Midface Rejuvenation With Autologous Fat Grafting.

BACKGROUND: Midface rejuvenation is important to restore a youthful and appealing appearance. However, there are several problems existed in the treatment of fat grafting, including low fat retention and undesired aesthetic outcomes. OBJECTIVE: To objectively evaluate the efficacy of midface fat grafting, and analyze the problems encountered in this process to increase patient satisfaction. METHODS: Thirty-two patients who underwent autologous fat grafting for midface augmentation were included. Facial analysis was performed based on preoperative and postoperative photographs. Satisfaction outcome was assessed by the patient, the surgeon, and a layperson postoperatively. RESULTS: After treatment, 87.5% of the patients were assessed as satisfactory and mostly satisfactory based on facial proportion and complications. The postoperative medial cheek projection was 1.92±0.26 times the height of the preoperative one ( P <0.01). A smooth lid-cheek junction, a single convex, and ameliorated nasolabial groove were obtained. The dark coloration and wrinkles in lower eyelid were improved. The most common complication was overcorrection, which could be resolved with further treatments. CONCLUSIONS: Autologous fat grafting remains an optimal option for midface rejuvenation with satisfactory results. Most of the complications are preventable and optimal outcomes can be obtained through correct comprehension of aesthetic features and proper operations.

Experimental Study on the Biological Outcome of Auricular Cartilage and Costal Cartilage at Different Time Periods After Autologous Cartilage Rhinoplasty.

Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty.

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Analysis of Factors Affecting Postoperative Drainage After Comprehensive Rhinoplasty.

This study aimed to explore and analyze the factors influencing the drainage volume after comprehensive rhinoplasty. The clinical data of 102 patients who underwent comprehensive rhinoplasty at Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to August 2021 were retrospectively analyzed. The effects of age, sex, body mass index, whether an osteotomy was performed, and whether a nasal septum flap was obtained on the indwelling time of the drainage tube after the operation were analyzed by single factor analysis and multiple logistic regression analysis. Age, body mass index, whether it was a primary rhinoplasty, whether an osteotomy was performed, and whether a nasal septum flap was obtained were the influencing factors for drainage time after augmentation rhinoplasty ( P <0.05). Sex had little effect on the drainage time after comprehensive rhinoplasty ( P >0.05). Body mass index, whether an osteotomy was performed and whether a nasal septum flap was obtained were the independent influencing factors for the postoperative drainage time ( P <0.05). For patients with multiple independent influencing factors, individualized management during the perioperative period should be promoted, and reasonable treatment strategies should be formulated, so as to reduce the indwelling time of the drainage tube after the operation.

Eyelid Lymphatics: An Anatomical Study by Microdissection.

OBJECTIVE: To obtain further understanding of the eyelid lymphatic anatomy. METHOD: Thirty-two halves of eyelids from 16 fresh fetus cadavers were studied by microdissection using a mixture of 3% Prussian blue and chloroform to visualize the lymphatic vessels. RESULTS: Three layers of lymphatic plexuses were demonstrated in the eyelids: a superficial or preorbicularis muscle plexus; a pretarsal or postorbicular muscle plexus; and a deep or posttarsal plexus. Furthermore, communicating branches among these plexuses were also spotted. CONCLUSIONS: The study results demonstrated the topographic distribution of the eyelid lymphatic vessels and confirmed the existence of communicating branches. This discovery will be conducive to understanding the route and mechanism by which inflammation of the eyelid spreads and cancer disseminates. It also provides anatomical insights to apply during eyelid surgery with regard to the prevention of possible eyelid lymphatic injury.

Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer-Related Lymphedema.

