Promoting angiogenesis by con-transplantation of bone marrow mesenchymal stem cells and human umbilical vein endothelial cells transfected with vascular endothelial growth factor 165 gene / 中国组织工程研究

BACKGROUND: How to promote the early vascularization of large tissue-engineered bone has become the hotspot of current research. Cell co-culture and the addition of bioactive factors to promote angiogenesis are very good methods to promote early vascularization. OBJECTIVE: To explore the ability of angiogenesis by co-transplantation of bone marrow mesenchymal stem cells (BMSCs) and human umbilical vein endothelial cells(HUVECs)which were transfected with vascular endothelial growth factor 165(VEGF165)gene in vivo,to move forward a single step to offer theoretical basis and experimental basis to build vascularized tissue-engineered bone which can be used to repair large segmental bone defects. METHODS: We built an ischemic skin flap with 4 cm×1.5 cm in the back of Sprague-Dawley rats, and then BMSCs+VEGF165-transfected HUVECs (group A), VEGF165-transfected HUVECs (group B), BMSCs+non-transfected HUVECs (group C), non-transfected HUVECs (group D), DMEM (group E) were respectively transplanted. ELISA method was used to detect peripheral blood VEGF level. Histologically, survival and microvessel density of the flap were observed. RESULTS AND CONCLUSION: (1) The flap survival quality of group A was better than that in the other groups. VEGF exhibited high expression continuously high expression at 2, 4, 7, 14 days after transplantation, and reached the peak at 7 days, but the expression level at 14 days was obviously lower than that at 2 days postoperatively. The VEGF level of group always exceeded that in group B at different time points (P < 0.05). The flap survival rate and microvessel density of group A was significantly higher than that in the other groups at 11 days postoperatively (both P < 0.05). In summary, co-transplantation of BMSCs and VEGF165-transfected HUVECs can promote survival of an ischemic flap in vivo through pro-angiogenic actions.

Application of anterolateral thigh myocutaneous flap in the reconstruction of tongue and mouth floor defect after tongue carcinoma / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of free anterolateral thigh myocutaneous flap in the reconstruction of tongue and mouth floor defect after radical resection of tongue carcinoma.</p><p><b>METHODS</b>From June 2006 to April 2009, 14 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by anterolateral thigh myocutaneous flaps at the same stage. These 14 cases included tongue carcinoma at lingual margin (n=9), at ventral tongue (n=3) and at mouth floor (n=2). The flap size ranged from 7 cm x 9 cm to 5 cm x 7 cm.</p><p><b>RESULTS</b>All the 14 flaps survived completely with primary healing. There was no functional morbidity in the lower extremities. The patients were followed up for 12-26 months with satisfied esthetic and functional results in reconstructed tongue. Only one case (T4 N1 M0) died of metastasis carcinoma 14 months after operation. No local recurrence happened.</p><p><b>CONCLUSIONS</b>The anterolateral thigh myocutaneous flap has abundant tissue volume to reconstruct the tongue and mouth floor defect, while leaving less morbidity at donor site. Both satisfied esthetic and functional results can be achieved.</p>

Analysis of the complications following mandibular distraction using internal distractors / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and the prophylactic for the complications following mandibular distraction osteogenesis using internal distractors.</p><p><b>METHODS</b>From 1997 to 2004, a total of 46 patients (61 sides) suffering from malformations or defects of mandible who underwent mandibular distraction osteogenesis were analyzed. The diseases included hemifacial microsomia in 27 cases, congenital or acquired mandibular hypoplasia and micrognathia bilateral in 8 cases and unilateral in 4 cases, electronical injury or postoperative mandibular defects in 3 cases, Treacher Collins syndrome in 2 cases, obstructive sleep apnea syndrome in 2 cases.</p><p><b>RESULTS</b>Of them, 9 patients had postoperative complications, which included 3 patients had complications associated with distractors, local infection occurred in 2 cases, apertognathia of anterior teeth in 2 case, 2 patients had sinus of the skin of the lower lip. 9 patients had been aggressivly managed and obtained satisfactory results.</p><p><b>CONCLUSIONS</b>The pivotal points to reduce complications are to understand the mechanism of mandibular distraction osteogenesis completely, and to be familiar with the anatomy of mandible and adjacent tissues. It is necessary to treat with it preoperatively and postoperatively.</p>

Complications of scalp coronal incision: analysis, prevention, and treatment / 中华整形外科杂志

<p><b>OBJECTIVE</b>The aim of this study was to analyze the complications of coronal incision and investigate the methods of prevention.</p><p><b>METHODS</b>The retrospective analysis was based on 149 cases, who have had operations since 1997 for congenital craniofacial malformation, second deformation of craniomaxillofacial trauma, maxillofacial tumor or cosmetic purposes.</p><p><b>RESULTS</b>Of them, there were injury of unilateral frontal branch of the facial nerve in 3 cases, subcutaneous hematoma in 9 cases, alopecia in 12 cases, incision scar in 14 cases, obvious strip scar in 2 cases, pains, numbness and paraesthesia in 23 cases, ptosis of facial soft tissue in 8 cases and infection in 4 cases.</p><p><b>CONCLUSIONS</b>The coronal incision has the merits of distinct exposure, hidden incision scar, but its complications can not be neglected. During the operation, care should be taken to anatomical layers, protecting the blood vessel and nerve bundle in order to reduce complications.</p>

Skeleton reconstruction of oblique facial clefts using mandibular outer table / 中华整形外科杂志

<p><b>OBJECTIVE</b>This paper presents a new method of skeleton reconstruction for oblique facial clefts using autogenous bone of the mandibular outer table.</p><p><b>METHODS</b>In the operation, the mandibular outer table was harvested through the intraoral approach. Assisted with internal rigid fixation technique, the mandibular outer table was used to reconstruct the naso-orbital framework as inlay or onlay bone graft.</p><p><b>RESULTS</b>From 1993 to 2001, seven cases of oblique facial clefts were repaired with mandibular outer table bone graft. Postoperative follow-up for 6 months to 3 years demonstrated that the grafted bone healed well with the adjacent bones. No obvious bone resorption was observed. The facial appearance was improved greatly.</p><p><b>CONCLUSIONS</b>The mandibular outer table, with similar bone density to the calvarium, is easy to harvest without donor site scar. The method is quite ideal for skeleton reconstruction of oblique facial clefts.</p>

Surgical management of craniomaxillofacial fibrous dysplasia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method to obtain good aesthetic and functional results in surgical management of craniomaxillofacial fibrous dysplasia and correct the grotesque deformity.</p><p><b>METHODS</b>According to the type of the lesions, different excision and reconstruction methods were used.</p><p><b>RESULTS</b>19 cases (4 monostotic cases and 15 polyostotic cases) were surgically treated. The period of follow-up range from 9 months to 5 years, all patients obtained satisfactory aesthetic and functional results. No relapse happened during follow up.</p><p><b>CONCLUSIONS</b>Based on modern craniomaxillofacial techniques and computer aided design, extensive radical excision and craniomaxillofacial skeleton reconstruction could be safely accomplished, and the better results were obtained, both aestheticly and functionally.</p>

Compositive treatment of square face / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the treatment of square face with compositive methods. METHODS A total of 71 patients with square-shape face were treated. According to the different face skeleton and desire of patient, mandible angle curved-osteotomy and mentoplasty were used as main methods and zygomatoplasty, buccal fat pad resecting and other aesthetic methods as assistant methods to recontour the whole face skeleton.</p><p><b>RESULTS</b>The face skeleton of all patients was improved with satisfaction. The following-up period was 6 months to 2 years. In this patients group, massive haemorrhage was occurred during operation in one patient, mental nerve of of one side was injured in two patients, the lip mucosa was wounded in five patients.</p><p><b>CONCLUSION</b>Mandible angle curve-osteotomy and mentoplasty combined with other assistant aesthetic operations were ideal methods to recontour square face. The result was satisfactory.</p>

