Advances and established therapies in linear scar prevention

Linear scars are scars formed after surgery or other trauma-healing procedures that typically exhibit a linear morphology.Optimal linear scars are characterized by narrowness,flatness,and a color closely resembling the adjacent tissue.Failure to meet these criteria can have detrimental effects on the physical and psychological wellbeing of patients.Thus,early intervention for linear scars can effectively improve functionality and aesthetics.This review aimed to consolidate the prevailing agreement on scar prevention therapies and provide clinical physicians with comprehensive and cutting-edge guidance.

Intralesional corticosteroid injections for infantile hemangioma

Infantile hemangiomas(IHs) are the most common benign soft-tissue tumors in infancy;about 10%–15% of them may result in various complications that require active management. The current first-line treatment for IH is oral propranolol;however, some studies recommend intralesional corticosteroid injections for small, limited, deep, or prominent tumors because of concern regarding serious systemic complications related to propranolol. This review summarizes and analyzes the current clinical studies on corticosteroid injections in IHs, discusses treatment norms, and explores future research directions.

MEK inhibitors for the treatment of extracranial arteriovenous malformations

Arteriovenous malformations(AVMs)are serious congenital vascular anomalies in which the arteries connect directly with veins without capillaries.This condition will continue to worsen without proper intervention and cause ulcers,repeated hemorrhages,and even cardiac insufficiency.Primary treatment options for AVMs include surgery and interventional treatment;however,they are associated with high risk and recurrence rates.Recent studies revealed that excessive activation of the Ras/MAPK pathway can induce the formation and development of peripheral AVM,whereas MEK inhibitors can effectively control nidus progression,making them a potential novel treatment for AVM.This review provides an up-to-date overview of correlated laboratory and clinical research to provide information for further research and clinical practice.

Advances in photodynamic therapy for port-wine stain and our experience

Port-wine stain(PWS)is a congenital capillary malformation that occurs in 0.3%–0.5%of newborns.The pulsed dye laser is the current gold standard treatment for PWS;however,its efficacy is poor.Photosensitizer photodynamic therapy(PDT)is considered a promising treatment for PWS.Here we provide a comprehensive overview of PDT.

Absolute ethanol embolization for treatment of peripheral arteriovenous malformations

Arteriovenous malformations(AVMs)are aggressive congenital high-flow vascular anomalies,in which the feeding artery and draining vein are connected through fistulas without normal capillary networks.In severe cases,the condition may cause swelling,ulceration,bleeding,and even heart failure.Various treatment options are available for AVMs,including laser,surgical resection,embolization,and targeted drug therapy.With the development of endovascular treatment technology,absolute ethanol embolization of AVMs has become one of the first-line therapies owing to its sustained efficacy and low recurrence rate.However,administration of this therapy is challenging and may lead to serious complications if inappropriately managed.In this article,we reviewed and summarized previous clinical articles,literature reviews,and clinical trial data to comprehensively describe clinical manifestations of AVMs,the mechanism of ethanol embolotherapy,key points in treatment and management of complications,and issues that need to be addressed.We expect to provide a reliable information reference source for clinical physicians and researchers.

Managing facial infiltrating lipomatosis associated with PIK3CA mutation:From surgery to targeted therapy

Facial infiltrating lipomatosis(FIL)is a congenital asymmetrical deformity of the maxillofacial region that can significantly affect a patient’s facial appearance and function.With the development of sequencing technologies,PIK3CA mutations are considered among the potential etiologies of FIL.The management and treatment of FIL involves plastic surgery;more recently,an improved understanding of its pathogenesis has given rise to new treatment options,including targeted therapy.Here we report the clinical data of two patients diagnosed with FIL and present current curative concepts.

Differentiation and Pro-Angiogenic Potential of Infantile Hemangioma Stem Cells

Objectives Infantile hemangioma(IH)is defined as a benign vascular tumor composed of immature vascular endothelial cells,with the unique characteristics of rich vascularization and self-regression into fibro-fatty tissue.CD133-positive hemangioma stem cells(HemSCs),present in the proliferating IH tissue,can be used to establish the IH animal model,which has highlighted the pathogenesis of IH in recent years.This study focused on the biological characteristics and differentiation capacity of HemSCs and aimed to provide a theoretical possibility for its application in tissue engineering.Methods To further confirm our hypothesis,we used fluorescence-activated cell sorting(FACS),in vitro multipotent induced differentiation,angiogenesis assay,and antibody array to identify the surface markers,multipotent differential potential,angiogenesis potential,and secreted factors of HemSCs,respectively,utilizing human adipose stem cells(hADSCs)as the control.Results We successfully isolated and cultured HemSCs.FACS indicated that,on average,more than 80%of HemSCs matched the criteria of mesenchymal stem cell(MSC)surface markers.Our results confirmed that HemSCs could differentiate into adipocytes,osteocytes,and chondrocytes.Additionally,compared with fibroblasts or hADSCs,HemSCs could promote angiogenesis through para-secretion.Conclusions HemSCs may originate from normal MSCs,and owing to their powerful proliferative and angiogenic abilities,they could be considered an IH pathogenic factor.These characteristics demonstratet heir potential as a candidate seed cell in tissue engineering.