BACKGROUND: Magnetic resonance lymphangiography (MRL) has been proven to be able to visualize pathological lymphatic networks and accompanying complications through subcutaneous injection of commonly used contrast agents. However, no comprehensive prior studies have previously been reported regarding MRL for the evaluation of upper extremity lymphedema in patients with breast cancer-related lymphedema (BCRL). In this study, we establish a novel MRL protocol to characterize the normal and abnormal characteristics of different clinical stages of BCRL in patients using high-spatial-resolution MRL. METHODS: Fifty females with unilateral upper extremity BCRL underwent MRL. Lymphatic vessel morphology in normal and affected limbs was compared. The appearance, distribution pattern, morphologic characteristics, and maximum transversal diameter of the lymphatic vessels, dermal backflow, and regeneration of lymphatic vessels were analyzed. RESULTS: Lymph fluid was retained in the subcutis of the affected limbs, and no edema was observed in the subfascial compartment. In stage 1, tortuous and dilated lymphatic vessels exhibited a beaded appearance, and their diameters were larger than those in the contralateral forearm (P < 0.05). In stage 2, the dilated lymphatic vessels exhibited larger diameters. "Dermal backflow" and tiny regenerated lymphatic vessels appeared. The thickened subcutaneous tissue showed a honeycomb pattern induced by soft tissue fibrosis and adipose hypertrophy. In stage 3, disordered and unrecognizable affected lymphatic vessels were observed with many small regenerated lymphatics and confluent dermal backflow; the tissue fibrosis was more serious. CONCLUSIONS: Each stage presents different characteristics, and the deformity degree of the lymphatic network is consistent with the severity of the disease. Magnetic resonance lymphangiography could provide adequate information for clinical staging in patients with BCRL.

Emulsified Fat Grafting Accelerates Tissue Expansion: An Experimental Study in a Rat Model.

INTRODUCTION: Tissue expansion has been applied in tissue repair and reconstruction of large soft tissue defects. Stromal vascular fraction (SVF) transplantation is a promising treatment in raising expansion efficiency. However, the clinical utilization of SVF is limited because of its conventional collagenase-based production. The aim of this study was to evaluate the effect of emulsified fat (EF), SVF obtained by using mechanical method, on accelerating tissue expansion. MATERIALS AND METHODS: The microstructure of EF fragments and the proportion of mesenchymal stem cells (MSCs; CD45-/CD34+) in EF were detected. Wistar rats were divided into the following 3 groups randomly: the 1-mL EF group, the 0.5-mL EF group, and the control group. The tissue expansion was carried out twice a week to maintain the capsule pressure at 60 mm Hg. After 4 weeks, inflation volume and histological changes, which includes collagen content, cell proliferation, and capillary density, were observed to evaluate the effect of EF on tissue expansion. RESULTS: Mechanical emulsification effectively destroyed the mature adipocytes in adipose tissue. The proportion of MSCs population in the EF fragments was 12.40 ± 0.86%. After expansion, the inflation volume and the levels of collagen deposition, cell proliferation, and capillary density of the expanded tissue in the 1-mL EF group were significantly higher than that in the 0.5-mL EF group and the control group (P < 0.05). However, all these regenerative indicators in the 0.5-mL EF group showed no statistical difference from the control group (P > 0.05). The thickness of epidermal and dermal layers showed no significant difference among the 3 groups (P > 0.05). CONCLUSIONS: Our findings suggested that EF grafting can be used as a new alternative to increase tissue expansion efficiency.

An Anatomical Murine Model of Heterotopic Periorbital Subunit Transplantation.

