Botulinum toxin type A relieves sternocleidomastoid muscle fibrosis in congenital muscular torticollis.

Congenital muscular torticollis (CMT) is a neck deformity that involves shortening of sternocleidomastoid muscle (SCM) characterized by muscle atrophy and interstitial fibrosis. To investigate wheatear Botulinum toxin type A (BTA) has anti-fibrotic effects in CMT, we established acquired muscular torticollis that mimetics CMT in rabbit by intra-SCM injection of anhydrous alcohol. The treatment groups received BTA (2.5units or 5units) injection into the fibrotic SCM. The shortening and thickening of SCM were recorded by B-mode ultrasound. Changes in Col1A1, Fn, α-SMA expression were determined by immunohistochemistry. In vitro studies, TGF-ß induced NIH3T3 fibroblasts were used to evaluate anti-fibrosis effect of BTA. Expression of the myofibroblast marker α-SMA and fibrosis markers Col1A1 and Fn were detected by Western blotting and quantitative RT-PCR. Our results showed that BTA injection attenuated shortening and thickening of fibrotic SCM. Elevated expression of Col1A1, Fn, α-SMA were confirmed in this fibrotic muscle model but reversed after BTA injection. Similar results observed in TGF-ß induced NIH3T3 fibroblasts in both mRNA and protein levels. In conclusion, our results suggested that BTA could be a promising agent against SCM fibrosis in CMT through regulating fibroblast and inhibiting myofibroblast differentiation.

[Imaging study on supratrochlear artery and its application in nasal reconstruction].

OBJECTIVE: To study the image of the muscular and cutaneous branches of supratrochlear artery by internal and external carotid angiography and to design the frontal flap for nasal reconstruction. METHODS: The muscular and cutaneous branches of supratrochlear artery of 30 adults were investigated through internal and external carotid angiography and three-dimensional reconstruction of vessels to explore the courses of branches of supratrochlear artery and their communication with supraorbital artery. According to image observation, the frontal flap was designed and used to perform nasal reconstruction in 11 cases of nasal defects, including 7 males and 4 females with an average age of 23 years (range, 15-48 years). The nasal defect ranged from 3.0 cm x 2.5 cm to 5.0 cm x 3.5 cm. RESULTS: Internal carotid angiography and three-dimensional imaging of the vessels showed that supratrochlear artery was found in 30 patients, with a diameter of (0.9 +/- 0.6) mm. The superficial cutaneous branch appeared constantly with a diameter of (0.7 +/- 0.3) mm. Deep muscular branch traveled among frontal muscle, with a diameter of (0.5 +/- 0.5) mm and a length of (32.0 +/- 6.2) mm, and it was missing in 4 patients, the branches communicated with each other and with supraorbital artery. All flaps survived with good appearance and without cartilage exposure. After 4 months to 3 years of follow-up, the postoperative aesthetic appearance and function of nasal tip, alar, and columella were satisfactory; the height and slope length of the external nose were moderate; and the reconstructed nose had good texture and normal ventilation function without constriction of naris. CONCLUSION: Imaging studies support the fact that supratrochlear artery has constant cutaneous branch. The application of frontal flap pedicled with cutaneous branch can improve the effectiveness of nasal reconstruction.

[Sonographically guided intralesional sclerotherapy for venous malformation].

OBJECTIVE: To investigate the safety and efficacy of sonographically guided percutaneous intralesional sclerotherapy for peripheral venous malformations. METHODS: From March 2004 to October 2007, 32 patients with venous malformations of soft tissues were treated with sonographically guided intralesional sclerotherapy. The malformed venous space was identified intraoperatively by duplex scanning, the gauge 7 needle was inserted into this venous space under real-time ultrasound visualization, and sclerosants were infused in the space gently. Absolute alcohol and bleomycin acted as sclerosants here, combined the two (for type I malformation) or bleomycin only (for type II malformation). The treatment could be repeated if the lesion was not cured in 3 weeks. All patients were followed up for 6 months to 2 years. RESULTS: Of the group, each patient received 1 - 6 times of the therapy (mean, 3 times). Twenty-seven patients achieved a complete response, and 5 achieved partial response. No major complications occurred. CONCLUSIONS: Sonographically guided percutaneous intralesional sclerotherapy for peripheral venous malformation is a simple, effective, safe therapy with minimal invasion, lower morbidity rate, and can be repeated.

[Variation of BDNF mRNA on focalcerebral ischemia reperfusion injury in rats with notogisenoside-Rg1].

OBJECTIVE: To study the effect of notoginsenoside-Rg, on expression of BDNF mRNA (brain-derived neurotrophic factor messenger ribonucleic acid) in cerebrum cortex after MCAO/R (middle cerebral artery occlusion reperfusion) injury in rat by real-time quantitative polymerase chain reaction. METHODS: 36 SD male rats were randomly divided into MCAO/R model group, notogisenoside-Rg1 therapy group (100 mg/kg) and the positive medicine control group (nimodipine 1 mg/kg). The MCAO/R model were made by thread-occluded method. The four rats were randomly taken from each groups and were killed to be breaken out brain tissues as specimens after which were treated with medicine in 1,3, 5 days. Total RNA was isolated from cerebrum cortex. Specific oligonucleotide primers of BDNF mRNA gene fragments were amplificated by RT-PCR to construct recombinant plasmid and sequence. To dilute recombinant plasmid didploidly and a quantitative standard curve was completed. Taqman fluorogenic quantitative RT-PCR (FQ-PCR) was set up to detect the BDNF mRNA variety of cerebrum cortex. RESULTS: Compared with the model group and the postive control group, notogisenoside-Rg1 treated groups could obviously improve some nervous deficit symptoms in the cerebral ischemia and increase BDNF mRNA amount that in the cerebrum cortex at different period after rat MCAO/R injury. CONCLUSION: Notoginsenoside-Rg1 can promote to generating internal BDNF protein in brain by up-regulation the expression of BDNF mRNA amount in the cerebrum cortex. BDNF bind in TrkB, which can give rise to protective effects for ischemic neurons by generating corresponding domino effect molecules. Accordingly it can be as a therapy method in cerebral ischemia injury.

[Clinic application of compound flap pedicled with arterial arch of palpebral margin].

OBJECTIVE: To study the clinic application of compound flap pedicled with arterial arch of palpebral margin in repairing severe full defect of eyelid. METHODS: According to eyelid structure and the defect size, the two compound flaps were designed beside the defect based on the arterial arch of the palpebral margin. If the defective area was too large, the lateral compound flap may be extended to lower or upper eyelid 0.5 cm away from the outer canthus, then cut and propelled the two compound flaps to repair the full eyelid defect. RESULTS: 20 cases had been cured with this method since 1998. In this cases, 4 cases were basal cell carcinoma of eyelid, 2 cases were squamous carcinoma, 3 angiomas, 6 chromatophore nexuses, 3 traumatic defects, 2 congenital defects. The largest length of eyelid full defect was 1.7 cm and the smallest was 0.8 cm. 6 cases were upper eyelid defect and 14 cases were lower eyelid defect. All the compound flaps survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. CONCLUSIONS: Repairing full eyelid defect with the compound eyelid flap is the same kind tissue repairing. It can not only provide enough tissues to primary repair large full defect of the upper or lower eyelid to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities. The arterial arch of the palpebral margin is constant and the blood supply of the compound flap is reliable. It is an ideal method of repairing the eyelid defect.

[Experience of vaginal reconstruction by using a pudendal-thigh island flaps].

OBJECTIVE: To evaluate a pudendal-thigh island flap for vaginal reconstruction. METHODS: Forty-seven patients with congenital absence of vagina were undergoing the treatment. Based on the pedicle including the posterior labial neurovascular bundle, a pudendal-thigh island flap was designed and raised in the groin crease just lateral to the labia majora under the deep fascia. It was then transferred to the tunnel between the urethra and the anus for reconstruction of the vagina. RESULTS: From May of 1993 to July of 2001, 47 patients were successfully treated for the vaginal reconstruction with the flap. The results were satisfactory without complications. CONCLUSION: The above mentioned technique could be a safe and effect method for vaginal reconstruction with the advantages of reliable blood supply, good sensation and few complications. The areaes with the bilateral pudendal-thigh could be large enongh for the vaginal reconstruction without problem of the donor closure.

[Repair of the facial tissue defects with reversed narrow pedicle lateral maxillocervical fasciocutaneous flap].

OBJECTIVE: To introduce a method of repairing facial tissue defects caused by various factors. METHODS: The reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm. RESULTS: This fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis. CONCLUSION: This fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.