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Mendenhall SD, Sawyer JD, West BL, Neumeister MW, Shaked A, Levin LS. Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States? Pediatr Transplant 2019; 23:e13466. [PMID: 31081211 DOI: 10.1111/petr.13466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/27/2018] [Indexed: 01/14/2023]
Abstract
Listing the world's first pediatric bilateral hand transplant patient for a donor posed many challenges including matching the appropriate donor age, bone size, skin tone, and growth potential in an already limited donor population. This study describes the prevalence and distribution of potential pediatric VCA donors in the United States. We assessed the UNOS database from 2008 to 2015 to identify the prevalence of potential pediatric VCA donors. Standard VCA inclusion and exclusion criteria were applied to the dataset for all pediatric solid organ donors. Frequency analyses were performed of characteristics important for VCA matching. The dataset began with 57 300 brain-dead donors and after applying the inclusion and exclusion criteria including age <18, decreased to 4663 (8.1%). The number of pediatric potential VCA donors per UNOS region ranged from 11 to 112/year. The majority of pediatric potential VCA donors were blood type O Whites, with the least common profile being blood type AB of "other" ethnicity. The present study confirmed that pediatric VCA donors are rare and may require longer travel times for procurement and listing at multiple centers in order to find a suitable donor. This will be a limiting factor for the expansion of pediatric VCA.
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Lutfy J, Pietak A, Mendenhall SD, Neumeister MW. Clinical Application of Mathematical Long Bone Ratios to Calculate Appropriate Donor Limb Lengths in Bilateral Upper Limb Transplantation. Hand (N Y) 2019; 14:523-529. [PMID: 29363357 PMCID: PMC6760092 DOI: 10.1177/1558944717753672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Limited methods exist to aid in deciding the appropriate donor limb lengths in bilateral upper limb amputees qualifying for vascularized composite allotransplantation. We hypothesized mathematical equations could be created using long bone length ratios, and applied to radiographs, to approximate the patient's limb length prior to amputation. Methods: A data set of 30 skeletons' unilateral upper limb long bones measured using osteometric board and calipers was used. Anatomic segment ratios were calculated based on humerus length after multivariate linear regression analysis. For clinical application testing, 5 cadavers' upper limbs were radiographed. Radiographic bone lengths were then measured along the long axis of each long bone. These measured radiographic lengths were then compared with the predicted bone lengths, generated from the skeleton data set ratios, for each cadaver. Results: The chi-square goodness-of-fit test showed excellent fit (P < .01) between the predicted and radiographically measured lengths for the 5 cadavers, and interobserver measurements showed no statistical difference. Depending on the cadaver, percent error in total limb length predicted to measure ranged from 0.9% to 2.7%. The variables to multiply an individual humerus length to calculate a given anatomic segment thus proved to be effective. Conclusions: If a bilateral upper limb amputee has 1 intact humerus, ratios to the humerus length can be reliably applied to calculate the preamputation limb length based on the patient's radiographic humerus length. These formulas are indicated for finding the appropriate limb lengths, and smaller anatomic segments, for donor-recipient matching in upper limb transplantation.
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Bjorklund KA, Sommer N, Neumeister MW, Kasten SJ. Establishing Validity Evidence for an Operative Performance Rating System for Plastic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:529-539. [PMID: 30253984 DOI: 10.1016/j.jsurg.2018.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of this study was to describe an operative performance rating system for plastic surgery residents and provide validity evidence for the instrument. METHODS Three plastic surgery residents (PGY levels 1, 5, and 6) from Southern Illinois University School of Medicine (SIUSOM) performed a carpal tunnel release with audio video recording. The 3 videos were reviewed by 8 expert hand surgeons and 3 SIUSOM faculty using the operative performance rating system instrument to assess resident operative performance. Validity evidence including content, internal structure, and relationship to other variables was collected. RESULTS Inter-rater reliability was consistently fair to moderate (weighted Cohen's Kappa 0.44-0.84 for experts, 0.24-0.55 for SIUSOM raters), and all assessment items were highly correlated (Cronbach's alpha of 0.9867). Local SIUSOM faculty routinely demonstrated higher overall scores for PGY 1 and PGY 6 residents compared to expert raters. CONCLUSIONS Although limited by small numbers, this pilot study suggests that potential bias based upon PGY year, identity, and performance history may exist and independent assessment by unbiased raters or comparison to national operative norms may be valuable. Our study provides baseline validity evidence for a resident operative performance assessment tool that can be integrated into practice in plastic surgery training programs.
