井上 義一

OBJECTIVES: External nasal deformity in patients with cleft lip and palate causes both functional and aesthetic problems. Corrective rhinoplasty using a reverse U-shaped incision and suturing of the alar cartilage is not always successful. Therefore, we compared the use of a newer septal extension graft technique with the conventional suture technique to determine an effective surgical method for improving nasal tip morphology. METHODS: We compared the outcomes of the conventional reverse U-shaped incision technique with the septal extension graft in 12 patients undergoing secondary cleft rhinoplasty (6 in each group). Ten plastic surgeons evaluated 6-month postoperative photographs using six criteria: nasal tip shape (frontal, lateral, and basal views), left-right asymmetry (frontal and basal views), and overall improvement. Each item was rated on a 4-point scale (1=poor, 4=excellent). Mann-Whitney U tests were used to assess statistical significance. RESULTS: The septal extension graft group showed significantly better nasal tip morphology in the frontal and basal views (P<0.001) and in the lateral view (P=0.007). However, there were no significant differences in symmetry improvement between the two techniques for the front (P=0.685) and bottom (P=0.602) views. CONCLUSIONS: Corrective rhinoplasty using a septal extension graft can significantly improve nasal tip morphology in cleft lip cases compared with the reverse U-shaped incision and alar cartilage suturing technique. However, decreased mobility of the nasal tip was noted. Further improvement is needed in terms of patient-reported satisfaction and postoperative stability.

BACKGROUND: Adipose-derived stem cell (ADSC)-enhanced fat grafting may improve graft retention and aesthetic outcomes in breast reconstruction, but its safety and efficacy remain uncertain. This systematic review and meta-analysis compared ADSC-enhanced with conventional fat grafting using rigorous methodology and predefined subgroup analyses. METHODS: Following PRISMA guidelines and PROSPERO registration (CRD42024553984), we searched six databases (January 2000-November 2024) for comparative studies. Random-effects meta-analyses assessed outcomes, with subgroups defined by ADSC preparation method, follow-up duration, and reconstruction indication. RESULTS: Thirty-one studies (1,426 patients: 634 ADSC-enhanced, 792 conventional) met inclusion criteria. ADSC-enhanced grafting significantly improved fat retention (mean difference [MD]: 26.8%, 95% CI: 18.2-35.5; P<0.001; moderate-certainty evidence). Ex vivo-expanded ADSCs achieved the greatest improvement (MD: 64.6%, 95% CI: 60.5-68.7), while stromal vascular fraction methods provided moderate gains (MD: 17.0%, 95% CI: 8.6-25.4; P<0.001; I²=78%). Complication rates were similar between groups (18.4% vs. 17.2%; RR: 1.07, 95% CI: 0.65-1.77; P=0.78). Among 813 patients with prior breast cancer, recurrence rates did not differ significantly (5.3% vs. 3.4%; RR: 1.56, 95% CI: 0.10-24.3; P=0.75). Patient-reported and aesthetic outcomes generally favored ADSC-enhanced grafting. CONCLUSIONS: ADSC-enhanced fat grafting increases graft retention without raising complication or recurrence risk. Ex vivo-expanded ADSCs offer the greatest benefit, with stromal vascular fraction yielding moderate improvement. Standardized protocols and long-term safety data are needed to optimize clinical use.

BACKGROUND: Exoscope-assisted digital imaging allows continuous real-time visualization of the surgical site on a large 3D monitor. We evaluated its usefulness in orbital fracture reduction surgery, a procedure with a narrow and deep operative field that restricts direct visibility for the operating surgeon. METHODS: This retrospective cohort study included all patients who underwent orbital floor fracture reduction with an absorbable plate via a subciliary approach at our institution from January 2022 to December 2024. ORBEYE 3D exoscope system (Olympus, Tokyo, Japan) was used in all cases when available, as the device was shared among several departments in our institution. Surgeries performed with and without the ORBEYE exoscope were compared for the following preoperative variables: (i) years since the surgeon's graduation and (ii) days from injury to surgery, and outcome variables including (iii) operative time, (iv) blood loss, and (v) absorbable plate size. Surgeons also completed a questionnaire regarding their experience with ORBEYE. RESULTS: Eleven patients underwent conventional surgery, and 10 underwent ORBEYE-assisted surgery. ORBEYE-assisted surgery resulted in a significantly shorter operative time, while no significant differences were observed in other preoperative or outcome variables. The involved surgeons reported reduced physical strain, particularly in the neck, as well as improved collaboration and education. Despite some disadvantages, all surgeons expressed a positive attitude toward continued ORBEYE use. CONCLUSIONS: ORBEYE-assisted surgery offers significant advantages in orbital floor fracture reduction, including reduced operative time, improved ergonomics, and enhanced teamwork and education. Its drawbacks are relatively minor, and broader adoption in plastic surgery should be considered.

Chronic wounds represent a significant global burden, afflicting millions with debilitating complications. Despite standard care, impaired healing persists due to factors like persistent inflammation and impaired tissue regeneration. Mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) offer an innovative regenerative medicine approach, delivering stem cell-derived therapeutic cargo in engineered nanoscale delivery systems. This review examines pioneering bioengineering strategies to engineer MSC-EVs into precision nanotherapeutics for chronic wounds. Emerging technologies like CRISPR gene editing, microfluidic manufacturing, and biomimetic delivery systems are highlighted for their potential to enhance MSC-EV targeting, optimize therapeutic cargo enrichment, and ensure consistent clinical-grade production. However, key hurdles remain, including batch variability, rigorous safety assessment for potential tumorigenicity, immunogenicity, and biodistribution profiling. Crucially, collaborative frameworks harmonizing regulatory science with bioengineering and patient advocacy hold the key to expediting global clinical translation. By overcoming these challenges, engineered MSC-EVs could catalyze a new era of off-the-shelf regenerative therapies, restoring hope and healing for millions afflicted by non-healing wounds.