Osteoinductive micro-nano guided bone regeneration membrane for in situ bone defect repair.

BACKGROUND: Biomaterials used in bone tissue engineering must fulfill the requirements of osteoconduction, osteoinduction, and osseointegration. However, biomaterials with good osteoconductive properties face several challenges, including inadequate vascularization, limited osteoinduction and barrier ability, as well as the potential to trigger immune and inflammatory responses. Therefore, there is an urgent need to develop guided bone regeneration membranes as a crucial component of tissue engineering strategies for repairing bone defects. METHODS: The mZIF-8/PLA membrane was prepared using electrospinning technology and simulated body fluid external mineralization method. Its ability to induce biomimetic mineralization was evaluated through TEM, EDS, XRD, FT-IR, zeta potential, and wettability techniques. The biocompatibility, osteoinduction properties, and osteo-immunomodulatory effects of the mZIF-8/PLA membrane were comprehensively evaluated by examining cell behaviors of surface-seeded BMSCs and macrophages, as well as the regulation of cellular genes and protein levels using PCR and WB. In vivo, the mZIF-8/PLA membrane's potential to promote bone regeneration and angiogenesis was assessed through Micro-CT and immunohistochemical staining. RESULTS: The mineralized deposition enhances hydrophilicity and cell compatibility of mZIF-8/PLA membrane. mZIF-8/PLA membrane promotes up-regulation of osteogenesis and angiogenesis related factors in BMSCs. Moreover, it induces the polarization of macrophages towards the M2 phenotype and modulates the local immune microenvironment. After 4-weeks of implantation, the mZIF-8/PLA membrane successfully bridges critical bone defects and almost completely repairs the defect area after 12-weeks, while significantly improving the strength and vascularization of new bone. CONCLUSIONS: The mZIF-8/PLA membrane with dual osteoconductive and immunomodulatory abilities could pave new research paths for bone tissue engineering.

Progress in the clinical treatment of keloids.

Keloid is a pathological scar that is higher than the skin surface following skin damage. Its lesion range often extends beyond the original damage boundary and does not naturally subside over time. Its pathogenesis is very complex, currently the main causes include fibroblast excessive proliferation, collagen and extracellular matrix (Extracellular matrix, ECM) excessive deposition, excessive angiogenesis, and so on. The traditional treatment method primarily involves surgical intervention, but it is associated with a high recurrence rate post-surgery. Consequently, many treatment methods are derived according to the different clinical characteristics of keloid. This paper will review the therapeutic progress in recent years from surgical treatment, physiotherapy, drug therapy, and biological therapy, with the goal of offering valuable insights for the clinical treatment of keloids.

Antioxidant biocompatible composite collagen dressing for diabetic wound healing in rat model.

Associated with persistent oxidative stress, altered inflammatory responses, poor angiogenesis and epithelization, wound healing in diabetic patients is impaired. N-acetylcysteine (NAC) is reported to resist excess reactive oxygen species (ROS) production, prompt angiogenesis and maturation of the epidermis. Studies have revealed that graphene oxide (GO) can regulate cellular behavior and form cross-links with naturally biodegradable polymers such as collagen (COL) to construct composite scaffolds. Here, we reported a COL-based implantable scaffold containing a mixture of GO capable of the sustained delivery of NAC to evaluate the wound healing in diabetic rats. The morphological, physical characteristics, biocompatibility and NAC release profile of the GO-COL-NAC (GCN) scaffold were evaluated in vitro. Wound healing studies were performed on a 20 mm dorsal full-skin defect of streptozotocin (STZ)-induced diabetic rats. The injured skin tissue was removed at the 18th day post-surgery for histological analysis and determination of glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD) activity. In diabetic rats, we confirmed that the GCN scaffold presented a beneficial effect in enhancing the wound healing process. Additionally, due to the sustained release of NAC, the scaffold may potentially induce the antioxidant defense system, upregulating the expression levels of the antioxidant enzymes in the wound tissue. The findings revealed that the antioxidant biocompatible composite collagen dressing could not only deliver NAC in situ for ROS inhibition but also promote the wound healing process. This scaffold with valuable therapy potential might enrich the approaches for surgeon in diabetic wound treatment in the future.

Dietary Intake of N-3 and N-6 Polyunsaturated Fatty Acids and Risk of Cancer: Meta-Analysis of Data from 32 Studies.

BACKGROUND: Large epidemiological studies have yielded conflicting results regarding the relationship between polyunsaturated fatty acids (PUFAs) and cancers. Here, we performed a meta-analysis to examine the link between dietary intake of n-3 and n-6 PUFAs and cancer risk. MATERIALS AND METHODS: We performed a search on PubMed, EMBASE, and the Cochrane Library. Studies that reported adjusted relative risk (RR) estimates with 95% confidence intervals (CI) for the associations of interest were included. RESULTS: Thirty-two studies involving 1,445,732 participants were included. Colorectal, breast and prostate cancer had been analyzed in our study. Specifically, for colorectal cancer, total n-3 PUFAs, marine n-3 PUFAs, α-linolenic acids (ALA) and n-6 PUFAs were not associated with the risk of it (RR 1.04, 95%CI 0.85-1.28; RR 0.99, 95%CI 0.89-1.09; RR 1.05, 95%CI 0.93-1.19; RR 1.02, 95%CI 0.94-1.11, respectively). For breast cancer, only marine n-3 PUFAs, but not total n-3 PUFAs, ALA, and n-6 PUFAs, was associated with a lower risk of it (RR 0.70, 95%CI 0.55-0.91). For prostate cancer, ALA and n-6 PUFAs also have no association with the risk of it. CONCLUSIONS: Most subtypes of PUFAs are probably not related to cancers. However, additional high-quality trials are warranted to corroborate the findings of this meta-analysis.

Treatment of Divided Eyelid Nevus With Orbicularis Oculi Myocutaneous Flap: Report of 17 Cases.

BACKGROUND: Divided eyelid nevus is a rare congenital dermatological abnormality associated with several functional and aesthetic problems. Reconstruction of periorbital defects after resection of the lesions has been an intractable challenge. Also, plastic surgeons are still in the exploration stage regarding the treatment of this disease, because the knowledge about it has only been derived from random case reports and series. OBJECTIVE: To evaluate the postoperative effect of advanced orbicularis oculi myocutaneous (OOMC) flap for the treatment of divided eyelid nevus and present our experiences using this technique in our department. METHODS: A retrospective study was performed on 17 patients who had undergone treatment of divided eyelid nevus with OOMC flap between December 2012 and January 2018. All patients were treated with advanced OOMC flap. In some cases, flap thinning surgery and/or blepharoplasty was performed in the second stage for symmetry and aesthetic purposes. RESULTS: Seventeen patients, aged between 1 and 33 years, were operated. During a follow-up period ranging from 10 to 80 months, all the flaps were viable, and no serious complications were recorded except for partial cilia loss in 6 cases. Four cases developed slightly bloated flap, but after surgical revision by performing flap thinning surgery or/and blepharoplasty in the second stage, they achieved an even better aesthetic reconstruction. Except for the above 4 cases, the other patients stated that no further revision was needed. CONCLUSIONS: The OOMC flap is an excellent method for the treatment of divided eyelid nevus, resulting in high functional and aesthetic reconstruction. In some cases, blepharoplasty can be performed in the second stage, which improves the aesthetic outcomes.

Simple Approach for Internal Fixation of Repositioned Fat Pedicles in Transconjunctival Lower Eyelid Blepharoplasty.

PURPOSE: To introduce an easy and effective approach for internal fixation of repositioned fat pedicles in transconjunctival lower eyelid blepharoplasty. METHODS: Thirty-six consecutive patients underwent fat repositioning transconjunctival lower blepharoplasty from August 2016 to January 2018. After release of the orbicularis oculi muscle and exposure of the intraorbital fat pedicles, a supraperiosteal pocket was dissected. A 6-0 nylon suture was passed through the shaft of a hypodermic needle from the sharp tip, then the hypodermic needle was pierced through the cheek skin about 5 to 8 mm below the orbital rim into the dissected pocket, the hypodermic needle was next pull out and pierced through the same pinhole but different pathways into the dissection pocket again. The hypodermic needle was curved accordingly and passed through the lower surface tissue of the pocket, the needle was then taken out. Two ends of the 6-0 nylon suture were both brought out through the transconjunctival incison. One end of the 6-0 nylon suture was sewed through the free margin of the fat pedicle and tied tightly with the other end. The fat pads were transferred and blended well with midface fat. The severity of tear trough deformity were evaluated according to Barton's grading system by two independent plastic surgeons pre and post-operatively. RESULTS: Tear trough deformity was improved in most cases. There were significant differences in preoperative and post-operative tear trough deformity grades (P < 0.5). All patients recover very well without significant complications. Three patients had transient mild to moderate lumpiness over the tear trough area, which were all resolved spontaneously eventually. One patient complained of retained fat tissue, and a revision surgery was given. CONCLUSIONS: In summary, The authors offered a new, simple, and effective approach to help fix the repositioned fat pads in transconjunctival lower lid blepharoplasty.

Superficial Muscular Aponeurotic System-Pedicled Flaps for the Reconstruction of Facial Defects: Clinical application and Anatomical Basis.

BACKGROUND: Application of distant skin flaps in facial defect reconstruction has limitations such as leaving a patch like appearance and being restricted by the length of the vascular pedicles. Leveraging the abundance of blood supply from superficial muscular aponeurotic system (SMAS), a local skin flap pedicled by SMAS can be used to avoid the aforementioned problems. Herein, we report the clinical application as well as the anatomical study of SMAS-pedicled skin flaps. METHODS: This study enrolled patients who underwent facial defect reconstruction surgery between 2013 and 2018 using SMAS-pedicled skin flaps. The flaps were designed according to the size and location of the defect. A follow-up was performed to evaluate the treatment outcomes and incidence of adverse events. In addition, six cadaveric heads were used to perform an anatomical study on the distribution and blood supply of SMAS. RESULTS: Twenty-three cases underwent the defect reconstruction surgery in the frontal regions (three cases), temporal region (four cases), periocular region (four cases), nasal region (seven cases), and other regions (five cases). All the flaps survived well. During the follow-up period up to 12 months, the flaps showed a satisfactory appearance, blood supply, and elasticity. The distribution and blood supply of SMAS at different anatomical regions have been successfully observed. Abundant vascular networks could be found in the SMAS layer. CONCLUSION: Based on the broad distribution of SMAS and the abundant blood supply, an SMAS-pedicled skin flap could be flexibly designed and versatilely used to reconstruct post-traumatic or post-excisional facial defects.

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction.

BACKGROUND: The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast reconstruction in addition to traditional donor sites. Currently, literature reporting its microsurgical safety and efficacy is relatively sparse and heterogeneous. Objective. To clarify the evidence regarding microsurgical safety and efficacy of PAP flap in breast reconstruction, which may contribute to future surgical decision-making. METHODS: Multiple databases were systematically searched by two independent reviewers. The result was statistically analyzed with Meta command of R GUI 3.5.1. The proportions with 95% confidence intervals (CIs) were calculated by using random-effect model. RESULTS: There were 12 studies including 516 PAP flaps meeting the inclusion criteria. The pooled surgical success rate was 99% (95% CI: 97%-100%) and overall rate of complications was 23% (95% CI: 18%-27%). The most common individual complication was wound dehiscence with incidence of 6% (95% CI: 4%-9%). The seroma rate was 2% (95%CI: 0%-6%). The hematoma rate was 1% (95% CI: 0%-2%). The partial necrosis rate was 2% (95% CI: 0%-5%). The rate of total flap loss was 1% (95% CI: 0%-3%). CONCLUSION: To date, this study is the first meta-analysis of microsurgical efficacy and safety evaluation of the PAP flap in breast reconstruction. This present work confirmed that the PAP flap is safe and reliable in breast reconstruction with high success rate, but a relatively low complication rate. Moreover, it might be more than an alternative to the deep inferior epigastric perforator flap (DIEP) in microsurgical breast reconstruction in selected patients.

Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.

BACKGROUND: Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. METHODS: Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. RESULTS: The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. CONCLUSIONS: The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.

[In vitro induction of human breast adipose-derived stem cells into epithelial-like cells by co-culturing].

OBJECTIVE: To explore the feasibility of the transdiferentiation of human breast adipose-derived stem cells (hbASCs) into mammary epithelial-like cells after co-culturing in Transwell in vitro. METHODS: The third passage hbASC and the HBL-100 cell line were co-cultured in a Transwell culture system for 15 days. The hbASCs were observed and identified by inverted phase contrast microscope and transmission electron microscopy, and immunocytochemistry staining in the induced and control groups. RESULTS: Both the third passage hbASCs and the HBL-100 cell line cells could adhere and grow rapidly after co-culture in the Transwell system. After co-culture for 15 days, the morphology of some induced hbASCs changed into epithelial-like cells. Some induced hbASCs showed positive expression of CK18, CK19 by immunocytochemistry staining, and typical epithelium cells with microvilli, desmosomes and tonofilaments observed under TEM. The positive rate of CK18 and CK19 was (24.4 +/- 12.0)% and (21.6 +/- 16.4)% in experimental group, and (1.8 +/- 1.7)% and (1.1 +/- 0.6)% in control group. CONCLUSION: The data suggests that hbASCs may have the potential to transdifferentiate into human mammary epithelial-like cells after co-culturing in Transwell in vitro.

[The application of expanded forehead flap in reconstructing defects around nasal tip].

OBJECTIVE: To discuss using expanded forehead flap to repair defects around nasal tip and to find a standard and rational repairing method. METHOD: Three-staged operations were adopted. The first stage is to implant expander. The second stage is to reconstruct defects around nasal tip using the expanded forehead flap with the supra trochlear vessels as its pedicle. If necessary, the autogenous cartilage was harvested from ribs and used as a nasal framework, which reestablished the projection of the tip. The third stage is to conduct the pedicle resection and repairing. RESULT: Seventeen patients who suffered from defects around nasal tip were cured using the expanded forehead flap. These flaps survived well. The appearance of nasal tips and ventilation function were very nice. CONCLUSION: The expanded forehead flap is an ideal method to reconstruct defects around nasal tip. The advantages of this method are safety, good appearance, matched colour and luster, and covert scar of donor site.

[Comparison study of clinical effect and complications between subfascial and submammary breast augmentation].

OBJECTIVE: To compare the clinical effect and complications of subfascial breast augmentation and submammary breast augmentation. METHOD: From Sept. 2009 to May 2012 , 25 patients with subfascial breast augmentation and 31 patients with submammary breast augmentation were observed. The postoperative results including visible implant edge or ripple, upper pole of the implant and long-term implant ptosis were compared respectively. The complications including hematoma, infection and capsular contraction were also recorded. RESULTS: 56 cases were followed up for 2 months to 26 months. The incidence rate of visible implant edge or ripple was 4.0% (1/25 ) in the subfascial group and 29.0% (9/31) in the submammary group, showing a significant difference between them ( PC 0.05). The incidence rate of convex upper pole of the implant was 8.0% (2/25) in the subfascial group and 35.5% (11/31) in the submammary group, showing a significant difference between them ( P < 0.05). Long-term implant ptosis was not found in the two groups. The incidence rate of hematoma was 4.0% (1/25) in the subfascial group and 6.5% (2/31) in the submammary group, infection was not found. The incidence rate of capsular contraction was 8.0% (2/25) in the subfascial group and 12.9% (4/31) in the submammary group, showing no statistical difference between them ( P > 0.05 ). CONCLUSIONS: Subfascial breast augmentation has more clinical advantages compared with submammary breast augmentation, but no evident difference was found in the common complication rate, such as capsular contraction.

