- Plastic and Reconstructive Surgery
Fulbright Scholar, Stanford University (2012 - Present)
Visiting Assistant Professor, Stanford University (2012 - Present)
Clinical Instructor, Stanford University Medical Center (2014 - Present)
Stanford Applied Regenerative Medicine Fellow, Stanford University Medical Center (2014 - Present)
Honors & Awards
Fulbright Scholar, Stanford University Department of Surgery (2012-2013)
NHMRC Clinical Overseas Research Fellow, Stanford University and The University of Melbourne Department of Surgery, Royal Melbourne Hospital (2013)
Education & Certifications
Board Certification: Plastic and Reconstructive Surgery, Australian Health Practitioners Regulatory Agency-(AHPRA) (2008)
The University of Melbourne, Department of Surgery (2008) Australia
Residency:The Royal Australasian College of Surgeons Plastic Surgery Training Program (2007) Australia
Fellowship:The Institute of Reconstructive Plastic Surgery, New York University Medical Center (2004) NY
Fellowship:St Vincent's Hospital Melbourne (2004) Australia
Residency:The Royal Australasian College of Surgeons Surgical Training Program (2003) Australia
Internship:The Princess Alexandra Hospital (1999) Australia
Medical Education:University of Queensland School of Medicine (1997) Australia
MBBS/BSc, University of Queensland, Bachelors of Medicine, Surgery and Science (1997)
FRACS, Royal Australasian College of Surgeons, Plastic, Reconstructive and Hand Surgery (2008)
PhD, University of Melbourne, Tissue-engineered Breast Reconstruction (2009)
FACS, American College of Surgeons, Fellow of the American College of Surgeons- Plastic & Reconstructive Surgery (2014)
A randomized 'N-of-1' single blinded clinical trial of barbed dermal sutures vs. smooth sutures in elective plastic surgery shows differences in scar appearance two-years post-operatively
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
2015; 68 (7): 1003-1009
Barbed sutures have unidirectional circumferential shallow barbs, which distribute tension throughout the wound and close wound securely without the need to tie knots.We compare two different methods of wound closure in elective plastic surgical cases: barbed 3/0 V-Loc™180 suture and smooth 3/0 Maxon™ sutures, both polyglyconate monofilament synthetic absorbable sutures. We assessed the aesthetic long-term results with a minimum two year follow up.This is a prospective, randomized controlled study with internal control. A single surgeon performed all cases. Patients who underwent elective operations that involved long wound closure were enrolled in the study. Each patient acted as their own internal control with half their wound being sutured with 3/0 V-Loc™180 barbed suture and the other half with smooth 3/0 Maxon™ deep dermal sutures and then a subcuticular skin closure. In both groups, the superficial fascial system was closed with 1 Vicryl interrupted sutures on both sides. Long-term cosmesis was evaluated using the modified Hollander cosmesis score by review of standardized postoperative photographs by 9 blinded plastic surgeons and specialist registrars.The study reports on 33 female patients. The time taken for wound closure was significantly reduced using the barbed suture (p < 0.001). There was no difference in the complication ratio in either group. Two-year aesthetic outcome was significantly superior when using the barbed suture (p = 0.0075).Barbed sutures closure of long wounds is faster and produces a better long-term aesthetic outcome than smooth sutures.
View details for DOI 10.1016/j.bjps.2015.03.015
View details for Web of Science ID 000356232100020
View details for PubMedID 25840525
Development and evaluation of elastomeric hollow fiber membranes as small diameter vascular graft substitutes
MATERIALS SCIENCE & ENGINEERING C-MATERIALS FOR BIOLOGICAL APPLICATIONS
2015; 49: 541-548
Engineering of small diameter (<6mm) vascular grafts (SDVGs) for clinical use remains a significant challenge. Here, elastomeric polyester urethane (PEU)-based hollow fiber membranes (HFMs) are presented as an SDVG candidate to target the limitations of current technologies and improve tissue engineering designs. HFMs are fabricated by a simple phase inversion method. HFM dimensions are tailored through adjustments to fabrication parameters. The walls of HFMs are highly porous. The HFMs are very elastic, with moduli ranging from 1-4MPa, strengths from 1-5MPa, and max strains from 300-500%. Permeability of the HFMs varies from 0.5-3.5×10(-6)cm/s, while burst pressure varies from 25 to 35psi. The suture retention forces of HFMs are in the range of 0.8 to 1.2N. These properties match those of blood vessels. A slow degradation profile is observed for all HFMs, with 71 to 78% of the original mass remaining after 8weeks, providing a suitable profile for potential cellular incorporation and tissue replacement. Both human endothelial cells and human mesenchymal stem cells proliferate well in the presence of HFMs up to 7days. These results demonstrate a promising customizable PEU HFMs for small diameter vascular repair and tissue engineering applications.
