Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Brunelli (Dorsoulnar) Flap for the Reconstruction of Defect of the Thumb Nail Unit After Oncological Resections With Mohs Micrographic Surgery.","authors":"Felipe Mesa, Oscar Leal, María Elena Ramos","doi":"10.1097/GOX.0000000000006401","DOIUrl":"10.1097/GOX.0000000000006401","url":null,"abstract":"<p><strong>Background: </strong>The Brunelli flap is an option in the reconstruction of the thumb after trauma or oncological resections. The arc of movement of the flap makes it possible to resolve defects in the proximal, palmar, dorsal, and lateral regions.</p><p><strong>Methods: </strong>We present a case series of 11 patients in whom a Brunelli flap was performed for postoncological reconstruction, melanoma in situ, and invasive squamous cell carcinoma of the thumb nail unit associated with Mohs micrographic surgery. This combination has not been described before.</p><p><strong>Results: </strong>The reconstruction was carried out using a Brunelli flap, incorporating certain variations to the original technique. Clinical follow-up was performed during a 1-year period. All flaps showed good viability. In 3 flaps, there was mild distal suffering that resolved with local healing. Three patients presented hypersensitivity in the distal part, which was managed with physical therapy. The functionality of the thumb was not altered in any case, and there were no complications in the donor site. No tumor recurrence was documented in any patient.</p><p><strong>Conclusions: </strong>The use of the Brunelli flap to reconstruct the nail unit after an oncological resection with Mohs surgery is a good alternative. The advantages include a dorsal artery as a constant vessel and a homodigital flap that does not cause morbidity in the donor area, and with Mohs surgery, amputation is avoided. Disadvantages include lack of sensation of the flap. Some limitations of our study are the sample size and lack of long-term follow-up.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6401"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study: Human Adipose Tissue Allograft for Fat Pad Defects in Patients With Preulcerative Lesions.","authors":"Matthew J Regulski, Molly C Saunders, Sharron E McCulloch, Alla Danilkovitch","doi":"10.1097/GOX.0000000000006404","DOIUrl":"10.1097/GOX.0000000000006404","url":null,"abstract":"<p><strong>Background: </strong>Loss or displacement of a fat pad on the foot increases plantar pressure, leading to pain and plantar ulcers. These ulcers, especially in patients with diabetic neuropathy, have high recurrence rates, often resulting in amputations. Standard of care focuses on reducing plantar pressure with shoe padding or orthotic devices, leaving the restoration of the fat pad as an unmet medical need. To address this, a human cryopreserved adipose tissue (hCAT) allograft has been developed to repair adipose tissue defects.</p><p><strong>Methods: </strong>Scientific characterization of hCAT included assessments of its structural properties, immunogenicity, persistence, and remodeling in both in vitro and in vivo models. The incidence of adverse events and ulcer recurrence was analyzed retrospectively in 12 patients with diabetic neuropathy with preulcerative lesions who received 1.5-3.0 mL subcutaneous hCAT implants in areas with fat pad defects.</p><p><strong>Results: </strong>When implanted in patients, hCAT remained palpable at the implantation sites, and no ulcerations occurred for an average of 6.4 months (range, 2-10 months). No product-related adverse events have been recorded to date. Long-term follow-up for implanted patients is ongoing.</p><p><strong>Conclusions: </strong>Use of hCAT seems to be safe and potentially beneficial for managing patients at risk for plantar ulcerations. Further studies are warranted to evaluate hCAT's potential to manage patients at high risk for plantar ulcer formation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6404"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review and Meta-analysis of Single-group Studies Assessing the Role of Calcium Hydroxylapatite in Aesthetic Enhancements and Satisfaction.","authors":"Mojgan Amiri, Renald Meçani, Christa D Niehot, Terri L Phillips, Katherine Goldie, Janina Kolb, Taulant Muka, Hua Daughtry","doi":"10.1097/GOX.0000000000006400","DOIUrl":"10.1097/GOX.0000000000006400","url":null,"abstract":"<p><strong>Background: </strong>Many studies assess aesthetic effectiveness of calcium hydroxylapatite (CaHA), with single-group designs as the most frequently applied designs in practice. This study systematically reviewed CaHA's effectiveness for aesthetic purposes among these studies.