BACKGROUND: Conventional reconstructive methods fail to achieve satisfactory results in total eyelid defect cases. Vascularized composite tissue allotransplantation might provide both good appearance and function for these patients. The structure of the eyelid is exceptional because it simultaneously consists of skin, connective tissue, the striated muscle, fiber structure, aponeuroses, and mucosa. Thus, before clinical application of eyelid allotransplantation, more experiments are needed to clarify the impact of ischemia, immunal suppressive agents, and deinnervation effects on these sophisticated structures. We developed an heterotopic periorbital transplantation model in rats to facilitate further experiment in this field. METHODS: Twenty-five inbred male Lewis rats were used for anatomy study (n=10), and as donors or recipients of the operations (n=10). In the anatomy study, the vascular distribution and innervation to the periorbital unit was identified and recorded. Then, according to the anatomy study, 10 heterotopic transplantations and 2 transplantations with pedicle ligated were performed. The posterior facial vein and the external carotid artery are selected as the graft pedicle. All transplanted eyelids were assessed daily. Micro-CT scanning and hematoxylin and eosin staining of the grafts were performed 60 days after the operation. RESULTS: All recipients tolerated the operation well. All grafts without pedicles ligated survived and new hair growth was observed. All of the transplanted eyelids were pink and pliable during the entire observation period, and we did not observe any signs of arterial or venous occlusion. In the recipients with graft pedicle ligated, the grafts were necrosed and mummified within 4 to 5 days. MicroCT of the survived grafts showed good blood supply and histologic staining revealed normal histologic morphologies. CONCLUSIONS: Our study proved the anatomical feasibility of periorbital transplantation by establishing a heterotopic transplantation model, which might facilitate future eyelid allotransplantation-related experiments.

Rat model of heterotopic toe allotransplantation.

BACKGROUND: Finger allotransplantation is a promising treatment for severe finger destruction. However, more research is required to decrease the risks of this procedure to a level at which the clinical use of this non-life-saving procedure is justified. A proper animal model is essential for the required experiments. METHODS: In this article, we established a toe transplantation model based on anatomic studies. A tapered dose of Cyclosporine A (CsA) was used as an immunosuppressive therapy in the Brown Norway-to-Lewis allotransplantation experimental group, whereas isotransplantation or allotransplantation without treatment or with ligated pedicles was performed on the control groups. Recipients were assessed daily after operation for any signs of rejection and complications. On postoperative day 90, skin graft test was used to test the level of donor-specific tolerance in the recipients. On postoperative day 120, x-rays and micro-computed tomographies were performed for bone morphology evaluation. The chimerism in the recipient peripheral blood, lymph node, spleen, and thymus was tested by flow cytometry and immunohistochemical staining. And histologic study of the toe grafts and skin grafts were carried out. RESULTS: The blood supply of the toe graft was confirmed, and accordingly, transplantations were performed. The isografts survived indefinitely. The allografts with ligated pedicles experienced necrosis within 5 d. The allografts without treatment exhibited necrosis within 14 d. Forty percent, 20%, and 40% of the allografts associated with the CsA treatment experienced severe rejection, mild rejection, and nonrejection, according to gross graft appearance, respectively. Skin grafting tests showed three different types of results. X-rays and micro-computed tomographies reveal nearly normal bone morphologies in the bone structures of all surviving animals with grafts. Low levels of donor-specific chimerism were detected in the peripheral blood samples. Spleen, lymph node, and thymus chimerism were also confirmed in the long-term surviving animals with allografts. Histologic evaluation of the long-term survivals revealed similar graft morphologies in the isografts and the nonrejected allografts, inflammatory cell infiltration in the mildly rejected allografts, and degraded cutaneous appendages in the severely rejected allografts. CONCLUSIONS: We established a toe allotransplantation model. Moreover, the low rate of chimerism did not introduce specific tolerance, which might explain the high rejection rate. This model might facilitate future research in finger allotransplantation.

Mechanical stretch upregulates SDF-1α in skin tissue and induces migration of circulating bone marrow-derived stem cells into the expanded skin.

BACKGROUND: Skin and soft tissue expansion is a procedure that stimulates skin regeneration by applying continuous mechanical stretching of normal donor skin for reconstruction purposes. We have reported that topical transplantation of bone marrow-derived mesenchymal stem cells (MSCs) can accelerate mechanical stretch induced skin regeneration. However, it is unclear how circulating MSCs respond to mechanical stretch in skin tissue. METHODS: MSCs from luciferase-Tg Lewis rats were transplanted into a rat tissue expansion model and tracked in vivo by luminescence imaging. Expression levels of chemokines including macrophage inflammatory protein-1α, thymus and activation-regulated chemokine, secondary lymphoid tissue chemokine, cutaneous T-cell attracting chemokine, and stromal-derived factor-1α (SDF-1α) were elevated in mechanically stretched tissues, as were their related chemokine receptors in MSCs. Chemotactic assays were conducted in vitro and in vivo to assess the impact of chemokine expression on MSC migration. RESULTS: MSC migration was observed in mechanically stretched skin. Mechanical stretching induced temporal upregulation of chemokine expression. Among all the tested chemokines, SDF-1α showed the most significant increase in stretched skin, suggesting a strong connection to migration of MSCs. The in vitro chemotactic assay showed that conditioned medium from mechanically stretched cells induced MSC migration, which could be blocked with the CXCR4 antagonist AMD3100, as effectively as medium containing 50 ng/ml rat recombinant SDF-1α. Results from in vivo study also showed that MSC migration to mechanically stretched skin was significantly blocked by AMD3100. Moreover, migrating MSCs expressed differentiation markers, suggesting a contribution of MSCs to skin regeneration through differentiation. CONCLUSION: Mechanical stretching can upregulate SDF-1α in skin and recruit circulating MSCs through the SDF-1α/CXCR4 pathway.

Adipose tissue-derived stem cells (ADSCs) transplantation promotes regeneration of expanded skin using a tissue expansion model.

Transplantation of adipose tissue-derived stem cells (ADSCs) is a promising method that has been used in regenerative medicine because it has shown the capacity to accelerate wound healing. However, roles of ADSCs transplantation in expanded-skin regeneration have remained unknown. To clarify the roles, a tissue expansion model was used in this study. The study comprised three groups of 13 rats in each group: the ADSCs group, the fibroblast (FB) group, and the control group. The skin regeneration in the ADSCs group was enhanced, as evidenced by increased cell proliferation and a higher hydroxyproline content and degree of neovascularization, all with p < 0.05, when compared with both the FB group and the control group. Consistent with enhanced cell proliferation and neovascularization, the regenerated skin in the ADSCs group was much thicker, which further reduced the retraction ratio of the expanded skin. Four weeks after operation, 5'-bromo-2'-deoxyuridine-labeled ADSCs appeared in subcutaneous tissue, vascular vessels, and hair follicles. The up-regulation of protein expression, such as epidermal growth factor and vascular endothelial growth factor, primarily emerged in the ADSC group, with the up-regulated basic fibroblast growth factor appearing in the FB group. Collectively, these results suggest that the transplantation of ADSCs could enhance the regeneration of expanded skin by participating in skin structures and up-regulating the secretion of epidermal growth factor and vascular endothelial growth factor.

Buttock Augmentation with Fat Grafting.

Refined buttock augmentation with fat grafting in Chinese women during the past decade is introduced. The ideal buttock contouring outcome and figure silhouette come from the proper individualized plan and meticulous maneuvers through fat grafting to the buttocks combined with liposuction procedures on the surrounding areas of the buttocks as well as on the other body parts. The fat grafts are collected, filtered, and condensed by gravitation in a sterilized canister during liposuction. It is recommended that fat grafts were only transplanted into the subcutaneous layers and with no injection into the musculatures of the buttocks. High patients' satisfaction was obtained with no major complications and fewer minor complications.

Long-term volume retention after fat processing with cotton gauze rolling and centrifugation: A comparative study in nude mice.

BACKGROUND: Autologous fat grafting for correcting soft-tissue defects in cosmetic and reconstructive procedures has grown in popularity. Fat processing is implicated as a variable affecting quality, viability, and subsequent graft retention. This study aimed to identify a better fat processing technique for optimal outcomes. METHODS: Fresh human aspirated fat was processed with cotton gauze rolling or centrifugation and named rolled fat (RF) and centrifuged fat (CF), respectively. Processed fat grafts were analyzed in vitro to determine yield, stromal vascular fraction (SVF) content, and viability. Then, RF and CF were transplanted subcutaneously to different flanks of every nude mouse. Fat samples were weighed to evaluate the volume retention 3 months post-transplantation. Tissue structure, densities of vessels, and CD68-positive macrophages were examined by histological staining. RESULTS: The compression rate of lipoaspirate by cotton gauze rolling was 25%, which was more effective than the rate of 50% by centrifugation. The numbers of SVF cells per gram of RF and CF were (1.02 ± 0.14) ×106 and (0.65 ± 0.26)×106, respectively (P < 0.05). Long-term graft retention was significantly higher in the RF group than in the CF group. Histological analysis of all implants revealed intact adipose tissue and equivalent vascularity. The number of CD68-positive macrophages in the RF group was much less than in the CF group on day 7. CONCLUSION: The results of this animal experiment showed that, compared with centrifugation, processing with cotton gauze rolling produces more condensed fat, higher SVF content, and decreased inflammatory response, thereby improving long-term volume retention. Further explorations are required to verify the superiority of cotton gauze rolling in clinical settings.