View details for DOI 10.1016/j.msec.2015.01.051
View details for Web of Science ID 000350514100063
- Tissue Engineered Breast Reconstruction Breast Reconstruction edited by Shiffman, M. A. Springer. 2015
Emerging Applications of Bedside 3D Printing in Plastic Surgery
Frontiers in Surgery
View details for DOI 10.3389/fsurg.2015.00025
Emerging Applications of Bedside 3D Printing in Plastic Surgery.
Frontiers in surgery
2015; 2: 25-?
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
View details for DOI 10.3389/fsurg.2015.00025
View details for PubMedID 26137465
The Dorsal Triangular Fibrocartilage of the Metacarpophalangeal Joint: A Cadaveric Study.
The Journal of hand surgery
2015; 40 (7): 1410-5
To describe a fibrocartilaginous structure on the dorsal surface of the metacarpophalangeal (MCP) joint.A combination of anatomical dissection, histology, ultrasound, and magnetic resonance imaging was undertaken to explore the anatomical structure described, with clinical correlation undertaken by surgical exploration of MCP joints.A dorsal structure of the MCP joint was identified as fibrocartilagenous in composition, triangular in shape, and-together with the volar plate and collateral and accessory collateral ligaments-forming a deepened dorsal fossa in which the metacarpal head invaginated. It was attached to the extensor tendon by loose connective tissue and formed part of the joint capsule.The dorsal fibrocartilage of the MCP joint is a constant anatomical structure that appears to complement the structural support for the metacarpal head and extensor tendon. Possible functions include stabilization of the extensor tendon, formation of a dorsal fossa, prevention of extensor tendon attrition, and synovial fluid production. Its structure and function may have implications in future development of joint replacement devices.This study adds to the collective knowledge about the precise anatomy of the MCP joint. Reconstructive surgery and, in particular, joint replacement surgery should consider the potential function and importance of this structure when designing interventions on the joint.
View details for DOI 10.1016/j.jhsa.2015.03.019
View details for PubMedID 25944552
A randomized 'N-of-1' single blinded trial of barbed dermal sutures vs. smooth sutures in elective plastic surgery shows differences in scar appearance two-years post-operatively.
J Plast Reconstr Aesthet Surg.
2015; 68 (7)
View details for DOI 10.1016/j.bjps.2015.03.015
- Non-Melanomatous Skin Cancer Plastic and Reconstructive Surgery: Approaches and Techniques edited by Farhadieh, R., Bulstrode, N., Cugno, S. Wiley. 2015; 1st
- Atypical Skin Lesions Plastic and Reconstructive Surgery: Approaches and Techniques edited by Farhadieh, R., Bulstrode, N., Cugno, S. Wiley. 2015; 1st
Rhabdomyoblastic differentiation in metastatic melanoma: making sense of a rare but complex form of mimicry.
International journal of surgical pathology
2014; 22 (6): 520-524
A case of melanoma with rhabdomyoblastic differentiation is presented in the context of the previously reported cases. The emerging literature seeking to identify the molecular basis of rhabdoid and rhabdomyoblastic differentiation, as well as their poor prognosis, is reviewed. The combination of a diverse range of morphology and the potential for spontaneous primary tumor regression, despite metastasis, makes the accurate diagnosis of melanoma challenging. Histopathology review is often recommended in these cases, as is referral to a specialized cancer center for discussion in a multidisciplinary meeting. Improved recognition of this rare pattern of melanoma morphology may provide the means for omics-based techniques to identify novel therapeutic targets to improve the prognostic outlook for these patients.
