Hair-Bearing Expanded Scalp Flap for Total Beard Reconstruction in Patients With Chin and Submental Postburn Scars.

BACKGROUND: Loss of beard in adult male caused by severe burn may cause cosmetic and psychological problems for these patients. Reconstruction of the beard with hair-bearing skin flaps in similar color and texture of the surrounding tissues remains a challenge. METHODS: Eight male patients suffered from submental postburn scar and beard loss were treated by using the hair-bearing expanded scalp flap. A 1000 mL nephroid tissue expander was first implanted under the frontal and mid scalp. After a 3 to 4-month tissue expansion, the expanded hair-bearing scalp flap based on bilateral superficial temporal vessels were raised and transferred for beard reconstruction, and the cutaneous pedicles were curled into tubes. Delay and division of the pedicles were performed 3 to 4 weeks after flap transfer. RESULTS: Eight male patients with postburn scar and beard loss were successfully treated with no major complication. One patient suffered from edge necrosis at distal end of the flap and healed after daily dressing change. Chin and submental areas were repaired by expanded scalp flap and total beard was reconstructed at the same time. All donor sites were closed directly without skin grafting. CONCLUSIONS: The modified expanded bipedicled scalp flap provides an easy and reliable way for total beard reconstruction and large-scale submental scars repairment.

Atropisomeric 9,10-dihydrophenanthrene/bibenzyl trimers with anti-inflammatory and PTP1B inhibitory activities from Bletilla striata.

Two pairs of novel trimeric dihydrophenanthrene-bibenzyl-dihydrophenanthrene enantiomers (1 and2), the first examples of a dihydrophenanthrene dimer linked to a bibenzyl or dihydrophenanthrene through a C-O-C bond (3 and4), and a pair of rare polymers with a bibenzyl connected to C-8' of the dihydrophenanthro[b]furan moiety via a methylene (5), together with four known compounds (6-9) were isolated from the tubers of Bletilla striata. Their structures including the absolute configurations were determined using spectroscopic data analysis and ECD and NMR calculations, combined with the exciton chirality method or the reversed helicity rule. The atropisomerism of dihydrophenanthrenes and related polymers was considered based on their chiral optical properties, and QM torsion profile calculations, which revealed the racemic mixture form of the polymers. Compounds 4, 5b, 6a and 7b significantly inhibited the production of NO in LPS-induced BV-2 cells, with IC50 values ranging from 0.78 to 5.52 µM. Further mechanistic study revealed that 7b suppressed the expression of iNOS, and suppressed the phosphorylation of the p65 subunit to regulate the NF-κB signaling pathway. Furthermore, compounds 2b, 5a, 5b, 7a and 7b displayed significant protein tyrosine phosphatase 1B (PTP1B) inhibitory activities with IC50 values of 3.43-12.30 µM.

Establishment of a Novel Mouse Model for Soft Tissue Expansion.

BACKGROUND: Despite its increasing use, not much is known about tissue expansion, and its complication rates are significantly high. Thus, there is an urgent need to establish a stable animal model to overcome the limitations and complications of tissue expansion. Although the mouse model has shown several advantages in the in-depth studies, an appropriate mouse expansion model has rarely been reported, likely because of its loose skin. MATERIALS AND METHODS: A micro expander was designed and implanted under the scalp of a mouse (expanded group); sterilized saline was regularly injected into the expander. In sham-operated mice (control group), a silicone sheet was implanted under the scalp. Skin samples were collected 5 wk after surgery. Histologic changes including epidermal and dermal thickness and collagen fiber arrangement were analyzed. In addition, vascular density and cell proliferation ratio were determined. An ultrastructural analysis was also performed. RESULTS: With the application of the expansion device, the skin became tight and showed area enlargement. The epidermal thickness of the expanded skin increased significantly (P < 0.01), whereas the thickness of the dermis decreased significantly (P < 0.05) as compared with the control skin. Masson staining demonstrated that collagen bundles were arranged more compactly in the expanded skin (P < 0.05) than in the controls. Furthermore, more proliferating cells (P < 0.05) and blood vessels (P < 0.01) were observed. Transmission electron microscopy showed that the fibers of expanded skin were stretched and broken into bundles of various diameters, with abundant active fibroblasts. CONCLUSIONS: A reliable mouse model of scalp skin expansion was successfully established, which may be a promising tool for in-depth studies on skin soft tissue expansion.

Montelukast Attenuates Retraction of Expanded Flap by Inhibiting Capsule Formation around Silicone Expander through TGF-ß1 Signaling.

BACKGROUND: Tissue expansion has tremendous applications in plastic surgery, but flap retraction provides insufficient tissue for use. Inspired by the use of montelukast to suppress capsular contracture, the authors investigated the effects of montelukast on capsule formation around the expander and retraction of the expanded scalp of the rat. METHODS: Thirty-six male Sprague-Dawley rats were randomly divided into control and montelukast groups. In each group, 12 expanded flaps with or without capsules were harvested for histologic and molecular analysis; the six remaining expanded flaps were transferred to repair defects. Myofibroblast and transforming growth factor-ß1 expression in the capsule was determined using immunofluorescence. Capsule ultrastructure was observed using transmission electron microscopy. Related protein expression in the capsules was detected using Western blot analysis. RESULTS: A comparison of control and montelukast groups revealed that areas of the harvested expanded flaps with capsules were greater (2.04 ± 0.11 cm 2 versus 2.42 ± 0.12 cm 2 , respectively; P = 0.04); the retraction rate decreased (41.3% ± 2.16% versus 28.13% ± 2.17%, respectively; P < 0.01). However, the increased areas and decreased retraction disappeared after capsule removal. The number of myofibroblasts declined. Thin, sparse collagen fibers were observed in the capsules. The expression of COL1, COL3, TGF-ß1, EGR1, and phosphorylated ERK1/2 in the capsules decreased. Furthermore, the recipient area repaired by the transferred expanded flap was increased from 4.25 ± 0.39 cm 2 to 6.58 ± 0.31 cm 2 ( P < 0.01). CONCLUSION: Montelukast attenuates retraction of the expanded flap by inhibiting capsule formation through suppressing transforming growth factor-ß1 signaling. CLINICAL RELEVANCE STATEMENT: This study provides novel insights into a method for increasing the area of the expanded flap.

Bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion.

Skin and soft tissue expansion stimulates the proliferation of skin epidermal basal cells and increase the dermal collagen deposition and angiogenesis. To explore the contribution of bone marrow-derived stem cells (BMSCs) to the generation of "new" skin during the expansion, we used a chimeric mouse model in which the donor C57BL mice were engrafted with the bone marrow of enhanced green fluorescent protein (EGFP) transgenic mice. BMSCs were collected from the tibia and femur of EGFP(+) transgenic mice, and then injected into normal C57BL mice via the tail vein (chimeric mice). Skin was obtained at different times (days 0, 7, 14, 21, 28, and 35). Skin stromal-derived factor-1 (SDF-1) expression was evaluated. The number, distribution, and phenotype changes of EGFP(+) cells in the skin were also evaluated by means of fluorescent microscopy. EGFP(+) cells were present stably in the normal skin. The number of EGFP(+) cells of the Group A mice changed with the tension, and reached the peak on day 21(17.1 ± 6.7%), as compared with either Group B (5.5 ± 1.0%) or Group C (5.1 ± 0.9%). The SDF-1 expression in the expanded skin was significant increased (≈11-fold, P < 0.01) compared to non-expanded skin on day 21. Immunofluorescence showed EGFP(+) cells were converted into vascular endothelial cells, epidermal cells, and spindle-shaped dermal fibroblasts. Strain can promote the expression of SDF-1 and facilitate the differentiation and proliferation of BMSCs in the expanded skin.

Human facial allotransplantation: a 2-year follow-up study.

BACKGROUND: Progress in composite tissue allotransplantation could provide a new treatment for patients with severe facial disfigurements. We did a partial facial allotransplantation in 2006, and report here the 2 year follow-up of the patient. METHODS: The recipient, a 30-year-old man from China, had his face severely injured by a bear in October, 2004. Allograft composite tissue transplantation was done in April, 2006, after careful systemic preparation. The surgery included anastomosis of the right mandibular artery and anterior facial vein, whole repair of total nose, upper lip, parotid gland, front wall of the maxillary sinus, part of the infraorbital wall, and zygomatic bone. Facial nerve anastomosis was done during the surgery. Quadruple immunomodulatory therapy was used, containing tacrolimus, mycophenolate mofetil, corticosteroids, and humanised IL-2 receptor monoclonal antibody. Follow-up included T lymphocyte subgroups in peripheral blood, pathological and immunohistochemical examinations, functional progress, and psychological support. FINDINGS: Composite tissue flap survived well. There were three acute rejection episodes at 3, 5, and 17 months after transplantation, but these were controlled by adjustment of the tacrolimus dose or the application of methylprednisolone pulse therapy. Hepatic and renal functions were normal, and there was no infection. The patient developed hyperglycaemia on day 3 after transplantation, which was controlled by medication. INTERPRETATION: Facial transplantation could be successful in the short term, but the procedure was not without complications. However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement.

Bone marrow mesenchymal stem cells increase skin regeneration efficiency in skin and soft tissue expansion.

BACKGROUND: Skin and soft tissue expansion has limitations such as long hospitalization time and flap retraction after expansion. Our previous study suggested that bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion. In this study, the authors explored the feasibility of applying the bone marrow mesenchymal stem cells (BMMSCs) to the treatment of skin and soft tissue expansion and increasing the skin regeneration efficiency. METHODS: Sixty silicone expanders were implanted in the backs of 15 pigs, and allogeneic BMMSCs were transplanted to skin shallow fascia layer (local transplantation, Group A) or via ear vein (systemic transplantation, Group B). Group C was the Sham operation control; and then the expanders were injected with normal saline (N.S.). Skin was obtained at different time points (days 0, 14, 21, 28, 35, and 42). The organizational structure changes of the target skin were observed in the expansion process. The distribution, differentiation, and paracrine function of labeled BMMSCs were detected. RESULTS: Comparing with Group B (25.00 ± 1.98 cm(2)) or Group C (24.00 ± 1.10 cm(2), no transplantation), the expanded skin area of Group A (28.82 ± 1.43 cm(2)) increased, with the morphology of epidermis thickened, and dermis thinned. The BMMSCs differentiated into vascular endothelial cells and dermal fibroblasts. The quantity of newborn cells was proportional to the number of transplanted cells. The gene expression of VEGF, bFGF, EGF, and SDF in Group A was higher than those in Group B or C. The most obvious changes were on day 35. CONCLUSIONS: The local transplanted BMMSCs could increase the skin regeneration efficiency in skin and soft tissue expansion and reduce skin shrinkage effectively after removing the expander. Growth factors, VEGF, bFGF, EGF, and SDF, are favorable to this process.

[Repair of facial and cervical scars with expanded deltopectoral flaps].

OBJECTIVE: To explore the methods for repair of facial and cervical scars after burn. METHODS: One hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later. RESULTS: Among 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting. CONCLUSION: Expanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars.