A randomized clinical trial assessing the efficacy of single and multiple intralesional collagenase injections for treating contracted scars

Background:Scar contractions caused by trauma or burns can cause secondary physical dysfunction and disfigurement.Many minimally invasive methods for scar contraction have shown limited applicability and efficacy.This study investigated the feasibility and efficacy of intralesional collagenase injections for scar contraction treatment.Methods:Patients with contracted scars who had limited joint movement and physical disfiguration for>1 year were enrolled in this single-blind,randomized clinical trial from July 2017 to February 2018 at Shanghai Ninth People’s Hospital.Collagenase was injected into the firm-contracted scar(15 U/cm^(2))three times at 4-week intervals in the multiple treatment group and once in the single treatment group,and a placebo injection was performed in the control group.Scar length and skin texture were documented at the 4-and 12-week follow-ups.The safety of the collagenase treatment was also evaluated.Results:The contracted scar was significantly elongated after both single and multiple collagenase treatments.The results showed that,compared to a one-time treatment,repeated injections were more effective at 12 weeks,with an average improvement of 26.83(15.79%).At 12 weeks,78.9% of the patients in the multiple group and 52.9%in the single group achieved significant improvement at 12 weeks.No severe adverse events were observed.Conclusion:Intralesional collagenase injection showed promising results in improving scar contraction and provides an alternative treatment for patients.

Concentrated Growth Factor from Autologous Platelet Promotes Hair Growth in Androgenetic Alopecia

Studies have shown that platelet concentrates can induce the proliferation of the dermal papilla and the vascularization of the perifollicular tissue, as well as accelerate the telogen-to-anagen transition, thereby promoting the regrowth of hair improving the appearance of hair loss. Herein, we report on the application of a new, modified form of platelet concentrates, namely, concentrated growth factors (CGFs), in 15 cases of androgenetic alopecia (AGA). 15 cases of androgenetic alopecia were treated with the use of monthly, subcutaneous injections of autologous CGF in the scalp. A total of 3 injections were administered 4 weeks apart, and the patients were followed up for 6 months. Assessments were performed before the treatments and at 4, 8, 12 and 24 weeks after the first treatment. The treatment outcomes were assessed by taking macroscopic photographs and trichoscopic photomicrographs, as well as by using the Global Aesthetic Improvement Scale (GAIS) and the patient satisfaction survey. In order to determine the safety of the treatment, the injection area was observed for signs of infection or mass evaluation. The photographs showed significant improvement in hair appearance after injections of CGF. The hair photomicrographs showed that CGF promoted the regrowth of hair in balding areas, with an increased hair density and an increased ratio of terminal to vellus hair. The GAIS suggested that CGF treatments were effective in treating AGA, and the majority of patients were satisfied with their improvement. In addition, treatments resulted in a faster rate of hair growth and a decrease in the greasy and unpleasant sensation of the hair of the patients. At the last visit, none of the 15 patients reported experiencing side-effects during the follow-up period. To conclude, the application of CGF can be an effective method in the treatment of androgenetic alopecia.

Analyzing the correlation among the five indications of the regenerative effectiveness of expanded skin:A retrospective study of 277 expansion cases

Background:Skin expansion is a useful method for harvesting extra tissue.However,the outcome is hardly predictable.Methods:A total of 158 patients with 277 expanded skin cases were reviewed and evaluated via photographs.The review and evaluation were conducted to determine the skin’s regenerative condition.The overall texture of the expanded skin,which was deemed good,fair,or poor,was evaluated.The occurrence of five indications of the limitation of skin regeneration(thinning,color change,stretch marks,varicose vessels,and skin lesions)during expansion was recorded.The correlation between the five indications and the overall texture was statistically analyzed.Results:Among the 277 retrospectively reviewed expansion cases,the occurrence rate of skin deterioration showed significant differences between the expansion sites(P<0.01).Skin deterioration was most commonly seen on the neck and at the back.The occurrence of each indication varied among locations.The odds ratios of color change,stretch marks,varicose vessels,thinning,and skin lesions between good and poor skin conditions were 44.97,5.09,22.26,89.79,and 4.61,respectively(all P<0.001).Conclusion:Skin color,stretch marks,varicose vessels,thickness,and skin lesions are closely correlated with the skin regenerative capacity.An integrated evaluation can help predict the regenerative capacity of expanded skin.

