Handy locoregional flaps for nasal reconstruction

Background Skin lesions on the nose are common.Multiple surgical techniques have been used for nasal reconstruction.These options may be autogenous or alloplastic and can be performed in single or multiple stages.The choice of coverage depends on the nature of the lesion,location on the nose,and available donor sites.This study aimed to evaluate the surgical outcomes of using locoregional flaps for nasal reconstruction.Methods A total of 27 patients underwent surgery.There were 9 men and 18 women,aged 7 months to 93 years.Four patients presented with involuting hemangioma,five patients with ischemic necrosis of the columella,and five patients with congenital nevus;the remaining 13 patients were previously diagnosed with basal cell carcinoma.Six techniques have been described for nasal reconstruction at our institution from 2016 to 2020.Most patients had basal cell carcinoma(n=13).Locoregional flaps and primary sutures were used for nasal reconstruction.Results The complications were minimal.One patient had a superficial infection and one experienced postoperative bleeding.No recurrence was observed,and none of the patients asked for a second opinion.Conclusion Radical excision of tumors combined with analysis of nasal defects and nearby donor sites is essential for nasal reconstruction.The use of locoregional flaps leads to consistent and good aesthetic outcomes.

Short and long term fate of human AMSC subcutaneously injected in mice

AIM:To study the ability of human adipose-derived mesenchymal stem cells(AMSCs)to survive over the short and long term,their biodistribution and their biosafety in vivo in tumor-prone environments.METHODS:We subcutaneously injected human AMSCs from different human donors into immunodeficient SCID mice over both short-(2 and 4 mo)and long-(17 mo)term in young,and aged tumor-prone mice.Presence of human cells was studied by immunohistochemistry and polymerase chain reaction analysis in all organs of injected mice.RESULTS:Subcutaneously injected AMSCs did not form teratomas at any time point.They did not migrate but remained at the site of injection regardless of animal age,and did not fuse with host cells in any organ examined.AMSCs survived in vivo for at least 17 mo after injection,and differentiated into fibroblasts of the subdermic connective tissue and into mature adipocytes of fat tissue,exclusively at the site of injection.CONCLUSION:Our results support the assertion that AMSC may be safe candidates for therapy when injected subcutaneously because of their long term inability to form teratomas.

Effects of asthma on stability of Wisconsin card sorting test measures A twin study

BACKGROUND： The four measures used to assess the stability of the Wisconsin card sorting test （WCST）, that is, the number of preservative errors, percentage of preservative errors, number of categories completed, and the number of trials to complete the first category, reflect the function of the frontal lobe. OBJECTIVE： This study was designed to investigate the effects of asthma on the stability of WCST measurements through the use of a twin study, and to analyze whether egg-type difference exists. DESIGN： A cohort study. SETTING： Mental Health Center, the First Affiliated Hospital of Chongqing Medical University. PARTICIPANTS： Fifty-nine pairs of twins, aged 6-16 years, were primarily selected from schools between August 2005 and February 2007 and the WCST and Zygosity identification test was applied. Twins with achromatopsia, severe upper limb diseases, somatic diseases, or mental disorders were excluded. According to disease history of asthmatic attack, children were assigned into asthma （n = 16） and non-asthma （n = 43） groups. METHODS： Four WCST measurements were determined in the 59 pairs of twins, and egg-type differences were identified in conjunction. RESULTS： All 59 pairs of twins were included in the final analysis. Among the pairs of twins, 28 （48.5 %） were monozygotic twins, and 31 （52%） were dizygotic twins. Among the monozygotic and dizygotic twins, the number of preservative errors and percentage of preservative errors were significantly higher in the asthma group than in the non-asthma group （P 〈 0.05）. However, there was no significant difference of each corresponding measure between the monozygotic and dizygotic twins （P 〉 0.05）. CONCLUSION： Asthma may affect the stability of WCST measures, but egg-type differences do not exist.

