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  • 1. Cheng, Angela
    et al.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Wong, Corrine
    Rozen, Shai
    A reliable anatomic approach for identification of the masseteric nerve2013In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 66, no 10, p. 1438-1440Article in journal (Refereed)
  • 2.
    Dimovska, Eleonora O. F.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Zelenski, Nicole A
    Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
    Lindqvist, Ebba K
    Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Women plastic surgeons are overlooked in the new era of webinars2021In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 74, no 10, p. 2776-2820Article in journal (Other academic)
  • 3.
    Driessen, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Akad Univ Hosp Uppsala, Dept Plast Surg, Sjukhusvagen 85, S-75185 Uppsala, Sweden..
    Arnardottir, Tinna Harper
    Akad Univ Hosp Uppsala, Dept Plast Surg, Sjukhusvagen 85, S-75185 Uppsala, Sweden..
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Akad Univ Hosp Uppsala, Dept Plast Surg, Sjukhusvagen 85, S-75185 Uppsala, Sweden.
    Rydevik Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Akad Univ Hosp Uppsala, Dept Plast Surg, Sjukhusvagen 85, S-75185 Uppsala, Sweden.
    How should indocyanine green dye angiography be assessed to best predict mastectomy skin flap necrosis?: A systematic review2020In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 73, no 6, p. 1031-1042Article, review/survey (Refereed)
    Abstract [en]

    Introduction: The incidence of skin flap necrosis after mastectomies is as high as 11-24%. Laser-assisted indocyanine green (ICG) angiography seems to be a promising technique to assess skin flap perfusion. The aim of this systematic review is to assess the current methodology of ICG and its objective outcome measures ability to predict mastectomy skin flap necrosis.

    Methods: A PubMed search was conducted on the 31 December 2018 using ((("Fluorescein Angiography"[Mesh]) OR ("Indocyanine Green"[Mesh])) AND "Mastectomy"[Mesh]). This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included data about the study size, study design, skin flap necrosis, camera details and the objective outcome parameters.

    Results: Of 51 results, 22 abstracts were considered relevant of which nine were excluded secondarily. A reference check resulted in three extra inclusions. Sixteen papers were reviewed focusing on their methods and our primary endpoint which was the objective outcome measures of ICG. Objective outcome measures were reported in 8 of 16 studies. They mainly include absolute perfusion units and relative perfusion units (RPUs). All studies revealed a substantial decrease in skin necrosis when the ICG was used. The absolute number of units considered to be predictive for necrosis varies greatly; RPUs have been quite well established and are considered to be predictive for necrosis between 15.6% and 41.6%. However, consensus for methods, numbers and parameters is lacking.

    Conclusion: ICG evaluation of skin perfusion is a promising technique to aid in the surgeon's decision-making, and this seems to decrease skin flap necrosis after mastectomy.

  • 4.
    Haber, Samer E.
    et al.
    Univ Paris, Assistance Publ Hop Paris, Hop Necker Enfants Malad, Serv Neurochirurg Pediat,Unite Fonctionnelle Chiru, Paris, France.;Univ Paris, Ctr Reference Malad Rares CRANIOST, Filiere Malad Rares Tete Cou, Paris, France..
    Leikola, Junnu
    Univ Helsinki, Toolo Hosp,Cent Hosp, Cleft Palate & Craniofacial Ctr, Dept Plast Surg, POB 266, FI-00029 Helsinki, Finland..
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Fauroux, Brigitte
    Univ Sorbonne Paris Cite, Serv Ventilat Noninvas & Sommeil delEnfant, Paris, France.;Univ Sorbonne Paris Cite, Assistance Publ Hop Paris, Hop Univ Necker Enfants Malad, Paris, France.;Univ Sorbonne Paris Cite, VIFASOM Vigilance Fatigue Sommeilet St Publ EA7330, Paris, France.;Univ Paris 05, Univ Sorbonne Paris C, Descartes, Paris, France..
    Morisseau-Durand, Marie-Paule
    Univ Paris 05, Hop Necker Enfants Malad, Assistance Publ Hop Paris, Serv Otorhinolaryngol Pediat, Paris, France.;Univ Paris 05, Ctr Reference Malad Rares MALO, Filiere Malad Rares TeteCou, Paris, France.;Univ Paris, Univ Paris Descartes, Paris, France..
    Paternoster, Giovanna
    Univ Paris, Assistance Publ Hop Paris, Hop Necker Enfants Malad, Serv Neurochirurg Pediat,Unite Fonctionnelle Chiru, Paris, France.;Univ Paris, Ctr Reference Malad Rares CRANIOST, Filiere Malad Rares Tete Cou, Paris, France..
    Khonsari, Roman H.
    Univ Paris, Ctr Reference Malad Rares CRANIOST, Filiere Malad Rares Tete Cou, Paris, France.;Univ Paris, Hop Necker Enfants Malad, Assistance Publ Hop Paris, Serv Chirurg maxillofaciale & Chirurg plast, Paris, France..
    Arnaud, Eric
    Univ Paris, Assistance Publ Hop Paris, Hop Necker Enfants Malad, Serv Neurochirurg Pediat,Unite Fonctionnelle Chiru, Paris, France.;Univ Paris, Ctr Reference Malad Rares CRANIOST, Filiere Malad Rares Tete Cou, Paris, France.;Clin Marcel Sembat, F-92100 Boulogne, France.;Hop Necker Enfants Malad, Serv Neurochirurg Pediat, Unite fonct Chirurg craniofaciale, 34 Ave Eylau, F-75116 Paris, France..
    Secondary Le Fort III after Early Fronto-Facial Monobloc Normalizes Sleep Apnea in Faciocraniosynostosis: A Cohort Study2022In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 75, no 8, p. 2706-2718Article in journal (Refereed)
    Abstract [en]

    Background: This study aims to assess the improvement of sleep apnea after sec-ondary Le Fort III facial advancement with distraction (LF3) in faciocraniosynostosis (FCS) pa-tients with sleep apnea who have previously undergone fronto-facial monobloc advancement (FFMBA) with distraction.

    Methods: Patients having undergone secondary LF3 were selected from a cohort of FCS pa-tients with documented sleep apnea who had previously undergone fronto-facial monobloc advancement. Patient charts and polysomnographic records were reviewed. Apnea-hypopnea index (AHI) was recorded before and at least 6 months after secondary LF3. The primary out-come was normalization of AHI (less than 5/h was considered normal). Hierarchical multilevel analysis was performed to predict postoperative AHI evolution.

    Results: Seventeen patients underwent a secondary LF3, 7.0 +/- 3.9 years after the primary FFMBA. The mean age was 9.6 +/- 3.9 years. A total of 15 patients (88%) normalized their AHI. Two of four patients were decannulated (50%). There was a statistically significant decrease in AHI (preoperative AHI 21.5/h vs. 3.9/h postoperatively, p = 0.003). Hierarchic multilevel mod-eling showed progressive AHI decrease postoperatively.

    Conclusion: Secondary LF3 improves residual or relapsing sleep apnea in FCS patients who have previously had FFMBA.

  • 5.
    Huss, Fredrik R M
    et al.
    Inst för Experimentell och Klinisk medicin, Linköping.
    Junker, Johan P E
    Inst för Experimentell och Klinisk medicin, Linköping.
    Johnson, Hans
    Inst för Experimentell och Klinisk medicin, Linköping.
    Kratz, Gunnar
    Inst för Experimentell och Klinisk medicin, Linköping.
    Macroporous gelatine spheres as culture substrate, transplantation vehicle, and biodegradable scaffold for guided regeneration of soft tissues. In vivo study in nude mice.2007In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 60, no 5, p. 543-55Article in journal (Refereed)
    Abstract [en]

    In the course of development of a new type of filler for the correction of small defects in soft tissues we studied macroporous gelatine spheres as culture substrate, transplantation vehicle, and biodegradable scaffold for guided regeneration of soft tissues in vivo. We injected intradermally in nude mice gelatine spheres that had either been preseeded with human fibroblasts or preadipocytes, or left unseeded. We compared the extent of regenerated tissue with that found after injections of saline or single-cell suspensions of human fibroblasts or preadipocytes. Routine histological examinations and immunohistochemical staining for von Willebrand factor (indicating neoangiogenesis) were made after 7, 21, and 56 days. Injected saline or single-cell suspensions had no effect. However, a quick and thorough tissue regeneration with developing neoangiogenesis was elicited by the gelatine spheres and the effect of spheres preseeded with preadipocytes surpassed the effect of spheres preseeded with fibroblasts, which in turn surpassed the effect of unseeded gelatine spheres. We suggest that minor soft tissue defects such as wrinkles or creases can be corrected by injection of naked macroporous gelatine spheres, whereas larger defects are best corrected by injection of macroporous gelatine spheres preseeded with fibroblasts, or preadipocytes, or both.

  • 6.
    Lauvrud, Anne Therese
    et al.
    Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.; Umeå Univ, Dept Surg & Perioperat Sci, S-90737 Umeå, Sweden.
    Gümüscü, Rojda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Umeå Univ, Dept Surg & Perioperat Sci, S-90737 Umeå, Sweden.
    Wiberg, Rebecca
    Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.; Umeå Univ, Dept Surg & Perioperat Sci, S-90737 Umeå, Sweden.
    Brohlin, Maria
    Umeå Univ, Dept Clin Microbiol Infect & Immun, Umeå, Sweden.
    Kelk, Peyman
    Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.
    Wiberg, Mikael
    Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.; Umeå Univ, Dept Surg & Perioperat Sci, S-90737 Umeå, Sweden.
    Kingham, Paul J.
    Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.
    Water jet-assisted lipoaspiration and Sepax cell separation system for the isolation of adipose stem cells with high adipogenic potential2021In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 74, no 10, p. 2759-2767Article in journal (Refereed)
    Abstract [en]

    Introduction: Water jet-assisted liposuction has gained popularity due to favourable fat grafting outcomes. In this study, we compared stem cells obtained from fat isolated with manual or the water jet-assisted procedure.

    Methods: Liposuction of abdominal fat was performed using the two methods on each donor (n = 10). Aspirate samples were collagenase digested and the isolated cells seeded in vitro prior to proliferation, adipogenic differentiation and angiogenic activity analyses.

    Results: Cells from either procedure proliferated at similar rates and exhibited a similar colony-forming ability. The cells expressed stem cell markers CD73, CD90 and CD105. In the water jet cell preparations, there were higher numbers of cells expressing CD146. Robust adipogenic differentiation was observed in cultures expanded from both manual and water jet lipoaspirates. Gene analysis showed higher expression of the adipocyte markers aP2 and GLUT4 in the adipocyte-differentiated water jet cell preparations, and ELISA indicated increased secretion of adiponectin from these cells. Both cell groups expressed vasculogenic factors and the water jet cells promoted the highest levels of in vitro angiogenesis. Given these positive results, we further characterised the water jet cells when prepared using an automated closed cell processing unit, the Sepax-2 system (Cytiva). The growth and stem cell properties of the Sepax-processed cells were similar to the standard centrifugation protocol, but there was evidence for greater adipogenic differentiation in the Sepax-processed cells.

    Conclusions: Water jet lipoaspirates yield cells with high adipogenic potential and angiogenic activity, which may be beneficial for use in cell-assisted lipotransfers.

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  • 7.
    Liu, Tianyi
    et al.
    Uppsala Univ Hosp, Uppsala, Sweden.
    Freijs, Christoffer
    Uppsala Univ Hosp, Uppsala, Sweden.
    Klein, Holger J.
    Uppsala Univ Hosp, Uppsala, Sweden; Zurich Univ Hosp, Zurich, Switzerland.
    Feinbaum, Anna
    Uppsala Univ Hosp, Uppsala, Sweden.
    Svee, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Liss, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala Univ Hosp, Uppsala, Sweden.
    Acosta, Rafael
    Deakin Univ, Geelong, Vic, Australia.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study2018In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 71, no 9, p. 1301-1309Article in journal (Refereed)
    Abstract [en]

    Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.

    Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.

    Results: Fifty-five patients participated with a mean age of 52 +/- 8 years at the time of reconstruction and a mean follow-up time of 11.4 +/- 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).

    Conclusion: Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  • 8. Mayo-Yáñez, Miguel
    et al.
    Rodríguez-Pérez, Esther
    Chiesa-Estomba, Carlos Miguel
    Calvo-Henríquez, Christian
    Rodríguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Deep inferior epigastric artery perforator free flap in head and neck reconstruction: A systematic review2021In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 74, no 4, p. 718-729Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Perforator flaps yield the best results for the patient with the least morbidity, and they should be considered the gold standard in head and neck reconstruction. Although deep inferior epigastric perforator (DIEP) flap is considered as the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study is to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area.

    METHODS: Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Studies on animal and human experiments published in peer-reviewed journals, where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered.

    RESULTS: A total of 31 articles and 185 flaps with 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (National Institutes of Health) highlights the lack of uniformity, with no standardisation of the outcome variable collection and monitoring.

    DISCUSSION: By virtue of its versatility, reliable vascular supply and high flap survival rate, the DIEP flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.

  • 9.
    Morén, Staffan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Lindestad, Per-åke
    Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
    Stålhammar, Lilian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Holmström, Mats
    Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients2022In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 75, no 10Article in journal (Refereed)
    Abstract [en]

    Speech may be affected in patients with cleft lip and palate (CLP). Professional listeners, naïve listeners, and patients may perceive speech differently. The aim of the study was to assess speech among adults treated for unilateral CLP (UCLP) as rated by naïve listeners, speech-language pathologists (SLPs), and self-assessment and to evaluate how well these ratings correlate.

    All patients with complete UCLP treated at the Uppsala University Hospital, Uppsala, Sweden, in 1960–1987 were invited. A total of 73 of 109 patients (67%) participated, with a mean of 35 years since the initiation of treatment. The noncleft control group consisted of 55 volunteers. All participants answered questionnaires for self-rating of speech, and their speech was audio-recorded digitally. Fourteen naïve listeners and four SLPs rated the speech individually from blinded recordings.

    There were more speech abnormalities among patients compared to controls according to the ratings of naïve listeners and SLPs. In controls and patients, there were positive correlations between the speech ratings by naïve listeners and SLPs r = 0.44 to 0.71, p < 0.001, Spearman). The patients were less satisfied and rated to have more speech abnormalities than controls (p < 0.001).

    Although adults treated for UCLP considered their speech as fairly good, they were less satisfied than noncleft controls. The agreement between ratings by naïve listeners and SLPs were good, while the agreement between these ratings and self-assessment varied widely. When assessing speech in adults treated for UCLP, differences in perception of speech abnormalities by professionals, laymen, and patients should be considered.

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  • 10. Neovius, E.
    et al.
    Lemberger, M.
    Docherty Skogh, A.
    Hilborn, Jöns
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - Ångström, Polymer Chemistry.
    Engstrand, T.
    Alveolar bone healing accompanied by severe swelling in cleft children treated with bone morphogenetic protein-2 delivered by hydrogel2013In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 66, no 1, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Background: The use of osteoinductive growth factors may be preferable for alveolar cleft repair because it eliminates the need of bone harvesting. In the present prospective randomised pilot study, patients with alveolar clefts were treated with either bone morphogenetic protein 2 (BMP-2) delivered by a hyaluronan-based hydrogel or autologous bone from the iliac crest. Methods: Seven patients with cleft lip or cleft lip and palate were included. Computed tomography (CT) was performed preoperatively and 6 months postoperatively. The residual cleft volume was compared with the initial volume. Surgery time, bleeding and hospital stay were compared between the two groups. Results: Four patients were randomised to treatment with BMP-2. A low BMP-2 concentration of 50 μg ml-1 hydrogel did not induce bone formation in treated patients (n = 2) after 6 months, as seen by CT scans. Therefore, the BMP-2 concentration was raised to 250 μg ml-1 hydrogel in the subsequently randomised patients (n = 2). Bone formation with volume ratio of 59% and 33% was here verified by CT scans after 6 months. However, a severe gingival swelling appeared during the first week in patients treated with higher BMP-2 doses. In the autologous bone group (n = 3), the volume ratio was 29%, 48%, and 69%. Mean surgery time was 100 min in the BMP-2 group and 123 min in the autologous bone group. The mean hospital stay was 2.75 and 3.33 days, respectively. Conclusions: BMP-2 at a concentration of 250 μg ml-1 delivered by a hydrogel can be used to treat alveolar cleft defects with good bone quantity and comparable to autologous bone grafts. However, severe gingival swelling may limit the use of BMP-2 for these patients. Therefore, the study was prematurely closed.

  • 11. Neovius, Erik
    et al.
    Fransson, Maria
    Matthis, Sköld Peter
    Persson, Cecilia
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Östlund, Sophie
    Farnebo, Filip
    Lundgren, T. Kalle
    Persistent diplopia after fractures involving the orbit related to nerve injury2015In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 68, no 2, p. 219-225Article in journal (Refereed)
    Abstract [en]

    Background: Fractures in the facial skeleton are common and may lead to orbital sequelae caused by the injury and/or the surgery. In this long-term follow-up, we examined the nature of sequelae after facial fractures involving the orbit and whether a higher complexity of the fractures produced more sequelae compared to simpler fracture patterns, and if so, to what extent. Methods: Patients surgically treated for facial fractures involving the orbit at the Karolinska University Hospital with a follow-up duration of >= 3 years were included in this retrospective study and were examined by a neuro-ophthalmologist. Based on the location and severity of the fractures, the patients were divided into four groups according to fracture complexity: 1) isolated zygomatic fracture, 2) isolated orbital floor blowout fracture, 3) zygomatic fracture combined with blowout fracture and 4) bilateral or multiple fracture patterns. Results: Out of 154 patients, 81 patients (53%) attended follow-up examinations, 65 male (80%) and 16 female (20%). The duration of follow-up was 3.0-7.6 years (mean of 4.9 years). The incidence of diplopia was 3.7%, visual loss 2.5%, dystopia 4.9% and visible enophthalmos (>2 mm) 8.6%. Severe diplopia (2.5%) was due to nerve injuries. Visual loss was encountered only in group 4 with complex fractures. Fracture complexity had an effect on the presence of any sequelae, with group 4 presenting a higher percentage of patients with sequelae than the other three groups. However, no statistically significant effect of group could be found on the individual, quantitative output values of dystopia and enophthalmos. Conclusions: In this study, severe persistent diplopia in patients was due to nerve injuries, which emphasizes the need for preoperative ophthalmologic examinations, in all patients with fractures involving the orbit. A higher fracture complexity was found to lead to a higher percentage of patients presenting sequelae. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  • 12.
    Neovius, Erik
    et al.
    Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden & Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Fransson, Maria
    Department of General Surgery, Sundsvall-Härnösand County Hospital, Sundsvall, Sweden.
    Persson, Cecilia
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences. Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Clarliden, Sophie
    Department of Oral- & Maxillofacial Surgery, Örebro University Hospital, Sweden.
    Farnebo, Filip
    Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden & Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Lundgren, T. Kalle
    Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden & Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Long-term sensory disturbances after orbitozygomatic fractures2017In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 70, p. 120-126Article in journal (Refereed)
    Abstract [en]

    Background: Orbitozygomatic fractures often lead to infraorbital nerve (ION) injury, and affected sensibility is a common long-term complaint within this patient group. We present a long-term follow-up study where the validated von Frey filament system was used for testing ION sensibility. Furthermore, we examined the incidence of persistent nerve injury and whether more complex fractures led to more pronounced ION sensibility disturbances. Methods: Patients treated for facial fractures involving the orbitozygomatic complex were included and the follow-up time was 3 years or more. Depending on the location and severity of the fractures, the patients were divided into 4 groups. The patients answered a questionnaire before ION sensibility testing with von Frey filaments. Results: Eighty-one patients were examined: 65 males (80%) and 16 females (20%). Examinations were conducted between 3.0 and 7.6 years (mean 4.9 years) after injury. Sixteen patients (20%) had affected and 6 patients (7.4%) had severely affected ION sensibility according to von Frey testing. No statistically significant differences were found in terms of questionnaire score between the groups. There was also no statistically significant correlation between questionnaire results and log von Frey values. Although the effect of groups could not be statistically verified using the log von Frey values, a larger proportion of patients with complex fractures had higher log von Frey values than the other groups

  • 13.
    Peroz, Roshan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Holmström, Mats
    Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Stockholm, Sweden..
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate?2017In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 70, no 5, p. 653-658Article in journal (Refereed)
    Abstract [en]

    Background: The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. Methods: All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. Results: A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Conclusion: Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  • 14.
    Rodriguez Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Institute of Surgical Sciences.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wong, Corrine
    Cheng, Angela
    Arbique, Gary
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai
    Influence of using a single facial vein as outflow in full-face transplantation: A Three-Dimensional Computed Tomographic Study2015In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 68, no 10, p. 1358-1363Article in journal (Refereed)
    Abstract [en]

    Background

    The purpose of this study is to evaluate the contribution of a single unilateral facial vein in the venous outflow of total face allograft using three-dimensional computed tomographic imaging techniques to further elucidate the mechanisms of venous complications following total face transplant.

    Methods

    Full-face soft tissue flaps were harvested from fresh adult human cadavers. A single facial vein was identified and injected distally to the submandibular gland with radiopaque contrast (barium sulfate/gelatin mixture) in every specimen. Following vascular injections, three-dimensional computed tomographic venographies of the faces were performed. Images were viewed using TeraRecon Software allowing analysis of the venous anatomy and perfusion in different facial subunits by observing radiopaque filling venous patterns.

    Results

    Three-dimensional computed tomographic venographies demonstrated a venous network with different degree of perfusion in subunits of the face in relation to the facial vein injection side: 100% of ipsilateral and contralateral forehead units, 100% of ipsilateral and 75% of contralateral periorbital units, 100% of ipsilateral and 25% of contralateral cheek units, 100% of ipsilateral and 75% of contralateral nose units, 100% of ipsilateral and 75% of contralateral upper lip units, 100% of ipsilateral and 25% of contralateral lower lip units and 50% of ipsilateral and 25% of contralateral chin units.

    Conclusion

    Venographies of the full-face grafts revealed better perfusion in the ipsilateral hemifaces from the facial vein in comparison with the contralateral hemifaces. Reduced perfusion was observed mostly in the contralateral cheek unit and contralateral lower face including lower lip and chin units.

  • 15. Rodriguez Lorenzo, Andres
    et al.
    Lin, Cheng-Hung
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Lin, Chuh-Hung
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Nguyen, A
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Chen, CT
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Wei, Fu-Chan
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers2011In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 64, no 5, p. 649-655Article in journal (Refereed)
    Abstract [en]

    Venous insufficiency is the most common cause of re-exploration in free-tissue transfers to the lower extremity. There is currently no consensus regarding the best approach to recipient vein selection. This study was designed to evaluate whether the type of venous system or the number of recipient veins would impact flap outcomes after microsurgical lower-extremity reconstruction. A retrospective study was conducted in 362 free-tissue transfers for lower-extremity reconstruction between 2003 and 2008. Flap outcomes were evaluated according to the selection of recipient vein system and number of veins. The deep venous system (80.4%) was more frequently selected than the superficial venous system (12.1%) or the combination of both systems (7.5%). In addition, one vein (65.5%) was more commonly used for anastomosis than two veins (34.5%). A total of 26 flaps (7.2%) presented with postoperative venous insufficiency. Male patients, composite defects including bones and the use of bone flaps presented higher rates of venous insufficiency with statistical significance. However, no significant differences were found among the different groups related to the age of patients, co-morbidities, aetiology, location of the defects or timing of reconstruction after trauma. The superficial venous system group was associated with a higher rate of venous insufficiency and partial flap loss compared with the deep venous system group (p = 0.036 and 0.018, respectively). One-vein-anastomosis flaps were associated with statistically significant fewer complete flap failure in comparison with two-vein-anastomosis flaps (p = 0.014). In conclusion, the assessment of recipient vein parameters by surgeon's experience is the best predictor of flap outcome in lower-extremity reconstruction. In our cohort of patients, the deep venous system was more reliable than the superficial venous system, but the use of more than one vein for anastomosis did not correlate with better flap outcomes.

  • 16.
    Rodriguez Lorenzo, Andres
    et al.
    Glasgow University.
    Morley, S.
    Payne, A.P.
    Tollan, C.J.
    Soutar, D.S.
    Anatomy of the motor nerve to the gracilis muscle and its implications in a one-stage microneurovascular gracilis transfer for facial reanimation2010In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 63, no 1, p. 54-58Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The present study was conducted to investigate the anatomy of the motor nerve to the gracilis muscle (MNG) to provide the anatomical basis for harvesting a one-stage gracilis transfer with a long nerve for re-animation of the paralysed face.

    METHODS:

    An anatomical study was performed on 24 lower-limb specimens (from the pelvis down to the knee) from 12 embalmed cadavers. The MNG was dissected from the surface of the muscle to the obturator foramen. Two anatomical regions were defined in the course of the nerve. The first region includes the part of the nerve that can easily be reached through a standard incision in the medial aspect of the thigh, that is, from the surface of the muscle to the posterior border of the adductor brevis muscle and the second region from there to the obturator foramen. Measurements of both anatomical regions and the maximum length of the nerve were taken with a calliper. The anatomical relations of the nerve were also noted and photo-documented.

    RESULTS:

    The median maximum length of the MNG from the surface of gracilis to the posterior border of adductor brevis ('first anatomical region') was 7.7 cm (Range 6.3-10.5 cm); from there to the obturator foramen ('second anatomical region') the length was 3.7 cm (Range 2-6 cm), giving a median length of dissection of the nerve as 11.5 cm (Range 9.9-13.6 cm). Intraneural dissection of the MNG has to be performed proximally in the course of the nerve (the part corresponding to the second anatomical region), just where it runs inside the fascia over the obturator externus muscle.

    CONCLUSIONS:

    Over 10-cm length of the MNG can be obtained when dissected along the course of the nerve up to the obturator foramen. To achieve the maximum length, intraneural dissection must normally be performed after the nerve passes the posterior border of the adductor brevis. An endoscopic approach or extended proximal incision is recommended to easily reach the proximal part of the nerve as far as the obturator foramen.

  • 17.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Gago, Bruno
    Pineda, Andres F.
    Bhatti, Madiha
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Superficial peroneal and sural nerve transfer to tibial nerve for restoration of plantar sensation after complex injuries of the tibial nerve: Cadaver feasibility study2011In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 64, no 11, p. 1512-1516Article in journal (Refereed)
    Abstract [en]

    Background: Nerve reconstruction following lower-extremity nerve injuries usually leads to worse outcomes in comparison with upper-extremity injuries due to the long distances of nerve regeneration. This study was performed to consider the clinical application of distal nerve transfer for the treatment of long gaps of the tibial nerve (TN) and in established compartment syndrome. It aimed to determine the anatomic suitability of transferring the sural nerve (SN) in combination with the superficial peroneal nerve (SPN) to the TN at the level of the tarsal tunnel for restoration of plantar sensation. Methods: Nine fresh above-knee amputated limbs were dissected with the aid of loupe magnification. We focussed on the detailed anatomy of the course of the SN and the SPN from its emergence proximally at the knee level to the foot. Two different regions, suprafascial and subfascial, were described for each nerve. The maximum length of dissection and the length of the nerves in each region were measured. In all dissections, we assessed the feasibility of directly transferring the SN and SPN to the TN at the level of the tarsal tunnel. Results: The average length of the course of the SN was 20.6 cm (SD +/- 2.3 cm) subfascially and 16.4 cm (SD +/- 0.9 cm) suprafascially. For the SPN, the average length was 19.4 cm (SD +/- 1.9 cm) subfascially and 18 cm (SD +/- 2.5 cm) suprafascially. The point of emergence of the nerve from the subfascial course to the suprafascial course was defined as the pivot point for its transfer to the TN. Both the SN and the SPN reached the TN comfortably at the level of the tarsal tunnel, allowing direct co-aptation. Conclusion: Distal nerve transfer using the SN in combination with the SPN is an anatomically reliable procedure, being a potential alternative to the use of nerve grafts in reconstruction of long gaps of the TN. In addition, selected patients with compartment syndrome may also benefit from this transfer to restore plantar sensation.