View details for DOI 10.1177/1066896913510031
View details for PubMedID 24275885
- The keystone concept: a time for good science. ANZ journal of surgery 2014; 84 (3): 194-195
- Massive primary melanoma without clinically detectable metastases. ANZ journal of surgery 2014
Dupuytren's contracture: an analysis of outcomes of percutaneous needle fasciotomy versus open fasciectomy.
ANZ journal of surgery
Percutaneous needle fasciotomy (PNF) is a minimally invasive technique used to manage Dupuytren's contracture. We compared outcomes of PNF versus open fasciectomy (OF) to examine the suitability of PNF in Australia.A retrospective cohort study using two questionnaires regarding Dupuytren's treatment was used to assess patients with uncomplicated primary disease. The primary outcomes were immediate and medium-term correction of contracture (2-year mean follow-up to time of survey). Secondary outcomes were patient satisfaction and complications including tendon/nerve injury, infection, skin necrosis and vascular damage.One hundred fifty-five out of 191 surveys were returned (81%). The final analysis included 125 cases (65%), 73 PNF and 52 OF. No significant differences were observed between both groups with regards to follow-up time, gender, smoking status, co-morbidities or preoperative deformity grade. No significant differences were observed in terms of immediate or medium-term deformity correction, tendon/nerve injury or circulatory complications. The postoperative infection rate was higher with OF, with these patients 7.57 (95% confidence interval 1.56, 36.77; P = 0.01) times as likely to have a postoperative infection as patients undergoing PNF. A higher number of patients who underwent PNF were told that they would require another operation (30% versus 12%; P = 0.02). Satisfaction scores were similar (OF 33.2 versus PNF 32.6; P = 0.82).The OF and PNF procedures provide comparable deformity correction for uncomplicated primary Dupuytren's disease in the immediate perioperative period. The reduced side effect profile of PNF should prompt surgeons to consider incorporating it in their practice for the first-line management of uncomplicated primary Dupuytren's disease.
View details for DOI 10.1111/ans.12513
View details for PubMedID 24438029
Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects
ANZ JOURNAL OF SURGERY
2013; 83 (12): 942-947
Radical inguinal lymphadenectomy (RIL) for bulky metastatic melanoma and non-melanoma skin cancers of the inguinal region, while shown to improve morbidity and survival oncologically, can result in substantial morbidity from wound complications. Skin defects cannot be closed primarily and the substantial dead space predisposes to seroma, wound dehiscence and infection. Despite the clear need for reconstructive options, extended series describing reconstruction of large inguinal defects in this setting have not been reported.A prospectively entered, retrospectively reviewed study of 20 consecutive patients undergoing quadriceps keystone island flaps (QKIF) for the closure of complicated inguinal defects is described.There was 100% flap survival, with no partial or complete flap losses. A reduction in wound breakdown/dehiscence from reported rates was seen, with four patients (20%) having wound breakdown, compared to double that rate in reported series. Other wound complications comprised six patients (30%) with mild wound infections, seven patients (35%) with seromas and two patients (10%) with haematomas.The QKIF is an effective means of reconstructing inguinal defects after RIL, particularly in high-risk patients, and is technically simpler than other reconstructive techniques advocated for this purpose. Furthermore, the QKIF offers patients with advanced disease (where management is primarily palliative) a potentially improved quality of life with reduced operative morbidity.
View details for DOI 10.1111/j.1445-2197.2011.05790.x
View details for Web of Science ID 000327552800014
View details for PubMedID 22507632
- Reply: Nipple Sensation Losses in Hall-Findlay Breast Reduction Techniques PLASTIC AND RECONSTRUCTIVE SURGERY 2013; 132 (4): 671E-673E
High-grade Angiosarcoma Associated with Ruptured Breast Implants.
