TY - JOUR A1 - Heine, Norbert A1 - Eigenberger, Andreas A1 - Brebant, Vanessa A1 - Hoesl, Vanessa A1 - Brix, Eva A1 - Prantl, Lukas A1 - Kempa, Sally T1 - Comparison of skin sensitivity following breast reconstruction with three different techniques: Autologous fat grafting, DIEP flap and expander/implant JF - Clinical Hemorheology and Microcirculation N2 - BACKGROUND: Autologous fat grafting (AFG) has been established over the past two decades as an additive technique during and after breast reconstruction. Complete reconstruction of the breast mound with AFG alone represents an exceptional technique that has been published mostly in case reports or in studies with limited cases.The purpose of this study is to investigate the influence of three different techniques for breast reconstruction on the recovery of skin sensitivity at the reconstructed breast. METHODS: The study included 30 patients after mastectomy following breast cancer. Three groups were examined: A) breast reconstruction by autologous fat grafting (AFG), B) breast reconstruction by deep inferior epigastric artery perforator flap (DIEP) and C) breast reconstruction by expander/implant (TE).Biometric data were compared; sensitivity tests were performed using Semmes-Weinstein monofilaments.The non-operated, healthy contralateral breasts of the patients were used as a reference. RESULTS: While the traditional reconstruction techniques by microsurgical anastomosed perforator flap or expander/implant showed a strongly decreased or completely missing sensitivity of the skin, the tests after reconstruction by AFG represented high values of sensory recovery, which came close to the reference group of non-operated breasts. CONCLUSION: To our knowledge, this is the first study to compare skin sensitivity after AFG-based reconstruction to established techniques for breast reconstruction. We could demonstrate in a limited group of patients, that breast reconstruction by autologous fat grafting can achieve higher values of skin sensitivity compared to traditional techniques. KW - Mammoplastik KW - Brusterhaltende Therapie KW - Haut KW - Empfindlichkeit Y1 - 2022 U6 - https://doi.org/10.3233/ch-219203 SN - 1875-8622 SN - 1386-0291 VL - 80 IS - 4 SP - 389 EP - 397 PB - IOS Press ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Reinhard, Ruben A1 - Siegmund, Andreas A1 - Heumann, Kerstin A1 - Felthaus, Oliver T1 - Cell-Enriched Lipotransfer (CELT) Improves Tissue Regeneration and Rejuvenation without Substantial Manipulation of the Adipose Tissue Graft JF - Cells N2 - The good availability and the large content of adult stem cells in adipose tissue has made it one of the most interesting tissues in regenerative medicine. Although lipofilling is one of the most frequent procedures in plastic surgery, the method still struggles with high absorption rates and volume losses of up to 70%. Therefore, many efforts have been made to optimize liposuction and to process the harvested tissue in order to increase fat graft retention. Because of their immunomodulatory properties, their cytokine secretory activity, and their differentiation potential, enrichment with adipose tissue-derived stem cells was identified as a promising tool to promote transplant survival. Here, we review the important parameters for lipofilling optimization. Finally, we present a new method for the enrichment of lipoaspirate with adipose tissue-derived stem cells and discuss the parameters that contribute to fat graft survival. Y1 - 2022 U6 - https://doi.org/10.3390/cells11193159 VL - 11 IS - 19 SP - 1 EP - 11 PB - MDPI ER - TY - JOUR A1 - Zellner, Johannes A1 - Hierl, Katja A1 - Mueller, Michael A1 - Pfeifer, Christian A1 - Berner, Arne A1 - Dienstknecht, Thomas A1 - Krutsch, Werner A1 - Geis, Sebastian A1 - Gehmert, Sebastian A1 - Kujat, Richard A1 - Dendorfer, Sebastian A1 - Prantl, Lukas A1 - Nerlich, Michael A1 - Angele, Peter ED - Gilbert, Jeremy T1 - Stem cell-based tissue-engineering for treatment of meniscal tears in the avascular zone JF - Journal of Biomedical Materials Research Part B Applied Biomaterials N2 - Meniscal tears in the avascular zone have a poor self-healing potential, however partial meniscectomy predisposes the knee for early osteoarthritis. Tissue engineering with mesenchymal stem cells and a hyaluronan collagen based scaffold is a promising approach to repair meniscal tears in the avascular zone. 4 mm longitudinal meniscal tears in the avascular zone of lateral menisci of New Zealand White Rabbits were performed. The defect was left empty, sutured with a 5-0 suture or filled with a hyaluronan/collagen composite matrix without cells, with platelet rich plasma or with autologous mesenchymal stem cells. Matrices with stem cells were in part precultured in chondrogenic medium for 14 days prior to the implantation. Menisci were harvested at 6 and 12 weeks. The developed repair tissue was analyzed macroscopically, histologically and biomechanically. Untreated defects, defects treated with suture alone, with