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Full Thickness Skin Graft in BAHA Eliminates Skin Overgrowth
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Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
generating predictive eye movements. We suggest that they may participate in the maintenance of predictive pursuit. Full Thickness Skin Graft in BAHA Eliminates Skin Overgrowth David Kaylie, MD (presenter) OBJECTIVE: The goal of this presentation is to convey the benefits of a full thickness skin graft technique in BAHA implantation by showing the following: 1) Elimination of skin overgrowth over the abutment. 2) Continuous device use following this technique. 3) Elimination of alopecia. 4) Reduction in surgical time. METHOD: This is a retrospective review of outcomes from patients from 3/08-1/10 that underwent a full thickness skin graft for BAHA implantation. The main outcomes studied were skin overgrowth, alopecia, time not spent using the device secondary to complications, and surgical time. The flap is designed one cm around a centrally placed processor template. It is manually elevated. It is thinned to the level of the follicles, preventing follicle damage. All the soft tissue is removed to the periosteum. Undermining and tack down sutures are unnecessary, reducing operative time. The abutment and flange are placed in standard fashion. An occlusive bolster is placed for even support of flap. RESULTS: Ten patients were identified with minimum of three month follow-up. There was no skin overgrowth or alopecia. No flap compromise was seen. One extrusion occurred secondary to trauma. No patients have had any periods of not using the device. Operative times are reported. CONCLUSION: The full thickness skin graft is a simplified technique that eliminates skin overgrowth. This technique also reduces OR time, eliminates alopecia and promotes continuous device use. Gene Dosage of Tumor-Related Genes in Vestibular Schwannoma Javier Gavilan, MD (presenter); Miguel Torres Licenciado; Juan Rey, PhD OBJECTIVE: To determine the gene dosage/amplification of eight tumor-related genes (EGFR, ERBB2, ERBB3, ERBB4, MDM2, MDM4, NMYC, CCND1) in vestibular schwannoma, and analyze their clinical implications. METHOD: Genomic DNA was isolated from 42 vestibular schwannomas. Quantitative real-time polymerase chain reaction was performed using the Quantimix Easy SYBR Green Kit (Biotools). Eight tumor-related genes including EGFR, ERBB2, ERBB3, ERBB4, MDM2, MDM4, NMYC, and CCND1 were studied. To normalize the fluorescent signal of the differently sized fragment, a ratio was calculated between each sample and non-tumor DNA, on the assumption that the gene dosage in normal tissue would be one. Final results were
calculated as a ratio of each normalized gene dosage versus the ribosomal dosage for every sample. A ratio between two and five was considered positive for gene copy gains, and values of more than five were considered positive for amplification. Gene dosage was correlated with clinical and radiological variables. RESULTS: Copy gains were observed in 29% of EGFR, 23% of ERBB2, 18% of ERBB3, 15% of ERBB4, 15% of MDM2, 12% of MDM4, 3% of NMYC, and 23% of CCND1. No gene amplification was found in any of the genes studied. Copy gains of EGFR, ERBB4 and MDM4 were associated with preoperative tinnitus. Copy gains of ERBB4 were associated with tumor size. CONCLUSION: Contrary to other tumors of the central nervous system, development of vestibular schwannoma does not appear to involve gene amplification. However, copy gains of certain tumor-related genes may play a role in the behavior of these tumors. Gene Expression in the Otocyst Veronika Starlinger, MD (presenter); Deepa Galaiya, MD; Roman Laske, MD; Kazuo Oshima, MD, PhD; Stefan Heller, PhD OBJECTIVE: 1) Identify a comprehensive set of genes that are expressed in otic progenitors. 2) Identify transcription factors critical for cochlear hair cell development. 3) Identify cochlear hair cell progenitor populations. METHOD: Serial Analysis of Gene Expression (SAGE) provides an unbiased, comprehensive and quantitative readout of gene expression, which is unequaled by any gene array currently available. 110 HH stage 18 (E3) chicken otocysts were dissected, and their total RNA was subjected to SAGE. SAGE library content was analyzed with three reference libraries (Ensembl 52, RefSeq, and Unigene) and resulting matches were annotated using Ingenuity Pathway Analysis software. Gene expression library content was validated using in situ hybridization. RESULTS: 39,326 17-mer tags were sequenced comprising 16,008 unique sequences. These sequences corresponded to 4,153 annotated genes and 8,054 non-annotated sequences. Our analysis identified 355 transcriptional regulators of which 302 are previously unknown in the context of the inner ear. In addition, 8 out of 14 growth factors detected were previously not linked to the inner ear. 41 cell surface marker CD molecules were identified. CONCLUSION: Comprehensive gene expression in the otocyst was described. Several novel transcription regulators, growth factors and cell surface marker CD molecules in the context of inner ear were identified. These findings provide a foundation for further studies on inner ear and hair cell development and hair cell regeneration. CD molecules may be used to identify and locate inner ear stem cells.
