Introduction to office-based procedures in facial plastic&reconstructive surgery

In-office interventions are becoming increasingly desired by patients,secondary to the decreased cost and downtime when compared to procedures performed in the operating theater.This is particularly evident in Facial Plastic&Reconstructive Surgery(FPRS),where facility and anesthesia fees can make nonfunctional procedures costprohibitive.This special issue aims to inform readers on how to best equip their office to safely and effectively offer these services,while providing an overview of the types of procedures that can be wellsuited for the office-based setting.

Complement components of nerve regeneration conditioned fluid influence the microenvironment of nerve regeneration

Nerve regeneration conditioned fluid is secreted by nerve stumps inside a nerve regeneration chamber.A better understanding of the proteinogram of nerve regeneration conditioned fluid can provide evidence for studying the role of the microenvironment in peripheral nerve regeneration.In this study,we used cylindrical silicone tubes as the nerve regeneration chamber model for the repair of injured rat sciatic nerve.Isobaric tags for relative and absolute quantitation proteomics technology and western blot analysis confirmed that there were more than 10 complement components（complement factor I,C1q-A,C1q-B,C2,C3,C4,C5,C7,C8β and complement factor D） in the nerve regeneration conditioned fluid and each varied at different time points.These findings suggest that all these complement components have a functional role in nerve regeneration.

Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities

Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities.Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study(5 with primary lymphedema and 12 with secondary lymphedema).All patients were treated with one course(4 weeks)of complex decongestive therapy.Changes inextracellular fluid(ECF),BMI,circumferences,and skin properties including skin stiffness(SF),percent water content(PWC),and trans-epidermal water loss(TEWL)were measured before and after treatment.Results The“elephantiasis-like”appearance of the affected limb was greatly improved after treatment.The ECF,BMI,and circumferences were significantly decreased after treatment(P<0.001)with an average ECF of 2.97±1.82 L,BMI of 1.638±2.647 kg/m^2,and circumference of 6.58±2.79 cm.The values of PWC,TEWL,and SFwere 50.5%±10.6%,18.55±10.2 g/m^2 h,and 0.161±0.176 N,respectively,before treatment and 36.05%±7%,8.3±2.07 g/m^2h,and 0.086±0.038 N,respectively,after treatment,there by showing significant decreases(P<0.05).Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.

A Prospective, Within-Patient Controlled Study to Compare the Ability of the Non Adherent Drawtex®Hydroconductive Dressing to a Transparent Polyurethane Film Dressing (Standard of Care) on the Healing of Split-Thickness Skin Graft Donor Sites

Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex? dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively;p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex? is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.

Efficacy and safety of CM310 in moderate-to-severe atopic dermatitis:A multicenter,randomized,double-blind,placebo-controlled phase 2b trial

Background:Atopic dermatitis(AD)affects approximately 10%of adults worldwide.CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling.This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods:This multicenter,randomized,double-blind,placebo-controlled,phase 2b trial was conducted in 21 medical institutions in China from February to November 2021.Totally 120 eligible patients were enrolled and randomized(1:1:1)to receive subcutaneous injections of 300 mg CM310,150 mg CM310,or placebo every 2 weeks for 16 weeks,followed by an 8-week follow-up period.The primary endpoint was the proportion of patients achieving≥75%improvement in the Eczema Area and Severity Index(EASI-75)score from baseline at week 16.Safety and pharmacodynamics were also studied.Results:At week 16,the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups(70%[28/40]for high-dose and 65%[26/40]for low-dose)than that in the placebo group(20%[8/40]).The differences in EASI-75 response rate were 50%(high vs.placebo,95%CI 31%-69%)and 45%(low vs.placebo,95%CI 26%-64%),with both P values<0.0001.CM310 at both doses also significantly improved the EASI score,Investigator’s Global Assessment score,daily peak pruritus Numerical Rating Scale,AD-affected body surface area,and Dermatology Life Quality Index compared with placebo.CM310 treatment reduced levels of thymus and activation-regulated chemokine,total immunoglobulin E,lactate dehydrogenase,and blood eosinophils.The incidence of treatment-emergent adverse events(TEAEs)was similar among all three groups,with the most common TEAEs reported being upper respiratory tract infection,atopic dermatitis,hyperlipidemia,and hyperuricemia.No severe adverse events were deemed to be attributed to CM310.Conclusion:CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration:ClinicalTrials.gov,NCT04805411.

