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Combined Lymphedema and Capillary Malformation of the Lower Extremity
S112
Scientific Forum Abstracts
surgical site infection or wound dehiscence. Major surgical complication was defined as deep incisional wound infection or return to the operating room. RESULTS: The mortality rate in the 30-day postoperative period was 0.2% and the overall complication rate was 12.0%. The likelihood of minor wound complication was 2 times higher in ASA class II, 4 times higher in class III, and 2.3 times higher in class IV, compared with ASA class I (p¼0.02, p¼0.001, p¼0.155). Patients in ASA II, III, and IV were 1.1, 1.8 and 4.0 times, respectively, more likely to develop medical complications than those in ASA I (p¼0.824, p¼0.198, p¼0.017, respectively). The likelihood of a major surgical complication was 1.2 times higher in class II, 2.0 times higher in class III, and 3.8 times higher in class IV (p¼0.668, p¼0.093, p¼0.008, respectively). CONCLUSIONS: As obesity increases, more patients will seek body-contouring surgery. Even after significant weight loss, many patients may still be poor surgical candidates. Appropriate screening and medical optimization are required to prevent complications and improve outcomes. Based on these results, the ASA classification system, which is simple and universally applicable, appears to predict significant complications and can be used to rapidly screen patients. Adipose-Derived Stem Cells Improve Engraftment of Full-Thickness Skin Grafts by Increasing Angiogenesis Michael S Hu, MD, MPH, Wan Xing Hong, Zeshaan N Maan, MB, BS, MRCS, Min Hu, MD, PhD, Andrew S Zimmermann, Graham G Walmsley, Michael Chung, H Peter Lorenz, MD, FACS, Michael T Longaker, MD, MBA, FACS Stanford University School of Medicine, Stanford, CA; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI INTRODUCTION: Autologous full-thickness skin grafts are among the most common procedures used for wound closure. However, in diabetic patients, skin graft rejection is common because of poor circulation. We examined the ability of adipose-derived stem cells (ASC) to promote engraftment of autologous skin grafts in diabetic mice. METHODS: Adipose-derived stem cells were harvested from inguinal fat pads of transgenic FVB-L2G mice. A 6-mm, full-thickness excisional wound was created on the dorsum of wild-type and diabetic FVB mice. The right ear of each mouse was harvested and used as an autologous skin graft. Wounds were treated with or without ASCs (5 105) via injection under the wound bed. Survival of ASCs was quantified in vivo through bioluminescent imaging (BLI). The effectiveness of the treatments was recorded during a period of 2 weeks. RESULTS: The ASCs were found to promote acceptance of autologous skin grafts in diabetic mice. All wild-type mice demonstrated successful engraftment of skin grafts without ASC treatment. Diabetic mice with ASC treatment achieved 100% engraftment; only 20% of grafts were taken in control diabetic mice (p<0.03).
J Am Coll Surg
Bioluminescent imaging revealed survival of ASCs when assessing for engraftment 2 weeks after wounding. Immunofluorescence showed an increase in vascular endothelial growth factor and CD31 in diabetic full-thickness skin grafts treated with ASCs vs no ASC treatment (p<0.05). CONCLUSIONS: We demonstrated improved engraftment of fullthickness skin grafts in diabetic mice with therapeutic ASCs. This cell-based application may improve the efficacy of skin grafting in patients with diabetes or other disorders that compromise circulation. Combined Lymphedema and Capillary Malformation of the Lower Extremity Reid A Maclellan, MD, Gulraiz Chaudry, MD, Arin K Greene, MD, FACS Boston Children’s Hospital, Harvard Medical School, Boston, MA INTRODUCTION: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique, but may be confused with other types of vascular malformation overgrowth conditions (eg, CLOVES, Klippel-Trenaunay, Parkes Weber). METHODS: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both capillary malformation and lymphedema. Diagnosis of lymphedema-capillary malformation was made by history, physical examination, and imaging studies. Because lymphedema-capillary malformation has phenotypical overlap with other conditions, only patients who had imaging confirming their diagnosis were included in the analysis. Clinical and radiologic features, morbidity, and treatment were recorded. RESULTS: Eight patients (4 female, 4 male) had confirmed lymphedema-capillary malformation. Referring diagnosis was KlippelTrenaunay syndrome (n¼4), diffuse capillary malformation with overgrowth (n¼3), or lymphatic malformation (n¼1). The condition was unilateral (n¼6) or bilateral (n¼2). Morbidity included infection (n¼6), problems fitting clothing (n¼6), bleeding or leaking vesicles (n¼5), leg length discrepancy (n¼4), and difficulty with ambulation (n¼3). All patients were managed with compression regimens. Operative management included liposuction (n¼3), treatment of phlebectatic veins (n¼3), staged skin/subcutaneous excision (n¼1), and/or epiphysiodesis (n¼1). CONCLUSIONS: Lymphedema and capillary malformation can occur together in the same extremity. Both conditions independently cause limb overgrowth primarily because of subcutaneous adipose deposition. Compression garments and suction-assisted lipectomy can improve the condition. Lymphedema-capillary malformation should not be confused with other vascular malformation overgrowth diseases that have different morbidities and treatments.