cell-free or with platelet rich plasma seeded implants showed a muted fibrous healing response. The implantation of stem cell-matrix constructs initiated fibrocartilage-like repair tissue, with better integration and biomechanical properties in the precultured stem cell-matrix group. A hyaluronan-collagen based composite scaffold seeded with mesenchymal stem cells is more effective in the repair avascular meniscal tear with stable meniscus-like tissue and to restore the native meniscus. KW - biomechanics KW - meniscus KW - scaffolds KW - stem cells KW - tissue engineering KW - Meniskusschaden KW - Tissue Engineering KW - Mesenchymzelle KW - Hyaluronsäure Y1 - 2013 U6 - https://doi.org/10.1002/jbm.b.32922 VL - 101 IS - 7 SP - 1133 EP - 1142 ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Gehmert, Sebastian A1 - Haerteis, Silke A1 - Aung, Thiha A1 - Rachel, Reinhard A1 - Jung, Ernst Michael A1 - Felthaus, Oliver T1 - Enhanced Resorption of Liposomal Packed Vitamin C Monitored by Ultrasound JF - Journal of Clinical Medicine N2 - Vitamin C is an essential nutrient for humans and is involved in a plethora of health-related functions. Several studies have shown a connection between vitamin C intake and an improved resistance to infections that involves the immune system. However, the body cannot store vitamin C and both the elevated oral intake, and the intravenous application have certain disadvantages. In this study, we wanted to show a new formulation for the liposomal packaging of vitamin C. Using freeze etching electron microscopy, we show the formed liposomes. With a novel approach of post-processing procedures of real-time sonography that combines enhancement effects by contrast-like ultrasound with a transducer, we wanted to demonstrate the elevated intestinal vitamin C resorption on four participants. With the method presented in this study, it is possible to make use of the liposomal packaging of vitamin C with simple household materials and equipment for intake elevation. For the first time, we show the enhanced resorption of ingested liposomes using microbubble enhanced ultrasound imaging. KW - ASCORBIC-ACID KW - CEUS KW - CONTRAST AGENT KW - CULTURES KW - DEFICIENCY KW - enhanced resorption KW - GULO KW - immune system KW - liposomal packing KW - MITOCHONDRIAL DYSFUNCTION KW - OXIDATIVE STRESS KW - PHOSPHATIDYLCHOLINE KW - sonography KW - vitamin C Y1 - 2020 U6 - https://doi.org/10.3390/jcm9061616 VL - 9 IS - 6 SP - 1 EP - 12 PB - MDPI CY - Basel ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Klein, Silvan A1 - Limm, Katharina A1 - Oefner, Peter J. A1 - Schratzenstaller, Thomas A1 - Felthaus, Oliver T1 - Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro JF - Plastic and Reconstructive Surgery N2 - Background: Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome. Methods: Human lipoaspirate was harvested from six different patients using water jet–assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins. Results: Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps. Conclusions: Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells’ secretome. Y1 - 2020 U6 - https://doi.org/10.1097/PRS.0000000000007343 VL - 146 IS - 6 SP - 749e EP - 758e PB - American Society of Plastic Surgeons ER - TY - JOUR A1 - Eigenberger, Andreas A1 - Felthaus, Oliver A1 - Schratzenstaller, Thomas A1 - Haerteis, Silke A1 - Utpatel, Kirsten A1 - Prantl, Lukas T1 - The Effects of Shear Force-Based Processing of Lipoaspirates on White Adipose Tissue and the Differentiation Potential of Adipose Derived Stem Cells JF - cells N2 - Autologous lipotransfer is a promising method for tissue regeneration, because white adipose tissue contains a heterogeneous cell population, including mesenchymal stem cells, endothelial cells, immune cells, and adipocytes. In order to improve the outcome, adipose tissue can be processed before application. In this study, we investigated changes caused by mechanical processing. Lipoaspirates were processed using sedimentation, first-time centrifugation, shear-force homogenization, and second-time centrifugation. The average adipocyte size, stromal vascular cell count, and adipocyte depot size were examined histologically at every processing step. In addition, the adipose derived stem cells (ADSCs) were isolated and differentiated osteogenically and adipogenically. While homogenization causes a disruption of adipocyte depots, the shape of the remaining adipocytes is not changed. On average, these adipocytes are smaller than the depot adipocytes, they are surrounded by the ECM, and therefore mechanically more stable. The volume loss of adipocyte depots leads to a significant enrichment of stromal vascular cells such as ADSCs. However, the mechanical processing does not change the potential of the ADSCs to differentiate adipogenically or steogenically. It thus appears that mechanically processed lipoaspirates are promising for the reparation of even mechanically stressed tissue as that found in nasolabial folds. The