Thin split thickness skin graft with melanocytes for the treatment of large scar with depigmention / 中华整形外科杂志

Objective@#To investigate the clinical outcome of autologous thin split thickness skin graft with melanocytes for the treatment of large scar with depigmentation, caused by extensive burn.@*Methods@#From August 2016 to June 2018, autologous thin split thickness skin graft with melanocytes was used on 19 patients, who had depigmented extensive burn scar. They include 15 males and 4 females, aged 19-54 years. The operation was performed under general anesthesia or local anesthesia. Local mechanical abrasion was carried out at the depigmented surface of the scar, until the superficial dermis. The thin split thickness skin graft with melanocytes was transplanted to the wound at recipient site, followed by package and fixation. The package was kept for two weeks.@*Results@#After a follow-up period of 3-6 months, all the grafts survived well with satisfactory appearance. The defects at donor site healed well too.@*Conclusions@#Satisfactory outcome can be achieved with autologous thin split thickness skin graft with melanocytes for the treatment of depigmented scar caused by extensive burn.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

The effect of thioredoxin-1 on different layers of skin flap during the early stage of ischemia-reperfusion injury / 中华整形外科杂志

Objective@#Ischemia-reperfusion (IR) injury is a leading cause of flap compromise and organ dysfunction during free-tissue transfer, and remains a great challenge for plastic surgeons. Thioredoxin-1 (Trx-1) was proved to protect the IR flap by mitigating the oxidative stress, and inhibiting the activation of apoptosis signal-regulating kinase-1 (ASK-1) and mitogen-activated protein kinase (MAPK) pathway. The aim of this study is to investigate the distinction of Trx-1 expression, apoptosis indices in different layers of IR flaps, and the feasibility of tissue-layer-specific administration of Trx-1.@*Methods@#Ten patients′ specimens of IR flaps for DIEP breast reconstruction were collected and assessed for apoptosis and Trx-1 expression. Twenty mice were used to establish the IR flap model. The mice were sacrificed twenty-four hours after reperfusion. The flap tissues were harvested and tested by immunohistochemistry staining and TUNEL assay. The tissue-layer-specific dermoprotective effect of Trx-1 and the molecular mechanisms were assessed by an in vitro epithelial skin cell hypoxia-reoxygenation model. The statistics were conducted by t test and ANOVA using SPSS 20.0.@*Results@#Trx-1 expression and apoptotic cells were observed mainly located in the basal layer of epidermis and the papillary layer of dermis in human IR flaps and mice models. Trx-1 depletion was 24.19 %± 2.23% in the basal layer of epidermis and the papillary layer of dermis of patient IR flaps, decreasing significantly compared with 70.71% ± 6.38% in control group (t = 27.54, P< 0.001). Similar tissue-layer-specific down regulation of Trx-1 also displayed in mice IR flap models (19.83% ± 2.34% vs. 76.59% ± 4.88%; t = 34.71, P<0.001). The apoptotic index in human samples significantly increased from 1.32% ± 1.52% in control group to 43.71 %± 3.17% in IR group (t =38.23, P<0.001); while it was proved to be dramatically raised in mice models from 0.86% ± 1.15% in control group to 41.14 %± 4.21% in IR group (t= 36.96, P < 0.001). Western Blot analysis revealed Trx-1 down regulation and a significant increase in ASK-1, p-p38, and c-PARP abundance in the hypoxia-reoxygenation-treated HaCaT cells (P < 0.01). Supplementation of recombinant human Trx-1 significantly reduced the apoptosis-related protein expression.@*Conclusions@#The basal layer of epidermis and the papillary layer of dermis are the main damaged tissue layers in the early stage of skin flap ischemia-reperfusion injury. The IR flap can be protected by precisely replenishing the vulnerable layers with Trx-1.