Bleomycin inhibits CLEC14A to attenuate the progression of extracranial arteriovenous malformations

Background:We previously reported that interstitial injection of bleomycin(BLM)reduces the size of early-stage extracranial arteriovenous malformation(AVM).Here,we sought to investigate the potential mechanism of BLM in treating extracranial AVM.Methods:Samples of human extracranial AVM(n=3)with no pharmacological treatment were harvested.AVM endothelial cells were isolated and cultured in primary cell culture.The transcriptome was examined using RNAsequencing,and differentially expressed C-type lectin domain family 14 member A(CLEC14A)was validated at the transcriptomic and protein levels.Immunocytochemical staining of CLEC14A was performed in samples of human extracranial AVM,with and without BLM treatment.Results:Through second-generation sequencing,we found that the expression of 5689 genes were differentially increased or decreased following 24-h BLM stimulation.We found that CLEC14A may play an important role in the progression of AVM and can be inhibited by BLM treatment.Conclusion:BLM inhibited CLEC14A expression to attenuate the progression of AVM.

Angiogenesis and proliferation of endothelial cells in hypertrophic and nodular port-wine stain

Background:Port-wine stain(PWS)has been classified not as the hyperplasia of cells,but rather,as an expansion of malformed vessels.However,previous studies have reported upregulated expression of proangiogenic factors in PWS.Several studies have indicated that the pathology exhibits proliferation of numerous endothelial cells in hypertrophic/nodular PWS.This study aimed to determine the expression of vascular epithelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9),angiopoietin-2(ANG-2),and basic fibroblast growth factor(bFGF)in hypertrophic PWS.Methods:Immunohistochemistry was used to analyze skin samples from 33 patients with hypertrophic PWS.Expression levels of VEGF,MMP-9,ANG-2,and bFGF in hypertrophic PWS were determined by multiplying the intensity by the percentage of immunoreactive cells.Immunoreactivity scores were classified as follows:negative(0),low(1),moderate(2,3,and 4),or high(6).Results:Based on pathological characteristics,hypertrophic PWS was divided into vascular malformation and pyogenic granuloma(PG)types.VEGF,MMP-9,ANG-2,and bFGF were significantly activated in the blood vessels of PG-type PWS samples compared with their counterparts in blood vessels of vascular malformation-type PWS samples and controls.PG-type hypertrophic PWS,which exhibited proliferation of endothelial cells,showed the strongest activation.Conclusion:The exuberant proliferation of endothelial cells in PG-type hypertrophic PWS may be associated with the regulation of proangiogenic factors during development.These proangiogenic factors that function in the angiogenesis and proliferation of endothelial cells may play an important role in the pathogenesis and progression of PWS.Furthermore,these factors may be dynamic and behave differently in various types of hypertrophic PWS.

Systemic Hemodynamic Changes in Low-Dose Ethanol Embolotherapy for Soft-Tissue Arteriovenous Malformations

Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this treatment.This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy.Methods From September 2012 to September 2014,34 male patients and 26 female patients with AVMs who underwent embolotherapy(100 sessions in total)with absolute ethanol were included in this study.Invasive systolic blood pressure(SBP)and heart rate(HR)were recorded before and after each injection and throughout the procedure.Differences between the initial and highest SBP(ΔmaxSP)and HR values(ΔmaxHR),as well as the initial and final SBP(ΔSP)and HR(ΔHR)values,were analyzed.We aimed to explore the potential association between these values and the amount of ethanol that was used.Results The total ethanol used was variable(0.01–0.40 mL/kg;mean,0.20 mL/kg).SBP and HR increased after ethanol injection in most sessions(91 in 100 sessions).SBP decreased in 9 sessions(9 in 100 sessions),while HR,oxygen saturation,and end-tidal CO2 decreased in one of the 9 sessions.ΔmaxSP andΔmaxHR averaged 38.4 mmHg and 27.8 bpm,respectively(both P<0.05),whileΔSP andΔHR averaged 3.4 mmHg and 4.0 bpm,respectively(both P<0.05).ΔmaxSP andΔmaxHR were positively correlated with the total dose of ethanol injected.Conclusions Elevations in SBP and HR during ethanol embolotherapy are common,temporary,and most likely pain-mediated;these increases tend to be positively correlated with ethanol dose.Hypotension may be regarded as an acute complication of ethanol embolotherapy.Hypotension combined with bradycardia,oxygen desaturation,and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.

