An Innovative Preauricular Free Flap Pedicled with Retrograde Vascular (PFFPRV) for Pediatric Nasal Reconstruction.

SUMMARY: Nasal reconstruction in pediatric patient is very challenging and it requires consideration of later nasal development. Herein, we introduce an innovative preauricular free flap pedicled with retrograde vascular (PFFPRV) for pediatric nasal reconstruction. In this PFFPRV technique, the retrograde superficial temporal vessels were used as the flap pedicle. The lateral alar artery and angular vein were used as vessels of the nasal recipient zone. The flap vessels were anastomosed directly to the recipient area vessels without additional vessel transplantation. Eight pediatric patients with nasal defects underwent this operation. All patients were followed up for more than 2 years. Patients' medical history data were retrospectively analyzed. Preoperative and postoperative facial photos were compared and analyzed. The satisfaction of patient's parents with the aesthetic results was assessed. All patients were successfully operated without intraoperative complications. None of the procedures required additional blood vessel grafts. One patient developed a vascular crisis the next day after the surgery and underwent vascular exploration operation. The free flaps of all patients survived without wound infection or necrosis. The color difference of flap gradually became unobvious. The transplanted flap did not show obvious contracture or retraction, and the nose was symmetrical and developed well. The parents of all patients were satisfied with the surgical results. We think this PFFPRV technique can be a reasonable alternative strategy for reconstruction of pediatric nasal defect, with no adverse effect on nasal development and no need of vascular transplantation. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Integrating the Fast-Track surgery concept into the surgical treatment of gynecomastia.

Background: The use of fast-track surgery pathway has been reported to reduce the stress of operation and accelerate rehabilitation in various surgical specialties. However, there has been a relative dearth of research on this subject for surgical treatment of gynecomastia.Materials and methods: The gynecomastia was treated by liposuction plus pull-through technique. The safety and recovery profiles were retrospectively compared between the patients in a standard pathway (including general anesthesia and postoperative drainage) and those in a fast-track pathway (including patient education, local tumescent anesthesia, no drainage, and effective pain control). Registered outcomes included postoperative complications, time to normal life, length of stay, patient satisfaction, etc.Results: From October of 2017 to October of 2021, 126 gynecomastia patients with Simon's grade I or II who underwent the surgical treatments were included in the study, of which 25 patients were treated according to standard pathway, and 101 patients underwent the fast-track pathway. During the follow-up, there was no difference between the cohorts in the incidence of postoperative complications. Both the time to normal life and length of stay significantly decreased to 0 after the introduction of fast-track pathway. Overall, 94.1% of the patients ranked the fast-track surgical pathway as 'great' or 'moderate' at the 3-month follow-up.Conclusions: The proposed fast-track pathway is feasible for surgical treatment of gynecomastia, leading to an enhanced recovery and high patient satisfaction without increasing the rate of complications. The fast-track surgery concept with implementation of local anesthetic techniques should be given serious consideration in gynecomastia management.

Experimental Study on the Biological Outcome of Auricular Cartilage and Costal Cartilage at Different Time Periods After Autologous Cartilage Rhinoplasty.

Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty.

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Surgical Removal of Foreign Material by Suction Curettage After Injection Rhinoplasty: Patient-Reported Outcomes.

BACKGROUND: Though generally safe, injection rhinoplasty with synthetic non-hyaluronic fillers may lead to various deformities, which impose a psychological burden on the patients. As the injected material is technically hard to be fully cleared in the nose, the surgery is primarily chosen to address the patients' psychological distress caused by injection. Unfortunately, there is a paucity of data regarding patient-reported outcomes of this procedure. METHODS: From August of 2017 to June of 2021, the authors retrospectively reviewed all cases who underwent the foreign material removals by suction curettage after injection rhinoplasties. The relevant demographic, treatment characteristics and complication details were collected. The modified Rhinoplasty Outcome Evaluation (ROE) questionnaires were prospectively completed before and 6 months after the surgery. RESULTS: Of the 46 patients, four cases developed minor surface irregularities on the nasal dorsum postoperatively; two cases who had recurrent nasal dorsum redness and swelling before the surgery still exhibited the redness with a less degree after the surgery; no patients needed secondary revision. There was a significant improvement in any of patient-reported outcomes at 6-month follow-up, relative to the preoperative baseline scores. CONCLUSION: The injected foreign material in the nose could be effectively removed by suction curettage with minimal complications. The patients' satisfaction and quality of life, which was severely impaired preoperatively, could be significantly improved after the surgery. LEVEL OF EVIDENCE IV: Therapeutic study. 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 .