Enzymatic Preparation of Gentiooligosaccharides by a Thermophilic and Thermostable ß-Glucosidase at a High Substrate Concentration.

Gentiooligosaccharides (GnOS) are a kind of oligosaccharide formed by glucose with ß-1-6 glycosidic bonds, which has become a new type of functional oligosaccharide for its unique refreshing bitter taste and valuable probiotic effects. However, the research on the enzymatic preparation of GnOS is not thorough enough. In this study, a GH1 thermophilic ß-glucosidase from Thermotoga sp. KOL6 was used as a biocatalyst for the synthesis of GnOS. TsBgl1 exhibited excellent thermophilic and thermostable properties by possessing a melting temperature of 101.5 °C and reacting at 80-90 °C efficiently. Its half-life at 90 °C was approximately 5 h, suggesting its high heat resistance as well. TsBgl1 also showed excellent glucose tolerance with an inhibition constant (Ki) of 1720 mM and was stimulated in the presence of 0-900 mM glucose. TsBgl1 showed the highest hydrolytic activity on laminaribiose (Glc-ß-1,3-Glc), but mainly synthetized gentiobiose (Glc-ß-1,6-Glc) during transglycosylation. By optimizing the reaction conditions and substrate concentration, the highest yield of GnOS synthesized by TsBgl1 reached 144.3 g·L-1 when 1000 g·L-1 glucose was used as a substrate, which was higher than the highest yield ever reported. The thermophilic and thermostable properties of TsBgl1 were considered to be significant advantages in the industrial production of GnOS, where long periods of high-temperature reactions are required. This study was expected to provide an excellent candidate enzyme for industrial production of GnOS and also provide a reference for studying the transglycosylation of GH1 ß-glucosidases.

Histopathological and Immunohistochemical Features of Small to Big Satellite Nevus Uncover the Nevogenesis of Large/Giant Congenital Melanocytic Nevus.

The nevogenesis of large/giant congenital melanocytic nevus (lgCMN) is a complex biological process including several integral prenatal stages. Limited by ethical concerns, the debate of whether lgCMN develops from the epidermis to the dermis or in the opposite direction remains controversial. With the present study of the accompanying satellite nevi, we tend to support that lgCMN develops from epidermis to dermis. The satellite nevi were divided into 3 groups: big (diameter >10 mm), medium (>5 mm but ≤10 mm), and small (≤5 mm). Hematoxylin and eosin and immunohistochemical staining (SOX10, Ki67, and p16) were performed to compare the nevocyte infiltration depth as well as the positively stained rates among these satellite nevi. Compared to big satellite nevi, less deeply the nevocytes infiltrated the dermis, as well as more cells expressed SOX10 and Ki67 in the epidermis and fewer cells expressed p16 in the dermis of small satellite nevi. Additionally, two specimens were obtained from each of 4 patients who underwent serial resections of lgCMN at an average interval of 1.75 years to examine the histopathological changes. In the present study, satellite nevi of different sizes represent different stages of lgCMN from early to late, deepening our comprehension of the sequential stages of lgCMN nevogenesis. Initially, abnormal nevocytes seeded, proliferated, and spread along the epidermis. At rete ridges that protrude from the papillary dermis within the epidermis, some nevocytes formed nests and gradually penetrated into the dermis. Eventually, the nevocytes infiltrated the dermis and entered a homeostatic state. This study provides new evidence supporting the theory of epidermal-to-dermal nevogenesis in lgCMN.