  • 18.
    Rodríguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Jensson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Weninger, Wolfgang J.
    Schmid, Melanie
    Meng, Stefan
    Tzou, Chieh-Han John
    Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function2016In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 4, no 12, p. e1164-Article in journal (Refereed)
    Abstract [en]

    Background: Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.

    Methods: Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.

    Results: The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.

    Conclusions: PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.

  • 19.
    Vejbrink Kildal, Villiam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Meng, Stefan
    Division of Anatomy, Medical University of Vienna, Austria. Radiology, Hanusch Hospital, Vienna, Austria..
    Pruidze, Paata
    Division of Anatomy, Medical University of Vienna, Austria..
    Reissig, Lukas
    Center of Anatomy and Cell Biology, Medical University of Vienna, Austria..
    Weninger, Wolfgang J.
    Center of Anatomy and Cell Biology, Medical University of Vienna, Austria..
    Tzou, Chieh-Han John
    Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland), Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria..
    Rodriguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Preoperative assessment of depressor anguli oris to prevent myectomy failure: An anatomical study using high-resolution ultrasound2024In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 88, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Background: Myectomies of the lower lip depressor muscles have unexplained high failure rates. This study aimed to examine the depressor anguli oris (DAO) muscle using high-resolution ultrasound to identify potential anatomical explanations for surgical failures and to determine the accuracy of utilizing preoperative ultrasound assessment to improve myectomies.

    Methods: Anatomical features of DAO and the surrounding anatomy were examined in 38 hemifaces of human body donors using high-resolution ultrasound and dissection.

    Results: The ultrasound and dissection measurements showed the DAO muscle width to be 16.2 ± 2.9 versus 14.5 ± 2.5 mm, respectively, and the location of the lateral muscle border 54.4 ± 5.7 versus 52.3 ± 5.4 mm lateral to the midline. In 60% of the cases, the facial artery was either completely covered by lateral DAO muscle fibers or was found to be in direct contact with the lateral border. Significant muscle fiber continuity was present between the DAO and surrounding muscles in 5% of cases, whereas continuity between the depressor labii inferioris and surrounding muscles was considerably more common and pronounced.

    Conclusions: High-resolution ultrasound can accurately reveal important preoperative anatomical information in myectomies. Two potential explanations for the surgical failures were discovered: an overlap of lateral DAO muscle fibers over the facial artery could lead to inadequate resections and continuity with the surrounding muscles might lead to muscle function takeover despite adequate resections. Both can be uncovered preoperatively by the surgeon through a brief, directed ultrasound examination, which may allow for modification of the surgical plan to reduce surgical failure.

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  • 20.
    Önefäldt, Daniel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Zommorodi, Sayid
    Akademiskt Ctr Plast Kirurgi, Stockholm, Sweden..
    Delgado, Alberto Falk
    Karolinska Univ Hosp, Plast & Craniofacial Surg, Theme Acute & Reparat Med, Solna, Sweden..
    Location of cutaneous malignant melanoma in Sweden 2004-2018-mortality and sex differences2022In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 75, no 9, p. 3398-3405Article in journal (Refereed)
    Abstract [en]

    Background: Cutaneous malignant melanoma (CMM) is one of the most common causes of cancer-related death in Sweden. There is increasing evidence that localisation of the primary CMM lesion differs between sexes and is associated with different outcomes. However, definitive convincing data is lacking. Aims: To describe changes in the distribution of CMM anatomical location over time according to sex and determine differences in mortality by location. Method: This is a retrospective nation-wide cohort study of all patients diagnosed with CMM in Sweden between 2004 and 2018. Hazard ratios (HRs) were calculated using a multivariate cox regression model adjusting for age, sex, T-stage, multiple melanomas and comorbidities. Results: A total of 68,666 patients were included. In males, trunk CMM was the most common location (51% of all male CMM), with an increasing proportion over time. In females, lower extremity CMM had the largest proportion in 2004 (33%) followed by trunk CMM (27%). By 2018, trunk CMM became more common than lower extremity CMM in females.

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