[Reduction mammaplasty with central gland pedicle based on Würinger's horizontal septum].

OBJECTIVE: To investigate the method and efficacy of reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum in the treatment of female breast hypertrophy. METHODS: From Mar. 2009 to Sept. 2011, a series of 21 consecutive patients with mild and moderate hypermastia underwent reduction mammaplasty with central gland pedicle. Only the mammary gland located at cranial portion of septum was resected and the mammary gland located at caudal portion of septum was preserved. RESULTS: In our series, the mean resection weight per breast was (327.8 +/- 148.6) g, the mean nipple-to clavicle midpoint was 20.0 cm (range, 18.0-22.0 cm) and the mean nipple-to-sternal-notch distance was 21.0 cm (range, 19.5-22.5 cm) postoperatively. Nipple was moved upward 6.5 cm on average (range, 4.0-10.0 cm). There was no hematoma and nipple-areolar complex (NAC) necrosis. Minimal wound dehiscence occurred in one case and healed by dressing change. 17 cases were followed up for 3 months to 2 years. Satisfactory breast shape was achieved with good NAC sensibility. CONCLUSIONS: The reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum is a safe and reliable technique for mild and moderate hypermastia. Satisfactory breast contour, as well as NAC viability and sensibility, could be achieved with lower occurrence of hematoma or seroma.

Safety, efficacy, and modifications of the dermal bra technique for reduction mammaplasty and ptosis correction: a 10-year retrospective study.

BACKGROUND: The dermal bra technique was reported by the authors in 2003 for reduction mammaplasty and ptosis correction. The authors have summarized and modified continuously and here share their experience and analyze the long-term safety and efficacy of this technique. METHODS: Three hundred forty-seven patients underwent the dermal bra technique in the authors' department from October of 2003 to October of 2011, and 213 of them were followed successfully for 3 months to 2 years. Patients before and after October of 2006 were divided into early and late groups. The incidence of complications, the long-term satisfaction rate, and modifications that have been developed were noted and analyzed. RESULTS: Short-term complications occurred in 55 breasts (7.9 percent), including hematoma (seroma), delayed wound healing, fat necrosis, deep folds, necrosis, and numbness of the nipple-areola complex. Long-term complications were found in 28 breasts (6.6 percent), including widened scar and enlarged areola, irregular areola, secondary ptosis, sunken nipple-areola complex, numbness of the nipple-areola complex, cyst, and chronic infection. Except for one case of nipple-areola complex numbness, all complications were corrected successfully. The long-term satisfaction rate was 95.7 percent. With three major modifications (W- or V-shaped gland resection, medial rotation of gland flap, and modified purse-string suture), the short-term and long-term complication rates (p < 0.01) and satisfaction rate (p < 0.05) of the late group were improved significantly compared with the early group. CONCLUSION: Effective modifications have significantly improved the safety and efficacy of the dermal bra technique and have made it a mature approach for reduction mammaplasty and ptosis correction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Correction of mild and moderate breast ptosis with glandular flap combined with dermal flap suspension].

OBJECTIVE: To investigate the therapeutic effect of glandular flap combined with dermal flap suspension for correction of mild and moderate breast ptosis. METHODS: The dermal flap was formed according to the breast ptosis and dissection was performed between the skin and gland. The superior-lateral gland was partially resected or cut vertically only to form the lateral glandular flap. Then the glandular flap was rotated medially and fixed to shrink the glandular base area. Then the breast was up-positioned and fixed with dermal flap to remodel the breast shape. RESULTS: From Mar. 2006 to Mar. 2010, 46 cases were treated with satisfactory result. There was no severe complication, except for 2 cases of unilateral hematoma. 40 cases were followed up for 6 months to 4 years with good breast shape. No secondary ptosis, breast flatten and NAC sensation disorder was happened. CONCLUSIONS: Glandular flap combined with dermal flap suspension is a good method for mild and moderate breast ptosis with reliable long-term results. The breasts have busty appearance and good projection with inconspicuous scar.

