No abstract

Autologous fat transfer is widely used by plastic surgeons for aesthetic and reconstructive purpose, but it has a great disadvantage because of its high variability rate of resorption. Numerous studies have examined the use of different agents to increase the viability of fat grafts. The results were discouraging because the use of a single angiogenic factor to stimulate fat graft angiogenesis may be inappropriate. We proposed to use two pharmacological factors, erythropoietin (EPO) and insulin (INS), in order to decrease the resorption rate, to improve graft vascularization, and to reduce the number of complications. Twenty-four Wistar male rats were randomly divided in four groups (I-IV) of six animals each. The rats belonging to control group were given autologous transfer of simple fat. In group II, the graft was improved with EPO, in group III with INS, and in group IV both pharmacological agents were administered. Histological evaluation of the grafts at two months after injection demonstrated adipocyte survival in all four groups. The volume of the graft has progressively decreased in all groups and the difference in graft volume at one and two months after transplantation was not significant. The highest maintenance of fat graft volume (95%) at two months was observed in group IV, followed by group II and group III. Necrotic cystic changes and increased fibrosis were most extensive in the control group. The combination of INS with EPO may have a synergistic and additive effect. Efficient administration and dose optimization of these growth factors are important things to consider in the future.

None of the currently used techniques for elbow flexion recovery in brachial plexus recovery o¤ers enough strength for normal life activities. The association between several methods grants a better result by a summarizing e¤ect compared to each method used separately. The paper reveals the improvement of the functional results in brachial plexus reconstruction by combining the techniques of nerve repair (nerve grafts, nerve transfers or direct muscular neurotization) with palliative muscular transfers. Of the 54 cases of microsurgical reconstruction of brachial plexus palsy, in 20 cases we associated a muscular transposition: 7 latissimus dorsi transfers (5 monopolar and 2 bipolar), 5 pectoralis major and 8 triceps transfers. The direct neuro-muscular neurotization of the biceps -EMG e‰cient -was associated with a muscular transfer in 8 cases: in 4 of the 7 latissimus dorsi transfers, in 3 cases of triceps transfer and in 2 case of pectoralis major transfer. The association of the 3 methods -direct neuromuscular neurotization, neuro-neuronal neurotization and muscular transfer -has a summarizing e¤ect in the flexion restoration of the elbow flexion, which represents a major problem in the brachial plexus palsy.

Silicone implants are frequently used for breast augmentation and reconstruction. However, late complication, such as capsular contracture, remain the most important side effect. In this study we compare different methods for reducing the inflammatory reaction around the silicone implant by introducing one microtextured breast implant in wistar rats. The rats were dividing in 4 groups: the first one was the control group that received untreated implant; in the second we used silicone implants impregnated with rifampin solution, the third one had implant combined with intramuscular dexamethasone injection and the last one had silicone implant associated with autologous centrifuged fat introduced in the implant pocket. The implants and the capsular tissue surrounding were removed after eight weeks. Capsule samples were submitted to histological evaluations. The present study demonstrated that fat grafting may have a role in reducing and preventing capsular contractures after breast augmentation with silicone implants by decreasing the inflammatory process.

The current approach to flexor tendon injuries is complex and is no longer limited to suturing techniques. Strategies for improving hand function currently include rehabilitation protocols, appropriate suturing materials and techniques, changing the gliding surface by using lubricants and providing growth factors. One product, originally used in spinal surgery, has been shown to be effective in preventing postoperative adhesions. It is a combination of carboxymethylcellulose and polyethylene oxide-Dynavisc ® (FzioMed, Inc.). The aim of the present study was to test the effect of Dynavisc ® on acute injuries of the intrasynovial flexor tendons in the prevention of postoperative adhesions and the improvement of functional results. The study was performed on 20 Wistar rats distributed in two groups. The control group, represented by 10 rats, in which after the reconstruction of the flexor tendon, the peritendinous area was injected with saline solution and the study group, in which the peritendinous area was injected with a single administration of the lubricating gel, Dynavisc ® (carboxymethylcellulose and polyethylene oxide). At 4 and 12 weeks, the rats were sacrificed and tissue biopsy consisted of tendon fragments and adjacent tissue. The evaluation of the results was performed by measuring the adhesion score and observing histological parameters. The presence of important adhesions was found in the control group compared with the group treated with Dynavisc ® , where a supple and smooth tendon, with significantly fewer adhesions were found. The differences between the two groups were significant, thus indicating the efficiency of the lubricant in preventing adhesions. This study supported the important role of Dynavisc ® in the regeneration of the tendon and the peritendinous structures, by limiting aberrant fibrous proliferation in the regeneration process and helping to build a peritendinous space.

The aim of this study is to demonstrate that the interdisciplinary approach could have a positive result on the rehabilitation program in brachial plexus paralysis in adults. The prevalence of brachial plexus injuries is currently increasing worldwide, mainly due to the growing number of car accidents, extreme sports or work-related injuries. In this study we chose to present an analysis of one complex surgical case of brachial plexus paralysis, with clinical and electrophysiological investigations. (1) Background: Current reconstructive surgical nerve transfer procedures aim to rehabilitate elbow flexion in such cases. Surgical strategies are based not only on clinical evaluation or investigations by magnetic resonance imaging but also on classical electrophysiological methods, such as electromyography (EMG). (2) Methods: Along with the other types of therapies already established, in the case of this pathology, Transcranial Magnetic Stimulation (TMS) is also used, which provides valuable information about cortical reorganization models concomitant with surgical procedures for nerve reconstruction in the last 3 decades. (3) Results: The study shows that interdisciplinary leads to a faster and more complex rehabilitation of the patient with brachial plexus paralysis and that electrophysiological signals could predict constant motor benefits when associated with rehabilitation programs. Keywords: brachial plexus; electromyography; transcranial magnetic stimulation; neuroplasticity;

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

Backgound : the purpose of the study is to consider the utility of Transcranial Magnetic Stimulation (TMS) in patients with Multiple Sclerosis (MS) and walking impairment, treated with Fampridine, as correlated with the 25-Foot-Walk test (T25-FW). It is known that clinical benefits should be identified within two to four weeks after starting the treatment; otherwise, if there is no benefit reported by patients, it should be discontinued. Methods: 15 MS patients with walking impairment, ranked between 3.5 and 7 on the Expanded Disability Status Scale (EDSS), were investigated by T25-FW and TMS. Evaluations were performed prior to Fampridine 10 mg twice daily administration, 5 and 12 days afterwards, and also 1 and 3 months later. The medium age was 42.8 years and an average duration of the disease was 12.06 years. Results: we assessed an improvement of walking by 2.1 seconds measured on the T25-FW after the first 12 days in 9 patients, which correlated with a 2 miliseconds improvement of the Central Motor Conduction Time (CMCT). For the other 6 patients there was no visible clinical improvement. Nevertheless, CMCT dropped by 0.5 ms and the motor conduction speed by 1 millisecond in 4 of these 6 patients. Fampridine administration was continued in the 4 cases. At the end of the 3 months period, their walking speed measured as on the T25-FW also improved by 2 sec. Conclusions: the amelioration of TMS parameters anticipated the improvement of speed on the T25-FW. In spite of the early false negative clinical response, electrophysiological findings could predict a future clinical improvement if treatment is continued.