</p><p><strong>Methods: </strong>A comprehensive search was conducted across 5 bibliographic databases. Single-group studies with at least 10 human adults were included. Summary measures of patients satisfaction and global aesthetic improvement scores were combined using the generalized linear mixed model. This systematic review adhered to the PRISMA reporting standards.</p><p><strong>Results: </strong>Of 3131 records, 46 single-group studies, majority focused on facial areas (n = 32), were included for final qualitative analysis. A total number of 27 studies were included in the meta-analysis. Findings of the meta-analysis showed that 98% (95% confidence interval [CI], 91%-99%; <i>I</i> ², 0.0%) of patients were satisfied with the injection results in the facial area and 90% (95% CI, 67%-97%, <i>I</i> ², 35%) in other treated body areas. Also, patients reported 89% (95% CI, 76%-96%; <i>I</i> ², 65%) improvement on the global aesthetic improvement scale in facial areas and 94% (95% CI, 75%-99%; <i>I</i> ², 0.0%) in other treated regions. Similarly, investigators reported global aesthetic improvement in 92% of patients (95% CI, 33%-100%; <i>I</i> ², 92%) in facial areas and 95% (95% CI, 1%-100%; <i>I</i> ², 89%) in other treated areas.</p><p><strong>Conclusions: </strong>Our findings showed aesthetic improvements and satisfaction following CaHA injections in both facial and nonfacial areas. However, studies focusing on nonfacial regions are limited. We recommend more rigorously designed trials to better understand CaHA's clinical effects.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6400"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway.","authors":"Zahra Ahmed, Alexander Zargaran, David Zargaran, Sara Sousi, Keiron Hakimnia, Sevasti Panagiota Glynou, Julie Davies, Stephen Hamilton, Afshin Mosahebi","doi":"10.1097/GOX.0000000000006374","DOIUrl":"10.1097/GOX.0000000000006374","url":null,"abstract":"<p><strong>Background: </strong>The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated.</p><p><strong>Methods: </strong>A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods.</p><p><strong>Results: </strong>This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO₂eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO₂eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO₂eq, respectively). Waste management alone contributed 4.21 kg CO₂eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste.</p><p><strong>Conclusions: </strong>This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6374"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Use of HArmonyCa and Hyaluronic Acid Fillers: A Holistic Approach to Facial Rejuvenation.","authors":"Sadiye Kus, Sukran Sarigul Guduk","doi":"10.1097/GOX.0000000000006360","DOIUrl":"10.1097/GOX.0000000000006360","url":null,"abstract":"<p><strong>Background: </strong>The multifactorial nature of aging necessitates a comprehensive assessment addressing contour, volume, and facial laxity, and a holistic treatment plan. We evaluated combined use of HArmonyCa with HA fillers to improve laxity and overall aesthetic outcomes. A detailed guide is also presented regarding facial shapes, special areas, and volume needs.</p><p><strong>Methods: </strong>This retrospective case series evaluates 10 patients' facial laxities with Facial Laxity Rating Scale using 2-dimensional before and after photographs (posttreatment and 6-month mark). Overall improvement was assessed by the investigator and patients by comparing to baseline. Patient satisfaction was measured with a questionnaire.</p><p><strong>Results: </strong>The Facial Laxity Rating Scale scores (jowl and neck) were highest at baseline and lowest at 6-month mark. Facial laxity significantly improved over time for jowl (<i>P</i> < 0.001) and neck (<i>P</i> = 0.007). At the sixth month, facial laxity significantly improved compared with baseline both in jowl (<i>P</i> = 0.001) and neck (<i>P</i> = 0.011). Global Aesthetic Improvement Score evaluations improved significantly during the 6-month period (<i>P</i> < 0.001). Global Aesthetic Improvement Score was significantly higher at 6-month posttreatment compared with immediate posttreatment evaluation (<i>P</i> < 0.001). Patients were satisfied immediately after treatment and 6 months after. The satisfaction significantly improved at the sixth month compared with immediately after treatment (<i>P</i> = 0.033).</p><p><strong>Conclusions: </strong>A combined use of HArmonyCa and HA fillers improves laxity in the lower face and neck and enhances aesthetic outcomes with high patient satisfaction. Overall improvement and patient satisfaction are higher at the sixth month, which is attributable to biostimulation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6360"},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes.","authors":"Alexis M Holland, William R Lorenz, Matthew N Marturano, Rose K Hollingsworth, Gregory T Scarola, Brittany S Mead, B Todd Heniford, Vedra A Augenstein","doi":"10.1097/GOX.0000000000006381","DOIUrl":"10.1097/GOX.0000000000006381","url":null,"abstract":"<p><strong>Background: </strong>Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes.</p><p><strong>Methods: </strong>Prospectively maintained database was reviewed for CP-AWR and separated by surgery date: \"early\" (2002-2016) and \"recent\" (2017-2023). A 1:1 propensity-scored matching was performed based on age, tobacco use, body mass index (BMI), American Society of Anesthesiologists (ASA) score, wound class, and defect size.</p><p><strong>Results: </strong>Of 701 CP-AWRs, 196 pairs matched. Match criteria were not significantly different between early and recent groups, except for BMI (34.6 ± 7.2 versus 32.1 ± 6.01 kg/m²; <i>P</i> = 0.001). Groups were comparable in sex and diabetes, but recent patients had fewer recurrent hernias (71.4% versus 56.1%; <i>P</i> = 0.002). Recent patients had more biologic (21.9% versus 49.0%; P < 0.001) and preperitoneal mesh (87.2% versus 97.4%; <i>P</i> = 0.005). Readmission and reoperation did not significantly differ, but length of stay (8.3 ± 6.7 versus 6.5 ± 3.4 d; <i>P</i> = 0.001) and wound complications decreased over time (50.5% versus 25.0%; <i>P</i> < 0.001). Hernia recurrence rates improved (6.6% versus 1.5%; <i>P</i> = 0.019), but follow-up was shorter (50.9 ± 52.8 versus 22.9 ± 22.6 months; <i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>Despite patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large dataset demonstrates the safety of a single-stage repair that should be part of hernia surgeons' repertoire.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6381"},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Management of Neuropathic Breast Pain.","authors":"Maria Bejar-Chapa, Seamus P Caragher, Lisa Gfrerer, Ian L Valerio, Amy S Colwell, Jonathan M Winograd","doi":"10.1097/GOX.0000000000006266","DOIUrl":"10.1097/GOX.0000000000006266","url":null,"abstract":"<p><p>Chronic postoperative pain after breast surgery is a significant concern, with studies indicating varying rates depending on the type of surgical procedure. The risk of developing neuropathic pain is notably increased with axillary lymph node dissection due to potential nerve injuries. Additionally, the method of breast reconstruction may influence postsurgical pain rates, with conflicting findings on the impact of reconstruction type. Recent advancements in techniques such as targeted muscle reinnervation, among others, show promise in addressing postoperative pain in these patients. As the prevalence of these procedures rises, future research is likely to focus on assessing and managing pain in this patient population. The development of patient-reported outcome measures specific to breast surgery pain can aid in clinical assessment and treatment planning. This review emphasizes the importance of gaining a deeper understanding of risk factors, nerve anatomy, and treatment options to enhance outcomes and quality of life for individuals undergoing breast surgery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6266"},"PeriodicalIF":1.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIEP Flap Weights in Immediate 1-stage and 2-stage Breast Reconstruction: Considering Chest Wall Deformity.","authors":"Mariko Inoue, Hironobu Aoki, Mina Kamegai, Rei Ogawa","doi":"10.1097/GOX.0000000000006393","DOIUrl":"10.1097/GOX.0000000000006393","url":null,"abstract":"<p><strong>Background: </strong>There are advantages and disadvantages to both immediate 1-stage and 2-stage autologous-breast reconstruction. The 2-stage procedure may suffer from a hitherto overlooked difficulty: the tissue expander may induce chest wall depression that may require using a heavier-than-expected flap to generate symmetrical breasts. We conducted a retrospective observational study to assess this phenomenon.</p><p><strong>Methods: </strong>Consecutive patients who underwent 1-stage or 2-stage unilateral autologous-breast reconstruction with a deep inferior epigastric perforator flap were included. The 2 groups were compared in terms of age, body mass index, mastectomized tissue weight, inset-flap weight, and percentage additional flap weight (defined as [inset-mastectomy]/mastectomy × 100). The latter reflects the amount of additional flap tissue relative to mastectomized tissue that was needed to generate symmetrical breasts. The chest wall deformity after tissue expansion in the 2-stage patients was quantitated with computed tomography.</p><p><strong>Results: </strong>Patients' healthy and affected breasts were symmetrical before surgery (<i>P</i> > 0.05). Compared with the 1-stage patients (n = 37), the 2-stage patients (n = 31) only differed in terms of a significantly higher mean percentage additional flap weight (28% versus 12%, <i>P</i> = 0.0077). Relative to preoperative values, nearly all 2-stage patients had mild (74%) or moderate (19%) chest wall deformity before tissue expander removal.</p><p><strong>Conclusions: </strong>Due to tissue expander-induced chest wall deformity, 2-stage breast reconstruction may require a larger flap volume than is anticipated on the basis of preoperative volumetric measurements. Considering this phenomenon when choosing between immediate 1-stage and 2-stage reconstruction could potentially help improve patient outcomes.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6393"},"PeriodicalIF":1.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surprise Baby: Abdominoplasty Performed During Unknown Pregnancy.","authors":"Jasmina Lagumdzija, Sebastian Ender, Maximilian Mahrhofer, Gottfried Wechselberger, Elisabeth Russe","doi":"10.1097/GOX.0000000000006356","DOIUrl":"10.1097/GOX.0000000000006356","url":null,"abstract":"<p><p>Abdominoplasty is a commonly performed procedure for patients after significant weight loss and in postpregnancy women. Stable weight and completed family planning are critical for optimal outcomes, as pregnancy postabdominoplasty can increase risks for both mother and fetus and potentially compromise aesthetic results. We present the first reported case of a patient undergoing abdominoplasty while unknowingly pregnant. A 40-year-old woman, 4 years postbariatric bypass surgery, presented for abdominoplasty with a body mass index of 28 kg/m². She had 3 children and had concluded her family planning. The surgery was performed without complications. Four months later, an unexpected pregnancy at 24 weeks was discovered. The patient developed gestational diabetes and hypertension but had no complications related to the abdominoplasty. The male newborn, delivered at 38 weeks, was small for gestational age but healthy. Ten years postsurgery, the patient maintained excellent aesthetic results with no abdominal complications. This case highlights that although family planning completion is recommended preoperatively to avoid complications, pregnancy postabdominoplasty can still result in favorable maternal and fetal outcomes. Although performing abdominoplasty on pregnant women is not advised, this case demonstrates that an undetected pregnancy during the procedure did not lead to adverse outcomes for the mother or child.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6356"},"PeriodicalIF":1.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Basement Membrane Fragmentation in Keloids and the Expression of Key Basement Membrane Component Genes.","authors":"Yusaku Saijo, Shizuko Ichinose, Teruyuki Dohi, Rei Ogawa","doi":"10.1097/GOX.0000000000006366","DOIUrl":"10.1097/GOX.0000000000006366","url":null,"abstract":"<p><strong>Background: </strong>Keloids are growing scars that arise from injury to the reticular dermis and subsequent chronic local inflammation. The latter may be promoted by vascular hyperpermeability, which permits the ingress of chronic inflammatory cells/factors. Cutaneous capillaries consist of endothelial cells that generate, and are anchored by, a vascular basement membrane (VBM). Because VBM blocks immune cells/factors ingress, we investigated whether keloids are associated with altered VBM structure and/or VBM component expression by local endothelial cells.</p><p><strong>Methods: </strong>In total, 54 keloid (n = 27) and adjacent normal skin (n = 27) samples from 14 patients underwent transmission electron microscopy (TEM). Cross-sections of whole capillaries were identified. VBM thickness, continuity, and the number of layers in keloid and normal skin tissues were quantified. The differential expression of 222 previously reported VBM component genes in keloid and normal skin endothelial cells was analyzed using the GSE121618-microarray dataset.</p><p><strong>Results: </strong>TEM images showed that keloid VBMs were significantly thinner than adjacent skin VBMs (0.053 versus 0.078 nm; P < 0.001). They were also greatly fragmented (continuity was 46% versus 85% in normal skin; P < 0.001) and had fewer (1.2 versus 2.4) layers (P < 0.001). Keloidal endothelial cells demonstrated downregulation of 22 genes, including papilin, laminin-α5, and laminin-α2, and upregulation of 28 genes, including laminin-β1, laminin-β2, laminin-γ1, and laminin-γ2.</p><p><strong>Conclusions: </strong>VBMs are greatly fragmented in keloids. These changes support the notion that keloids are initiated/promoted, at least partly, by vascular hyperpermeability.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 12","pages":"e6366"},"PeriodicalIF":1.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}