Scientific Forum Abstracts
surgical site infection or wound dehiscence. Major surgical complication was defined as deep incisional wound infection or return to the operating room. RESULTS: The mortality rate in the 30-day postoperative period was 0.2% and the overall complication rate was 12.0%. The likelihood of minor wound complication was 2 times higher in ASA class II, 4 times higher in class III, and 2.3 times higher in class IV, compared with ASA class I (p¼0.02, p¼0.001, p¼0.155). Patients in ASA II, III, and IV were 1.1, 1.8 and 4.0 times, respectively, more likely to develop medical complications than those in ASA I (p¼0.824, p¼0.198, p¼0.017, respectively). The likelihood of a major surgical complication was 1.2 times higher in class II, 2.0 times higher in class III, and 3.8 times higher in class IV (p¼0.668, p¼0.093, p¼0.008, respectively). CONCLUSIONS: As obesity increases, more patients will seek body-contouring surgery. Even after significant weight loss, many patients may still be poor surgical candidates. Appropriate screening and medical optimization are required to prevent complications and improve outcomes. Based on these results, the ASA classification system, which is simple and universally applicable, appears to predict significant complications and can be used to rapidly screen patients. Adipose-Derived Stem Cells Improve Engraftment of Full-Thickness Skin Grafts by Increasing Angiogenesis Michael S Hu, MD, MPH, Wan Xing Hong, Zeshaan N Maan, MB, BS, MRCS, Min Hu, MD, PhD, Andrew S Zimmermann, Graham G Walmsley, Michael Chung, H Peter Lorenz, MD, FACS, Michael T Longaker, MD, MBA, FACS Stanford University School of Medicine, Stanford, CA; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI INTRODUCTION: Autologous full-thickness skin grafts are among the most common procedures used for wound closure. However, in diabetic patients, skin graft rejection is common because of poor circulation. We examined the ability of adipose-derived stem cells (ASC) to promote engraftment of autologous skin grafts in diabetic mice. METHODS: Adipose-derived stem cells were harvested from inguinal fat pads of transgenic FVB-L2G mice. A 6-mm, full-thickness excisional wound was created on the dorsum of wild-type and diabetic FVB mice. The right ear of each mouse was harvested and used as an autologous skin graft. Wounds were treated with or without ASCs (5 105) via injection under the wound bed. Survival of ASCs was quantified in vivo through bioluminescent imaging (BLI). The effectiveness of the treatments was recorded during a period of 2 weeks. RESULTS: The ASCs were found to promote acceptance of autologous skin grafts in diabetic mice. All wild-type mice demonstrated successful engraftment of skin grafts without ASC treatment. Diabetic mice with ASC treatment achieved 100% engraftment; only 20% of grafts were taken in control diabetic mice (p<0.03).
J Am Coll Surg
Bioluminescent imaging revealed survival of ASCs when assessing for engraftment 2 weeks after wounding. Immunofluorescence showed an increase in vascular endothelial growth factor and CD31 in diabetic full-thickness skin grafts treated with ASCs vs no ASC treatment (p<0.05). CONCLUSIONS: We demonstrated improved engraftment of fullthickness skin grafts in diabetic mice with therapeutic ASCs. This cell-based application may improve the efficacy of skin grafting in patients with diabetes or other disorders that compromise circulation. Combined Lymphedema and Capillary Malformation of the Lower Extremity Reid A Maclellan, MD, Gulraiz Chaudry, MD, Arin K Greene, MD, FACS Boston Children’s Hospital, Harvard Medical School, Boston, MA INTRODUCTION: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique, but may be confused with other types of vascular malformation overgrowth conditions (eg, CLOVES, Klippel-Trenaunay, Parkes Weber). METHODS: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both capillary malformation and lymphedema. Diagnosis of lymphedema-capillary malformation was made by history, physical examination, and imaging studies. Because lymphedema-capillary malformation has phenotypical overlap with other conditions, only patients who had imaging confirming their diagnosis were included in the analysis. Clinical and radiologic features, morbidity, and treatment were recorded. RESULTS: Eight patients (4 female, 4 male) had confirmed lymphedema-capillary malformation. Referring diagnosis was KlippelTrenaunay syndrome (n¼4), diffuse capillary malformation with overgrowth (n¼3), or lymphatic malformation (n¼1). The condition was unilateral (n¼6) or bilateral (n¼2). Morbidity included infection (n¼6), problems fitting clothing (n¼6), bleeding or leaking vesicles (n¼5), leg length discrepancy (n¼4), and difficulty with ambulation (n¼3). All patients were managed with compression regimens. Operative management included liposuction (n¼3), treatment of phlebectatic veins (n¼3), staged skin/subcutaneous excision (n¼1), and/or epiphysiodesis (n¼1). CONCLUSIONS: Lymphedema and capillary malformation can occur together in the same extremity. Both conditions independently cause limb overgrowth primarily because of subcutaneous adipose deposition. Compression garments and suction-assisted lipectomy can improve the condition. Lymphedema-capillary malformation should not be confused with other vascular malformation overgrowth diseases that have different morbidities and treatments.