Plastic and reconstructive surgery. Global open
2013; 1 (1)
Since the serendipitous discovery that implanted polymers cause sarcomas in rats, much research has been conducted to prove or disprove a link between silicone breast implants and/or polymer-based materials and breast cancer. In light of an initial report that 35% of rats implanted with a variety of polymers developed fibrosarcomas, we report a case of primary angiosarcoma found in a patient presenting with bilateral rupture of gel-filled breast implants.
View details for DOI 10.1097/GOX.0b013e31828ff1cb
View details for PubMedID 25289205
- Nipple Sensation Losses in Hall-Findlay Breast Reduction Technique PLASTIC AND RECONSTRUCTIVE SURGERY 2013; 131 (3): 461E-462E
The cervico-submental keystone island flap for locoregional head and neck reconstruction
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
2013; 66 (1): 23-28
Locally advanced head and neck cancer often requires wide resections of the cheek and parotid gland, and in an ageing population preferred reconstructive options aim to avoid lengthy operating times or high risk surgery. While most large parotid defects traditionally require free flap reconstruction, we describe a new and versatile locoregional flap that has been shown to be reliable, simple and safe.We describe the cervico-submental (CSM) keystone-design perforator island flap for head and neck reconstruction, including an analysis of 33 consecutive patients with a range of head and neck defects. The flap was raised based on perforators of the external carotid artery and its branches, and designed to overlay the C2/C3 dermatomes (an aide memoire for flap design). The indications, and surgical technique are described.In 33 consecutive patients, no major complications were encountered. Five patients developed superficial infections, one developed post-operative bleeding and one patient developed partial tip necrosis. Theatre time was considerably shorter than our alternative reconstructive options.The CSM keystone-design perforator island flap is a novel and versatile flap, which can be used in a range of advanced cheek and parotidectomy defects, and may enable improved surgical management in an increasingly elderly and high-risk population.
View details for DOI 10.1016/j.bjps.2012.08.027
View details for Web of Science ID 000312953600013
View details for PubMedID 22974756
Oncologic clearance with preservation of reconstructive options: literature review and the 'delayed reconstruction after pathology evaluation (DRAPE)' technique
ANZ JOURNAL OF SURGERY
2012; 82 (11): 780-785
Intraoperative frozen section and Mohs' micrographic surgery (MMS) are two techniques used to ensure oncological clearance without resorting to unnecessarily wide margins that might compromise reconstructive options for definitive wound closure. In addition to some technical issues, these techniques are suboptimal for resection of tumours such as melanoma, where specific tissue margins at histopathology are required to ensure minimal risk of local recurrence. We describe a technique that minimizes the amount of tissue excised and uses definitive paraffin sections interpreted in a pathology laboratory in order to delay reconstruction until after clear oncologic margins are obtained. This 'delayed reconstruction after pathology evaluation (DRAPE)' technique is particularly directed at extensive and complicated skin lesions, located in areas of the body that can be difficult to reconstruct and are prone to disfigurement and/or loss of function. A review of the literature is undertaken, establishing the role of each technique in achieving clear surgical margins. A case example is presented, highlighting the role of the DRAPE approach. The DRAPE technique is presented as a useful option for high-risk lesions, especially within aesthetically sensitive regions or for complex reconstructions, and when reconstruction can be reasonably delayed while tumour clearance is established.
View details for DOI 10.1111/j.1445-2197.2012.06265.x
View details for Web of Science ID 000310679900006
View details for PubMedID 22984967
Keystone Island Flap Reconstruction of Parotid Defects
PLASTIC AND RECONSTRUCTIVE SURGERY
2012; 130 (1): 36E-41E
Skin cancers of the face and scalp have a propensity to metastasize to the parotid group of lymph nodes. The resection of these secondary tumors and other primary tumors in the parotid region often results in defects requiring flap reconstruction. Pectoralis major flaps are reliable and free flaps are arguably the criterion standard. However, we have found keystone island flaps to be a simple and robust alternative, with low donor-site and patient morbidity. The aim of this article is to share our surgical technique, experience, and outcomes of reconstructing parotid defects with keystone island flaps.The authors retrospectively reviewed 62 patients who had 63 parotid defect reconstructions at a single institution from 2004 to 2009 (5-year period).The diseases involved were squamous cell carcinoma (52 cases), melanoma (five cases), basal cell carcinoma (four cases), and others (two cases). Nine patients presented with a previous history of radiotherapy and 33 patients required adjuvant radiotherapy. Seven patients (11 percent) suffered postoperative complications necessitating a return to the operating room.Keystone island perforator-based flaps present an alternative to free tissue transfer. From the series presented, it can be seen that reliable and reproducible results are achievable.Therapeutic, IV.
