The Application of "Table Tennis Racquet" Random Skin Flap in the Treatment of Facial Skin Carcinoma.

BACKGROUND: The repair of facial skin and soft tissue defects remains a clinical challenge. The author introduced a novel "table tennis racquet" random skin flap for wound repair after facial skin cancer excision and discussed its survival mechanisms. METHODS: A lateral mandibular neck skin flap shaped like a table tennis racquet with no well-known blood vessels at the narrow pedicle was designed in 31 cases to repair tissue defects. Among them, there were 8 cases of skin carcinoma in the frontotemporal area and 23 cases of skin carcinoma in the cheek. The flap area was 8.0 × 7.0 cm at maximum and 3.0 × 2.5 cm at minimum, with a pedicle width of 1.0-2.0 cm and a pedicle length of 2.0-6.0 cm. RESULTS: All 31 "table tennis racquet" random skin flaps survived, although there were 3 cases with delayed healing of distal flap bruising. All of them had an ideal local shape after repair with a concealed donor area and inconspicuous scars. CONCLUSIONS: This flap has a "table tennis racquet" shape with a pedicle without well-known blood vessels and has a length-to-width ratio that exceeds that of conventional random flaps, making it unconventional. Because of its long and narrow pedicle, it not only has a large rotation and coverage area but also can be designed away from the defect area, avoiding the defect of no donor tissue being localized near the defect. Overall, this approach is an ideal option for repairing tissue defects after enlarged excision of facial skin carcinoma.

Autologous i-PRF promotes healing of radiation-induced skin injury.

Skin, as an exposed tissue, often suffers damage after exposure to radiotherapy and accidental events, which may lead to the formation of chronic refractory wounds. However, effective treatment options are usually limited for severe radiation-induced skin injury (RSI). Platelet-rich plasma (PRP) has been identified to promote wound healing, but whether a new generation of blood-derived biomaterial, injectable platelet-rich fibrin (i-PRF), is effective in repairing RSI remains unclear. In this study, blood was drawn from humans and Sprague-Dawley rats to prepare PRP and i-PRF, and the regenerative functions of PRP and i-PRF were investigated by exposing the dorsal skin of SD rats to local radiation (45 Gy) and exposing HDF-α cells and human umbilical vein endothelial cells (HUVECs) cells to X-rays (10 Gy). The healing effect of i-PRF on RSI was analysed by tube formation assay, cell migration and apoptosis assays, ROS assay, wound healing assay, histological characterisation and immunostaining. The results showed that exposure to high doses of radiation reduced cell viability, increased ROS levels and induced cell apoptosis, thereby causing dorsal trauma of rats. However, both PRP and i-PRF could resisted RSI, and they were capable of reducing inflammation and promoting angiogenesis and vascular regeneration. i-PRF has a higher concentration of platelets and platelet-derived growth factors, which has a more convenient preparation method and better repair effect and possesses a good application prospect for the repair of RSI.

Plasma exosome-derived connexin43 as a promising biomarker for melanoma patients.

BACKGROUND: To examine the levels of exosome-derived connexin 43 (Cx43) in plasma and estimate its forecast value in patients with melanoma. METHODS: We measured the plasma exosome-derived Cx43 levels in the plasma of 112 melanoma patients and 50 healthy controls. RESULTS: The plasma exosome-derived Cx43 levels in patients with melanoma were substantially downregulated as opposed to the levels in healthy controls (P < 0.001). Kaplan-Meier analysis indicated that overall survival (OS) and disease-free survival (DFS) were poorer in patients with melanoma who exhibited lower levels of plasma exosome-derived Cx43 (both P < 0.001). The levels of plasma exosome-derived Cx43 were considerably elevated in patients with melanoma whose tumor was situated in the skin, tumor size < 10 cm, with Clark level I-III, TNM stages IIb-IV, and had no lymph node metastasis as opposed to patients whose tumor was situated in the viscera or mucosa, tumor size ≥ 10 cm, Clark level IV-V, TNM stages IIb-IV and had lymph node metastasis (all P < 0.05). The receiver operating characteristic (ROC) of plasma exosome-derived Cx43 for forecasting 5-year DFS in patients with melanoma was 0.78 (95% confidence interval (CI): 0.70-0.86), with a specificity of 77.78% and a sensitivity of 81.55%. The ROC of plasma exosome-derived Cx43 for forecasting 5-year OS of patients with melanoma was 0.77 (95% CI: 0.68-0.84), with a specificity of 80.0% and sensitivity of 65.98%. CONCLUSION: The overall findings indicated that the levels of plasma exosome-derived Cx43 in patients with melanoma were considerably downregulated. It can therefore be inferred that the levels of plasma exosome-derived Cx43 might be a prospective prognostic indicator for 5 5-year OS and 5-year DFS of patients with melanoma.

Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma.

OBJECTIVE: To investigate the efficacy and safety of broadband light (BBL) combined with intradermal injection of tranexamic acid for treating melasma. METHODS: 120 women with melasma admitted to our hospital from January 2021 to April 2022 were randomly categorized into the following groups: control group, treated with 250 mg tranexamic acid given orally twice daily, except during menstruation; group I, treated with BBL (Sciton, Inc., USA) monthly; group II, received intradermal injections of tranexamic acid monthly; and group III, treated with BBL with intradermal injection of tranexamic acid monthly. Treatment in each group lasted three months. The MASI (Melasma Area Severity Index) and VISIA (Canfield VISIA Complexion Analysis) were used for evaluation. RESULTS: After treatment course, MASI scores and VISIA brown spot and red zone ranking improved in all four groups (p < 0.05). The decrease in MASI scores and improvement rates of VISIA brown spot and red zone rankings were not significantly different among the control group, group I, and group II; however, the decreased MASI scores and improvement rates of VISIA brown spot and red zone rankings were significantly higher in group III than in the other three groups (p < 0.05). CONCLUSION: The effect of BBL combined with the intradermal injection of TA in the treatment of melasma is remarkable. This combination therapy can be an alternative and effective treatment for managing melasma.

A study of combination unilateral subcutaneous botulinum toxin a treatment for androgenetic alopecia.

OBJECTIVE: To observe the efficacy of unilateral subcutaneous injection of botulinum toxin A combined with finasteride and minoxidil in the treatment of androgenic alopecia. METHODS: Thirty-seven patients with androgenic alopecia were treated with finasteride and minoxidil as standard therapy and were randomly assigned to subcutaneous injections of botulinum toxin A in one hemisphere of the head at the beginning of a 6-month treatment. Before treatment, 3 months after treatment, and 6 months after treatment, the patient's head hair growth was photographed and evaluated. RESULTS: After 3 and 6 months of treatment, hair density of the treated androgenic alopecia patients was higher than before treatment (p < 0.05), and the hair density of the botulinum toxin A injection side was higher than that of the control side (p < 0.05). After 6 months of treatment, the response rate of botulinum toxin A combined with finasteride and minoxidil was 77.5%, with no significant side effects observed. CONCLUSION: Finasteride and minoxidil have a significant effect on androgenic alopecia, and the effect is further increased after combined with botulinum toxin A subcutaneous injection.

LncRNA TUG1 exhibits pro-fibrosis activity in hypertrophic scar through TAK1/YAP/TAZ pathway via miR-27b-3p.