Bone marrow-derived mesenchymal stem cells transplantation accelerates tissue expansion by promoting skin regeneration during expansion.

OBJECTIVE: To evaluate the effect of bone marrow-derived mesenchymal stem cells (BM-MSCs) transplantation on tissue expansion. BACKGROUND: Tissue expansion provides a better solution to large defect reconstruction with perfectly matched skin and without deformity at the donor site. How to promote tissue expansion and reduce complications has been a focus in this field. BM-MSCs have been found to exhibit tissue regeneration-promoting ability, but their effect on skin growth during tissue expansion has remained unclear. METHODS: BM-MSCs transplantation was performed on a rat tissue expansion model. Inflation volume, expansion time, and area were examined to determine the effect on tissue expansion. Factors related to skin regeneration were examined to evaluate BM-MSCs' role in skin regeneration during expansion. The mechanism was explored by in vivo and in vitro experiments. RESULTS: Higher inflation volume, larger expansion area, and shorter expansion time could be achieved by BM-MSCs transplantation (all P < 0.05). The skin regeneration during expansion was enhanced by BM-MSCs treatment, as evidenced by a thicker epidermis and further evidenced by increased cell proliferation, collagen synthesis, and angiogenesis. Cell tracking showed that the transplanted BM-MSCs appeared in skin structures, suggesting a direct contribution to skin regeneration. The paracrine secretion effect of BM-MSCs was also examined. The roles of epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were studied, and EGF was found to play an important role in the skin regeneration-promoting effect of BM-MSCs. CONCLUSIONS: This study shows that BM-MSCs transplantation can shorten the tissue expansion process by enhancing skin regeneration.

Transplantation of adipose stromal cells promotes neovascularization of random skin flaps.

The delivery of bone marrow-derived mononulear cells (BM-MNCs) has been proved to be effective at promoting neovascularization of ischemic skin flaps. However, the limited source of BM-MNCs restricts their clinical application. Stromal vascular fraction (SVF) contains a group of heterogeneous cells in the adipose tissue, including adipose tissue-derived stem cells, and it has abundant reserve in human body. In this study, we evaluated the therapeutic potential of SVF to promote neovascularization of random skin flaps. Female Wistar rats were randomly devided into three groups with 8 in each group and received allogeneic SVF, BM-MNCs and phosphate-buffered saline (PBS), respectively, before surgery. Two days after cell administration, a 10 × 3 cm random skin flap was elevated. Flap survival, blood flow perfusion and capillary density were examined 7 days after surgery, and the relevant mechanism was also explored. Results showed that SVF group and BM-MNCs group had higher survival percentage (72.2 ± 2.0% and 76.4 ± 3.1%, respectively) as compared with the control group (56.8 ± 4.6%, P < 0.05). Blood flow perfusion and capillary density of flap tissues in SVF and BM-MNCs groups were both improved. The expression levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were increased in flap tissues of SVF and BM-MNCs groups detected by ELISA. These results indicate that SVF could promote vascularization and increase flap survival probably by secreting VEGF and bFGF. The effect of transplantation of SVF on therapeutic angiogenesis of skin flaps is equivalent to that of BM-MNCs.