View details for DOI 10.1097/PRS.0b013e3182547f55
View details for Web of Science ID 000305967800005
View details for PubMedID 22743953
Comparing Breast-Reduction Techniques: Time-to-Event Analysis and Recommendations
AESTHETIC PLASTIC SURGERY
2012; 36 (3): 600-606
Breast reduction is a common procedure used to improve physical and aesthetic factors associated with breast hypertrophy. This study investigated how surgical technique alone affects the risk factors for complications and profiled differences between techniques. Complications were assessed by the use of time-to-event methods.Patient information was extracted from a cohort of 283 patients. Demographic, surgical, and follow-up information was analyzed for patients undergoing surgical procedures using the inferior pedicle Wise pattern (IPWP) and modified Hall-Findlay (MHF) techniques. The patients managed with the IPWP technique were considered control subjects. The failure rates were described using the Kaplan-Meier failure estimator to provide a true estimate of the experienced complication rates.Overall, few differences were noted between the groups except for total tissue removed. The overall failure (complication) rate at 6 months was 18.8%, with 9% of all the patients experiencing a major complication that required operative intervention/revision. As expected, the period with the greatest risk of complication was the first month after surgery. Surgical technique, total tissue removed, and age were nonpredictive of complications. Overall, the IPWP group had significantly more total tissue removed than the MHF group (median difference, 227 g; P=0.002). There was no evidence of a learning curve when an experienced surgeon moved from the one technique to the other.At 6 months after surgery, 19% of patients are expected to have experienced a complication. There appears to be few differences in outcomes between the techniques of breast reductions used, and the success or otherwise almost certainly relates to factors independent of surgical technique and includes patient selection, operative skill, and experience. Time-to-event analysis provides a precise assessment and description of the complication profile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
View details for DOI 10.1007/s00266-011-9860-3
View details for Web of Science ID 000304203800018
View details for PubMedID 22258836
The Superior Thyroid Artery Perforator Flap: Anatomical Study and Clinical Series
PLASTIC AND RECONSTRUCTIVE SURGERY
2012; 129 (3): 641-646
The redundant tissues of the anterior neck are well suited as a donor site for fasciocutaneous flaps in head and neck reconstruction, with similar skin quality and numerous underlying perforators. However, historic cadaveric research has limited the use of this as a donor site for the design of long and/or large flaps for fear of vascular compromise. The authors undertook an anatomical study to identify the vascular basis for such flaps and have modified previous designs to offer the versatile and reliable superior thyroid artery perforator (STAP) flap. Forty-five consecutive computed tomographic angiograms of the neck were reviewed, assessing the vascular supply of the anterior skin of the neck. Based on these findings, eight consecutive patients underwent head and neck reconstruction using a flap based on the dominant perforator of the region. In all cases, a perforator larger than 0.5 mm was identified within a 2-cm radius of the midpoint of the sternocleidomastoid muscle at its anterior border. This perforator was seen to emerge through the investing layer of deep cervical fascia as a fasciocutaneous perforator and to perforate the platysma on its ipsilateral side of the neck, proximal to the midline. This was seen to be a superior thyroid artery perforator in 89 of 90 sides and an inferior thyroid artery perforator in one case. Eight consecutive patients underwent preoperative imaging and successful flap planning and execution based on this dominant perforator. The superior thyroid artery perforator (STAP) flap demonstrates reliable vascular anatomy and is well suited to reconstruction of a broad range of head and neck defects.Therapeutic, IV.
