Reconstruction of the Deformed Tragus Accompanied by Accessory Auricle.

BACKGROUND: Accessory auricles are common congenital external ear malformations. However, it remains challenging to treat a complicated accessory auricle and reconstruct the involved tragus. OBJECTIVES: In this study the aim was to present a new classification of accessory auricles and the surgical management of each type. METHODS: We retrospectively reviewed the records of 110 patients who underwent accessory auricle surgery. The accessory auricle was classified by 3 types, according to its morphology and relationship with the tragus: Types I, II, and III. The type III accessory auricle was divided into 3 subtypes: IIIa, IIIb, and IIIc. The surgical techniques utilized varied among the different types. RESULTS: The total number of accessory auricles in 110 patients was 149. Type I was the most common type (52.3%), followed by types II (31.5%) and III (16.1%). Among the type III subtypes, type IIIa was observed in 12 (8.1%), type IIIb in 3 (2%), and type IIIc in 9 (6%) ears. None of the patients experienced short-term complications. Three patients (4 ears) showed mild hypertrophic scarring. Three patients (3 ears) showed a smaller tragus than the normal side. The average score for aesthetic outcomes was 3.7 points on a 4-point Likert scale. CONCLUSIONS: Classification of accessory auricles provides guidance for surgery. Different surgical techniques were employed based on the type of accessory auricle. The final incision at the edge of the reconstructed tragus provided an aesthetically pleasing outcome.

Efficacy of autologous platelet-rich plasma for long-term glucocorticoids caused chronic wound: a case report.

The repair of bone explore wounds is one of the difficult problems in plastic and reconstruction surgery. Platelet-rich plasma (PRP) is a safe and efficient therapeutic option for various trauma, including Osteoarticular, musculoskeletal, and Wound injuries. However, the preparation and storage of PRP becomes challenging for patients with poor systemic status and requiring multi-use of PRP. The availability of safe, reliable tissue bank makes it possible. We report a case of a 42-year-old woman patient with a chronic hip wound combined with ischium bone exploration. And the patient who was treated with long-term glucocorticoids for rheumatoid arthritis has been through the experience of extensive conservative management. Thereafter necrosectomy and Vacuum-Assisted Closure (VAC) surgical procedure failed, and a PRP daily injection was performed at the ischial muscle and soft tissue. Neo-muscle appeared around the explored ischium bone after 8 weeks of injection and Complete wound healing was obtained in 3 months.

3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator.

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h, P<0.01). MTA, ROM, and AOFAS scores between the two groups showed no significant differences pre-operation, after the removal of the external fixator, or at follow-up. Plantigrade feet were achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in two patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Patients in the 3DPM group reported higher satisfaction than those in the control group, owing to better patient-surgeon communication. Surgical planning using patient-specific 3DPMs significantly reduced operation duration and increased patient satisfaction, while providing similar improvements in ankle movement and function compared to traditional surgical planning for the correction of SPAC with external fixators.

Stack-Up Technique to Create a Three-Dimensional Costal Cartilage Framework in Ear Reconstruction.

BACKGROUND: Ear reconstruction is one of the most challenging procedures for plastic surgeons. The costal cartilage is the most accepted material, and the framework fabrication methods also vary with the different ear reconstruction methods. This study aimed to present our clinical experience using a novel method for costal cartilage framework fabrication with the "fully expansion technique" ear reconstruction without a skin graft. From January 2017 to June 2018, 107 patients with unilateral microtia underwent ear reconstruction with the fully expansion technique. Costal cartilage was designed into different components and stacked up to form the multilayer structure and adequate projection. Preexpansion provided larger skin flap for fully cover the anterior and posterior parts of the framework. Then the anterior ear structures and the posterior sulcus, as well as the ideal bilateral symmetry, were established simultaneously without a skin graft. A total of 107 patients in this group were followed up for 8 to 24 month, and altogether 98 patients (91.6%) were satisfied with the reconstruction. The cartilage "stack-up" framework fabrication and fully expansion technique provided a well-defined, well-projected, and bilateral symmetrical reconstructed ear.

Latissimus Dorsi-Myocutaneous Flap in the Repair of Titanium Mesh Exposure and Scalp Defect After Cranioplasty.

Titanium mesh was widely used for cranium defect repair but associated with high complication rates. In this study, the authors describe a method using latissimus dorsi-myocutaneous flap in the repair of titanium mesh exposure and scalp defect after cranioplasty, and the plate retaining is also achieved. Fifteen patients from April 2012 to May 2016 underwent this procedure, the age ranged from 32 to 62 years and 47 years old on average, and all the patient had plate exposure combined with surgical site infection and variation of scalp defect. All the patients had fully flap survive, and follow up ranged from 6 months to 24 months, 1 patient had titanium mesh re-expose and received additional operation to remove the plate. The free latissimus dorsi musculocutaneous flap could supply large size of bulky tissue coverage with good blood supply and strong anti-infection ability. This method was an option for retaining the titanium mesh and repairing the exposure for the mild infection with small size scalp defect patient.

Repair of Craniomaxillofacial Traumatic Soft Tissue Defects With Tissue Expansion in the Early Stage.

BACKGROUND: Craniomaxillofacial traumatic soft tissue defects severely affect the function and appearance of the patients. The traditional skin grafting or free flap transplantation can only close the defects in the early stage of operation but cannot ensure similar color, texture, and relative aesthetic contour. In the present study, the authors have explored a novel strategy to repair craniomaxillofacial traumatic soft tissue defects by tissue expansion in the early stage and have obtained satisfactory results. METHODS: Eighteen patients suffering large craniomaxillofacial traumatic soft tissue defects were treated by thorough debridement leaving the wounds unclosed or simply closed with thin split-thickness scalp grafts, adjacent expander implantation in the first stage, and expanded flap transposition in the second stage. RESULTS: There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years (mean, 19.4 ±â€Š12.2 years), with average 15 months follow-up (range, 3-67 months). The average expansion time was 74.3 days (range, 53-96 days). The 18 patients with a total of 22 expanders were treated with satisfactory results. All the flaps survived and the skin color, texture, and contour well matched those of the peripheral tissue. Only 1 complication of infection happened in the 18 cases (5.56%) and the 22 expanders (4.55%), which was similar to the rate reported in the literature. No other complications related to the expanders occurred. CONCLUSION: Debridement and tissue expansion in the early stage has been proved to be a more effective strategy to repair craniomaxillofacial traumatic soft tissue defects. This strategy can not only achieve satisfactory color, unbulky and well-matched texture similar to normal, but also avoid unnecessary donor site injuries.

Reconstruction of Large Postburn Facial-Scalp Scars by Expanded Pedicled Deltopectoral Flap and Random Scalp Flap: Technique Improvements to Enlarge the Reconstructive Territory.

The scars of face and scalp caused by burning often show as 1 large facial-scalp scar. The deltopectoral flap was recognized as one of the first choices for the facial scar reconstruction. However, this flap cannot cross the level of zygomatic arch traditionally when it was transferred with pedicle. When the flap reconstructed the facial-scalp scars with expanded random scalp flap, another flap was often needed to reconstruct the remaining temple and forehead scars. The authors reviewed 24 patients of large facial-scalp scars reconstructed by expanded pedicled deltopectoral flap and scalp flap with several technique improvements. The seaming scar between the deltopectoral flap and scalp flap in the temple region formed the new hairline. The technique improvements included ligation of the perforating branches of the transverse cervical artery and thoracoacromial artery when dissecting the pocket, the partial bolster compressive dressing to the distal part of the flap and dividing the pedicle partly as a delaying procedure before dividing the pedicle completely. Good skin compliance, normal contours, and emotional expression were noted. There were complications including expander exposure in 3 patients, stretch marks in 5 patients, flap tip necrosis in 2 patients, and mild postoperative hypertrophic scars in 3 patients. In conclusion, the expanded pedicled deltopectoral flap can enlarge the reconstructive territory in face successfully with the technique improvements. The combination of the expanded pedicled deltopectoral flap and scalp flap is a reliable and excellent reconstructive option for large postburn facial-scalp scars.

Penile reconstruction by preexpanded free scapular flap in severely burned patient.

BACKGROUND: Penile reconstruction or phalloplasty has always been one of the most challenging problems for plastic surgeons. In 1936, Bogoras performed the first phalloplasty by using traditional tubed pedicle flaps. Many other flaps and methods have been applied since, including lower abdominal flaps, pudendal-thigh flaps, parascapular flaps, paraumbilical flaps and, of course, radial forearm flaps. For each method, reports of both functional and esthetic successes abound. In this case, donor sites for phalloplasty were somewhat limited by the severe electric burn injury. After much consideration, we decided to preexpand the scapular flap and to use this for phalloplasty, with satisfactory outcome. Our case is a 31-year-old patient who sustained a 19% total burn surface area by electrical burn in August 2011. The burn area involved both forearms, abdominal region, both femoral regions, and perineum including genitalia loss. Most of the burn wounds were skin grafted shortly after the injury. Due to the nature of the burn, regular donor sites for penile reconstruction were unavailable. Before surgery, we went through a detailed plan for phalloplasty with the patient and his family. The patient consented to the 2-stage surgery for the penile reconstruction. The first stage was insertion of a 600-mL soft tissue expander in the scapular region. After 4 months of expansion, the second stage of free scapular flap transfer was performed in March 2012. RESULTS: The reconstruction was successful with good appearance and patient satisfaction, complicated by urethral fistula. Eight months later, the urinary fistula was repaired successfully. CONCLUSIONS: The free scapular flap proved to be an ideal solution to this patient's dilemma. The flap has adequate amount of tissue and a reliable blood supply. Its amenability to be expanded allows better donor-site primary closure. Tissue bulk resulted in adequate stiffness without artificial prosthesis for the phallus to be functional.

Histone deacetylase inhibitor reduces hypertrophic scarring in a rabbit ear model.

BACKGROUND: Hypertrophic scars result from excessive collagen deposition at sites of healing dermal wounds and could be functionally and cosmetically problematic. The authors tested the ability of the histone deacetylase inhibitor trichostatin A to reduce hypertrophic scar formation in a rabbit ear model. METHODS: The authors have developed a reliable rabbit model that results in hypertrophic scarring. Four 1-cm, full-thickness, circular wounds were made on each ear. After the wounds reepithelialized, 0.02% trichostatin A was injected intradermally into the wounds in the treatment group. Expression of collagen I and fibronectin was detected by reverse transcription polymerase chain reaction and Western blot analysis at postoperative day 23. Scar hypertrophy was quantified by measurement of the scar elevation index at postoperative day 45. RESULTS: Compared with the control group, injection of trichostatin A led to much more normal-appearing scars in the rabbit ear. The scar elevation index at postoperative day 45 was significantly decreased after injection of trichostatin A compared with untreated scars. Furthermore, the authors confirmed the decreased expression of collagen I and fibronectin at postoperative day 23 (after the rabbits had been treated with trichostatin A for 1 week) in the treated scars compared with the control scars according to reverse transcription polymerase chain reaction and Western blot analysis. CONCLUSIONS: The introduction of trichostatin A can result in the decreased formation of hypertrophic scars in a rabbit ear model, which is corroborated by evidence of decreased collagen I and fibronectin synthesis.

Clinical application of full-face, whole, full-thickness skin grafting: a case report.

A considerable portion of burn patients suffers severe full-face burns. Even after they were treated, some severe abnormalities still stay with them such as upper- and lower-eyelid ectropions, upper- and lower-lip ectropions, microstomia and extensive facial scar hyperplasia accompanied with pruritus. Patients suffer a great deal physically, emotionally and socially. Here we conclude our treatment experience of full-face burns with the full-face, whole, full-thickness skin grafting, which has not yet reported in the literature. We transplanted a whole, full-thickness skin graft to cover the wound in the primary operation and then remedied eyelid ectropions and microstomia in the operation that followed. The results of a 4-year-follow-up suggest that the patient has recovered part of facial expression and sensation without any geographic scars. Full-face, whole, full-thickness skin grafting appears to be an effective and relatively simple method for full-face burns that do not respond well to facial composite tissue allotransplantation (CTA).

Trichostatin A inhibits collagen synthesis and induces apoptosis in keloid fibroblasts.

Keloid, a fibro-proliferative benign tumor of skin, is characterized by an enriched milieu of growth factors and an abundant accumulation of extracellular matrix (ECM). Transforming growth factor (TGF)-ß1 is well known as the crucial fibrogenic cytokine promoting ECM production and tissue fibrosis in keloid forming. Epigenetic modifications have been shown to play a role in the pathogenesis of cancer as well as autoimmune and inflammatory disorders. Recent publication reports epigenetic modifications in keloid fibroblasts that include an altered pattern of DNA methylation and histone acetylation. Therefore, the field of epigenetics may provide a new therapeutic idea for keloid treatment strategies. Currently, there is some evidence from experimental studies that histone deacetylase (HDAC) inhibitor Trichostatin A (TSA) causes abrogation of TGF-ß1 induced collagen synthesis in skin fibroblasts. Furthermore, TSA could suppress proliferation and induce apoptosis in a broad spectrum of tumor cells both in vitro and in vivo. These findings suggest that TSA could also cause abrogation of TGF-ß1 induced collagen synthesis and induce apoptosis of proliferating keloid fibroblasts.

Resurfacing partial nose defects with a retroauricular skin/cartilage free flap.

BACKGROUND: The retroauricular skin has always received much attention by plastic surgeons for use in nose reconstruction because of its rich vascularity. Anatomically, the skin of this area lies hidden behind the ear and is very similar to that of the face. More importantly, the retroauricular skin flap along with the cartilage can be used to repair defective cartilage of the nose. All these reasons make this area an ideal donor site for nose reconstruction. This article presents the surgical procedures for reconstruction of partial nasal defects with the use of retroauricular skin/cartilage free flaps. METHODS: Based on the anatomy and blood supply of the retroauricular region, a flap was designed and harvested with the retroauricular vessels as its pedicle. This flap was used to repair the partial nose defects in 10 patients, between the years 2002 and 2008. Of these, 4 patients presented with unilateral ala defects; 2 with nasal tip defects; 2 with defects on the nasal tip and bilateral ala; 1 with unilateral ala and tip defect; and 1 with unilateral ala and lateral defect. The size of the defect ranged from 2.5 × 1.5 cm to 4.0 × 3.0 cm. The flap varied between 3.0 × 2.0 cm and 4.5 × 3.5 cm. In all cases, the auricular cartilage of 1.5 × 1.0 cm to 1.0 × 0.5 cm was taken along with the flap. The retroauricular vessels were anastomosed with the facial vessels. The donor site was covered with full-thickness skin graft or local flap. RESULTS: No flap failure was recorded. Excellent morphologic reconstruction was obtained with these flaps with no sequela at the donor site in terms of form and function. Postoperatively, the blood supply to the flaps was fairly good in 8 cases, although there was vein congestion in 2 cases on the fourth day. However, the postoperative results of the 10 cases were satisfactory after treatment. CONCLUSION: The retroauricular skin-cartilage free flap is a good choice for partial nasal reconstruction, having the merits of a well-hidden donor site, good color match, and 1-stage operation for cartilage support and nose reconstruction.

Rolling autogenetic dermis up to form a tube may be used as scaffold in tissue-engineered blood vessels.

Coronary and peripheral artery bypass grafting are widely being used to deal with vascular deficiencies currently, and a man-made synthetic tube or autogenous arteries or veins are needed a lot. But one's autogenous arteries or veins are limited, and artificial graft substitute isn't yet available in clinical applications because of many disadvantages. Various polymeric materials have been used as scaffolds, but without satisfying results due to intimal hyperplasia and the rate of degradation. Autogenetic dermis, which has the advantages of resistance to immunogenicity, good biocompatibility, and appropriate mechanical and physiological properties, has gained our attention to use it as a scaffold for tissue-engineered blood vessels. What is more, autogenetic dermis can be harvested easily. So we postulate that autogenetic dermis rolled up to form a tube may be an ideal scaffold for tissue-engineered blood vessels.

