Modified Scalp Replantation for Total Scalp Avulsion: Scalp-Shifting Technique.

BACKGROUND: Scalp replantation is the best treatment for scalp avulsion due to its functional and esthetic benefits. Regular scalp replantation requires only unilateral or bilateral superficial temporal vascular anastomosis. However, shear force always damages vessels in severe scalp avulsions. Short, superficial temporal vessels (STVs) make tension-free anastomosis challenging. PURPOSE: The objective of this article is to improve the regular scalp replantation technique. When the STVs are short, tension-free anastomosis, and cosmetic symmetry can be achieved without vein grafts or vascular replacement. METHOD: This study retrospectively reviewed 18 patients with scalp avulsion, of which 10 underwent scalp-shifting replantation, and 8 underwent regular scalp replantation with direct anastomosis of the STVs. Postoperatively, the authors, assessed whether there was a significant difference in the percentage of scalp survival and in the facial symmetry of patients between the 2 methods. RESULT: The percentages of scalp survival and facial symmetry were good after surgeries using both methods, and no significant differences were observed. CONCLUSION: The authors use scalp-shifting replantation to create tension-free anastomoses in cases where scalp avulsion injuries have left the superficial temporal arteries too short. This technique ensures facial symmetry, scalp reimplantation survival, and equally excellent results in function and esthetics.

Reconstruction of Scalp and Skull Defects by a Free Anterolateral Thigh Flap Combined With Fascia Lata and Vastus Lateralis Muscle.

BACKGROUND: Reconstruction of composite scalp and skull defects is a great challenge for plastic surgeons, and this study aimed to report the therapeutic regimen of using free ALT flaps with fascia lata and vastus lateralis muscle to cover scalp and cranial defects. METHODS: A retrospective analysis was performed including 10 patients with composite scalp and skull defects who were treated with a free ALT flap with fascia lata and vastus lateralis muscle from January 2012 to June 2020. All patients underwent a 1-stage operation and were followed up for 1 year with clinical data including sex, age, etiology, skull defect area, scalp defect area, flap area, dura mater involvement, recipient vessel, donor site repair, lumbar cistern drainage, and complications. RESULTS: All flaps survived well, 2 patients developed complications, one had cerebrospinal fluid leakage, and another experienced partial skin graft necrosis; All patients were satisfied with both the appearance and functional outcomes of the procedure. CONCLUSION: Free tissue transplantation is an effective method for large defects of the scalp and skull. The combination of a free ALT flap with fascia lata and vastus lateralis muscle, which has a long pedicle, convenient flap designs, less donor-site morbidity, and effective prevention of cerebrospinal fluid leakage, is an ideal choice to repair the composite scalp and cranial defects in stage 1.

Hair follicle stem cells promote epidermal regeneration under expanded condition.

Skin soft tissue expansion is the process of obtaining excess skin mixed with skin development, wound healing, and mechanical stretching. Previous studies have reported that tissue expansion significantly induces epidermal proliferation throughout the skin. However, the mechanisms underlying epidermal regeneration during skin soft tissue expansion are yet to be clarified. Hair follicle stem cells (HFSCs) have been recognized as a promising approach for epidermal regeneration. This study examines HFSC-related epidermal regeneration mechanisms under expanded condition and proposes a potential method for its cellular and molecular regulation.

Complications of Injected Exogenous Growth Factor for Cosmetic Facial Rejuvenation: A Case Series and Sequential Therapy.

BACKGROUND: Exogenous growth factor presents promising soft tissue regeneration, but the complications from injectable exogenous growth factor seem to be growing. However, there is no detailed summary of complications and sequential treatment protocols. It is noted that the injection of exogenous growth factor into the soft tissue is an unreasonable or even illegal procedure, which could cause uncontrollable tissue growth and some other complications. METHODS: A total of 65 patients underwent analysis retrospectively for complications related to the injection of exogenous growth factor from 2017to 2022 at Xijing Hospital in China. Initially the symptoms mainly consisted of redness, skin temperature arisen, itching, tissue hypertrophy, localized swelling, mass, and lump, with later manifestations including ulcerations and purulent discharge. A comprehensive treatment scheme was formulated based on the location and size of the lumps as well as the type of complication. Post-treatment satisfaction was evaluated over a mean 16-month follow-up (range 6-39 months). RESULTS: A total of 65 patients participated in the treatment. Drug injection therapy was initially performed on all patients. If injections were not effective, surgical treatment (debridement/excision/liposuction) was performed. Twenty-eight patients were managed with intralesional injections alone. Patients reported improved satisfaction in 23 cases (82.14%), full symptom resolution in 3 cases (10.72%), and no improvement in 2 cases (7.14%). Surgery was required for 37 patients. Postoperative improved satisfaction was reported in 30 cases (81.08%), full symptom resolution was recorded in 4 cases (10.82%), and no improvement was seen in 3 cases (8.10%). CONCLUSIONS: This study highlights the management of complications arising from exogenous growth factor injections through the implementation of a sequential therapy approach. Specifically, this approach involves the initial administration of drug injection therapy, and if drug injection therapy proves ineffective, then surgical treatment is pursued. In conclusion, the injection of exogenous growth factors into soft tissues should be forbidden. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prenatal diagnosis of micrognathia: a systematic review.

