ± 2.7 SD, and 5.0 centimeters ± 2.0 SD was observed in the anterior, apical, and posterior vaginal compartments, respectively. Conclusion:The increased degree of prolapse as demonstrated by MRI defecography may change clinical decision making and surgical planning. Therefore, MRI defecography may be a valuable adjunct in the clinical assessment of POP. 2/5 Materials and MethodsThis retrospective study was conducted at North Shore University Hospital. Institutional review board approval was obtained. Thirty-six women presenting for assessment of POP, who required MRI defecography as part of their clinical assessment, constituted the study population. The senior authors examined all patients in the study using the standard guidelines for the POP-Q examination. The clinical exams and MRIs were performed prior to any intent of studying the relationship between MRI and the POP-Q examination. MRI TechniquePatients underwent MRI with a 1.5-T scanner (Signa Excite HDx; GE Healthcare, Milwaukee, WI) with an 8-channel phased array coil in the supine position. Patients administered a fleet enema in the morning and emptied their bladders prior to imaging. 60ml of sterile lubricating jelly (Triad Disposables, Inc, Mukwonago, WI) was instilled into the vagina. 200ml of lubricating ultrasound transmission gel (Aquasonic, Parker Laboratories, Inc, Fairfield, NJ) was instilled into the rectum.Following an initial three plane localizer sequence, sagittal images were obtained employing a steady-state acquisition (FIESTA=fast imaging employin...

Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.