Fatal Cerebral Infarction and Ophthalmic Artery Occlusion After Nasal Augmentation with Hyaluronic Acid-A Case Report and Review of Literature.

BACKGROUND: Cerebral infarction is a rare complication of hyaluronic acid (HA) filler injection, usually presenting with sudden increase in intracranial pressure and loss of vision. METHODS: A 40-year-old Asian woman in a coma was transferred to the emergency intensive care unit of Xijing Hospital, China, 48 h after nasal augmentation with HA. Magnetic resonance imaging indicated cerebral infarction and left optic nerve edema and ischemia. Magnetic resonance angiography did not reveal vessel embolism. RESULTS: The patient developed gastric ulceration, pulmonary infection, respiratory failure, and cerebral herniation, and died 6 days after the HA filler injection. CONCLUSION: Facial cosmetic HA filler injection can cause devastating and even fatal complications. LEVEL OF EVIDENCE V: 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.

["W-shape" flap at nasal tip for the correction of the nasal deformity secondary to unilateral cleft lip].

OBJECTIVE: To investigate an effective method for the correction of the narrow nostril secondary to cleft lip. METHODS: A "bird wing shape" incision was made on the nasal tip to form a "W-shape" flap for repairing the nasal deformities secondary to cleft lip, especially for the cases with narrow nostril. RESULTS: Twenty-eight patients were treated with this method. All the cases achieved a symmetry shape of nasal ala, nostril, nasal columella and a normal height of nasal tip except for 2 cases with malformation at nasal tip who achieved improvement after reoperation. 21 cases were followed up for 6-12 months with good cosmetic result and no recurrence. CONCLUSIONS: "W-shape" flap at the nasal tip is an ideal way for the correction of mild to moderate narrow nostril deformity secondary to cleft lip.

[Advantages and disadvantages of composite tissue allotransplantation].

OBJECTIVE: To review the research progress of composite tissue allotransplantation (CTA), analyze the superiority and the inferiority, and inform the possible direction of further research. METHODS: Literature concerning CTA was reviewed and analyzed in terms of the limits of conventional reparative and reconstructive surgery, the definition of CTA, potential advantages, and treatment risks. RESULTS: The clinical research of CTA both at home and abroad proved that the therapeutic effect of CTA was better than that of conventional reparative and reconstructive surgery. However, the risks resulting from immunosuppressive therapy were still the primary factors restraining the wide clinical application of CTA. CONCLUSION: The development of immunosuppressive therapy explores a great development potential for the CTA, and how to decrease the treatment risk of immunosuppressive therapy will be the main research direction in the field of CTA.

[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.

[A modified technique for the repair of secondary defect of unilateral cleft lip].

OBJECTIVE: To investigate the effect of a modified technique for repairing secondary defect of unilateral cleft lip. METHODS: The incision line was designed along the oral-nasal contour line. The lateral crus of nasal alar were rotated and repositioned in order to reconstruct the nasal sill and base. V-Y plasty was performed with a muco-cartilage flap inside the nasal cavity to reset the alar cartilage backwards and correct the nasal deformity. RESULTS: Satisfactory results were achieved in all 69 patients with this modified technique. The post-operative scar was inconspicuous. CONCLUSIONS: This modified technique with advantages of contour line incision and alar cartilage backward re-reposition is a good option for the repair of secondary defect of unilateral cleft lip.

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.

[Immunosuppressive treatment about the patient operated facial allotransplantation in perioperative period].

OBJECTIVE: To investigate the perioperation medication on the first patient who was operated facial allotransplantation, including immunosuppressive drug and adjunctive drug, so that to search a effective medication schedule to the patient operated facial allotransplantation. METHODS: FK506, MMF, Prednisone and Zenapax was performed as immunosuppressive regiment in perioperative treatment; meanwhile, anti-infectives was administered to take precautions against all sorts of infections, such as bacterium, virus and fungus. Furthermore, all kinds of adjunctive drug, Losec, glucurolactone and so on, was administered to protect those function of stomach, liver, kidney and so on. Clinical observations were made on the signs and symptoms of graft survival or rejection, as well as immunological indexes were tested in laboratory. Biopsies of graft were also made at 30 d after operation. Side effect and complication of drug was monitored, in case the body suffered harm. RESULTS: Facial allograft was survived, and the temperature and color of skin were normal. Swelling of tissue was gradually subsidise after 4 days, and recovered in a half month. The count and ratio between Th and Ts were normal, skin Biopsies of every time had no found of hyperacute or acute rejection, and side effect and complication of drug had no monitored. CONCLUSIONS: The regiment of perioperation medication was successfully performed.

[Change of expression of P-selectin in avulsion-injured vessels].

OBJECTIVE: To determine the change of P-selectin in avulsion-injured vessels. METHODS: Different stretch forces of 60, 70, 80 and 90 g were applied to a vascular injury model. The expression changes of P-selectin were evaluated by RT-PCR. RESULTS: The expression of P-selection mRNA in the injured vessels increased with the stretch force. CONCLUSION: The result associated with our previous study indicated that P-selectin may be involved in thrombosis.

[The influence of Matrine on apoptosis of fibroblasts and the expression of apoptotic modulation related protein in hypertrophic scar of rabbit ear].

OBJECTIVE: To investigate the effects of Matrine on apoptosis of fibroblasts and the expression of apoptotic modulation related protein in the hypertrophic scar. METHODS: Hypertrophic scar was produced on the ear of 24 New Zealand white rabbits, which were employed as the model, and were randomly and equally divided into control (CC) and Matrine (M) groups (12 in each group). Matrine (50 g/L) was injected into the ear scar in M group and with normal saline in C group once every four days. At 2, 4, 6, 8 and 12 weeks after the injection, the apoptotic fibroblast count in the scar was determined by TUNEL method, and the expressions of apoptosis related modulation proteins p53, bcl-2, bax were detected by immunohistochemistry method. RESULTS: The apoptotic fibroblast count was much larger in M group than that in C group at all test time points (P < 0.05). Furthermore, the bax expression was increased and that of p53 and bcl-2 was decreased significantly in M group. In adding, the scar became flat in M group. CONCLUSION: Matrine might obviously enhance the fibroblast apoptosis in rabbit ear hypertrophic scar, and up-regulate the expression of apoptosis related modulation protein bax and down-regulate the expression of p53 and Bcl-2.