Individual prefabricated titanium implant for the reconstruction of the skull bone defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>This paper presents a new method of individual prefabricated titanium implant for the reconstruction of the skull bone defect.</p><p><b>METHOD</b>A computer-based 3D model of the cranial bone defect is created from helical CT-data and serves as the basis for the computer aided design and manufacturing (CAD/CAM) of the individual prefabricated titanium implant for the cranial bone defect reconstruction.</p><p><b>RESULT</b>Since 2001, a total of nine patients suffering from the cranial bone defect have been operated on by this method with satisfied result. The fallow-up is 3 to 12 months.</p><p><b>CONCLUSION</b>These individual prefabricated titanium implants have won a high precision, a good biomechanics and a excellent biocompatibility. It is a quite ideal and very simple method with much less complication for the surgical treatment of the cranial bone defect.</p>

Chin augmentation with bone transplantation from the mandible / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a new method for mentoplasty.</p><p><b>METHODS</b>The bilateral prominent mandibular angle or outer lamina was resected through the intraoral approach. The resected bone fragments were shaped and rigid fixed to the chin with miniplates and screws.</p><p><b>RESULTS</b>A total of 30 patients (28 females, 2 males) accepted chin augmentation with this method. The mandibular angle bone was used in 20 cases and the mandibular outer lamina was used in 10 cases. The operative results were satisfactory, and the patient's facial contour was improved substantially.</p><p><b>CONCLUSION</b>No rejection reaction was found after this procedure. Chin augmentation with autogenous mandibular bone is an ideal method for genioplasty.</p>

Applications of autogenous outer table of the calvarial and mandibular bone in posttraumatic deformities of the nose / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the applications of bone grafts from the cranium or mandible in the repair of posttraumatic deformities of the nose.</p><p><b>METHODS</b>From 1997 to 2002, a total of 44 patients, who presented with secondary nose deformity as well as facial fractures, were reconstructed by autogeneous outer table grafts of the calvarial or mandibular bone after facial skeleton reposition. In this series, 32 cases used the calvarial bone, 12 cases used the mandible bone, which was harvested through a coronal incision and an oral approach respectively.</p><p><b>RESULTS</b>The surgical incisions healed primarily in all patients with minimal scar. The facial appearance was greatly improved. No implant infection, extrusion and shift were observed in the postoperative follow-up of 6 months to 2 years. There was not obvious bone resorption, nor donor site morbidity.</p><p><b>CONCLUSION</b>Autogeneous calvarial and mandibular bone was an ideal material of bone graft in reconstruction of severe posttraumatic deformities of the nose. Compared with other autogeneous and alloplastic materials, the outer table of the calvarial and mandibular bone produced less morbidity of the donor site, invisible scar, no rejection and less resorption.</p>

Secondary reconstruction of post-fracture deformities in the nasal-orbital ethmoid region / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the surgical reconstruction of secondary fracture deformities of the nasal-orbital ethmoid area.</p><p><b>METHODS</b>Typical bicoronal and subciliary incisions or the adjacent scar incision were employed to expose the fractured area. The flattened nasal bone was narrowed by curved osteotomy along the medial orbital rims and trimed with a bur. 2-3 pieces of cranial outer table were used to reconstruct the nasal framework, which were fixed to the frontal bone with mini-plates. After the medial orbital wall and orbital floor were exposed, the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with autogenous cranial outer table or Medpor. The medial canthal tendons were anchored superior-posteriorly to the lacrimal fossa with transnasal wires.</p><p><b>RESULTS</b>From December 1996 to December 2001, 34 cases of severe nasal-orbital ethmoid fracture deformities were repaired with this technique. Of them, 12 cases had combined orbital-zygomatic fracture, 4 cases had fontal sinus fracture, 1 case had Le Fort II and 1 case had Le Fort III fracture. All the patients recovered well and their facial appearance improved greatly.</p><p><b>CONCLUSIONS</b>The key points for surgical reconstruction of the periorbital post-fracture deformities are narrowing the flattened nasal root by curved osteotomy, the nasal framework reconstruction with autogenous bone graft, the orbital wall repair to correct enophthalmos, and most importantly, the medial canthal tendon reduction and canthal plasty.</p>