Subclavian brachial plexus metastasis from breast cancer:A case report

BACKGROUND The common area of breast cancer metastases are bone,lung and liver.Brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative,which were detected by ultrasound,magnetic resonance imaging(MRI)and 18Ffluorodeoxyglucose positron emission tomography and computed tomography(FDG-PET/CT).CASE SUMMARY Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before.Ultrasound first revealed a soft lesion measuring 38 mm×37 mm which located on the right side of the clavicle to the armpit subcutaneously.The right subclavian brachial plexus(beam level)was significantly thickened,wrapped around by a hypoechoic lesion,the surrounded axillary artery and vein were pressed.MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow.FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism.These results supported brachial plexus metastasis from breast cancer.Ultrasound exam also found many lesions between pectoralis major,deltoid muscle and inner upper arm.The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology.Pathology showed large areas of tumor cells in fibroblast tissue.Immunohistochemistry showed the following results:A2-1:GATA3(+),ER(+,strong,90%),PR(+,moderate,10%),HER-2(3+),Ki67(+15%),P120(membrane+),P63(-),E-cadherin(+),CK5/6(-).These results were consistent with the primary right breast cancer characteristics,thus supporting lesion metastasis from breast cancer.CONCLUSION The brachial plexus metastasis from breast cancer is uncommon.Ultrasound has great value in detecting brachial plexus metastasis of breast cancer.It is an easy,non-invasive and affordable method.Close attention should be paid to new grown out lesions in those patients who had a history of breast cancer when doing ultrasound review.

Oral Propranolol: A Useful Treatment for Infantile Hemangioma

Background: Infantile haemangioma is the commonest childhood tumor. Several lines of treatment are available. Recent reports have focused on the value of propranolol in treating rapidly proliferating haemangioma. The aim of this study was to assess oral propranolol in treatment for facial haemangioma. Patients and Methods: Fifteen patients with rapidly proliferating infantile facial haemangioma with cosmetic disfigurement were treated with oral propranolol. All patients had cardiovascular pre-treatment work-up and commenced on oral propranolol at 3 mg/kg/day. Results: A rapid decrease in hemangioma proliferation was seen in 100% of patients and significant regressions occuring in all patients. This treatment was well tolerated and had little side effects. Conclusions: Oral propranolol is a reliable and easily reproducible method for treatment of facial hemangioma.

Assessment and management of immature facial scars by non-surgical methods

Background:Scar quality is affected by patients’wound healing conditions,trauma type,and skin features that differ due to ethnicity.Despite tremendous improvements in scar remodeling techniques,conspicuous scars can still remain postoperatively.Non-surgical methods used for handling scars include the use of topical corticosteroids,pressure therapy,lasers,and platelet-rich plasma(PRP).This study aimed to assess and evaluate different non-surgical modalities for treating immature facial scars.Methods:Fifteen patients with scars were included for non-surgical management.They received one or more of 5 treatments:corticosteroid injection,topical silicone gel application with or without bandage,pressure therapy,lasers,or PRP injection.Scars were assessed using the Patient and Observer Scar Assessment Scale(POSAS)and serial photographs.Results:There were no significant differences in the results obtained using POSAS.None of the patients required a secondary intervention or sought a second opinion.The rate of complications associated with the treatments were very minor.Conclusion:Good assessment of patient characteristics,proper planning,and appropriate treatment lead to favorable outcomes.

A multidisciplinary approach to sphincter pharyngoplasty for correction of velopharyngeal dysfunction following repair of cleft palate

Background:Management of severe velopharyngeal dysfunction is best performed by a multispecialty team.This team could include a speech-language pathologist,otolaryngologist,prosthodontist,and a plastic surgeon.The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps.In this study,a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.Methods:Twenty patients underwent sphincter pharyngoplasty.Preoperative diagnosis was performed using auditory perceptual assessment,nasoendoscopy assessment,nasometry,and videofluoroscopy.Results:There were statistically significant differences between the preoperative and postoperative assessments.Bleeding occurred in two patients.Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months,and one patient experienced slight wound dehiscence.Conclusion:Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.

Micropunch grafting for healing of refractory chronic venous leg ulcers

Background: Chronic venous ulcers are a serious problem for both patients and physicians. The CEAP classification(clinical manifestations(C), etiologic factors(E), anatomic distribution of disease(A), and underlying pathophysiologic findings(P)) for chronic venous disorders(CVD) was developed in 1994. Published papers on CVD use all or part of the CEAP. Micropunch grafts, which are a variation of skin grafts, have been used with great success in plastic surgery for both esthetic and reconstructive purposes. This study aimed to assess the outcomes of micropunch grafting in the treatment of chronic refractory venous ulcers.Methods: Patients with chronic venous ulcers who did not respond to conservative treatment for more than 6months were included in the study. All patients underwent ulcer coverage by micropunch skin grafts using a micrometer. The patients were discharged on the same day as the surgery. Micropunch skin grafts were manually counted per square centimeter intraoperatively and during follow-up using Dermlite DermatoschopeTM II Pro HR.Patient satisfaction was assessed by using a questionnaire.Results: Twenty patients underwent the surgery. Most of the patients were middle-aged males. The ulcers were predominantly small-and medium-sized. The mean operation time was 167.00 ± 86.01 min. After 6 months, the survival rate of the planted micrografts was 84%. Three ulcers had graft loss and two patients had an infection at the ulcer site, which was managed conservatively. The patients were followed-up for 14 months.Conclusion: Micropunch grafting is a useful and convenient method for the treatment of difficult venous ulcers and can be performed on an outpatient basis.

