Name: stromal vascular fraction-enriched fat grafting for the treatment of symptomatic end-neuromata
Uploaded: 2017-11-23T13:00:00
Description: Watch this Scientific Journal Video about Stromal Vascular Fraction-enriched Fat Grafting for the Treatment of Symptomatic End-neuromata at JoVE.com

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Protokollen følger retningslinjerne i University Hospital Zürich menneskelige forskning etiske komité.
1. diagnoser af Neuromata og patienten udvælgelse
<ol><li>Udføre præoperativ nerve blokke proksimalt for neuroma for at bekræfte diagnoserne. Vurdere blokke i den midterste tredjedel af underarmen og udelukke potentielle udløsere af de overlappende områder, innervation af SBRN, såsom laterale antebrachial kutan nerve (LACN), bageste interosseous nerve (PIN), og en dorsal gren af n...

<ol>
	<li>Mackinnon, S. E., Dellon, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+of+treatment+of+recurrent+dorsoradial+wrist+neuromas.">Results of treatment of recurrent dorsoradial wrist neuromas.</a> Ann Plast Surg. 19 (1), 54-61 (1987).</li><li>Hazari, A., Elliot, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+end-neuromas,+neuromas-in-continuity+and+scarred+nerves+of+the+digits+by+proximal+relocation.">Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation.</a> J Hand Surg Br. 29 (4), 338-350 (2004).</li><li>Goldstein, S. A., Sturim, H. 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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interposition+of+a+pedicle+fat+flap+significantly+improves+specificity+of+reinnervation+and+motor+recovery+after+repair+of+transected+nerves+in+adjacency+in+rats.">Interposition of a pedicle fat flap significantly improves specificity of reinnervation and motor recovery after repair of transected nerves in adjacency in rats.</a> Plast Reconstr Surg. 107 (1), 116-123 (2001).</li><li>Calcagni, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+novel+treatment+of+SVF-enriched+fat+grafting+for+painful+end-neuromas+of+superficial+radial+nerve.">The novel treatment of SVF-enriched fat grafting for painful end-neuromas of superficial radial nerve.</a> Microsurgery. , (2016).</li><li>Hawker, G. A., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain:+Visual+Analog+Scale+for+Pain+(VAS+Pain),+Numeric+Rating+Scale+for+Pain+(NRS+Pain),+McGill+Pain+Questionnaire+(MPQ),+Short-Form+McGill+Pain+Questionnaire+(SF-MPQ),+Chronic+Pain+Grade+Scale+(CPGS),+Short+Form-36+Bodily+Pain+Scale+(SF-36+BPS),+and+Measure+of+Intermittent+and+Constant+Osteoarthritis+Pain+(ICOAP).">Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).</a> Arthritis Care Res (Hoboken). 63 Suppl. 63, S240-S252 (2011).</li><li>Stokvis, A., van der Avoort, D. J., van Neck, J. W., Hovius, S. E., Coert, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+neuroma+pain:+a+prospective+follow-up+study.">Surgical management of neuroma pain: a prospective follow-up study.</a> Pain. 151 (3), 862-869 (2010).</li><li>Kolle, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enrichment+of+autologous+fat+grafts+with+ex-vivo+expanded+adipose+tissue-derived+stem+cells+for+graft+survival:+a+randomised+placebo-controlled+trial.">Enrichment of autologous fat grafts with ex-vivo expanded adipose tissue-derived stem cells for graft survival: a randomised placebo-controlled trial.</a> Lancet. 382 (9898), 1113-1120 (2013).</li><li>Zhu, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adipocyte+regeneration+after+free+fat+transplantation:+promotion+by+stromal+vascular+fraction+cells.">Adipocyte regeneration after free fat transplantation: promotion by stromal vascular fraction cells.</a> Cell Transplant. 24 (1), 49-62 (2015).</li><li>Eto, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+human+adipose+tissue-resident+hematopoietic+cell+populations+reveals+a+novel+macrophage+subpopulation+with+CD34+expression+and+mesenchymal+multipotency.">Characterization of human adipose tissue-resident hematopoietic cell populations reveals a novel macrophage subpopulation with CD34 expression and mesenchymal multipotency.</a> Stem Cells Dev. 22 (6), 985-997 (2013).</li><li>Premaratne, G. 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Formålet med den foreliggende undersøgelse er metodisk illustrerer de tekniske aspekter af SVF-beriget fedt podning som en roman behandling af symptomatisk ende-neuromata.
Neuromata af SBRN er forbundet med en kirurgisk succesrate på kun 33%12. Vaienti et al. præsenteret en række gunstige resultater i tidlig opfølgning ved hjælp af perineural fedt podning (PFG) uden at tilføje SVF hos 8 patienter med smertefulde neuromata af overekstrem...

Forvaltningen af symptomatisk ende-neuromata af SBRN er stadig en udfordring med et væld af eksisterende kirurgiske behandlinger. Hovedsagelig, neuroma er skåret ud og de resterende nerve stumpen er flyttet ind i nærliggende strukturer som muskler1,2, ben3eller vener4. Dette antages for at forhindre den ud spiring af de regenererende neurale fascicles ved at efterligne atmosfæren af en ende-orgel. Men ingen af disse teknikker viste sig overlegne, da høje priser af smerte tilbagefald og utilstrækkelig smertereduktion blev ofte iagttaget.
For nylig, fedt podning omkring de resterende nerve stump givet lovende resultater og blev anbefalet som en ny behandlingsmulighed for smertefulde ende-neuromata af overekstremiteterne5. Udover fungerer som et mekanisk barriere til at forhindre fortsatte bevægelse og tryk smerte, er de gavnlige aspekt af fedt podning snarere tilskrives cellulært niveau. Menneskers fedtvæv indeholder flere celletyper, herunder preadipocytes, mastceller, pericytes, endotel celler, vaskulære glatte muskelceller, fibroblaster, og fedtholdigt afledte stamceller (ADSCs) sammen med hæmatopoietisk stamceller6. Denne heterogene celle population er benævnt Adipose-Derived regenerering celler (ADRCs) eller SVF, og kan fås fra lipoaspirate af et isoleret system (Se Tabel materialer) og anvendte enzym reagens (Se tabel af materialer )7. Den nøjagtige virkningsmekanisme er stadig ikke fuldt forstået; SVF har dog været forbundet med forbedringer af angiogenese, immunomodulation, differentiering og sekretion af ekstracellulære matrix8.
Koncentreret cellen befolkningen i SVF tilføjes fedt graften med formålet at reducere resorption sats og øge fedt graften regenerativ potentiale som nylige undersøgelser afslørede smerte tilbagefald efter 12 måneder med fedt podning uden tilsat SVF 5. Derudover handlingen biologiske også indeholder gavnlige virkninger på nerven i sig selv ved at reducere uorganiseret cytoskeletale spiring af stump9 og efterfølgende ar adherences, hvilket kan resultere i nerve entrapment.
De første kliniske undersøgelse til at beskrive SVF-beriget fedt podning som en roman kirurgisk mulighed for behandling af symptomatisk ende-neuromata af SBRN har været for nylig offentliggjort10. Generelt, kan teknikken anvendes til enhver neuroma forekommer efter utilsigtet eller iatrogen nerveskade. Formålet med den nuværende efterfølgende undersøgelse er metodisk illustrerer de tekniske aspekter af denne procedure.

<table border="0" cellpadding="0" cellspacing="0" width="688">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">Cytori Celution System</td>
			<td style="width:71px;">Cytori</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">isolation system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Celase</td>
			<td style="width:71px;">Cytori</td>
			<td style="width:119px;"></td>
			<td>enyzme reagent</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">liposuction system</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:331px;">tumescent solution (500 ml Lactated Ringers, 20 ml of 1% lidocaine and 1 mg epinephrine)</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">14-gauge infiltrator</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">3 mm-collecting cannula (15, 26, 32 cm)</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">60 mL Tommey syringes</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">mosquito clamp</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Toomey syringe stand</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:331px;">4 cannulas (fat injecting cannulas 1.5 mm, syringe NO.2, 90 mm)</td>
			<td style="width:71px;">Chalybs</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">10 mL syringes</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">connecting device for syringes</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">#11- and #15-blade scalpel</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">stevens scissors</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">pins pincette</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">bipolar electrocautery</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:331px;">suture material</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">adhesive dressing</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">binocular loupes magnifier glasses (2.5-3.5x)</td>
			<td style="width:71px;">Carl Zeiss</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:331px;">Statistical Package for Social Sciences, version 22</td>
			<td>IBM</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

stromal vascular fraction-enriched fat grafting for the treatment of symptomatic end-neuromata

Formålet med denne undersøgelse var at metodisk illustrere og fremhæve de afgørende trin i stromale vaskulære brøkdel (SVF)-beriget fedt podning som en roman behandling af symptomatisk ende-neuromata af perifere sensoriske nerver, og i denne undersøgelse, specielt i den overfladiske gren af den radiale nerve (SBRN). Trods et væld af eksisterende behandlinger er vedvarende postoperative smerter og fælles smerte tilbagefald stadig meget fælles, uafhængig af den procedure, der er vurderet. En neuroma er microsurgically skåret i overensstemmelse hermed til standardiseret protokol. I stedet for flytning af regenererende nerve stumpen i nabolandet anatomiske strukturer, såsom muskel eller knogle, et fedt graft er anvendt perifocally og fungerer som et mekanisk barriere. For at reducere fedt resorption sats og styrke af graften regenerativ potentiale, er den stærkt koncentreret SVF integreret i podning. SVF er isoleret fra spæk af enzymatiske og mekanisk separation af lipoaspirate af en specifik kommercielle isolation system. SVF-beriget fedt graften giver både en mekanisk barriere og forskellige biologiske effekter på cellulært niveau, herunder forbedring af angiogenese, inflammation og fibrose. Både mekaniske og biologiske effekter bidrage til at reducere uorganiseret cytoskeletale udkommet af nerve stump under nerve regenerering og dermed undgå en gentagelse af smertefulde ende-neuromata.

Data blev analyseret ved hjælp af statistisk software og præsenteret som middel ± standardafvigelser. Kolmogorov-Smirnov test blev anvendt til at kontrollere ikke-parametrisk fordelingen af befolkningens undersøgelse og bekræftet en negativ empirisk fordeling. Baseret på den ikke-parametrisk karakter af befolkningens undersøgelse, var Wilcoxon's test for beslægtede prøver ansat til at sammenligne præoperativ og postoperative resultater. Statistisk signifikans blev betragtet på ...

Watch this Scientific Journal Video about Stromal Vascular Fraction-enriched Fat Grafting for the Treatment of Symptomatic End-neuromata at JoVE.com

Stromal Vascular Fraction-enriched Fat Grafting for the Treatment of Symptomatic End-neuromata

Stromale vaskulære brøkdel-beriget fedt podning til behandling af symptomatisk ende-neuromata

Formålet med undersøgelsen er at illustrere den tekniske procedure af stromale vaskulære brøkdel (SVF)-beriget fedt podning som en roman behandling af symptomatisk ende-neuromata. Denne teknik giver fordele for både den mekaniske barriere og biologiske handling på cellulært niveau af den forarbejdede og koncentreret SVF.

The purpose of this study was to methodically illustrate and highlight the crucial steps of stromal vascular fraction (SVF)-enriched fat grafting as a ...

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