Escolar Documentos
Profissional Documentos
Cultura Documentos
SCS-16-0858
ORIGINAL ARTICLE
From the JW Plastic Surgery Center; yCBK Plastic Surgery Clinic; zWell
Plastic Surgery Clinic, Seoul; L&C BIO Co/R&D Center, Seongnam;
jjDepartment of Plastic Surgery, SMG-SNU Boramae Medical Center;
and Department of Plastic and Reconstructive Surgery, College of
Medicine, Seoul National University, Seoul, Korea.
Received June 14, 2016.
Accepted for publication August 27, 2016.
Address correspondence and reprint requests to Euicheol C. Jeong, MD,
PhD, Department of Plastic Surgery, SMG-SNU Boramae Medical
Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul 07061, Korea;
E-mail: ecjeong@me.com
H-GK is the Director of the Research Institute in L&C Bio Co. ECJ has
received research grant support from L&C Bio Co. The remaining
authors report no conflicts of interest.
Copyright # 2016 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000003225
Implant Preparation
The study was designed such that each rat was implanted with
each 10 10 mm2 of the following: silicone only, 0.7-mm ADM/
silicone, 1.5-mm ADM/silicone, and ADM only (1 layer of
3.0 mm). The ADM-silicone implants were prepared by cutting
respective ADM sheets into size and by suturing the ADM sheets to
silicone using 5-0 polypropylene sutures (Fig. 1A). The ADMcontaining implants were allowed to hydrate during the surgical
preparation of the rats.
Copyright 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
SCS-16-0858
Suh et al
RESULTS
Histological Examination
Formalin-fixed specimens were cut into 4-mm-thick sections
and treated with hematoxylin and eosin (H&E) and a-smooth
muscle stains. The tissues were examined at 100 magnification
for H&E samples and at 400 for the smooth muscle stains. The
histologic slides were then presented to a pathologist who was
blinded to the nature of each specimen and who was asked to
determine the capsule thickness and myofibroblast activity.
The capsule thickness was measured from each of the H&E
samples except the 3-mm ADM-only specimen from microscope
reticles calibrated with a 0.01-mm-stage micrometer slide. Myofibroblast activity was graded by the intensity of the a-smooth muscle
stains. A total lack of staining was graded as 0; sparse staining as 1;
mild staining as 2; moderate staining as 3; and intense staining as 4.
Both of these findings were measured or evaluated in 3 separate
locations in each sample and reported as an average value.
Statistical Analysis
The in vivo study of the animals, capsule thickness, and myofibroblast activity were expressed as mean standard deviation.
Statistical analysis was performed with 1-way ANOVA and paired
t-tests. All statistical analyses were performed using GraphPad
DISCUSSION
In Asian patients, silicone implants are widely used in rhinoplasty
because the material is biologically stable, resistant to degradation,
easy to carve, and convenient to remove in the patient with revision
rhinoplasty.14
A significant shortcoming of implants is that implant visibility
via obliteration of the dorsal esthetic line and translucency of skin in
those patients with thinner envelope.4,8 10 This is very common
among Caucasian patients with inherently thin skin, and is observed
with frequency even in Asian patients in whom the skin envelope
has been thinned. This phenomenon is caused by host inflammatory
No ADM
0.7-mm ADM
1.5-mm ADM
210
253
217
187
213
167
183
163
183
197.3 28.5
103
116
85
100
83
90
123
70
110
97.8 17.2
85
100
75
113
116
86
67
85
90
90.8 16.2
Copyright 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
SCS-16-0858
FIGURE 2. Hematoxylin and eosin staining of the capsule at 100. (A) The thick
capsule in the silicone-only specimen, Pocket A. (B) Capsule in the 0.7-mm-thick
ADM layered silicone implant, pocket B. (C) Capsule in the 1.5-mm-thick ADMlayered silicone implant, pocket C. (D) No capsule in the 3-mm ADM-only
specimen, Pocket D. The omnidirectional appearance of the collagen layer is
characteristic of ADM. Dense fibrous capsule is less thick in the ADM-layered
implant. ADM, acellular dermal matrix.