Purpose: This systematic review aimed to analyze the characteristics of different diagnostic techniques for micrognathia, summarize the consistent diagnostic criteria of each technique, and provide a simple and convenient prenatal diagnosis strategy for micrognathia. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search was undertaken in three international databases (PubMed, Scopus, and Web of Science). The three reviewers assessed all papers and extracted the following variables: author's name and year of publication, country, study design, number of participants, gestational age, equipment for prenatal examination, biometric parameters related to micrognathia, main results. Results: A total of 25 articles included in the analysis. Nineteen articles described cross-sectional studies (76 percent), 4 (16 percent) were case-control studies, and 2 (8 percent) were cohort studies. Fifteen studies (60 percent) had a prospective design, 9 (36 percent) had a retrospective design, and one (4 percent) had both prospective and retrospective design. Thirty-two percent of the studies (n = 8) were performed in USA, and the remaining studies were performed in China (n = 4), Israel (n = 3), Netherlands (n = 3), UK (n = 1), France (n = 1), Italy (n = 1), Belgium(n = 1), Germany (n = 1), Spain (n = 1), and Austria (n = 1). The prenatal diagnosis of micrognathia can be performed as early as possible in the first trimester, while the second and third trimester of pregnancy were the main prenatal diagnosis period. The articles that were included in the qualitative synthesis describe 30 biometric parameters related to the mandible. Conclusion: Of the 30 biometric parameters related to the mandible, 15 can obtain the simple and convenient diagnostic criteria or warning value for micrognathia. Based on these diagnostic criteria or warning value, clinicians can quickly make a preliminary judgment on facial deformities, to carry out cytologic examination to further clarify the diagnosis of micrognathia.

Application of Preexpanded Free Flaps Based on Thoracic Branch of Supraclavicular Artery for Facial Scar Treatment.

BACKGROUND: As an exposure region, the face is susceptible to burn injuries, which often lead to physical and psychological problems. For facial scar reconstruction, the subclavicular region has the advantages of matched color, similar texture, and thin and pliable tissue supply. The island or pedicled subclavicular flap, which is nourished by the thoracic branch of supraclavicular artery (TBSA) had been reported to cover cervical facial defects and achieved good outcomes. However, the main restriction is the limitation of the pedicle length. Therefore, the authors applied preexpanded TBSA free flap transplantation for treatments of upper and contralateral facial scars to overcome the pedicle limitation. METHODS: Three patients were treated with preexpanded TBSA flaps to repair the facial defects after scar resections. Two of them were combined with forearm or deltopectoral flaps according to different purposes. The patients were followed up for 2 to 7 years. The clinical data and surgical techniques were recorded and analyzed. The scars were scored by Vancouver Scar Scale. RESULTS: Two of the TBSA flaps survived well without complication. Partial flap necrosis in the distal end was healed by dressing changes, and mild contracture in the left medial canthus was corrected by Z plasty in case 1. The scars around transferred flaps and donor sites were scored 3 to 4 by Vancouver Scar Scale. The patients were satisfied with the outcomes. All the donor sites were closed primarily. CONCLUSION: A preexpanded TBSA-free flap could overcome the restriction of pedicle length for reconstruction procedures. The method is a feasible alternative of thoracic flaps to repair facial defects beyond pedicle limitation.

Restoration of Lower Facial and Neck Esthetics by Application of Pre-Expanded Bipedicle Scalp and Free Scapular Flaps.

OBJECTIVE: To introduce the surgical procedures and experiences in restoration of lower facial esthetics for a male and a female patients who suffered from burn injuries. The difference of surgical methods which varied from sexes were discussed. MATERIALS AND METHODS: The clinical data of the patients was collected and retrospectively analyzed. The cervical contracture was repaired by pre-expanded free scapular flaps with sufficient pliable tissue for large defects. Moreover, for the male patient, prefabricated double pedicle scalp flap was applied to rebuild the beard region. The patients were followed up for 2 years. Surgical procedures and outcomes were detailed in the article. RESULTS: All the flaps were survived well. The facial hair-bearing area of the man was recovered with natural appearance. The reconstructed mental cervical angels and mandibular margins were clear. The neck extension mobility was improved. The 2 patients were satisfied with the outcomes of the treatments. CONCLUSION: The treatments of facial and neck scar varied from sexes and different requirements. For male patient, the combination of scalp and scapular flaps was a feasible method to achieve natural beard and cervical appearance. For female patient, bilateral expanded scapular flaps could meet the demands of large tissue supply and a relative hidden donor site.

Two Pre-Expanded Free Flaps Used for Auricular Reconstruction and Ipsilateral Facial Scar Release.