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Mendenhall SD, Ginnetti MT, Sawyer JD, Verhulst SJ, West BL, Levin LS, Neumeister MW. Prevalence and Distribution of Potential Vascularized Composite Allotransplant Donors, Implications for Optimizing the Donor-recipient Match. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1833. [PMID: 30276058 PMCID: PMC6157933 DOI: 10.1097/gox.0000000000001833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation (VCA) is an emerging and growing field. Little is known about the prevalence and distribution of the adult potential donor population in the United States now that it falls under the oversight of the United Network for Organ Sharing (UNOS). METHODS We assessed the UNOS database from 2008 to 2015 to estimate the prevalence and distribution of adult potential vascularized composite allograft donors. Donor inclusion and exclusion criteria were developed in a way to minimize risk to recipients and were applied to the dataset. Donors were categorized by factors that influence vascularized composite allograft matching including ABO blood type, cytomegalovirus status, and ethnicity (correlate for skin color) and sorted by UNOS region. RESULTS Just under half of all brain dead donors met the inclusion/exclusion criteria. Blood type O, cytomegalovirus+, White donors represented the most frequent donor profile while blood type AB, cytomegalovirus-, Asian donors were the least common. UNOS region 3 had the most and region 1 had the least potential VCA donors per year. Nearly all potential VCA donors were solid organ donors with the liver being the most commonly donated solid organ in this population. CONCLUSIONS A large portion of the solid organ donor pool would qualify as adult vascularized composite allograft donors in the current UNOS system. These data will assist transplant teams in determining the prevalence and distribution of vascularized composite allograft donors for their individual patients awaiting composite allografts based on relevant matching characteristics in addition to standard transplant criteria.
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Daugherty TH, Pribaz JJ, Neumeister MW. The Use of Prefabricated Flaps in Burn Reconstruction. Clin Plast Surg 2017; 44:813-821. [DOI: 10.1016/j.cps.2017.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hultman CS, Neumeister MW. Volume 2: Rehabilitation, Reconstruction, and Recovery. Clin Plast Surg 2017; 44:xvii. [DOI: 10.1016/j.cps.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hultman CS, Neumeister MW. Wellness and Burnout in Burn Care Providers: Professionalism, the Social Covenant, and the 7 Habits of Highly Effective Teams. Clin Plast Surg 2017; 44:943-948. [PMID: 28888320 DOI: 10.1016/j.cps.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores the functioning of highly effective teams in burn care. Critical to the success of the team is the health of burn care providers, who can experience burnout. Wellness must be promoted by health care organizations, which, in turn, are responsible for the health of the populations they serve. Professionalism not only frames the social covenant between patients and burn care physicians but may also serve as a critical force in protecting against burnout and promoting wellness.
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Neumeister MW, Murray KA. Calcinosis of the Hand in Scleroderma: A Case Report. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255039900700501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Calcinosis associated with scleroderma is a well recognized phenomenon. Fifteen to 44% of patients with systemic scleroderma and associated CREST (calcifications, raynaud's phenomenon, esophageal motility disorder, sclerodactyly and telangiectasias) syndrome have deposition of calcium in the fingers and hands. The tumourous effect may limit motion, cause neuropraxia, compound microangiopathy or present as calcific ulcers. This report describes the case of a patient with scleroderma and CREST syndrome in whom calcinosis in the hand resulted in severe, debilitating pain necessitating surgical evacuation of the deposits. The patient had complete pain relief in the postopertive period. A further surgical extirpation of calcium was required for recurring pain at six months after surgery. The patient has remained symptom free since that time. The rare occurence of excruciating pain prompted this report and literature review.