View details for DOI 10.1097/PRS.0b013e3182402eb2
View details for Web of Science ID 000300932300071
View details for PubMedID 22373971
- The Keystone Perforator Flap Concept Elsevier Australia. 2012
Tissue-Engineered Breast Reconstruction: Bridging the Gap toward Large-Volume Tissue Engineering in Humans
PLASTIC AND RECONSTRUCTIVE SURGERY
2011; 128 (6): 1206-1215
Use of autologous tissue is ideal in breast reconstruction; however, insufficient donor tissue and surgical and donor-site morbidity all limit its use. Tissue engineering could provide replacement tissue, but only if vascularization of large tissue volumes is achievable. The authors sought to upscale their small-animal adipose tissue-engineering models to produce large volumes of tissue in a large animal (i.e., pig).Bilateral large-volume (78.5 ml) chambers were inserted subcutaneously in the groin enclosing a fat flap (5 ml) based on the superficial circumflex iliac pedicle for 6 (n = 4), 12 (n = 1), and 22 weeks (n = 2). Right chambers included a poly(L-lactide-co-glycolide) sponge. Other pedicle configurations, including a vascular pedicle alone (n = 2) or in combination with muscle (n = 2) or a free fat graft (n = 2), were investigated in preliminary studies. Serial assessment of tissue growth and vascularization by magnetic resonance imaging was undertaken during growth and correlated with quantitative histomorphometry at chamber removal.All chambers filled with new tissue by 6 weeks, vascularized by the arteriovenous pedicle. In the fat flap chambers, the initial 5 ml of fat expanded to 25.9 ± 2.4, 39.4 ± 3.9, and 56.5 ml (by magnetic resonance imaging) at 6, 12, and 22 weeks, respectively. Adipose tissue volume was maintained up to 22 weeks after chamber removal (n = 2), including one where the specimen was transferred on its pedicle to an adjacent submammary pocket.The first clinically relevant volumes of tissue for in situ and remote breast reconstruction have been formed with implications for scaling of existing tissue-engineering models into human trials.
View details for DOI 10.1097/PRS.0b013e318230c5b2
View details for Web of Science ID 000297329700050
View details for PubMedID 22094739
Minimally invasive late free flap salvage: Indications, efficacy and implications for reconstructive microsurgeons
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
2011; 64 (11): 1517-1520
One of the most common causes of free flap compromise is microvascular thrombosis. Acland et al describe two described zones of injury: zone 1 the anastomotic site and zone 2 downstream. Factors contributing to zone 1 thromboses include anastomotic irregularities, suture material and platelet adhesion. This often presents in the early postoperative period. Zone 2 however, is less well described and is associated with diffuse microvascular ischaemia. Often, these cases are associated with the use of vein grafts in a delayed reconstructive setting, and present relatively late in their postoperative follow up. There are sporadic reports in the literature of late free flap salvage managed via anastomotic revision, thrombectomy, and the use of thrombolytic agents. We describe the successful use of catheter-directed endovascular urokinase in revascularizing two free flaps which presented in the late postoperative setting. This report demonstrates the safety and efficacy of this technique in free flap salvage. Although late presentation of free flap compromise is uncommon, this report reiterates the importance of long-term surveillance of these patients. It should be remembered, however, that long-term anticoagulation is required, and may not be feasible in certain patient populations. Given that free tissue transfer is often employed when other forms of reconstruction are unavailable, endovascular thrombolysis is a valuable tool for the reconstructive microsurgeon, and its role in early free flap salvage warrants exploration.
View details for DOI 10.1016/j.bjps.2011.03.036
View details for Web of Science ID 000296579400024
View details for PubMedID 21497571
The omega - O - variant designs (types A and B) of the keystone perforator island flap.
ANZ journal of surgery
2011; 81 (9): 650-652
View details for PubMedID 22295410
Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs.