Total Nasal Tip Defect:Bilateral Lateral Nasal Artery Flaps for Lining Reconstruction

Background In full-thickness nasal defects,the internal lining is perhaps the most challenging aspect of the three layers to rebuild.Nasal damage is usually more concentrated on the tip,soft triangles,alar wings,and columella,but the lateral nasal arteries are often left intact and the damage to the dorsal sidewalls are normally superficial.Methods Twelve patients who required total nasal reconstruction received a forehead flap placement as external coverage and autologous rib cartilage as structural support.Residual normal/superficial scar tissue flaps on the dorsal sidewalls with lateral nasal artery pedicles were mobilized and designed for internal lining repair without creating secondary donor site damage.The flaps were then turned 180°downward and placed between the alar medial angles and the fornix.Results No total lining flap necrosis occurred in all the patients.Partial necrosis occurred on the distal edge owing to overpressure of the nostril splint to the flaps;however,the wounds eventually healed,and the nasal structural integrity was preserved.The patients were satisfied with the aesthetic results and had no complaints of airway stenosis.Conclusions Lateral nasal artery pedicle dorsal sidewall skin flaps are appropriately thick,providing enough nostril circumferential support to improve airway stenosis.It allows sufficient blood supply and creates no extra donor site damage.Blood vessels and skin flaps are often undamaged,thereby allowing maximum application in total nasal reconstruction.

基质血管细胞辅助脂肪移植体内生物成像分析：移植的基质血管细胞群和移植脂肪的相互作用及相互性

目的虽然脂肪移植被广泛应用于缺失软组织的重建中，但其移植后的存活率不稳定，使其应用受到限制。最近有研究表明，脂肪来源基质血管成分能提高移植脂肪的成活率。目前，很少有对体内移植脂肪成活量的动态改变和移植脂肪对移植的SVFs影响的报道。方法本研究中，对从荧光素酶（Luc）转基因大鼠中分离出脂肪组织和SVF进行脂肪成活率的生物成像分析。一组是将荧光素酶大鼠脂肪（0．2m1）联合从0．2ml野生大鼠的脂肪中分离出新鲜的SVFs，皮下注入裸鼠的背部；另一组单纯注入脂肪。观察体内脂肪63d，比较两组的成活率。63d后，提取脂肪，用免疫组化染色对其结构的完整性进行评估。此外，为了评估周围脂肪组织对移植的SVFs的影响，我们将从0．2ml荧光素酶大鼠中分离出的SVFs单独或联合野生大鼠的脂肪组织移植到裸鼠的背部，并用生物成像动态观察63d。用特殊的细胞标记物分析SVFs的分化。结果Luc脂肪的生物成像结果表明，联合sVF移植的脂肪组织比单纯脂肪移植的成活率高（P〈0．001）。SVF辅助脂肪移植的细胞结构更完整，坏死和囊肿较少。SVFs移植的结果表明，不加入脂肪，注入的SVFs在21d内就快速消退。而加入脂肪组织，移植的SVF能存活较长时间，在移植63d后还存在。SVFs对脂肪移植的成活率和分化成脂肪细胞、前脂肪细胞和内皮细胞再生有影响。结论我们介绍了一种观测体内移植的脂肪组织的全新技术。生物成像结果表明，SVF辅助脂肪移植要比单独脂肪移植有显著的优势。同时，周围脂肪组织的微环境对提高SVFs的存活和分化也有重要作用。我们的研究也表明，SVFs对分化成多细胞类型脂肪的再生和存活有重要作用。