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Hultman CS, Neumeister MW. Burn Care: Rescue, Resuscitation, and Resurfacing. Clin Plast Surg 2017. [DOI: 10.1016/s0094-1298(17)30065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rollins C, Huettner F, Neumeister MW. Clinician’s Guide to Nutritional Therapy Following Major Burn Injury. Clin Plast Surg 2017; 44:555-566. [DOI: 10.1016/j.cps.2017.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hultman CS, Neumeister MW. Volume 1: Rescue, Resuscitation, and Resurfacing. Clin Plast Surg 2017; 44:xv. [PMID: 28576258 DOI: 10.1016/j.cps.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Neumeister MW. HAND Has Been Accepted to MEDLINE!! Hand (N Y) 2017; 12:221. [PMID: 28453353 PMCID: PMC5480676 DOI: 10.1177/1558944717707722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Neumeister MW. A Tribute to Jaiyoung Ryu, MD, From All of Us at the AAHS. Hand (N Y) 2017; 12:222. [PMID: 28453352 PMCID: PMC5480677 DOI: 10.1177/1558944717707736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Strong AL, Neumeister MW, Levi B. Stem Cells and Tissue Engineering: Regeneration of the Skin and Its Contents. Clin Plast Surg 2017; 44:635-650. [PMID: 28576253 DOI: 10.1016/j.cps.2017.02.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this review, the authors discuss the stages of skin wound healing, the role of stem cells in accelerating skin wound healing, and the mechanism by which these stem cells may reconstitute the skin in the context of tissue engineering.
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Neumeister MW. Can a Plastic Surgeon be a Department Chairman?….Really? HANDCHIR MIKROCHIR P 2016; 48:69-72. [PMID: 27096204 DOI: 10.1055/s-0042-104233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is significant responsibility in being a Department of Surgery Chairman within a medical school. The Chairman is appointed by the Dean of Medicine to lead surgery in a path that serves the mission of the school. The Department of Surgery Chairman is charged with facilitating the academic, operational, and programmatic surgical initiatives of the School of Medicine. Traditionally the Chairman of Surgery has been a general surgeon but now our educational and clinical experiences have changed making traditional leadership less intuitive. Plastic surgeons appointed as current Chairman of the Department of Surgery are rare in the United States. Whereas, general surgeons may have less interaction with other surgical sub-specialties today, Plastic surgeons have more interaction crossing all disciplines of surgery. Innovation and creativity that defines our discipline, seems to fit well with Department leadership where strategic planning, vision and curriculum development, and the pursuit of academic and clinical quality remain core essentials to plastic surgery. This article is an editorial of my philosophy as a plastic surgeon leading a Department of Surgery.
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Abrams TE, Ogletree RJ, Ratnapradipa D, Neumeister MW. Adult survivors’ lived experience of burns and post-burn health: A qualitative analysis. Burns 2016; 42:152-162. [DOI: 10.1016/j.burns.2015.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
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Schmucker RW, Mendenhall SD, Reichensperger JD, Yang M, Neumeister MW. Defining the Salvage Time Window for the Use of Ischemic Postconditioning in Skeletal Muscle Ischemia Reperfusion Injury. J Reconstr Microsurg 2015; 31:597-606. [PMID: 26165885 DOI: 10.1055/s-0035-1556066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to determine the optimal salvage time window within which ischemic postconditioning can be used to ameliorate ischemia/reperfusion (I/R) injury in skeletal muscle. METHODS A total of 48 Sprague-Dawley rats were divided into two groups: I/R only (control) and I/R with postconditioning. Subgroups were divided by duration of ischemia (2, 4, 6, and 8 hours). A pedicled gracilis muscle model was used. The postconditioning protocol consisted of six cycles of 15 seconds of reperfusion followed by 15 seconds of ischemia (total time = 3 minutes). Muscles were harvested 24 hours after I/R injury to examine tissue viability, histology, myeloperoxidase activity, and protective gene expression. RESULTS Postconditioning groups showed improved muscle viability after 4 and 6 hours of ischemia time as compared with controls (p < 0.05). Higher expression of mitochondrial complexes I, II, III, endothelial nitric oxide synthase, inducible nitric oxide synthase, and Bcl-2 were observed in the postconditioning group after 4 and 6 hours of ischemia (p < 0.05). Lower expression of tumor necrosis factor-α and caspase 3 was observed in the postconditioning group at 4 hours (p < 0.05). Myeloperoxidase activity was similar in both groups at all-time points except 8 hours ischemia, where the control group had higher activity (p < 0.05). CONCLUSION Results of this study demonstrate that the effective time window within which postconditioning is most effective for the salvage of skeletal muscle is between 4 and 6 hours of ischemia. Postconditioning offered improved mitochondrial and vascular function with decreased inflammation and cell death. This may be clinically useful as a postinjury salvage technique to attenuate I/R injury after 4 to 6 hours of ischemia.
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Hulsen J, Diederich R, Neumeister MW, Bueno RA. Integra® dermal regenerative template application on exposed tendon. Hand (N Y) 2014; 9:539-42. [PMID: 25414619 PMCID: PMC4235916 DOI: 10.1007/s11552-014-9630-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tendon without paratenon presents the reconstructive surgeon with a tissue coverage challenge. Integra® dermal regenerative template has been shown to initiate a stable, vascularized bed for skin grafting over tendon. However, histological processes that occur during incorporation have not been described. The purpose of this study is to characterize the pattern of changes that occur when Integra® is applied to an avascular tendon. We hypothesize that vascular incorporation will originate from the wound periphery and proceed toward the tendon center. METHODS A full-thickness defect was created over a denuded Achilles tendon in a single hind limb in eight New Zealand white rabbits. Integra was placed over the avascular tendon, and the limb was dressed and splinted. Two animals were euthanized at each timepoint (weeks 1, 2, 3, and 4), and hematoxylin and eosin (H&E)-stained tissue specimens were microscopically evaluated. RESULTS Week 1 specimens demonstrated limited adherence between Integra and the tendon, while myofibroblasts were found encircling the tendon. No cellularity was noted centrally. At week 2, the dermis-Integra junction had increasing vascularity and the central portion developed increasing cellularity. By week 3, Integra was completely revascularized. At week 4, Integra had the histological appearance of normal dermis. CONCLUSION Neovascularization of Integra® over exposed tendon occurs from the peripheral tissue. Ingrowth proceeds from the dermis-Integra interface toward the center of the graft. Four weeks after application to the denuded tendon, Integra has the histological appearance of native dermis.
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Abstract
Metacarpal fractures are among the most common fractures of the upper extremity. Surgical management is generally offered for unstable or significantly displaced fractures. A more conservative, nonsurgical approach, however, may provide safe, rapid recovery while maintaining normal active range of motion. This article reviews the nonsurgical approach, protocols, and outcomes of metacarpal fractures.
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Lin CH, Webb K, Neumeister MW. Immediate Tissue Transplantation in Upper Limb Trauma. Clin Plast Surg 2014; 41:397-406. [DOI: 10.1016/j.cps.2014.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Neumeister MW, Webb KNB, Romanelli M. Minimally invasive treatment of Raynaud phenomenon: the role of botulinum type A. Hand Clin 2014; 30:17-24. [PMID: 24286738 DOI: 10.1016/j.hcl.2013.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although the mechanism is unknown, Btx-A injection may be an effective, localized, nonsurgical treatment option without addictive properties or systemic side effects for the treatment of ischemic digits. Clinical research supports the safety and efficacy of injection of Btx-A for the treatment of Raynaud phenomenon.
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Derby BM, Dai H, Reichensperger J, Cox L, Harrison C, Cosenza N, Yang M, Bueno RA, Neumeister MW. Adipose-derived stem cell to epithelial stem cell transdifferentiation: a mechanism to potentially improve understanding of fat grafting's impact on skin rejuvenation. Aesthet Surg J 2014; 34:142-53. [PMID: 24334307 DOI: 10.1177/1090820x13515700] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent evidence suggests that lipofilling improves overlying skin composition and appearance. Adipose-derived stem cells (ADSC) have been implicated. OBJECTIVE The authors identify ADSC transdifferentiation into epithelial stem cells through coexpression of GFP+ (green fluorescent protein positive) ADSC with the epithelial stem cell marker p63 in an in vivo fat grafting model. METHODS Six male, GFP+ mice served as adipose tissue donors. Twelve nude mice served as recipients. Recipients were subdivided into 2 arms (6 mice/each arm) and received either whole-fat specimen (group 1) or isolated and purified ADSC + peptide hydrogel carrier (group 2) engrafted into a 1-cm(2) left parascapular subdermal plane. The right parascapular subdermal plane served as control. Skin flaps were harvested at 8 weeks and subjected to (1) confocal fluorescent microscopy and (2) reverse transcriptase polymerase chain reaction (RT-PCR) for p63 mRNA expression levels. RESULTS Gross examination of skin flaps demonstrated subjectively increased dermal vessel presence surrounding whole-fat and ADSC specimens. The GFP+ cells were seen within overlying dermal architecture after engraftment and were found to coexpress p63. Significantly increased levels of p63 expression were found in the ADSC + hydrogel skin flaps. CONCLUSIONS We offer suggestive evidence that GFP+ ADSC are found within the dermis 8 weeks after engraftment and coexpress the epithelial stem cell marker p63, indicating that ADSC may transdifferentiate into epithelial stem cells after fat grafting. These findings complement current understanding of how fat grafts may rejuvenate overlying skin.
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