OBJECTIVES: Auricular reconstruction is a great challenge for surgeons to achieve good aesthetic outcomes when adjacent tissues were burned. Compared with pedicle flap therapies, there are some advantages of pre-expanded free flaps for ear rebuilding, such as thinner layer tissues for aesthetic requirements of delicate auricular structures and less donor site deformity. In this study, the authors introduced 6 sequential surgical procedures for total auricular reconstruction with severe ipsilateral facial scar. METHODS: Pre-expanded deltopectoral flap was used to release periauricular contracture and repair facial scar. The injured ear was restored by expanded forearm flap including autologous cartilage framework. The surgical procedures were lasted more than 2 years. An 8 and half year's follow-up was performed from November 2012 to April 2021. The clinical data and surgical techniques were recorded and analyzed. RESULTS: The patient was satisfied with the aesthetic outcomes of the new ear. The skin texture and color of the grafts were approximately matched to the recipient sites. Facial expression was not affected severely. Sensations of the transferred flap and new ear had partially recovered. The donor sites were recovered without severe complication. CONCLUSIONS: The pre-expanded free forearm flap is a feasible method for total ear reconstruction when local flap therapies could not be applied. Repair of ipsilateral facial scar is beneficial for auricular procedures.

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.

Inhibition of Lymphatic Drainage With a Self-Designed Surgical Approach Prolongs the Vascularized Skin Allograft Survival in Rats.

Vascularized composite allotransplantation (VCA) is an emerging treatment for significant tissue defects. However, VCAs usually consist of multiple highly antigenic skin tissues. Previous studies have shown that the lymphatic system in skin plays important roles in the initiation of immune responses during acute rejection, by transporting T cells and antigen-presenting dendritic cells to regional lymph nodes. Therefore, we designed a new surgical treatment to inhibit lymphatic drainage of skin allografts and investigated whether this approach could promote the survival of allografts and suppress immunological events after transplantation. This procedure was achieved by connecting the vascularized allografts to recipient tissues with only an annular plastic holder, allowing the minimum of allograft contact with recipients. Our results showed that the self-designed treatment for inhibiting lymphatic drainage promoted the survival of allografts, reduced the serum concentration of IL-2, and decreased the percentage of CD4CD25 and CD8CD25 from the lymphatic nodes draining the transplantation region. In conclusion, these data suggest that self-designed surgical approach is effective in inhibiting lymphatic drainage of skin allografts, and the lymphatic system may be new therapeutic targets for developing techniques or drugs against acute rejection after VCAs.

Pharmacological interventions for melanoma: Comparative analysis using bayesian meta-analysis.

We conducted a network meta-analysis in order to compare different strategies for managing melanoma patients. Electronic databases were searched for eligible randomized trials that compared different strategies in efficacy and tolerability. Five interventions were associated with a significant improvement in PFS over chemotherapy (all HR < 1): Ipilimumab, Tremelimumab, Nivolumab, Pembrolizumab 2 mg/kg and Ipilimumab + Nivolumab. Three interventions exhibited significantly improved OS results over chemotherapy (all HR < 1): Ipilimumab, Nivolumab and Ipilimumab + Chemotherapy. Four interventions were superior to chemotherapy in CR and PR (all OR > 1): Nivolumab, Pembrolizumab 10 mg/kg, Pembrolizumab 2 mg/kg and Ipilimumab + Nivolumab. However, the other seven interventions were associated with an increased risk of pruritus compared to chemotherapy (all OR > 1). Ipilimumab, Tremelimumab, Ipilimumab + Nivolumab and Ipilimumab + Chemotherapy might result in a higher risk of diarrhea compared to chemotherapy (all OR > 1). Immune checkpoint therapy or combined interventions might be more effective than chemotherapy for managing melanoma patients. However, chemotherapy appears to be more tolerable than these combined strategies with respect to adverse events.

The utilization of perforated bioinert chambers to generate an in vivo isolated space for tissue engineering involving chondrocytes, mesenchymal stem cells, and fibroblasts.

Vascular invasion and admixture of the nude mouse cells with seeded cells make it difficult to reapply the regenerated tissues to the restoration of host tissue defects. Therefore, a device that is capable of allowing for autologous or allogenic tissue growth while preventing host tissue invasion will be a valuable tool for in vivo tissue engineering. We have previously fabricated a novel silicon-perforated chamber. The aim of this study was to evaluate whether this chamber, after being implanted subcutaneously in experimental animals, would hinder host tissue ingrowth while providing an environment inside its cavity for in vivo growth of either autologous or allogenic implant cells. We found that the chamber did not induce severe foreign body reaction, and the chambers with perforated pores of 1-3 mm in diameter effectively inhibited the host granulation tissue or vascular invasion for as long as 3 months. In addition, the exudates rich in vascular endothelial growth factor, basic fibroblast growth factor, transforming growth factor-ß, insulin-like growth factor-1, and platelet-derived growth factor-BB were steadily generated and collected in the chambers. In vitro cell culture studies revealed that the exudates were able to support the viability and proliferation of rabbit chondrocytes, rat mesenchymal stem cells, and human fibroblasts. The results indicate that this novel chamber could potentially provide an environment favorable for in vivo tissue engineering while effectively preventing host tissue or vascular invasion.