Increased levels of YKL-40 in patients with diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Diabetes mellitus (DM) could be classified as type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), gestational diabetes mellitus (GDM) and others according to etiology and pathology. Diabetic nephropathy (DN) is one of the most serious complications of DM. YKL-40 is a marker of inflammation and some studies have indicated that DM was related with inflammation. The objective of our study is to perform a systematic review and meta-analysis to confirm the relationship between YKL-40 and DM as well as DN. METHODS: Pubmed, Embase, CNKI and Chinese wanfang databases were searched for eligible studies by two independent authors. Studies were included in this meta-analysis if they fulfilled the following inclusion criteria: (1) a study involving the role of YKL-40 in DM (or DN) designed as a case-control study or cohort study; (2) the data of serum YKL-40 levels were available; (3) studies were published in English or Chinese. Finally, twenty-five studies were included in this meta-analysis. RESULTS: Compared with healthy controls, DM patients had significantly higher levels of YKL-40 (DM: SMD = 1.62, 95% CI 1.08 to 2.25, P = 0.000; GDM: SMD = 2.85, 95% CI 1.01 to 4.70, P = 0.002). Additionally, DM patients with different degree of albuminuria had significantly higher levels of YKL-40 compared with healthy controls (normoalbuminuria: SMD = 1.58, 95% CI 0.59 to 2.56, P = 0.002; microalbuminuria: SMD = 2.57, 95% CI 0.92 to 4.22, P = 0.002; macroalbuminuria: SMD = 2.69, 95% CI 1.40 to 3.98, P = 0.000) and serum YKL-40 levels increased with increasing severity of albuminuria among DM patients (microalbuminuria vs normoalbuminuria: SMD = 1.49, 95% CI 0.28 to 2.71, P = 0.016; macroalbuminuria vs microalbuminuria: SMD = 0.93, 95% CI 0.34 to 1.52, P = 0.002). CONCLUSIONS: Our current meta-analysis demonstrates that serum level of YKL-40 is increased in DM and positively associated with the severe degree of albuminuria. Therefore, we suggest that YKL-40 could be considered to be detected, along with other inflammatory markers, if DM, especially DN, is suspected.

Surgical reconstruction of massive scrotal lymphedema associated with hidradenitis suppurativa: a case report.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory cutaneous disease affecting apocrine glands. It can be associated with lymphedema of the surrounding tissues and most commonly affects scrotum. As a debilitating complication of HS, lymphedema can cause significant morbidity and further exacerbate HS condition, thus causing a vicious cycle. Surgery was reported to be the most common treatment for this complication. Here, we present a 41-year-old patient with massive scrotal lymphedema following a 2-year history of HS. To reduce the volume of the scrotal mass and improve the appearance and function of the scrotum, we modified the Charle's procedure by complete excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. We found that this approach achieved satisfactory cosmetic results, maintained cutaneous sensation and restored erections. There was no adverse event following surgery. No recurrence occurred over 6-month of follow-up. We believe that this modified Charles' procedure can improve the morphology and lymphatic function of the scrotum and recommend its use whenever possible. While rare, HS associated lymphedema should alert clinician to the potential consequence of an advanced disease situation. Collaborative approach with surgery in the management of this condition should be considered at early stage.

Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations.

BACKGROUND: Microcystic lymphatic malformations (LMs) are congenital lesions with the diameter of the majority of cysts <1 cm. Bleomycin sclerotherapy has been shown to yield beneficial results for macrocystic LMs. This study aims to evaluate the safety and efficacy of consecutive bleomycin sclerotherapy for large diffuse microcystic LMs. METHODS: The location and size of the lesions were detected by ultrasound for the 46 patients included in this study. Bleomycin lavage was performed in larger cysts and intradermal injection for the superficial lesion. The outcome and complications were assessed for its efficacy and safety. RESULTS: The large diffuse microcystic LMs mainly located in the neck, abdominal wall and axilla/lateral chest wall. The average lesion size was 10.6 cm × 7.2 cm. The mean number of treatment sessions was 4.5 with 7.3 mg bleomycin for per session averagely. Excellent (69.6%) and moderate (23.9%) responses were obtained. There was no recurrence for the 6 patients (13%) who received a long follow-up. Obvious local swelling, slight intralesional hemorrhage and low-grade fever were the most commonly occurred complications. No lung fibrosis was identified for the patients who received more than 6 sessions. CONCLUSIONS: Local lavage combined with intradermal injection of bleomycin is effective and safe for large diffuse microcystic LMs with good therapeutic effect and low complication rates, and can be regarded as the mainstay of therapy for microcystic LMs.