Rotation and transposition flaps in facial plastic and reconstructive surgery

Reconstructive defects of the human face pose unique challenges to even the most experienced surgeon given their myriad of presentations and the individuality of each patient’s anatomy,clinical presentation,and perspective or preferences.A robust armamentarium of reconstructive options must be cultivated for each facial subunit so that experience and artistry can be best utilized to rebuild the patient’s structure and function.This review will outline a subset of local rotation and transposition flaps that are most useful for facial reconstruction,organized by facial subunit.

Partial auricular reconstruction surgery for facial skin cancer

Auricular defects resulting from excision of cutaneous malignancies pose a challenge to the reconstructive surgeon due to the complex anatomy,convexities,and concavities of the ear.A surgeon must be familiar with analyzing defects of the ear and understand the variety of reconstructive options available with the goals of restoring function,re-establishing anatomic units,and achieving aesthetic balance.This review summarizes current methods for reconstruction of partial auricular defects resulting from neoplasm.A brief overview of ear anatomy and aesthetic relationships is also provided.Techniques for the reconstruction are classified by anatomic region:upper-third,middle-third,and lower-third defects.

Ginsenoside Rb1 Reduces D-GalN/LPS-induced Acute Liver Injury by Regulating TLR4/NF-κB Signaling and NLRP3 Inflammasome

Background and Aims:The effect of ginsenoside Rb1 on D-galactosamine(D-GalN)/lipopolysaccharide(LPS)-induced acute liver injury(ALI)is unknown.The aim of this study was to evaluate the effect of ginsenoside Rb1 on ALI and its underlying mechanisms.Methods:Mice were pretreated with ginsenoside Rb1 by intraperitoneal injection for 3 days before D-GalN/LPS treatment,to induce ALI.The survival rate was monitored every hour for 24 h,and serum biochemical parameters,hepatic index and histopathological analysis were evaluated to measure the degree of liver injury.ELISA was used to detect oxidative stress and inflammatory cytokines in hepatic tissue and serum.Immunohistochemistry staining,RT-PCR and western blotting were performed to evaluate the expression of toll-like receptor 4(TLR4),nuclear factorkappa B(NF-κB),and NLR family,pyrin domain-containing 3 protein(NLRP3)in liver tissue and Kupffer cells(KCs).Results:Ginsenoside Rb1 improved survival with D-GalN/LPS-induced ALI by up to 80%,significantly ameliorated the increased alanine and aspartate transaminase,restored the hepatic pathological changes and reduced the levels of oxidative stress and inflammatory cytokines altered by D-GalN/LPS.Compared to the control group,the KCs were increased in the D-GalN/LPS groups but did not increase significantly with Rb1 pretreatment.D-GalN/LPS could upregulate while Rb1 pretreatment could downregulate the expression of interleukin(IL)-1β,IL-18,NLRP3,apoptosis associated specklike protein containing CARD(ASC)and caspase-1 in isolated KCs.Furthermore,ginsenoside Rb1 inhibited activation of the TLR4/NF-κB signaling pathway and NLRP3 inflammasome induced by D-GalN/LPS administration.Conclusions:Ginsenoside Rb1 protects mice against D-GalN/LPS-induced ALI by attenuating oxidative stress and the inflammatory response through the TLR4/NF-κB signaling pathway and NLRP3 inflammasome activation.

Long non-coding RNA SAP30-2:1 is downregulated in congenital heart disease and regulates cell proliferation by targeting HAND2

Congenital heart disease(CHD)is the most common birth defect worldwide.Long non-coding RNAs(lncRNAs)have been implicated in many diseases.However,their involvement in CHD is not well understood.This study aimed to investigate the role of dysregulated lncRNAs in CHD.We used Gene Expression Omnibus data mining,bioinformatics analysis,and analysis of clinical tissue samples and observed that the novel lncRNA SAP30-2:1 with unknown function was significantly downregulated in damaged cardiac tissues from patients with CHD.Knockdown of lncRNA SAP30-2:1 inhibited the proliferation of human embryonic kidney and AC16 cells and decreased the expression of heart and neural crest derivatives expressed 2(HAND2).Moreover,lncRNA SAP30-2:1 was associated with HAND2 by RNA immunoprecipitation.Overall,these results suggest that lncRNA SAP30-2:1 may be involved in heart development through affecting cell proliferation via targeting HAND2 and may thus represent a novel therapeutic target for CHD.

The modified bilobed flap for reconstructing sacral decubitus ulcers

Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An ideal flap should be simple to design,have a reliable vascular supply and minimal donor site morbidity.Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.Case presentation:We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019.A description of our management,operative protocol,outcome and complications is outlined.Seven paraplegic patients(6 male,1 female;average age 53.1 years)with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery.The average size of the pressure ulcers was 7×5 cm(range 6.2×4.5 cm to 11×10 cm).All 7 flaps survived.The patients were followed up for 12 months without significant complications,such as flap necrosis or recurrence.Conclusions:The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap.The superior cluneal nerve can be included in the design.The technique is simple and reliable.It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.