Hypertrophic Scar (HS) is a complicated fibrotic disease. In addition, its pathogenesis is still to be further explored. Long non-coding RNAs (lncRNAs) have been proved to be participated in multiple diseases, including HS. However, the role of lncRNA TUG1 in HS remains unclear. The expression level of RNA and protein in cells were detected by q-PCR and western blot, respectively. MTT assay was performed to test the cell proliferation. Cell migration was detected by transwell assay. Cell apoptosis was measured by flow cytometry. Dual luciferase report assay and RNA pull down were used to verify the relationship between TUG1, miR-27b-3p and TAK1.TUG1 and TAK1 were upregulated in HS, while miR-27b-3p was downregulated. Knockdown of TUG1 significantly suppressed the proliferation and migration and induced the apoptosis of HS fibroblasts (HSF). In addition, silencing of TUG1 notably inhibited the extracellular matrix (ECM) biosynthesis in HSF. Overexpression of miR-27b-3p has the same effect on HS as that of TUG1 knockdown. Meanwhile, TUG1 could sponge miR-27b-3p, and TAK1 was the direct target of miR-27b-3p. Furthermore, knockdown of TUG1 significantly suppressed the fibrosis in HS via miR-27b-3p/TAK1/YAP/TAZ axis mediation. LncRNA TUG1 promotes the fibrosis in HS via sponging miR-27b-3p and then activates TAK1/YAP/TAZ pathway, which may serve as a potential target for treatment of HS.

Pressure-driven spreadable deferoxamine-laden hydrogels for vascularized skin flaps.

The development of hydrogels that support vascularization to improve the survival of skin flaps, yet establishing homogeneous angiogenic niches without compromising the ease of use in surgical settings remains a challenge. Here, pressure-driven spreadable hydrogels were developed utilizing beta-sheet rich silk nanofiber materials. These silk nanofiber-based hydrogels exhibited excellent spreading under mild pressure to form a thin coating to cover all the regions of the skin flaps. Deferoxamine (DFO) was loaded onto the silk nanofibers to support vascularization and these DFO-laden hydrogels were implanted under skin flaps in rats to fill the interface between the wound bed and the flap using the applied pressure. The thickness of the spread hydrogels was below 200 µm, minimizing the physical barrier effects from the hydrogels. The distribution of the hydrogels provided homogeneous angiogenic stimulation, accelerating rapid blood vessel network formation and significantly improving the survival of the skin flaps. The hydrogels also modulated the immune reactions, further facilitating the regeneration of the skin flaps. Considering the homogeneous distribution at the wound sites, improved vascularization, reduced barrier effects and low inflammation, these hydrogels appear to be promising candidates for use in tissue repair where a high blood supply is in demand. The pressure-driven spreading properties should simplify the use of the hydrogels in surgical settings to facilitate clinical translation.

"Pingpong racket" flap model for evaluating flap survival.

BACKGROUND: Random skin flap is widely used to repair tissue defects; however, it is often accompanied by ischemia and necrosis of the distal flap due to inferior axial vascularity. Even though different drugs, biomaterials, and stem cell therapies have been developed to improve the survival of random flap, evaluating the promotion of flap survival remains a big challenge. Based on successful clinical practice, we designed a "Pingpong racket" shape flap in the rat. Without the predetected blood vessels procedure, the "pingpong racket" flap provides a preferable option to evaluate the function of drugs and biomaterials in promoting flap survival. MATERIALS AND METHODS: "Pingpong racket" dorsal flaps with different pedicle lengths were developed in the rats. The survival area was evaluated by digital photography and computer-assisted analysis. The quantitative survival area was considered a useful indicator for analyzing drugs' applicability in improving skin flap survival. RESULTS: A new model with a pedicle width of 1 cm and a flap diameter of 3 cm, in which the length of the pedicle could be tuned, was established. No iliolumbar vessels passed through the pedicle. The necrosis ratio ( round ) of the flap was 29.88% in the 2 cm long pedicle, 74.69% in the 3 cm long pedicle, 95.52% in the 4 cm long pedicle, and in the 5 cm long pedicle; necrotic area could be found in both the round part and in the pedicle. CONCLUSION: The new 3 cm long pedicle flap is suitable for evaluating the drugs for promoting skin flap survival. Rat dorsal "Pingpong racket" flap can be easily handled, thus avoiding blood vessels' detection. The flap could achieve comparable results to clinical and alleviate the negative influence of the flap's longitudinal contraction. Besides, it is intuitive and aesthetically pleasing.