Establishing the rabbit dorsal prefabricated flap model with lead oxide microangiography / 中华整形外科杂志

Objective@#This study aims to establish a model of prefabricated flaps on the back of rabbits, with the purpose to explore the optimal concentration of lead oxide suspension for microangiography.@*Methods@#Twenty clean grade male New Zealand white rabbits, with the weigh at 3.5-4.0 kg, were selected for the prefabricated flap model, pedicled with thoracodorsal vascular bundles, through 2-staged surgeries. Traditional flap model was established on the back of 2 rabbits. Small pieces of flap were taken for HE stain at 7th and 14th day after initial surgery. The time of second operation was determined by this result. Prefabricated flap models were established on the remained 18 rabbits, and divided into 9 groups. Nine different concentrations of lead oxide suspension (60%, 50%, 40%, 37%, 33%, 30%, 27%, 23%, and 20%) were injected through the aorta for each group, on 7 days after the 2nd surgery. The microangiographic results of gross specimen and prefabricated flap were observed by X-ray imaging.@*Results@#Microvascular lumens were observed by HE stain, on 14 days after the initial surgery. The number of microvessels in each 200× high power field, increased from 1-2 on day 7 to 10-20 on day 14. The vascularization process was mature. These suggest the prefabricated flap is ready for second surgery. Lead oxide perfusion angiography showed that there was non-development of tertiary arteries at 60% and 50% concentration. Tertiary arteries were not well developed at 40%, 37% or under 30% concentration. Clear arteriole development could only be obtained at 33% and 30% concentrations.@*Conclusions@#In this study, a rabbit model of prefabricated flap pedicled with thoracodorsal vascular bundles was successfully constructed by 2-staged surgeries. The microvasculature of the flap could be clearly displayed using lead oxide suspension with the concentration of 30%-33%.

Natural sideburn reconstruction with retroauricular expanded flap with original hairline / 中华整形外科杂志

Objective@#To introduce a reconstruction procedure of natural sideburn, with combined expanded retroauricular flap and scalp flap.@*Methods@#A retrospective study was produced in Plastic Surgery Hospital, PUMC, from January 2014 to December 2017. Twenty patients (21 sides) underwent sideburn reconstruction with combined expanded retroauricular flap and scalp flap (double pedicled flap, n=3; single pedicled flap, n=17) were included in this study. There were 12 male (12 sides) and 8 female (9 sides), with the mean age of (23.8±3.2) years. The sideburn defect was caused by burn in 19 patients, and it was resulted from hemangioma in 1 patient.@*Results@#The size of flaps ranges from 8 cm×12 cm to 10 cm×16 cm. Venous congestion at the distal end of the flap occurred in 1 patient, which was cured after dressing change, and the sideburn was not affected. The reconstructed sideburns are natural, symmetric, and without obvious scar. The follow-up time was 3-40 months. Fourteen patients were very satisfied with the reconstructed sideburn, and 6 patients were satisfied. No severe complication was observed during follow-up time.@*Conclusions@#The combined retroauricular flap and scalp flap is an alternative method for sideburn reconstruction, which provide natural hair distribution, inconspicuous scars and less complications.

Precision management of traumatic injury and scars: an indication that plastic surgery steps into the era of aesthetic reconstruction / 中华整形外科杂志

Reconstructive treatment of traumatic injury and scars is the essence of plastic surgery. Technological development plays a vital role in treating traumatic injury and scars and realizing functional restoration and mental recovery. The techniques developed for the treatment of traumatic injury and scars were reviewed in this paper, which could hopefully provide some clues and experiences for future innovation and advances in this field and showcase the possible direction for technological progress with high standard.

Advances in the revascularization of prefabricated flap / 中华整形外科杂志

The principle of prefabricated flap is to establish a new blood supply system, in order to supply the free flap or random flap. The key to produce a prefabricated flap is the establishment of blood supply. Currently, a series of methods could be used to promote vascular regeneration and flap survival, including chemical stimulation, stem cell transplantation, hyperbaric oxygen therapy, biomaterials application, nerve implantation, tissue expansion and microsurgical technique. The reasonable combination of multiple methods could better promote the angiogenesis of the prefabricated flap, and ultimately realize the survival of the flap, thus create a new way for the repairment of complex tissue defects.

Role of adipose-derived mesenchymal stem cells in inhibiting bleomycin-induced skin fibrosis development in nude mice / 中华整形外科杂志

Objective@#To investigate the role and the mechanism of adipose-derived mesenchymal stem cells (ADSCs) in inhibiting bleomycin-induced skin fibrosis in nude mice, in order to provide experimental basis for the prevention and treatment of dermatitis, keloid, scleroderma, and other skin fibrosis disorders.@*Methods@#Twenty-four female BALB/c nude mice aged 5-6 weeks were randomly divided into blank control group, transplantation control group, model group, and transplantation group. There were 6 mice in each group. In blank control group, PBS solution was injected subcutaneously on the back of nude mice twice a day, at intervals of 1 h. The transplanted control group was injected with 1×106/ml ADSCs 1 ml and then injected with 1 ml PBS solution at intervals of 1 h. In the model group, 1 mg/ml bleomycin was injected firstly, and then 1 ml PBS was injected at intervals of 1 h. In the transplantation group, 1 ml of bleomycin was injected firstly, and 1 ml of ADSCs were injected at intervals of 1 h. After 4 weeks injection, the skin texture of each group nude mice was grossly observed. The expression of fibrosis-related proteins was detected by Western blot. The expression of fibrosis-associated genes was detected by RT-PCR. The expression of α-smooth muscle actin (α-SMA), an indicator marker of skin fibrosis, was detected by immunohistochemistry staining. The experimental data was analyzed with GraphPad 7.0 software. Two groups were compared by t test, and multiple groups of samples were compared using one-way ANOVA. The P<0.05 was regarded as statistically significant.@*Results@#The results of Western blot showed that the expression of TGF-β1, Notch1 and α-SMA in ADSCs transplantation group was significantly lower than that in the model group, but there was no significant difference between the blank control group and the transplantation control group. Real-time PCR results showed that the expression levels of TGF-β1, type Ⅰ collagen, Notch1, and Smad3 were significantly higher than those in the ADSCs group. The expression of α-SMA mRNA in the control group, transplantation control group, model group and transplantation group was 0.37±0.01, 0.35±0.05, 1.43±0.10, and 0.83±0.03, respectively. Compared with the blank control group and the transplantation control group, the expression level of α-SMA in the model group was significantly increased (F=352.3, P=0.000), while the expression level of α-SMA in the ADSCs transplantation group was significantly lower than that in the model group (t=10.39, P=0.009).@*Conclusions@#The local injection of ADSCs may reduce the expression of TGF-β1, Smad3 and Notch1 by paracrine function, remodel the extracellular matrix, inhibit the proliferation of fibroblasts, and thus inhibit the process of skin fibrosis.

Augmented reality in plastic surgery: recent applications and developments / 中华整形外科杂志

Augmented reality(AR)is a technique that superimposes continuous computer-generated images onto real scenes. With the collaborative work of tracking module, registration module and display module, real-time fused images can be composed and shown. In recent years, AR has been applied in several medical fields, such as medical education, remote medical aid, navigation system, etc.Latest applications and developments of AR in plastic surgery was reviewed in this article.

The clinical applications of nanofat for depressed scars treatment / 中华整形外科杂志

Objective@#To treat the depressed scars by injecting nanofat and investigate its therapeutic effect.@*Methods@#Autologous fat was harvested from abdomen or thigh using low-pressure suction. The lipoaspirate was mechanically emulsified after rinsing. Emulsification of the fat was achieved by shifting the fat between two 5 ml syringes connected to each other by a three direct connector. After this emulsification process, the fatty liquid was again filtered over the sterile nylon cloth. Nanofat was injected into the dermis of depressed scars using a 26-gauge needle and the injection volume was 1-2 ml/cm2. After three months, another injection would be performed if the depressed scar remained obvious.@*Results@#From January 2016 to October 2017, eighteen patients and thirty-three depressed scars were treated. There was a temporary erythema of the injected area that lasted two to three weeks. The clinical result gradually improved over time and were maximal from three months postoperatively for most cases. Three months after nanofat injecting, the cavity of scars was significantly decreased; The color of scars were significantly improved and more close to the adjacent skin; The stiffness of scars was also obvious decreased. The follow-up ranged 4 months to 18 months and the average was 11.0±4.6 months. Seventeen patients were satisfied with the result, one patients was not satisfied and the satisfaction rate was 94%. No infections, fat cysts, granulomas, or other unwanted side effects were observed.@*Conclusions@#Nanofat injecting is a definite and effective treatment for depressed scars with fewer complications.

Clinical application of prefabricated super-thin perforator flaps after expansion in the reconstruction of facial and cervical scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a combined application of tissue expansion, perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.</p><p><b>METHODS</b>In the first stage, the position and course of the perforators were confirmed with the multi-detector computed tomography ( MDCT) and color Doppler ultrasound. The expanders were implanted between subdermal vascular plexus and superficial fascia. In the second stage, the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.</p><p><b>RESULTS</b>26 cases with extensive facial and cervical scars were included in this study. Except for one case with necrosis at the distal end, the other 25 flaps survived completely. The maximum flap size was 35 cm x 10 cm with a pedicle of 8 cm x 4 cm. Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap, thus avoiding secondary flap debulking and revisions. All the patients got improvement in contours, facial features and emotional expression.</p><p><b>CONCLUSIONS</b>The combined application of tissue expansion, perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.</p>

Changes of microcirculation in congested flap / 中华医学美学美容杂志

Objective To explore the change patterns of microcirculation in congested flap. Methods A congested flap model for long-term microeirculation observation was set up, and the mi-crocireulation of the congested tissues was observed carefully. Results Following congestion, the number of the capillaries in the congested flap were decreasing, the velocity of the bloodstreams were getting slower, and the aggregation of the red blood cells and the formation of the white thrombus were becoming more serious. About 72 hours later, the original microcirculation system of the flap was nearly exhausted. About 36 hours later, the neogenetie capillaries could be observed, with clear neogenetie capillaries observed at 48 hours. The congested tissues with nascent capillaries survived, while the capillaries without nascent formation suffered from necrosis in the end. Conclusions If the cause is not removed, the microcirculation status of the congested flap would get worse irreversibly, and the nascent capillaries would play an important role in the survival of congested tissues.

Aesthetic eyebrow reconstruction by using follicular-unit hair grafting technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>To search a new option for aesthetic reconstruction of the eyebrow.</p><p><b>METHODS</b>Under local anesthesia, a scalp strip was harvested from the back of the head, closed to the hairline. Under 2 times magnification, the strip was then divided into a series of follicular-unit micrografts with 1-3 hairs. Usually, 150 micrografts were needed per eyebrow in a man whereas 100 micrografts in a woman. After the micro-slits or micro-slots were prepared in the recipient site, the grafts were implanted into the holes, parallel to the original hair directions.</p><p><b>RESULTS</b>From Apr 1998 to Feb 2000, thirty-two patients with 48 eyebrow-losses, resulted from burn scar, skin grafting, chemical peeling, lesion excising or congenital loss, were treated by this one-session operation. All of the patients were satisfied with the results. The grafted hairs grow in the direction of normal eyebrow, which achieve 95%-96% survival even in a scarring area. The appearance of the reconstructed eyebrows was more natural, close to the normal eyebrow, compared to the traditional methods.</p><p><b>CONCLUSION</b>The above-mentioned technique is a simple, safe and effective method for eyebrow reconstruction. It might be an ideal method for eyebrow reconstruction with the appearance much closer toa normal eyebrow.</p>

Dense-packing hair grafting technique for restoration of cicatricial alopecia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility of using dense-packing hair grafting technique for restoration of cicatricial alopecia.</p><p><b>METHODS</b>Under local anesthesia, a scalp strip was harvested from the back of the head. A series of micro-grafts with 1-3 hairs and mini-grafts with 4-6 hairs were created from this strip. In the scarring recipient area, micro-slots were made with a 18 G needle for the micro-grafts and mini-slits were made with a No. 64 mini-blade for the mini-grafts. The grafts were then implanted into these holes.</p><p><b>RESULTS</b>Ninety-six patients with 128 bald scarring areas, resulted from burn, trauma or infection, were treated with the above-mentioned technique from April. 1998 to February. 2000. All of the patients were satisfied with the appearance. In the micro-graft area, the graft density reached 10-15 mini-grafts/cm2 per session. In the micro-graft area, the graft density reached 16-19 micro-grafts/cm2 per session. Postoperative following-up for more than 1 year showed that the grafted hairs were growing well with 90%-95% survival of the hair. One third of the patients obtained satisfactory results with only one session. Two thirds of the patients needed the second session to improve the appearance.</p><p><b>CONCLUSIONS</b>The dense-packing hair grafting technique is a simple, safe and effective method for hair restoration surgery. It is not only used for male pattern baldness, but could also be applied for restoration of cicatricial alopecia.</p>

Reconstruction of the lower face and the anterior neck with a bipedicled expanded flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explain a method for lower face and anterior neck reconstruction.</p><p><b>METHODS</b>Tissue expanders were implanted subcutaneously beside the defect. When the skin was properly expanded, the bipedicled expanded skin flap was created and transferred to the lower face and the anterior neck. If the defect can not be repaired by one stage, the expanded skin was re-expanded for the rest.</p><p><b>RESULTS</b>11 patients have been treated with this method since 1990. All flaps survived and all the defects have been successfully repaired with satisfactory results.</p><p><b>CONCLUSION</b>The bipedicled expanded flap, which provided good blood supply, improved the survival rate of the flap and reduced the incision scar on the face, is an effective surgical procedure.</p>

Aesthetic correction of gynecomastia under endoscope through a small incision of mammary areola combined with tumescent liposuction / 中华医学美学美容杂志

Objective To gain the best cosmetic result and to avoid the manifest postoperative scar, bleeding and injury of the sensory nerves in the nipple and areola. Methods The gynecomastia was corrected under the endoscope through a small incision (2~3.5 cm) around the areola combined with the tumescent liposuction of the breast to individuals whose breast hyperplasia was mainly because of the fat tissue hyperplasia and the incised tissues were sent for pathological examinations. Results Since March 2000, 16 young men with normal men genitals appearance had undergone this operation, in which 4 cases were breast gland tissue hyperplasia, 3 cases of fat tissue hyperplasia and 9 cases of mixed fat and gland tissue hyperplasia. The results were satisfactory with normal men breast appearance and small areola incisions. No complications happened such as hematoma, abnormal feeling and necrosis in nipple and the breast. The incised tissue of the unilateral breast was 100~320g with average of 130g. The sunction lipectomy volume of the unilateral breast was 20~130ml with average of 68ml. The pathological examination revealed that the incised tissue were fat tissue and breast gland tissue. During 5 months to 3 years following up, no breast hyperplasia recurred. Conclusions The endoscopic operative technique is an ideal option to correct the gynecomastia because it minimizes the areolar incision and avoids the injury of the nipple and areola. It is also helpful to the distal part incision and remoulding of the breast.

Histologic features of capsule in breast implant / 中华医学美学美容杂志

Objective To study the histologic characteristics of the capsule of breast implant. Methods Four miniprostheses were seperatelly implanted in four positions beneath the panniculus carnosus muscle in 30 rabbits. After 3 weeks, 1, 2, 3, 4, 6 and 12 months, capsular histology examination and the assay of capsular collagen content and type were performed. Results ⑴ Capsule was divided into two layers: the inner layer was dense and the outer loose connective tissues. Collagen component was more, cellular component was less and capsule was thicker (P0.05). ⑵ Capsular collagen content increased gradually in 3 months (P0.05). ⑶Collagen fibers were the most component, reticular fibers were second and elastic fibers were least. After 3 months, elastic fibers decreased, and collagen and reticular fibers became full layer gradually. ⑷ Capsular collagen type I in the capsule was gradually increased and type III decreased before 3 months. There were no significant changes after 3 months. Conclusions Histology of the implant capsule is similar to that of scar and the result of wound healing around implant.