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
generating predictive eye movements. We suggest that they may participate in the maintenance of predictive pursuit. Full Thickness Skin Graft in BAHA Eliminates Skin Overgrowth David Kaylie, MD (presenter) OBJECTIVE: The goal of this presentation is to convey the benefits of a full thickness skin graft technique in BAHA implantation by showing the following: 1) Elimination of skin overgrowth over the abutment. 2) Continuous device use following this technique. 3) Elimination of alopecia. 4) Reduction in surgical time. METHOD: This is a retrospective review of outcomes from patients from 3/08-1/10 that underwent a full thickness skin graft for BAHA implantation. The main outcomes studied were skin overgrowth, alopecia, time not spent using the device secondary to complications, and surgical time. The flap is designed one cm around a centrally placed processor template. It is manually elevated. It is thinned to the level of the follicles, preventing follicle damage. All the soft tissue is removed to the periosteum. Undermining and tack down sutures are unnecessary, reducing operative time. The abutment and flange are placed in standard fashion. An occlusive bolster is placed for even support of flap. RESULTS: Ten patients were identified with minimum of three month follow-up. There was no skin overgrowth or alopecia. No flap compromise was seen. One extrusion occurred secondary to trauma. No patients have had any periods of not using the device. Operative times are reported. CONCLUSION: The full thickness skin graft is a simplified technique that eliminates skin overgrowth. This technique also reduces OR time, eliminates alopecia and promotes continuous device use. Gene Dosage of Tumor-Related Genes in Vestibular Schwannoma Javier Gavilan, MD (presenter); Miguel Torres Licenciado; Juan Rey, PhD OBJECTIVE: To determine the gene dosage/amplification of eight tumor-related genes (EGFR, ERBB2, ERBB3, ERBB4, MDM2, MDM4, NMYC, CCND1) in vestibular schwannoma, and analyze their clinical implications. METHOD: Genomic DNA was isolated from 42 vestibular schwannomas. Quantitative real-time polymerase chain reaction was performed using the Quantimix Easy SYBR Green Kit (Biotools). Eight tumor-related genes including EGFR, ERBB2, ERBB3, ERBB4, MDM2, MDM4, NMYC, and CCND1 were studied. To normalize the fluorescent signal of the differently sized fragment, a ratio was calculated between each sample and non-tumor DNA, on the assumption that the gene dosage in normal tissue would be one. Final results were
calculated as a ratio of each normalized gene dosage versus the ribosomal dosage for every sample. A ratio between two and five was considered positive for gene copy gains, and values of more than five were considered positive for amplification. Gene dosage was correlated with clinical and radiological variables. RESULTS: Copy gains were observed in 29% of EGFR, 23% of ERBB2, 18% of ERBB3, 15% of ERBB4, 15% of MDM2, 12% of MDM4, 3% of NMYC, and 23% of CCND1. No gene amplification was found in any of the genes studied. Copy gains of EGFR, ERBB4 and MDM4 were associated with preoperative tinnitus. Copy gains of ERBB4 were associated with tumor size. CONCLUSION: Contrary to other tumors of the central nervous system, development of vestibular schwannoma does not appear to involve gene amplification. However, copy gains of certain tumor-related genes may play a role in the behavior of these tumors. Gene Expression in the Otocyst Veronika Starlinger, MD (presenter); Deepa Galaiya, MD; Roman Laske, MD; Kazuo Oshima, MD, PhD; Stefan Heller, PhD OBJECTIVE: 1) Identify a comprehensive set of genes that are expressed in otic progenitors. 2) Identify transcription factors critical for cochlear hair cell development. 3) Identify cochlear hair cell progenitor populations. METHOD: Serial Analysis of Gene Expression (SAGE) provides an unbiased, comprehensive and quantitative readout of gene expression, which is unequaled by any gene array currently available. 110 HH stage 18 (E3) chicken otocysts were dissected, and their total RNA was subjected to SAGE. SAGE library content was analyzed with three reference libraries (Ensembl 52, RefSeq, and Unigene) and resulting matches were annotated using Ingenuity Pathway Analysis software. Gene expression library content was validated using in situ hybridization. RESULTS: 39,326 17-mer tags were sequenced comprising 16,008 unique sequences. These sequences corresponded to 4,153 annotated genes and 8,054 non-annotated sequences. Our analysis identified 355 transcriptional regulators of which 302 are previously unknown in the context of the inner ear. In addition, 8 out of 14 growth factors detected were previously not linked to the inner ear. 41 cell surface marker CD molecules were identified. CONCLUSION: Comprehensive gene expression in the otocyst was described. Several novel transcription regulators, growth factors and cell surface marker CD molecules in the context of inner ear were identified. These findings provide a foundation for further studies on inner ear and hair cell development and hair cell regeneration. CD molecules may be used to identify and locate inner ear stem cells.