The Practice of China’s Cosmetic Medicine Dated Back to 3800-4800 Years Ago

Objective To investigate the developmental history of cosmetic surgery and cosmetic medicine in China.Methods The history of cosmetic surgery and cosmetology in China was explored via a review of the literature reported across the globe and the archeological discoveries recorded in China.Results The ancient underground city of“Sanxingdui”,discovered in Guanghan,Sich­uan,China,was built between 1800 and 2800 BC.Many bronze figure sculptures with decorative perforations in the earlobe area were unearthed there,making it perhaps the earliest record of cosmetic surgery practice in the world.The practice of decorative per­forations in the earlobe predates the practice of nose jobs found in ancient India.The Pre­scriptions for Fifty-two Diseases from the Western Han Dynasty,unearthed in Mawangdui,Changsha,Hunan Province,recorded the treatment of vitiligo in traditional Chinese medi­cine.This might be one of the earliest records of aesthetic medicine in the world.Conclusion China is one of the earliest birthplaces of cosmetic surgery and cosmetol­ogy in the world.The practice of cosmetic medicine in China predates the practice of nasal reconstruction found in ancient India.

A Fast and Effective Surgical Method for a Painful Skin Lesion

Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To report a novel surgical technique that can alleviate severe pain caused by a large lesion in an EAH patient.Methods On magnetic resonance imaging(MRI),a subcutaneous abnormal signal was detected in the right hip and groin area of an 18-year-old male.The lesion was carefully elevated from the normal tissue above the plane of the deep fascia and was sutured in situ.Additionally,a small sample of the central lesion tissue was collected for histological examination.Results The visual analog scale score of pain decreased from 9 points to 2 points at 1week and to 0 points at 2 weeks after the surgery.The only complication observed was local numbness,which recovered spontaneously.No recurrence of pain was observed after 1 year of surgery.Histological findings demonstrated that the numbers of eccrine sweat glands and abnormal vessels decreased post-surgery.Conclusion The surgical procedure used in our case may represent a novel,easy,safe,and effective option for the treatment of a large,severely painful EAH.

Intralesional Interstitial Injection of Bleomycin for Management of Extracranial Arteriovenous Malformations in Children

Background Despite many advances in the treatment for extracranial arteriovenous mal­formations(AVMs),they still result in tedious dissection and potential unacceptable com­plications,particularly in children.Therefore,this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.Methods A total of 10 children(6 boys and 4 girls)with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017.Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month inter­val.Therapeutic effectiveness was evaluated and classified into four categories:complete response(CR),partial response(PR),no response,and worsening at 3 months after the last session.Further clinical follow-up outcomes were classified as improved,stable,or aggra­vated.Adverse events were recorded according to the Society of Interventional Radiology classification.Results All 10 children completed the sessions and follow-ups.CR occurred in 3(30%)patients,PR in 6(60%),and no response in 1(20%).Minor complications(class A)included maculopapular rash,bulla,vomiting,and hyperpigmentation,whereas no major complications occurred.Conclusion Intralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes.This method may be an earlier treatment alternative in children to prevent potential destructive progression,considering the serious complications of currently available therapeutic methods.

Three-Dimensional Volumetric Analysis of Venous Malformations for Assessing the Effectiveness of Percutaneous Sclerotherapy

BACKGROUND Percutaneous sclerotherapy can be used to successfully treat venous malformations(VMs)of the head,neck,and limbs.However,the standard curative effect of sclerotherapy has rarely been analyzed,and there is currently no accurate statistical method to measure the volume of VMs after sclerotherapy.Here,we propose a novel threedimensional(3D)reconstruction method to evaluate this effect.OBJECTIVE To test the feasibility of 3D software(MIMICS 19.0)to evaluate the treatment effect of sclerotherapy.METHODS This retrospective study included patients with VMs on the head,neck,and limbs who were treated with ethanol sclerotherapy or foam sclerotherapy every 8 weeks.MIMICS 19.0 was used to calculate the performance of the lesion after treatment and measure the VM volumes before and after the treatment.The effect of the clinical treatment dose on the lesion was evaluated,and the treatment effect of each patient was recorded.The relationship between the number of treatments and the reduced volume of VMs was analyzed.RESULTS Based on the MIMICS-calculated regions of interest(ROI),we found that 1 mL of ethanol reduced the lesion by 473 mm3 and that one dosage of foam(1 mL of polidocanol and 4 mL air content)reduced the lesion by 2138 mm3,demonstrating that the foam sclerosing agent exhibited greater efficacy in this study.CONCLUSIONS The MIMICS 3D volume reconstruction method can effectively and safely evaluate the efficacy of sclerotherapy and provide a preoperative evaluation.This method is simple,accurate,and feasible.