[Analysis of the complications following the periareolar reduction mammaplasty using polypropylene mesh as suspension device].

OBJECTIVE: To investigate the cause and the prophylactic measures for the complication following the periareolar reduction mammaplasty using polypropylene mesh as suspension device. METHODS: From Dec. 1999 to Dec. 2005, 78 patients who underwent periareolar reduction mammaplasty using polypropylene mesh as suspension device were analysed. Among them, 47 cases were followed-up for 6 months to 5 years, and their long-term effect was evaluated. RESULTS: Early after operation, complications included seroma (3 cases), infection (3 cases), delayed wound healing (3 cases), and paraesthesia of nipple-areolar complex (1 case). The 47 followed-up patients presented abnormal wave-like skin appearance in superior polar of breast (7 cases), palpable cord-like mammary content in peripheral region of breast (3 cases), widening of periareolar scar and secondary ptosis (2 cases) and paraesthesia of nipple-areolar complex (1 case). All other patients acquired good appearance and felt satisfactory. 2 patients could lactate after operation. 5 patients underwent mammary X-ray radiography after operation. No mesh shadow or calcification was revealed. CONCLUSIONS: Although polypropylene mesh is a good suspension device in reduction mammaplasty, the long-term complication is relatively high because of the hardness of the tissue. More soft tissue is necessary as alternative device for clinical application.

[3-Dimensional reconstruction of MRI in patients with polyacrylamide hydrogel injection for augmentation mammoplasty].

OBJECTIVE: To investigate the effective diagnostic method for the patients with polyacrylamide hydrogen injection for augmentation mammaplasty. METHODS: MRI scanning (layer thickness 1mm, t2 _ ps3d_ cor alignment) was performed on 23 patients with polyacrylamide hydrogen injection for augmentation mammaplasty. The data were imported into computer and processed. 3D reconstruction and analysis modules were run subsequently to do the volume reconstruction and surface reconstruction to obtain stereoscopic images of the gel and adjacent structures in virtual reality, and to calculate the volume of the hydrogel. RESULTS: Among the 23 patients (46 breasts), the injected hydrogel with integrity capsule existed in retromammary space with no malposition in 5 cases (10 breasts). The capsule was not integrally formed and hydrogel was separately distributed with irregular edge in 6 patients (12 breasts). The pectoris major space, subcutaneous and gland invasion was found in 11 patients (22 breasts). Small amount of hydrogel sparsely distributed in mammary gland and degenerative muscular tissue in 1 patient (2 breasts) who had received extracting surgery before. The volume of hydrogel ranged from 220.309 ml to 372.371 ml (mean: 306.328 ml) in 22 untreated patients (44 breasts). CONCLUSIONS: The volume and distribution of hydrogel can be known clearly by 3D MRI reconstruction technique. This feasible technique is helpful in removing the hydrogel completely.

[The immediate local skin flaps transference for the treatment of acute auricle trauma defect].

OBJECTIVE: To investigate the advantage and postoperation notice of immediate local skin flaps transference for the treatment of acute auricle trauma defect. METHOD: A retrospective study was carried out to judge the immediate local skin flaps transference for sixty-three patients who underwent ear injury. RESULT: All the flaps survived postoperation. After a follow-up observation for 12-18 months, the shapes of all patients' ears were satisfying, and there were no osteochondritis. CONCLUSION: Immediate local skin flaps transference for the treatment of acute auricle trauma defect could recover the shape of ears in short time. The colour of flaps were similar as the ears, so the local skin flaps were ideal material for the ear reconstruction. If the wound were contaminated, antibiotics must be used, in addition to the Dexamethasone intravenous for seven to ten days which may inhibit the osteochondrites to some extent.