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.

Negative pressure wound therapy： An update

PurposeTo 没有滥用或 misuse.MethodsFourty 弊病，在尖锐、长期的创伤的管理得到帮助真空的闭合(休假) 的最大的利益病人们在学习被包括。在他们之中， 9 个病人有长期的创伤和剩余的 32 个病人有的尖锐创伤。在尖锐创伤， 19 个病人有 co 疾病的条件。有的 gaped 伤害的七个病人， 4 个病人有 necrotizing fasciitis， 2 个病人有住院时期从 1 ～ 6 个星期改变了的 enterocutaneous fistula.ResultsThe。后续时期直到 6 个月。没有死亡在这研究期间被记录。所有皮肤接枝显示出完全的愈合。Necrotizing fasciitis 与好结果被管理。有 enterocutaneous 管的创伤改善了。在长期的创伤，好愈合和优秀结果是 obtained.ConclusionThe 休假治疗是为有问题的尖锐、长期的创伤的管理的一个必要元素。

Establishment of a novel method for primary culture of normal human cervical keratinocytes

Background Cervical keratinocytes are recovered at a low numbers and frequently associated with contaminating human fibroblasts which rapidly overgrow the epithelial cells in culture with medium supplemented with 10% fetal bovine serum （FBS）. However, it is difficult to initiate keratinocyte cultures with serum-free keratinocyte growth medium alone because cell attachment can be poor. Therefore, the culture of these cells is extremely difficult. In this study, we described a modified culture medium and coated culture plastics for growing normal human cervical epithelial cells in vitro. Methods Normal cervical epithelial tissue pieces were obtained and digested with type I collagenase to dissociate the cells and a single cell suspension produced. The cells were cultured on plastic tissue culture substrate alone or substrate coated with collagen type I from rat tail, with modified keratinocyte serum-free medium （K-SFM） supplemented with 5% FBS. After attachment, the medium were replaced with K-SFM without FBS. The expression of basal keratins of the ectocervical epithelium, K5, K14 and K19 were assayed by immunofluorescence with monoclonal antibodies to identify the cell purity. Results Our results indicate that cells attached to the culture plastic more quickly in K-SFM supplemented with 5% FBS than in K-SFM alone, as well as to tissue culture plastic coated with collagen type I than plastic alone. The modified medium composed of K-SFM and 5% FBS combined with a specific tissue culture plastic coated with collagen type I from rat tail was the best method for culture of normal cervical epithelial cells. K5, K14 and K19 were assayed and keratinocyte purity was nearly 100%. Conclusion A novel, simple and effective method can be used to rapidly obtain highly purified keratinocytes from normal human cervical epithelium.

WNT5A drives interleukin-6-dependent epithelial-mesenchymal transition via the JAK/STAT pathway in keloid pathogenesis

Background:Keloid scarring is a fibroproliferative disease caused by aberrant genetic activation with an unclear underlying mechanism.Genetic predisposition,aberrant cellular responses to environmental factors,increased inflammatory cytokines and epithelial-mesenchymal transition(EMT)phenomena are known as major contributors.In this study,we aimed to identify the molecular drivers that initiate keloid pathogenesis.Methods:Bulk tissue RNA sequencing analyses of keloid and normal tissues along with ex vivo and in vitro tests were performed to identify the contributing genes to keloid pathogenesis.An animal model of inflammatory keloid scarring was reproduced by replication of a skin fibrosis model with intradermal bleomycin injection in C57BL/6 mice.Results:Gene set enrichment analysis revealed upregulation of Wnt family member 5A(WNT5A)expression and genes associated with EMT in keloid tissues.Consistently,human keloid tissues and the bleomycin-induced skin fibrosis animal model showed significantly increased expression ofWNT5A and EMT markers.Increased activation of the interleukin(IL)-6/Janus kinase(JAK)/signal transducer and activator of transcription(STAT)pathway and subsequent elevation of EMT markerswas also observed in keratinocytes co-cultured withWNT5A-activated fibroblasts or keloid fibroblasts.Furthermore,WNT5A silencing and the blockage of IL-6 secretion via neutralizing IL-6 antibody reversed hyperactivation of the STAT pathway and EMT markers in keratinocytes.Lastly,STAT3 silencing significantly reduced the EMT-like phenotypes in both keratinocytes and IL-6-stimulated keratinocytes.Conclusions:Intercellular communication via the WNT5A and STAT pathways possibly underlies a partial mechanism of EMT-like phenomena in keloid pathogenesis.IL-6 secreted from WNT5A-activated fibroblasts or keloid fibroblasts activates the JAK/STAT signaling pathway in adjacent keratinocytes which in turn express EMT markers.A better understanding of keloid development and the role of WNT5A in EMT will promote the development of next-generation targeted treatments for keloid scars.

A promising tool for surgical lipotransfer: a constant pressure and quantity injection device in facial fat grafting

Background: The purpose of this study was to preliminarily assess a constant pressure and quantity fat granule injection device for minimal invasive properties in clinic.Methods: A retrospective controlled study was carried out, from October 2013 to January 2015, on 76 female healthy patients aged between 26 and 53 years at the General Hospital of Lanzhou Military Command, China. To achieve small volume, high thrust, and precision requirements of facial fat grafting, an integrated handheld controller and motor design was adopted, reducing the volume and weight of the fat transplantation injection device. The 76 patients underwent 90 procedures each side of the face;each patient was treated with the aforementioned device on the face's left side, while a conventional hand-push injection device was used on the right side as control. The outcome was assessed on pre- and postoperative images, with 6-24 months follow-up.Results: The current device consistently allowed deposition of fat threads at about 55 μL/cm after cannula withdrawal;the volume of fat injected could be precisely adjusted to 0.04 mL/s. This device had the advantages of small-volume injection and convenient operation. The patients exhibited a good, stable shape and a smooth contour line in both sides. The long term satisfaction was higher for the left side than for the right one. Nodules and unevenness occurred only on the right side. Ecchymosis occurred significantly less frequent on the left side than the right one. Intraoperative pain was significantly lower for the left side than the right one.Conclusions: This device offered superior control compared with the conventional one and constitutes a promising tool for surgeons practicing lipotransfer.

Treatment of severe burn injury of 98%TBSA with 95% full-thickness burn and severe inhalation injury:a case report

The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.

Guidelines for burn rehabilitation in China

Quality of life and functional recovery after burn injury is the final goal of burn care,especially as most of burn patients survive the injury due to advanced medical science.However,dysfunction,disfigurement,contractures,psychological problems and other discomforts due to burns and the consequent scars are common,and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients.This guideline,organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment,which is suitable for the current medical circumstances of China.It can be used as the start of the tools for burn rehabilitation.

Endothelial progenitor cells and burn injury–exploring the relationship

Burn wounds result in varying degrees of soft tissue damage that are typically graded clinically.Recently a key participant in neovascularization,the endothelial progenitor cel,has been the subject of intense cardiovascular research to explore whether it can serve as a biomarker for vascular injury.In this review,we examine the identity of the endothelial progenitor cell as well as the evidence that support its role as a key responder after burn insult.While there is conflicting evidence with regards to the delta of endothelial progenitor cell mobilization and burn severity,it is clear that they play an important role in wound healing.Systematic and controlled studies are needed to clarify this relationship,and whether this population can serve as a biomarker for burn severity.

Projection capacity assessment of hyaluronic acid fillers

Aim: Hyaluronic acid (HA) is considered as the gold standard biomaterial for facial soft tissue correction. Over the last 8 years, there has been a strong demand from physicians for HA products with high projection capacity to restore facial volume loss at the level of the cheeks, cheekbones, chin, temples and jawlines. The projection capacity is thus an essential property for HA fillers especially for the products dedicated to the restoration of the volume of the face. Methods: ln this publication, a new skin model assay for evaluating the projection capacity of HA fillers is presented, applied and discussed. Results: This skin model assay enables to efficiently assess the projection capacity of a HA filler product. The comparative evaluation of a product benefiting from the novel OXlFREE technology and Juvéderm Voluma shows a higher projection capacity for the OXlFREE product than for Juvéderm Voluma. Conclusion: This assay is demonstrated to be a key tool to guide physicians in the selection of products with high ability of tissue projection to optimize their aesthetic outcomes when they need to create facial volume.