No ADM
0.7-mm ADM
1.5-mm ADM
1
2
3
4
5
6
7
8
9
Mean
4
3
4
4
4
3
4
4
4
3.8 0.4
2
2
3
2
1
2
2
2
1
1.9 0.6
1
0
1
2
2
2
1
1
1
1.2 0.7
Copyright 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
SCS-16-0858
Suh et al
CONCLUSION
FIGURE 4. (A) The ADM (Megaderm, L&C Bio, Seoul, Korea) (above) and the
carved silicone implant (below); size of the ADM is 0.7 mm 5 cm 1.2 cm. (B)
The silicone implant was fixed with ADM using absorbable sutures, which will be
used in the rhinoplasty. ADM, acellular dermal matrix.
ACKNOWLEDGMENT
The authors thank Dr Sohee Oh for statistical analysis in the
preparation of this manuscript.
REFERENCES
1. Shirakabe Y, Suzuki Y, Lam SM. A systematic approach to rhinoplasty
of the Japanese nose: a thirty-year experience. Aesthetic Plast Surg
2003;27:221231
2. McCurdy JA Jr. The Asian nose: augmentation rhinoplasty with Lshaped silicone implants. Facial Plast Surg 2002;18:245252
3. Jang YJ, Yu MS. Rhinoplasty for the Asian nose. Facial Plast Surg
2010;26:93101
4. Won TB, Jin HR. Revision rhinoplasty in Asians. Ann Plast Surg
2010;65:379
5. Romo T III, Kwak ES. Nasal grafts and implants in revision rhinoplasty.
Facial Plast Surg Clin North Am 2006;14:373387
6. Romo T III, Sclafani AP, Sabini P. Reconstruction of the major saddle nose
deformity using composite allo-implants. Facial Plast Surg 1998;14:151157
7. Gordon CR, Alghoul M, Goldberg JS, et al. Diced cartilage grafts
wrapped in AlloDerm for dorsal nasal augmentation. J Craniofac Surg
2011;22:11961199
8. Park CH, Kim IW, Hong SM, et al. Revision rhinoplasty of Asian noses:
analysis and treatment. Arch Otolaryngol Head Neck Surg
2009;135:146155
9. Kim HS, Park SS, Kim MH, et al. Problems associated with alloplastic
materials in rhinoplasty. Yonsei Med J 2014;55:16171623
10. Kim YS, Hyun DW, Seong SY, et al. Immediate re-insertion of nonautologous materials in revision augmentation rhinoplasty. Ann Plast
Surg 2015;74:524527
11. Hong JP, Yoon JY, Choi JW. Are polytetrafluoroethylene (Gore-Tex)
implants an alternative material for nasal dorsal augmentation in
Asians? J Craniofac Surg 2010;21:17501754
12. Lee KC, Ha SU, Park JM, et al. Foreign body removal and immediate
nasal reconstruction with superficial temporal fascia. Aesthetic Plast
Surg 2006;30:351355
13. Lee Y, Han SB. Use of a temporoparietal fascia-covered silastic implant
in nose reconstruction after foreign body removal. Plast Reconstr Surg
1999;104:500505
14. Li SH, Liu HW, Cheng B, et al. Combined alloplastic implant and
autologous dermis graft for nasal augmentation rhinoplasty in Asians.
Aesthetic Plast Surg 2014;38:817819
15. Silverman RP, Li EN, Holton LH III et al. Ventral hernia repair using
allogenic acellular dermal matrix in a swine model. Hernia 2004;8:336342
16. Sherris DA, Oriel BS. Human acellular dermal matrix grafts for
rhinoplasty. Aesthet Surg J 2011;31(suppl):95S100S
17. Skovsted Yde S, Brunbjerg ME, Damsgaard TE. Acellular dermal
matrices in breast reconstructionsa literature review. J Plast Surg
Hand Surg 2016;50:187196
18. Stump A, Holton LH III, Connor J, et al. The use of acellular dermal
matrix to prevent capsule formation around implants in a primate model.
Plast Reconstr Surg 2009;124:8289
#
Copyright 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.