Using injectable fillers for chin and jawline rejuvenation

Objective:As the population ages,facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging.In the mandibular region,skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection.While surgical procedures,including chin implantation,may be performed,nonsurgical procedures are becoming increasingly popular due to their temporary,noninvasive,yet effective methods.This review covers the use of hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate in the jawline.Methods:PubMed was searched for data on the mechanism of action,pertinent anatomy,indications,contraindications,technique,and evidence supporting the safety and efficacy of the fillers.Results:There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods.While the advantages of injectable fillers include relatively affordable cost,minimal patient discomfort,and limited recovery times,taking measures to prevent short-and long-term complications is necessary for optimal results.Conclusions:Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.

Visual Clues for the Histopathologic Diagnosis of Psoriasis:A Retrospective Case-Control Study

Objective:The histopathologic diagnosis of psoriasis remains challenging.This study aimed to uncover clues for the histopathologic diagnosis of psoriasis in patients whose lesions required differentiation from other inflammatory skin disorders.Methods:A retrospective analysis was conducted between psoriasis biopsy sections and other inflammatory skin diseases sections.The psoriasis and control groups were compared regarding the pathological characteristics,including the?sign,hypogranulosis,and neutrophilic infiltration or pustules within the epidermis.We also summarized the clinical information and the classic and non-classic histologic features of psoriasis.Comparisons between psoriasis and control groups were performed using the c-square test.Results:Biopsy sections from 190 patients were analyzed.Of these patients,100 had a confirmed clinicopathological diagnosis of psoriasis,while 90 were diagnosed with an inflammatory skin disorder other than psoriasis(control group).The classic histologic features included the mound of parakeratosis(68.0%),confluent parakera tosis(42.0%),hypogranulosis(86.0%),regular psoriasiform hyperplasia(79.0%),Munro microabscess(85.0%),spongiform pustule of Kogoj(43.0%),suprapapillary plate thinning(87.0%),and dermal papilla capillary ectasia(98.0%).The?sign was present in 79.0%and 21.1%,respectively,of the lesional biopsy samples from the psoriasis and control groups(P<0.001).The combination of the?sign and neutrophil infiltration in the upper epidermis was present in 74.0%and 10.0%,respectively,of the lesional biopsy samples from the psoriasis and control groups(P<0.001).The combination of these 2 features had a sensitivity of 0.89 and specificity of 0.76 in distinguishing between the psoriasis and control groups.Conclusion:The?sign is a useful visual clue for the histopathologic diagnosis of psoriasis.However,for some inflammatory skin disorders that are very similar to psoriasis,such as pityriasis rubra pilaris,the combination of the?sign and neutrophil infiltration in the upper epidermis is needed to distinguish the condition from psoriasis.

Luteolin suppresses oral carcinoma 3(OC3) cell growth and migration via modulating polo-like kinase 1(PLK1) expression and cellular energy metabolism

Oral squamous cell carcinoma(OSCC)is a prevalent malignant tumor affecting the head and neck region(Leemans et al.,2018).It is often diagnosed at a later stage,leading to a poor prognosis(Muzaffar et al.,2021;Li et al.,2023).Despite advances in OSCC treatment,the overall 5-year survival rate of OSCC patients remains alarmingly low,falling below 50%(Jehn et al.,2019;Johnson et al.,2020).According to statistics,only 50%of patients with oral cancer can be treated with surgery.Once discovered,it is more frequently at an advanced stage.In addition,owing to the aggressively invasive and metastatic characteristics of OSCC,most patients die within one year of diagnosis.Hence,the pursuit of novel therapeutic drugs and treatments to improve the response of oral cancer to medication,along with a deeper understanding of their effects.

Landscape of antitumor CD4^(+)T cells in melanoma:unraveling novel HLA class II-driven immune escape

In a recently published article in Nature,Oliveira et al.presented new insights on the relationship between the phenotype and antigen specificity of CD4^(+)tumor-infiltrating cells(TILs)in melanoma,indicating that exhausted cytotoxic CD4^(+)T cells could be directly elicited by HLA class II-restricted neoantigens.

Fibroblast growth factor(FGF)signaling in development and skeletal diseases

Fibroblast growth factors(FGF)and their receptors serve many functions in both the developing and adult organism.Humans contain 18 FGF ligands and four FGF receptors(FGFR).FGF ligands are polypeptide growth factors that regulate several developmental processes including cellular proliferation,differentiation,and migration,morphogenesis,and patterning.FGF-FGFR signaling is also critical to the developing axial and craniofacial skeleton.In particular,the signaling cascade has been implicated in intramembranous ossification of cranial bones as well as cranial suture homeostasis.In the adult,FGFs and FGFRs are crucial for tissue repair.FGF signaling generally follows one of three transduction pathways:RAS/MAP kinase,PI3/AKT,or PLCg.Each pathway likely regulates specific cellular behaviors.Inappropriate expression of FGF and improper activation of FGFRs are associated with various pathologic conditions,unregulated cell growth,and tumorigenesis.Additionally,aberrant signaling has been implicated in many skeletal abnormalities including achondroplasia and craniosynostosis.The biology and mechanisms of the FGF family have been the subject of significant research over the past 30 years.Recently,work has focused on the therapeutic targeting and potential of FGF ligands and their associated receptors.The majority of FGF-related therapy is aimed at age-related disorders.Increased understanding of FGF signaling and biology may reveal additional therapeutic roles,both in utero and postnatally.This review discusses the role of FGF signaling in general physiologic and pathologic embryogenesis and further explores it within the context of skeletal development.

Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons.Innovations in wound care,soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries.In this review,the principles of reconstruction of complex lower extremity traumatic wounds are outlined.These principles include appropriate initial evaluation of the patient and mangled extremity,as well as appropriate patient selection for limb salvage.The authors emphasize proper planning for reconstruction,timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option.The role of different reconstructive and wound care modalities is discussed,notably negative pressure wound therapy and dermal substitutes.The role of pedicled flaps and microvascular free-tissue transfer are discussed,as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium.Finally,the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds.Upon completion of this review,the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

Aesthetic reconstruction of the severely disfigured burned face:a creative strategy for a"natural"appearance using pre-patterned autogenous free flaps

The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. The"keystone"of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the"piece of a puzzle"into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative"sculpting"is employed both"in situ"at the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author's approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as the"palette"upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a"natural"facial appearance while preserving fluid motions of facial expression.

Serum zinc levels and multiple health outcomes: Implications for zinc-based biomaterials

Background:Zinc-based biomaterials,including biodegradable metal,nanoparticles,and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations.The impact of serum zinc concentrations on major health outcomes can provide insights for device design and clinical transformation of zinc-based biomaterials.Methods:This nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey(NHANES,2011-2014)including 3607 participants.Using unadjusted and multivariate-adjusted logistic regression analyses,two-piecewise linear regression model with a smoothing function and threshold level analysis,we evaluated the associations between elevated serum zinc levels and major health outcomes.Results:Elevated serum zinc levels were significantly associated with an increase in total spine and total femur bone mineral density(BMD).Every 10μg/dL increase was associated with a 1.12-fold increase in diabetes mellitus(DM)and 1.23-fold and 1.29-fold increase in cardiovascular diseases(CVD)and coronary heart disease(CHD),in participants with serum zinc levels≥100μg/dL.It had no significant linear or nonlinear associations with risk of fractures,congestive heart failure,heart attack,thyroid disease,arthritis,osteoarthritis,rheumatoid arthritis,dyslipidemia and cancer.Conclusion:Serum zinc levels are significantly associated with increased BMD in the total spine and total femur,and risk of DM,and CVD/CHD among participants with serum zinc levels≥100μg/dL.

Sustained high level transgene expression in mammalian cells mediated by the optimized piggyBac transposon system

Sustained,high level transgene expression in mammalian cells is desired in many cases for studying gene functions.Traditionally,stable transgene expression has been accomplished by using retroviral or lentiviral vectors.However,such viral vector-mediated transgene expression is often at low levels and can be reduced over time due to low copy numbers and/or chromatin remodeling repression.The piggyBac transposon has emerged as a promising nonviral vector system for efficient gene transfer into mammalian cells.Despite its inherent advantages over lentiviral and retroviral systems,piggyBac system has not been widely used,at least in part due to their limited manipulation flexibilities.Here,we seek to optimize piggyBac-mediated transgene expression and generate a more efficient,user-friendly piggyBac system.By engineering a panel of versatile piggyBac vectors and constructing recombinant adenoviruses expressing piggyBac transposase(PBase),we demonstrate that adenovirusmediated PBase expression significantly enhances the integration efficiency and expression level of transgenes in mesenchymal stem cells and osteosarcoma cells,compared to that obtained from co-transfection of the CMV-PBase plasmid.We further determine the drug selection timeline to achieve optimal stable transgene expression.Moreover,we demonstrate that the transgene copy number of piggyBac-mediated integration is approximately 10 times higher than that mediated by retroviral vectors.Using the engineered tandem expression vector,we show that three transgenes can be simultaneously expressed in a single vector with high efficiency.Thus,these results strongly suggest that the optimized piggyBac system is a valuable tool for making stable cell lines with sustained,high transgene expression.

Molecular basis of cranial suture biology and disease:Osteoblastic and osteoclastic perspectives

The normal growth and development of the skull is a tightly regulated process that occurs along the osteogenic interfaces of the cranial sutures.Here,the borders of the calvarial bones and neighboring tissues above and below,function as a complex.Through coordinated remodeling efforts of bone deposition and resorption,the cranial sutures maintain a state of patency from infancy through early adulthood as the skull continues to grow and accommodate the developing brain’s demands for expansion.However,when this delicate balance is disturbed,a number of pathologic conditions ensue;and if left uncorrected,may result in visual and neurocognitive impairments.A prime example includes craniosynostosis,or premature fusion of one or more cranial and/or facial suture(s).At the present time,the only therapeutic measure for craniosynostosis is surgical correction by cranial vault reconstruction.However,elegant studies performed over the past decade have identified several genes critical for the maintenance of suture patency and induction of suture fusion.Such deeper understandings of the pathogenesis and molecular mechanisms that regulate suture biology may provide necessary insights toward the development of non-surgical therapeutic alternatives for patients with cranial suture defects.In this review,we discuss the intricate cellular and molecular interplay that exists within the suture among its three major components:dura mater,osteoblastic related molecular pathways and osteoclastic related molecular pathways.

Lymph node metastasis from non-melanoma skin cancer

The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.

An updated diced cartilage fascia technique for dorsal augmentation in rhinoplasty

The aim of this paper is to discuss an updated technique for dorsal augmentation during rhinoplasty using diced cartilage wrapped in fascia. The usage of diced cartilage has been variously described in the literature with consistently satisfactory results. Herein, we present our experience with patients undergoing dorsal augmentation during rhinoplasty using an updated method of diced cartilage wrapped in fascia. Diced cartilage fascia techniques have become the technique of choice for dorsal augmentation for an ever-increasing number of rhinoplasty surgeons. The term is broadly descriptive and there remains a wide-range of ways to execute. Updating and enhancing the technique with greater attention to precision, and creating an aesthetically optimal and predictable result, may result in even improved outcomes for future patients.

Nanofibrillar collagen scaffolds for lymphedema treatment:current applications and future directions

Aim:Biosynthetic scaffolds represent cutting-edge therapeutic efforts for secondary lymphedema.In particular,nanofibrillar collagen scaffolds have shown efficacy in both preclinical and clinical contexts,and there has been growing interest in these scaffolds in recent years.This study systematically reviewed the current literature on nanofibrillar collagen scaffolds for lymphedema treatment to synthesize findings and highlight areas for further research.Methods:This was a systematic scoping review of the literature on nanofibrillar collagen scaffolds for lymphedema treatment.Results:Upon review of the literature,32 relevant articles were identified,of which seven articles specifically investigating nanofibrillar collagen scaffolds were selected for inclusion.Of these articles,three investigated scaffold placement in small or large animal models,while four were clinical investigations ranging from case reports to retrospective cohort studies.Across all studies,scaffold implantation was associated with significant improvement in lymphedema symptoms compared to untreated controls,especially when used in combination with physiologic microsurgical procedures such as vascularized lymph node transfer.However,even when used alone or in combination with lymph node fragments,subcutaneous placement of these scaffolds improved lymphedema symptoms.Additionally,in a rodent model of lymphedema,scaffold placement at the time of lymph node harvest forestalled the development of lymphedema,highlighting the preventative capacity of these scaffolds as well.Conclusion:Nanofibrillar collagen scaffolds have been demonstrated to effectively treat and/or prevent secondary lymphedema in both preclinical and clinical investigations.Ultimately,these scaffolds represent a promising intersection of tissue engineering and lymphedema therapy,and further clinical investigation is warranted.

Current applications of propeller flaps in reconstruction of trunk wounds

Aim: Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available. Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included 'trunk wound propeller flap', 'trunk propeller flap', and 'freestyle trunk wound flap'. Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps. Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%). Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results.

Post-traumatic lymphedema:review of the literature and surgical treatment options

Post-traumatic lymphedema(PTL)is a complex,debilitating,and potentially common disease which has received limited attention to date.The available literature is reviewed to identify injury patterns and critical lymphatic areas associated with the disease.A deeper understanding of these critical anatomic regions allows the reconstructive surgeon to potentially identify PTL patients earlier in order to apply surgical and nonsurgical interventions in the acute phase,improving lymphatic physiology and,ultimately,patient outcomes.Current diagnostic and treatment approaches are discussed in detail,with a focus on lymphatic microsurgical techniques developed and applied to PTL within the last decade.