2011; 16 (4): 86-94
View details for DOI 10.1258/ht.2011.011012
- Anatomical Basis for the Keystone Island Flap in the Upper Thigh PLASTIC AND RECONSTRUCTIVE SURGERY 2010; 125 (1): 421-423
Long-Term Persistence of Tissue-Engineered Adipose Flaps in a Murine Model to 1 Year: An Update
PLASTIC AND RECONSTRUCTIVE SURGERY
2009; 124 (4): 1077-1084
Tissue engineering of patient-specific adipose tissue has the potential to revolutionize reconstructive surgery. Numerous models have been described for the production of adipose tissue with success in the short term, but little has been reported on the stability of this tissue-engineered fat beyond 4 months.A murine model of de novo adipogenesis producing a potentially transplantable adipose tissue flap within 4 to 6 weeks was developed in the authors' laboratory. In this study, the authors assess the ability of three-chamber (44-microl volume) configurations shown to be adipogenic in previous short-term studies (autograft, n = 8; open, n = 6; fat flap, n = 11) to maintain their tissue volume for up to 12 months in vivo, to determine the most adipogenic configuration in the long term.Those chambers having the most contact with existing vascularized adipose tissue (open and fat flap groups) showed increased mean adipose tissue percentage (77 +/- 5.6 percent and 81 +/- 6.9 percent, respectively; p < 0.0007) and volume (12 +/- 6.8 microl and 30 +/- 14 microl, respectively; p < 0.025) when compared with short-term controls and greater adipose tissue volume than the autograft (sealed) chamber group (4.9 +/- 5.8 microl; p = 0.0001) at 1 year. Inclusion of a vascularized fat flap within the chamber produced the best results, with new fat completely filling the chamber by 1 year.These findings demonstrate that fat produced by tissue engineering is capable of maintaining its volume when the appropriate microenvironment is provided. This has important implications for the application of tissue-engineering techniques in humans.
View details for DOI 10.1097/PRS.0b013e3181b59ff6
View details for Web of Science ID 000270332300009
View details for PubMedID 19935290
- The keystone technique for resolution of chronic lower limb wound with lymphoedema JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY 2009; 62 (5): 701-702
- Benign symmetric lipomatosis PATHOLOGY 2009; 41 (6): 600-602
Myogel, a novel, basement membrane-rich, extracellular matrix derived from skeletal muscle, is highly adipogenic in vivo and in vitro
CELLS TISSUES ORGANS
2008; 188 (4): 347-358
Biological and synthetic scaffolds play important roles in tissue engineering and are being developed towards human clinical applications. Based on previous work from our laboratory, we propose that extracellular matrices from skeletal muscle could be developed for adipose tissue engineering.Extracellular matrices (Myogels) extracted from skeletal muscle of various species were assessed using biochemical assays including ELISA and Western blotting. Biofunctionality was assessed using an in vitro differentiation assay and a tissue engineering construct model in the rat.Myogels were successfully extracted from mice, rats, pigs and humans. Myogels contained significant levels of laminin alpha4- and alpha2-subunits and collagen I compared to Matrigel, which contains laminin 1 (alpha1beta1gamma1) and collagen IV. Levels of growth factors such as fibroblast growth factor 2 were significantly higher than Matrigel, vascular endothelial growth factor-A levels were significantly lower and all other growth factors were comparable. Myogels reproducibly stimulated adipogenic differentiation of preadipocytes in vitro and the growth of adipose tissue in the rat.We found Myogel induces adipocyte differentiation in vitroand shows strong adipogenic potential in vivo, inducing the growth of well-vascularised adipose tissue. Myogel offers an alternative for current support scaffolds in adipose tissue engineering, allowing the scaling up of animal models towards clinical adipose tissue engineering applications.
View details for DOI 10.1159/000121575
View details for Web of Science ID 000259725900002
View details for PubMedID 18354248
Host rather than graft origin of matrigel-induced adipose tissue in the murine tissue-engineering chamber
2007; 13 (9): 2291-2300
We have recently shown that Matrigel-filled chambers containing fibroblast growth factor-2 (FGF2) and placed around an epigastric pedicle in the mouse were highly adipogenic. Contact of this construct with pre-existing tissue or a free adipose graft was required. To further investigate the mechanisms underpinning formation of new adipose tissue, we seeded these chambers with human adipose biopsies and human adipose-derived cell populations in severe combined immunodeficient mice and assessed the origin of the resultant adipose tissue after 6 weeks using species-specific probes. The tissues were negative for human-specific vimentin labeling, suggesting that the fat originates from the murine host rather than the human graft. This was supported by the strong presence of mouse-specific Cot-1 deoxyribonucleic acid labeling, and the absence of human Cot-1 labeling in the new fat. Even chambers seeded with FGF2/Matrigel containing cultured human stromal-vascular fraction (SVF) labeled strongly only for human vimentin in cells that did not have a mature adipocyte phenotype; the newly formed fat tissue was negative for human vimentin. These findings indicate that grafts placed in the chamber have an inductive function for neo-adipogenesis, rather than supplying adipocyte-precursor cells to generate the new fat tissue, and preliminary observations implicate the SVF in producing inductive factors. This surprising finding opens the door for refinement of current adipose tissue-engineering approaches.
View details for DOI 10.1089/ten.2006.0382
View details for Web of Science ID 000249391900014
View details for PubMedID 17638518
Contact with existing adipose tissue is inductive for adipogenesis in Matrigel
2006; 12 (7): 2041-2047
The effect of adipose tissue on inductive adipogenesis within Matrigel (BD Biosciences) was assessed by using a murine chamber model containing a vascular pedicle. Three-chamber configurations that varied in the access to an adipose tissue source were used, including sealed- and open-chamber groups that had no access and limited access, respectively, to the surrounding adipose tissue, and a sealed-chamber group in which adipose tissue was placed as an autograft. All groups showed neovascularization, but varied in the amount of adipogenesis seen in direct relation to their access to preexisting adipose tissue: open chambers showed strong adipogenesis, whereas the sealed chambers had little or no adipose tissue; adipogenesis was restored in the autograft chamber group that contained 2- to 5-mg fat autografts. These showed significantly more adipogenesis than the sealed chambers with no autograft ( p < 0.01). Autografts with 1mg of fat were capable of producing adipogenesis but did so less consistently than the larger autografts. These findings have important implications for adipose tissue engineering strategies and for understanding de novo production of adipose tissue.
View details for Web of Science ID 000239571800030
View details for PubMedID 16889532
THE INDUCTION OF IMMEDIATE-EARLY GENES IN POSTISCHEMIC AND TRANSPLANTED LIVERS IN RATS - ITS RELATION TO ORGAN SURVIVAL
1994; 58 (7): 840-845
The protein products of the immediate early genes (IEG)s have been proposed to play an important role in long-term tissue plasticity such as cell repair or programmed cell death. The expression of liver IEGs was studied following liver ischemia (LI) or OLT in rats. In LI, 60 min of warm ischemia was induced in shunted rats (shunt LI group; 100% survival) and nonshunted rats (nonshunted LI group; poor survival). In OLT, donor livers were transplanted into the recipients within 1 hr (fresh liver OLT group; 100% survival) or after 24 hr of storage using University of Wisconsin solution (preserved liver OLT group; poor survival). Using both models, IEG mRNAs (c-fos and c-jun) were analyzed by Northern blot hybridization at various times before and after reperfusion. The expression of liver IEGs was not induced by warm ischemia and cold preservation alone. Reperfusion of livers following warm ischemia or cold preservation resulted in a distinctly different pattern of gene expression in viable and nonviable livers. In shunted LI and fresh liver OLT groups (viable), c-fos and c-jun mRNAs increased markedly to a peak value within 1-2 hr of reperfusion, returning to basal level by 3 hr. In nonviable livers, the level of these mRNAs was detected continuously at 3 hr of reperfusion in the nonshunted LI model and also at 6 hr after reperfusion in the preserved liver OLT group. Our data suggest that a protracted pattern of expression of c-fos and c-jun in the liver at the early stage of reperfusion might be correlated with the severity of liver transplant-related insults and subsequent graft failure.
View details for Web of Science ID A1994PM73400016
View details for PubMedID 7940719