Aberrant Notch signaling: a potential pathomechanism of vitiligo.

Vitiligo is characterized by a localized and progressive loss of melanocytes which are pigment cells responsible for the pigmentation of human. The etiopathogenetic mechanisms leading to melanocytes loss in vitiligo lesions are not yet fully understood and no effective treatment or cure exists. Notch signaling has been shown to control many cellular functions of melanocytes. Activation of Notch signaling occurs during the formation of melanocytic tumors and inactivation of Notch signaling causes a dramatic elimination of melanocytes precursors. So we postulate that inactivation of Notch signaling in the melanocytes may be a potential pathomechanism of vitiligo. If the hypothesis was proved to be practical, we could provide new understanding of the etiology of vitiligo and produce new therapeutic avenues.

Detection of serum gastric cancer-associated MG7-Ag from gastric cancer patients using a sensitive and convenient ELISA method.

PURPOSE: To seek a high sensitive and convenient method for early diagnosis of gastric cancer by testing MG7-Ag in serum of gastric cancer patients and some other control groups using a convenient ELISA method. EXPERIMENT DESIGN: The expression of serum MG7-Ag was detected in 116 preoperative gastric cancer patients, 63 postoperative gastric cancer patients, 78 precancerous lesion patients, 50 healthy blood donors and patients of other cancers by a convenient ELISA method. For comparison, serum CEA, CA 50, CA 19-9 and TAG-72 were also detected in preoperative gastric cancer patients. Meanwhile, the expression of MG7-Ag was detected by immunohistochemical analysis in the groups of patients with gastric cancer or precancerous lesion mentioned above. RESULTS: The positive rate of Mg7-Ag determined by ELISA was 83. 6% of preoperative gastric cancer patients, 54.8% of lung cancer patients, 45.5% of rectal cancer patients, 17.6% of colonic cancer patients, 14.2% of breast cancer patients, 47.6% of postoperative gastric cancer patients, 12.8% of precancerous lesions patients and 0% of healthy blood donors, respectively. The sensitivity of ELISA (83.6%) was found to be similar with that of immunohistochemistry (94%, p > 0. 01), while the false positive rate was lower (12.8% vs. 51.3%). MG7-Ag expression level in gastric cancer was correlated with tumor differentiation (p < 0. 01) and pathological stage (p < 0. 01). CONCLUSION: This ELISA method may be a non-invasive candidate method for screening of large population with high risk of gastric cancer.

[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.

[Expanded skin flaps for the treatment of large scalp and face scar].

OBJECTIVE: To explore the method to repair large scalp and face scars. METHODS: 1-3 expanders under the scalp were needed for repair the scalp scar. The expanded deltopectoral flaps were transferred to repair the face scar. RESULTS: 12 cases were treated with satisfactory results. All the flaps survived and the donor sites were closed primarily. 2 cases had expander exposure which didn't affect the treatment results. Atrophic cutaneous striae was occurred because of overexpansion. CONCLUSIONS: Skin expansion is a good method for large scalp and face scar.

[Influence of endothelial cells on the proliferation of scar-derived fibroblast in hypertropic scar tissue].

OBJECTIVE: To investigate the influence of the endothelial cells on the scar-derived fibroblasts in the hypertropic scar tissue. METHODS: The endothelial cell from the human umbilical vein was cultured and its supernatant was then collected. Thereafter, it was mixed with the pre-cultured scar-derived fibroblasts from the hypertropic scar tissue. The fibroblasts were analyzed with a flow cytometer in a MTT-assay method to evaluate the cell proliferation and its division cycle. RESULTS: The endothelial cells were significantly increasing the scar-derived fibroblast proliferation (P < 0.05), compared with the control. The proportion of the fibroblasts in the S-stage of cell cycle was also quite high. CONCLUSION: The endothelial cells may secrete some active products, which may enhance the proliferation of the scar-derived fibroblasts and stimulate the fibroblasts into the S-stage of cell generation cycle.