changes resulting from the processing correspond more to a filtration of mechanically less stable components than to a manipulation of the tissue. KW - white adipose tissue KW - lipograft KW - stem cells KW - fat grafting KW - surgery KW - cell-enriched lipotransfer KW - CELT KW - lipoaspirate Y1 - 2022 U6 - https://doi.org/10.3390/cells11162543 VL - 11 IS - 16 PB - MDPI CY - Basel ER - TY - JOUR A1 - Knödler, Leonard A1 - Knödler, Samuel A1 - Kauke-Navarro, Martin A1 - Knödler, Christoph A1 - Höfer, Simon A1 - Bächer, Helena A1 - Gassner, Ulrich M. A1 - Machens, Hans-Günther A1 - Prantl, Lukas A1 - Panayi, Adriana T1 - Three-dimensional Medical Printing and Associated Legal Issues in Plastic Surgery: A Scoping Review JF - Plastic & Reconstructive Surgery-Global Open N2 - Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon’s workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes. Y1 - 2023 U6 - https://doi.org/10.1097/GOX.0000000000004965 SN - 2169-7574 VL - 11 IS - 4 PB - Wolters Kluwer ER - TY - JOUR A1 - Lotter, Luisa A1 - Brebant, Vanessa A1 - Eigenberger, Andreas A1 - Hartmann, Robin A1 - Mueller, Karolina A1 - Baringer, Magnus A1 - Prantl, Lukas A1 - Schiltz, Daniel T1 - "Topographic Shift": a new digital approach to evaluating topographic changes of the female breast JF - Archives of Gynecology and Obstetrics N2 - Purpose To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans. Method The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. Results The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm). Conclusion The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the decollete. KW - 3D measurement KW - 3D scan KW - 3D volumetry KW - AUGMENTATION KW - Breast augmentation KW - Breast implant KW - MAMMAPLASTY KW - SHAPE KW - Topographic shift Y1 - 2021 U6 - https://doi.org/10.1007/s00404-020-05837-3 VL - 303 IS - 2 SP - 515 EP - 520 PB - Springer Nature ER - TY - JOUR A1 - Knödler, Leonard A1 - Berkin, Özdemir A1 - Moog, Philipp A1 - Prantl, Lukas A1 - Broer, P. Niclas A1 - Knödler, Christoph A1 - Rieger, Ulrich M. A1 - Perl, Markus A1 - von Isenburg, Sarah A1 - Gassner, Ulrich M. A1 - Obed, Doha A1 - Haug, Valentin A1 - Panayi, Adriana C A1 - Knödler, Samuel T1 - Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today JF - Aesthetic Plastic Surgery N2 - Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). KW - European Convention on Human Rights KW - European Law KW - German Basic Law KW - Human Rights KW - Reconstructive Surgery Y1 - 2022 U6 - https://doi.org/10.1007/s00266-022-02990-9 VL - 114 PB - Springer-Verlag GmbH CY - Heidelberg ER - TY - JOUR A1 - Heine, Norbert A1 - Eigenberger, Andreas A1 - Brebant, Vanessa A1 - Kempa, Sally A1 - Seitz, Stephan A1 - Prantl, Lukas A1 - Kuehlmann, Britta T1 - The effect of radiotherapy on fat engraftment for complete breast reconstruction using lipofilling only JF - Archives of Gynecology and Obstetrics N2 - Purpose Lipofilling has been established as a standard technique for contour enhancement following breast reconstruction. However, there is a paucity in current literature regarding the use of this technique for complete reconstruction of the female breast as an alternative to conventional techniques, such as expander or flap-based procedures. In particular, the influence of pre-operative irradiation for successful reconstruction has rarely been examined in published studies. Here, the authors describe their experience with successful fat injection in pre-radiated breasts in comparison with non-pre-radiated patients. Methods In this retrospective study, we examined a total of 95 lipofilling treatments on 26 patients (28 breasts). All of them experienced mastectomy following breast cancer; local breast defects after partial resection of the gland were not included in this study. In total, 47 lipofilling procedures in 12 non-irradiated patients (14 breasts) and 48 procedures in 14 irradiated women (also 14 breasts) were performed. Per session, approximately 297 +/- 112 cc of adipose tissue was grafted in group A (no radiotherapy) and approximately 259 +/- 93 cc was grafted in group B (radiotherapy). Results Among the group of women without pre-operative radiation, 71% of breast reconstructions limited to lipofilling only showed constant engraftment of fat tissue with a successful reconstructive result, whereas only 21% of the patients with pre-radiated breasts showed complete reconstruction of the breast with a permanent fat in-growth. Conclusion Preoperative radiotherapy significantly impedes successful completion of breast reconstructions planned only by autologous fat transfer. Patients should be selected individually and carefully for complete breast reconstruction using lipofilling only. KW - Breast augmentation KW - Breast cancer KW - CANCER KW - Fat graft KW - Lipofilling KW - OUTCOMES KW - PLATELET-RICH PLASMA KW - RADIATION-THERAPY KW - Radiotherapy KW - RECIPIENT-SITE KW - Reconstruction Y1 - 2022 U6 - https://doi.org/10.1007/s00404-022-06610-4 PB - Springer ER -