Protein Arginine Methyltransferase 5 Promotes Esophageal Squamous Cell Carcinoma Proliferation and Metastasis via LKB1/AMPK/mTOR Signaling Pathway.

Background: Esophageal squamous cell carcinoma (ESCC) is the eighth most common cancer in the world. Protein arginine methyltransferase 5 (PRMT5), an enzyme that catalyzes symmetric and asymmetric methylation on arginine residues of histone and non-histone proteins, is overexpressed in many cancers. However, whether or not PRMT5 participates in the regulation of ESCC remains largely unclear. Methods: PRMT5 mRNA and protein expression in ESCC tissues and cell lines were examined by RT-PCR, western blotting, and immunohistochemistry assays. Cell proliferation was examined by RT-PCR, western blotting, immunohistochemistry assays, MTT, and EdU assays. Cell apoptosis and cell cycle were examined by RT-PCR, western blotting, immunohistochemistry assays, and flow cytometry. Cell migration and invasion were examined by RT-PCR, western blotting, immunohistochemistry assays, and wound-healing and transwell assays. Tumor volume, tumors, and mouse weight were measured in different groups. Lung tissues with metastatic foci, the number of nodules, and lung/total weight were measured in different groups. Results: In the present study, the PRMT5 expression level was dramatically upregulated in ESCC clinical tissues as well as ESCC cell lines (ECA109 and KYSE150). Furthermore, knocking down PRMT5 obviously suppressed cell migration, invasion, proliferation, and cell arrest in G1 phase and promoted cell apoptosis in ESCC cells. Meanwhile, downregulating PRMT5 also increased the expression levels of Bax, caspase-3, and caspase-9, while expression levels of Bax-2, MMP-2, MMP-9, and p21 were decreased, which are members of the cyclin-dependent kinase family. Furthermore, knocking down PRMT5 could increase the expression of LKB1 and the phosphorylation (p)-AMPK expression and decrease the p-mTOR level. Additionally, overexpression of LKB1 could reveal anti-tumor effects in ESCC cell lines by inhibiting ESCC cell, migration, invasion, and proliferation and accelerating cell apoptosis. Besides, upregulating LKB1 expression could increase the levels of Bax, caspase-3, and caspase-9 and weaken the levels of Bax-2, MMP-2, and MMP-9. Moreover, knocking down PRMT5 could weaken the tumor growth and lung metastasis in vivo with upregulating the LKB1 expression and the p-AMPK level and downregulating the p-mTOR expression. Conclusion: PRMT5 may act as a tumor-inducing agent in ESCC by modulating LKB1/AMPK/mTOR pathway signaling.

Classification and Management of Polyacrylamide Gel Migration After Injection Augmentation Mammaplasty: A Preliminary Report.

BACKGROUND: Polyacrylamide gel (PAAG) migration after esthetic breast injection is clinically variable and complex, and thus, the rate of incomplete removal after debridement is high. OBJECTIVES: We aimed to describe a practical classification system for PAAG migration after breast injection and evaluate the outcome of our management. METHODS: A retrospective review of medical records was conducted for patients who presented to our institution for the management of PAAG migration after injection augmentation mammaplasty from June 2013 to November 2018. PAAG migration was evaluated by MRI examination and classified based on the migrating direction outside the breast contour. Surgery was performed to remove the material completely through different incisions. RESULTS: Seventy-eight women met the study criteria, with 106 breasts identified as showing PAAG migration. Patients were classified as having superior (22%), lateral (25%), inferior (34%), medial (10%) or complex (9%) PAAG displacement. The mean follow-up was 9 months (range 3-18 months). Postoperative complications included seroma (n = 3), delayed wound healing (n = 2), occasional breast pain (n = 5) and paresthesia or numbness at the migrated site (n = 2). MRI re-examination revealed that most of the injected material was removed, and no patient needed a secondary debridement operation. CONCLUSION: PAAG migration after injection augmentation mammaplasty can be clinically characterized into different types based on the migrating direction. It is helpful to perform MRI examinations preoperatively to fully evaluate PAAG migration. Under the guidance of our classification system, the injected material could be effectively eradicated with an acceptable complication rate. LEVEL OF EVIDENCE III: 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 .

Correction of Severe Short Nose Using a Costal Cartilage Extension Framework.

BACKGROUND: Various techniques for the aesthetic correction of short noses have been described, but the selection of the adequate graft material remains controversial. Previous reports have mainly focused on the application of septal cartilage or alloplastic materials for short nose elongation, but the lengthening effect is often unsatisfactory for severe short noses. We propose costal cartilage as an alternative treatment for short noses, describe the technique, and discuss outcomes, patient selection, and complications based on our 15-year experience. METHODS: From February 2004 to December 2018, 611 patients with varying degrees of short noses were included in this retrospective study. All patients underwent nose elongation surgery using a costal cartilage graft. Nasal length before and after surgery was measured based on a 3-dimensional simulation technology. Outcomes and complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey. RESULTS: Nasal elongation using costal cartilage was successfully achieved, with a mean increase in nasal length of 4.06 ±0.79 mm. Patients were followed up for a period of 8.5 months on average, ranging from 6 months to 8 years. Follow-up examinations demonstrated stable results. The overall complication rate was 3.8%. Complications included infection, implant extrusion, migration, deviation, visibility, prominence, and reddening of the nasal skin. Most patients (95.2%) rated their outcome as improved and much improved. CONCLUSION: Nasal elongation using costal cartilage grafting is an effective therapeutic approach for patients with severe short noses. Reliable outcomes and the use of autologous tissue along with minimal donor site morbidity contribute to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.

The perforator flap from the contralateral large healthy breast as an alternative for breast reconstruction or combined breast and thoracic reconstruction.

BACKGROUND: It has been demonstrated that contralateral breast tissue can be used for delayed breast reconstruction. The current report presented the clinical outcomes of the perforator flap from the contralateral lower breast as a pedicled flap for immediate or delayed breast reconstruction and as a free flap for delayed breast reconstruction or simultaneous breast and thoracic reconstruction in patients with macromastia. METHODS: From June 2014 to August 2018, a total of 15 female patients with a mastectomy defect on one side and a large healthy breast on the other side were collected in our department. The pedicled flap based on the fourth internal thoracic artery perforator from the healthy breast was harvested for three immediate breast reconstructions and five delayed breast reconstructions. The free flap with the thoracoacromial vascular pedicle from the contralateral breast was transferred to the defect side for three delayed breast reconstructions and four simultaneous breast and thoracic reconstructions. RESULTS: The flap sizes ranged from 9 × 26 to 20 × 40 cm. All flaps survived well postoperatively. Two patients developed delayed wound healing problems on the reconstructed breast. No patient had complications with reduction mammaplasty. The mean follow-up for patients was 21 months, with no tumor recurrence in either breast. The patients were satisfied with the reconstruction even though a certain degree of asymmetry was observed in all cases. CONCLUSION: For patients with a large healthy breast, the contralateral breast is an alternative tissue source for breast reconstruction or combined breast and thoracic reconstruction.

Three End-to-End Techniques for Microvascular Anastomosis of Vessels With Different Size Discrepancy.

BACKGROUND: Size discrepancy in microvascular anastomosis is a common issue in free flap transfer and replantation surgery. A number of different techniques have been described to overcome the problem, but optimal method continues to be defined. METHODS: Since June 2015 to May 2018, clinical courses of 103 microvascular cases performed by one senior surgeon were reviewed. Three end-to-end techniques including mechanical dilation, single-mattress suture, and wedge resection were applied in 364 anastomoses with caliber ratio between 1:1 and 1:1.5, 1:1.5 and 1:2, and 1:2 and 1: 3, respectively. RESULTS: A total of 112 flaps were incorporated in this study. The incidence of anastomotic failure was 3.0% (11/364), and the overall flap failure rate was 3.6% (4/112). The failure cases included 2 replanted scalps, 1 replanted ear, and 1 superficial temporal artery flap for nasal reconstruction. CONCLUSIONS: Our results depicted operational convenience and reliability of the 3 end-to-end anastomotic techniques in addressing mild-to-large vessel discrepancy.

Supermicrosurgical reconstruction of nasal tip defects using the preauricular reversed superficial temporal artery flap.

BACKGROUND: Microsurgical reconstruction of nasal tip defects is difficult to achieve. The free composite auricular flap allows for repair in a one-stage procedure. However, anastomosis to the recipient facial artery is often complicated because of its variable anatomy and the need for a vessel graft. In this study, we describe our experience using the alar artery and angular vein as recipient vessels for direct super microsurgical anastomosis. METHOD: From February 2004 to December 2015, thirty-two patients with different degrees of full-thickness multi-subunit nasal tip defects were included in this study. The superficial temporal vessels, alar artery, and angular vein were marked preoperatively by ultrasound detection. The preauricular reversed superficial temporal artery flap was harvested and transferred to the nasal tip defect region as a free flap using a supermicrosurgical technique. Patient pictures were taken before surgery and at 1, 3, and 6 months of follow-up. Outcomes and complications were recorded and analyzed. Moreover, a postoperative patient satisfaction survey was performed. RESULTS: The reversed superficial temporal artery flap was used in a total of 32 patients for the reconstruction of nasal tip defects in a one-stage procedure. In all cases, the alar artery and angular vein showed no anatomical variations and were used as recipient vessels. The size of the harvested preauricular flap size was 2.5 × 2.0 to 4.0 × 3.6 cm2, and the average flap size was 3.6 × 2.7 cm2. The length of the arterial pedicle was 4.0 to 6.7 cm, 5.58 cm on average. The length of the venous pedicle was 5.0 to 6.8 cm, 6.21 cm on average. Direct anastomosis was achieved in all patients, and in none of the cases, a vascular graft was needed. Donor sites were all closed primarily. Flap survival was complete, except for one case of vascular thrombosis, resulting in a 10% flap necrosis. Temporary hematoma was noted in one patient. The postoperative outcome showed excellent functional coverage and improved esthetic appearance. The average follow-up period was 12 months. The majority of patients (98.5%) rated their postoperative outcome as highly improved and improved. No late recurrence or other complications were seen in any of the patients. Twenty-two patients underwent a secondary debulking procedure of the flap for fine adjustment. CONCLUSION: Our results demonstrate that the alar artery and angular vein are suitable recipient vessels for the super microsurgical reconstruction of nasal tip defects. Surgical planning and procedure are facilitated by their reliable anatomy without the need for a vessel graft. This technique may offer wider applications by extension to other facial cutaneous defects.

Clinical presentation and genetic profiles of Chinese patients with velocardiofacial syndrome in a large referral centre.

Diagnosis and treatment of velocardiofacial syndrome (VCFS) with variable genotypes and phenotypes are considered to be very complicated. Establishing an exact correlation between the phenotypes and genotypes of VCFS is still a challenging. In this paper, 88 Chinese VCFS patients were divided into five groups based on palatal anomalies and one or two of other four common phenotypes, and copy number variations (CNVs) were detected using multiplex ligation-dependent probe amplification (MLPA), array comparative genomic hybridization (aCGH) and quantitative polymerase chain reaction. The findings showed that palatal anomalies and characteristic malformation of face were important indicators for 22q11.2 microdeletion, and there was difference inthe phenotypic spectrum between the duplication and deletion of 22q11.2. MLPA was a highly cost-effective, sensitive and preferred method for patients with 22q11.2 deletion or duplication. Our results also firstly reported that all three patients who simultaneously exhibited palatal anomalies and cognitive disorder, without other phenotypes, have Top3b duplication, which strongly suggested that Top3b may be a pathogenic gene for these patients. Further, the findings showed that patients with palatal anomalies and congenital heart disease or immune deficiency, with or without other uncommon phenotypes, exhibited heterogeneity in CNVs, including 4q34.1-qter, 6q25.3, 4q23, Xp11.4, 13q21.1, 17q23.2, 7p21.3, 2p11.2, 11q24.3 and 16q23.3, and some possible pathogenic genes, including BCOR, PRR20A, TBX2, SMYD1, KLKB1 and TULP4 have been suggested. For these patients, aCGH, whole genomic sequencing,combined with references and phenomics database to find pathogenic gene,may be choices of priority. Taking these findings together, we offered an alternative method for diagnosis of Chinese VCFS patients based on this phenotypic strategy.

Staged immediate nipple reconstruction with tube flap in secondary autologous breast reconstruction.

In the setting of secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap, the mastectomy skin is usually deepithelialized and buried under the reconstructed breast. In this study, by virtue of tube flap technique, we hypothesize that an amount of mastectomy skin could be transferred to the apex of reconstructed breast mound for nipple reconstruction. A total of 30 female postmastectomy patients were recruited between June 2012 and August 2015. A bipedicle DIEP flap was harvested and folded upward to reconstruct the breast. An inferiorly based mastectomy flap was raised and rolled into a tube. The free end of the flap was sutured to the reconstructed breast mound to allow revascularization. After serial stages, a sufficient tissue bulk from the mastectomy flap was transferred to the apex of the breast mound and remolded into a new nipple. Reconstructed breasts and nipples survived well postoperatively. The mean nipple projection was 9.2 ± 2.7 mm at the 1-year follow-up. In total 24 patients ranked the overall nipple and breast reconstruction to be very good or good. Based on DIEP flap breast reconstruction, the staged immediate nipple reconstruction with local mastectomy tube flap could maintain a long term residual projection with aesthetically acceptable outcomes.

Surgical treatment of axillary bromhidrosis by combining suction-curettage with subdermal undermining through a miniature incision.

The suction-curettage technique has been widely applied in the treatment of axillary bromhidrosis. However, it can only moderately eradicate the malodor. From 2011 to 2013, we performed the suction-curettage procedure alone in 91 patients with primary axillary bromhidrosis (group A). From 2014 to 2016, we refined the suction-curettage technique by performing wide subdermal scissors undermining through a miniature incision in 80 patients (group B). Through a miniature incision at the inferior pole of the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with scissors within the axillary area and then the undermined apocrine glands were removed by suction-curettage. In group B, 87.5 percent of axillae (140/160) showed significant malodor eradication postoperatively, which was higher than the 33 percent of axillae (60/182) associated with the group A (p < 0.01). Accordingly, patients in group B had a higher satisfaction about the procedure and life quality improvement (p < 0.01). The overall complication rate for the group B was 13.7 percent, which was significantly higher than the 4.4 percent complication rate in the group A (p < 0.01). By combining the suction-curettage with subdermal undermining through a miniature incision, we could achieve a higher curative effect for primary axillary bromhidrosis in comparison to the suction-curettage technique alone. The complication rate was significantly higher than the suction-curettage alone but the final result was acceptable to the patients.

Long-Term Safety and Efficacy of Botulinum Toxin A Treatment in Adolescent Patients with Axillary Bromhidrosis.

BACKGROUND: For adolescent bromhidrosis, the long-term safety and efficacy of botulinum toxin type A (BTX-A) treatment are not clear to date. PATIENTS AND METHODS: From June 2011 to July 2016, 62 adolescent patients with primary axillary bromhidrosis were recruited and 50 U of BTX-A was administered in each axilla. Repetitive injections were performed when the malodor returned. RESULTS: The average follow-up was 2.64 years. There were no reported local or systemic adverse effects. After the first BTX-A injection, 61.3% of patients (38/62) maintained the duration of more than 4 weeks. Of these patients, 21 patients underwent two sessions, 8 patients underwent three sessions, and 4 patients underwent four sessions. Twenty-four of sixty-two (38.7%) of patients had the duration of < 4 weeks. The second injection with the same dose was immediately administered, and the resulting duration increased to 9 weeks. Nineteen patients received the third injection with 100 U per underarm, and the resulting duration was extended up to 16 weeks. Overall, 82% of patients (51/62) ranked the BTX-A treatment to be very good or good. CONCLUSION: For adolescent axillary bromhidrosis, BTX-A injection is safe and effective over a long-term follow-up. The duration of efficacy is variable, and the dosage should be fine-tuned based on the individual response. 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 .

A low initial botulinum toxin A treatment response does not predict poor long-term outcomes in patients with axillary bromhidrosis.

PURPOSE: For patients with axillary bromhidrosis, it is not clear that whether a low response to initial botulinum toxin A (BTX-A) treatment is related to poor long-term outcomes. PATIENTS AND METHODS: From August 2011 to March 2016, 31 patients with primary axillary bromhidrosis were recruited. They had the duration of efficacy for less than 4 weeks (median, 3 weeks; range, 1-3 weeks) after the first BTX-A injection (50 U per underarm) and were considered to have a low response to BTX-A treatment. The second injection with the same dose was immediately administered once the symptoms recurred. Subsequent sessions were performed with a double dose. RESULTS: The duration of efficacy rose significantly to 10 weeks (range, 1-24 weeks) after the second injection (p < .01). Twenty-five patients received the third injection. The resultant duration further increased to 16 weeks (range, 12-26 weeks). No patients reported adverse effects during our follow-up period. CONCLUSIONS: For patients with primary axillary bromhidrosis, a low initial BTX-A treatment response does not predict poor long-term outcomes. Immediate reinjection with the same dose and subsequent sessions with a double dose is a safe strategy and can increase the duration of BTX-A therapy.

Simultaneous reconstruction of columella and philtrum using prolabial flap combined with Abbe flap in secondary bilateral cleft lip and nasal deformity.

Open rhinoplasty and Abbe flap techniques are traditionally useful tools for the reconstruction of secondary bilateral cleft lip nasal (BCLN) deformity. We aimed to investigate the long-term outcomes of simultaneous columella and philtrum reconstruction using prolabial flap combined with Abbe flap in secondary BCLN deformity. From January 2009 to July 2014, 26 patients (17 males and 9 females; mean age 21 years) with secondary BCLN deformity were recruited. All patients had severe short columella and philtrum deficiency. The whole superiorly based prolabial flap was harvested and trimmed for columella reconstruction. An Abbe flap from the central lower lip was elevated to reconstruct the esthetic philtral unit. No flap necrosis occurred postoperatively. The average follow-up was 2.7 years. The columella length was 4.7 ± 1.3 mm preoperatively and 10.4 ± 2.1 mm postoperatively. The philtrum length increased to 14.4 ± 2.6 mm postoperatively from a preoperative 8.9 ± 2.4 mm. Regarding the overall impression of the reconstruction, 22 patients ranked it as very good or good. In secondary BCLN deformity, the prolabial flap combined with Abbe flap technique is an effective alternative for the treatment of severe short columella complicated with severe philtrum deficiency.

Effectiveness of botulinum toxin A injection for the treatment of secondary axillary bromhidrosis.

Surgical removal of apocrine glands is a valid treatment option for axillary bromhidrosis. However, malodor may recur after the operation. The value of botulinum toxin A (BTX-A) injection in the treatment of secondary axillary bromhidrosis was investigated in the present study. From July of 2012 to May of 2016, 53 patients with secondary axillary bromhidrosis were enrolled in our clinic. Various BTX-A injection strategies were applied depending on different types of previous surgery. None of the patients reported adverse side effects after the procedure. The duration of efficacy ranged from 1 to 12 months, with the median value of 6 months. At the end of follow-up, 48 patients ranked the satisfaction with BTX-A treatment as "very good" or "good". For patients with secondary axillary bromhidrosis following various surgical modalities, the BTX-A treatment strategy we propose can achieve a lengthy duration of efficacy with a low risk of side effects and should be considered a good and reliable option.

A Selective Cell Population from Dermis Strengthens Bone Regeneration.

Finding appropriate seed cells for bone tissue engineering remains a significant challenge. Considering that skin is the largest organ, we hypothesized that human bone morphogenetic protein receptor type IB (BmprIB)+ dermal cells could have enhanced osteogenic capacity in the healing of critical-sized calvarial defects in an immunodeficient mouse model. In this study, immunohistochemical staining revealed that BmprIB was expressed throughout reticular dermal cells; the positive expression rate of BmprIB was 3.5% ± 0.4% in freshly separated dermal cells, by flow cytometry. Furthermore, in vitro osteogenic capacity of BmprIB+ cells was confirmed by osteogenic-related staining and marker gene expression compared with unsorted dermal cells. In vivo osteogenic capacity was demonstrated by implantation of human BmprIB+ cell/coral constructs in the treatment of 4-mm diameter calvarial defects in an immunodeficient mouse model compared with implantation of unsorted cell/coral constructs and coral scaffold alone. These results indicate that the selective cell population BmprIB from human dermis is a promising osteogenic progenitor cell that can be a large-quantity and high-quality cell source for bone tissue engineering and regeneration. Stem Cells Translational Medicine 2017;6:306-315.

What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

BACKGROUND: We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap. METHODS: A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively. RESULTS: Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%). CONCLUSIONS: It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap.