Clinical efficacy of blood derivatives on wound healing: A systematic review and network meta-analysis.

This study aims to evaluate the clinical effects of different blood derivatives on wound healing using network meta-analysis. PubMed, Embase, OVID, Web of Science, SCOPUS and Cochrane Central were searched to obtain studies about blood derivatives on wound healing until October 2023. R 4.2.0 and Stata 15.0 softwares were used for data analysis. Forty-four studies comprising 5164 patients were included. The results of network meta-analysis showed that the healing area from high to low was GF + ORCCB, ORCCB, GF, PRF, Unnas paste dressing, APG, PRP injection, PRP, PRP + thrombin gel, PPP, HPL, CT. The healing time from low to high was PRP + thrombin gel, GF, PRP, PC + K, PC, APG, PRF, CT, Silver sulfadiazine ointment. The number of patients cured from high to low was APG, PRP injection, PRP, Aurix, PRF, Leucopatch, HPL, Antimicrobial Ointment Dressing, CT, 60 µg/cm2 repifermin, 120 µg/cm2 repifermin, AFG, PPP. The order of analgesic effect from high to low was AFG, Aminogam gel, PRF, PRP, Oxidised oil, APG, GF, CT. The order of the number of wound infection cases from low to high is APG, 20 µg/cm2 repifermin, 60 µg/cm2 repifermin, PRP, LeucoPatch, CT, PPP, Antiseptic ointment dressing. Healing area: GF + ORCCB had the best effect; Healing time: PRP + thrombin gel took the shortest time. The number of cured patients and the reduction of wound infection: APG has the best effect. Analgesic effect: AFG has the best effect. More studies with large sample sizes are needed to confirm the above findings.

Correlation of bioactive components of platelet rich plasma derived from human female adult peripheral blood and umbilical cord blood with age.

Platelet-rich plasma (PRP) has gained significant attention in the field of regenerative medicine due to its potential therapeutic applications. However, few studies have reported the components, especially anti-ageing-related components, of PRP derived from umbilical cord blood (UCB). It is essential to understand the influence of age on the composition and efficacy of PRP to optimize its clinical use. The present study compared the concentrations of bioactive components in PRP from healthy female adults and UCB-derived PRP. PRP was obtained from blood samples from females in four age groups (12 per group): neonates (UCB donors) and adults aged 18-25, 26-45, and 46-65 years, respectively. The concentrations of epidermal growth factor, basic fibroblast growth factor-2 (FGF-2), insulin-like growth factor-1, platelet-derived growth factor-AA (PDGF-AA), PDGF-AB/BB, vascular endothelial growth factor A, RANTES, TIMP-1, TIMP-2, GDF11, and clusterin and activity of superoxide dismutase, catalase, and glutathione peroxidase (GPx) in the PRP samples were determined and compared among groups. Pairwise comparisons between the groups showed statistically significant differences in the concentrations of some bioactive components of PRP, such as FGF-2, PDGF-AB/BB, and clusterin, and GPx activity. UCB-derived PRP contains various active ingredients such as VEGF-A, CAT activity, and TIMP-2. Contrary to expectations, UCB-derived PRP did not show higher concentrations of the anti-ageing protein GDF11. Because UCB is a rich source of bioactive components with low immunogenicity, its use in PRP preparation is an important research direction for future studies.

Transconjunctival fat repositioning blepharoplasty: is excess fat herniation a prerequisite?

BACKGROUND: The fat repositioning technique has been widely used for the treatment of tear trough deformity, and there is a strong belief that excess fat herniation is a prerequisite for the procedure. OBJECTIVE: The purpose of this study was to evaluate its effect in patients with minimal or no excess fat herniation. METHODS: A total of 232 patients underwent the procedure and met the inclusion criteria. Of them, 198 were primary cases, and 34 had a history of fat removal for blepharoplasty. The amount of infraorbital fat was evaluated preoperatively by palpation. Release of the tear trough ligament and fat redistribution were sequentially performed as previously described. Surgical outcome was assessed based on Hirmand's grading system and the FACE-Q scales. RESULTS: Tear trough deformities were eliminated in more than 85% of cases. Aesthetic results were comparable between the primary and secondary surgery groups. The percentage of patients who complained of extremely or moderately severe tear trough deformities decreased from 86.3% preoperatively to 34.0% postoperatively. The scores of the lower eyelid FACE-Q decreased significantly (P<0.05). Patients were satisfied with their decision to undergo blepharoplasty (78.2±18.7). Undercorrection of the tear trough occurred in 30 patients. Other complications included 12 cases of transient conjunctiva bleeding, 2 cases of eyelid numbness, and 6 cases of dry eye. These resolved spontaneously. CONCLUSION: Fat repositioning is a feasible and effective technique for the treatment of tear trough deformities in patients with minimal or no excess orbital fat herniation provided that a fat pad is palpable. LEVEL OF EVIDENCE: 4.

Objective Assessment of the Effectiveness of the Transconjunctival Fat-Repositioning Technique Using Magnetic Resonance Imaging and Three-Dimensional Surface Imaging.

Background: To quantify the surgical outcomes of transconjunctival fat repositioning technique, we study the lower periorbital area with magnetic resonance imaging (MRI) and three-dimensional (3D) surface imaging. Methods: The preoperative and postoperative images were analyzed. The T1-weighted MR images in the quasi-sagittal plane parallel to the long axis of the orbit and passing through the globe center were used to measure the transposed fat, and 3D comparison was performed to calculate the tear trough depth. Changes throughout the surgery and their relationships with clinical characteristics were statistically analyzed. Results: A total of 11 patients who underwent surgery were included. The mean follow-up period was 10.1 months. MRI measurements showed that the fat area beneath the tear trough increased from 0 to 22.7 ± 6.7 mm2 after fat repositioning, whereas the fat area of the eyelid bag decreased from 46.3 ± 11.0 mm2 to 25.5 ± 14.0 mm2. The 3D results revealed an increase in thickness by 1.2 ± 0.4 mm in the tear tough areas. Conclusion: Both MRI and 3D imaging provide options to objectively assess the fat-repositioning technique.

Efficacy of autologous platelet-rich plasma in treating patients with burn wounds: A protocol for systematic review and meta-analysis.

BACKGROUND: Burns are still regarded among severe health problems related to high morbidity and mortality rates globally. In essence, health problems associated with burns can cause significant economic burden to society. Regardless of treatment available options, no best treatment was considered adequate for treating severe burns. In particular, only a few studies have focused on the effect of autologous platelet-rich plasma to treat burn wounds. The present study aim to systematically review existing literature to examine the effectiveness and safety of autologous platelet-rich plasma (PRP) to treat burn wounds. METHODS: For this study, we will conduct a systematic search using MEDLINE, EMBASE, the Cochrane Library, Web of Science, CINAHL, as well as Scopus to discover randomised controlled trials (RCTs) for the examination of effectiveness and safety of autologous PRP to treat burn wounds from their inception to March 2021 with no language restrictions. Additionally, we will search Google Scholar, ClinicalTrials.gov, as well as the reference lists of studies considered in the research to ascertain possibly eligible studies. We used two independent authors to evaluate studies for inclusion and conduct data extraction. We intend to assess study bias and quality utilizing the Cochrane Collaboration's Risk of Bias Tool 2.0. Also, we will pool study results using the fixed-effects model or random-effects model. Finally, any disagreements emanating from the process will be addressed through discussion or using a third author to mediate situations leading to disagreement. RESULTS: The study aims at assessing the effectiveness and safety of autologous PRP for treating burn wounds. CONCLUSION: The study will provide specific substantiation to assess autologous PRP's effectiveness and safety in treating patients with burn wounds. ETHICS AND DISSEMINATION: The study does not require ethical approval since no published studies are used in it. OSF REGISTRATION NUMBER: March 29, 2021.osf.io/74z5u. (https://osf.io/74z5u/).

The Anti-photoaging Effects of Pre- and Post-treatment of Platelet-rich Plasma on UVB-damaged HaCaT Keratinocytes.

Platelet-rich plasma (PRP) has seen wide clinical use owing to its regenerative and repair abilities. OBJECTIVE: To investigate the anti-photoaging effects of pre- and post-treatment of PRP on UVB-damaged HaCaT cells. METHODS: HaCaT cells were irradiated with 80 mJ/cm2 UVB, before or after PRP treatment (1000 × 107 /L), and following measurements were taken: survival rate of UVB-irradiated HaCaT cells, malondialdehyde (MDA) content and activities of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT). Western blot was used to determine the effect of different PRP intervention on the expression of PI3K, AKT, ERK, MMP-1, MMP-9, TIMP-1 and γ-H2AX in the UVB-irradiated HaCaT cells. RESULTS: pre- and post-PRP treatment reduced MDA content and increased the activities of GSH-Px, SOD and CAT in photoaged HaCaT cells. These changes resulted in reduced cytotoxic effects. Besides, different PRP intervention promoted cell proliferation via PI3K/AKT pathway. Furthermore, PRP application suppressed the expression of γ-H2AX. Also, PRP intervention alleviated photoaging effects by upregulating the expression level of tissue inhibitor of metalloproteinases-1 (TIMP-1) while downregulating matrix metalloproteinase (MMP) expression level in photoaged HaCaT cells. CONCLUSION: pre- and post-PRP treatment play anti-photoaging role through strengthening cellular oxidative defense capacity, mitigating MMP expression, alleviating DNA damages and promoting proliferation of UVB-irradiated HaCaT cells.

Investigating the effect of age on platelet ultrastructure using transmission electron microscopy.

In the present study, the age- and sex-related differences in platelet ultrastructure were investigated using transmission electron microscopy (TEM). A total of 15 healthy volunteers were grouped according to age, with 5 people in each of the following groups: young group (25-45 years), middle-aged group (46-65 years), and old-aged group (> 65 years). In the TEM micrographs, the internal components, specifically the α-granules, dense granules, and lysosomal granules, of 20 platelets were counted for each group. Two-way analysis of variance of age and sex variance was used to compare the results. The ultrastructure of the platelets in the old-aged group was observed to be quite different from those of the young and middle-aged groups. Specifically, with ageing, the platelet membrane becomes more irregular in shape and non-smooth, and multiple platelet membrane ruptures are observed. Furthermore, the pseudopodia and protuberances become more numerous and slender, and the number of α-granules is significantly reduced. These morphological changes indicate that ageing may affect the function of platelets, which in turn affects the efficacy of platelet concentrates. Thus, the effects of age should be considered when using platelet concentrates prepared from elderly autologous blood.

ETV4 promotes proliferation and invasion of lung adenocarcinoma by transcriptionally upregulating MSI2.

The oncogenic roles of ETV4 have been revealed in multiple cancers. However, its expression and functions in lung cancer are rarely explored. Here, we firstly detected the expression of ETV4 in lung adenocarcinoma (LUAD) via online data and local experiment validation. Furthermore, we explored the functions and corresponding mechanisms of ETV4 in LUAD. Upregulation of ETV4 in LUAD is indicated by online data and our results of qPCR, Western blot and immunohistochemistry in collective tissue samples. ETV4 knockdown significantly inhibits proliferation and invasion in LUAD indicated by the outcomes of CCK8, plate clone formation, and Transwell invasion assays. Mechanistically, chromatin immunoprecipitation and luciferase reporter system assays indicated that ETV4 could directly bind at the promoter of MSI2 and promote its transcription. Furthermore, ectopic expression MSI2 can rescue the inhibitory effects caused by ETV4 knockdown in LUAD. Therefore, we proved that upregulation of ETV4 could promote proliferation and invasion of LUAD by transcriptionally upregulating MSI2 offering a potential therapy treatment target of LUAD.

Application of standardized platelet-rich plasma in elderly patients with complex wounds.

In recent years, autologous platelet-rich plasma (PRP) derivatives have been used widely in the regeneration and repair of tissue, but a standard definition and preparation method for PRP are lacking. We developed a standardized method using platelet indices as quality-control indicators for PRP preparation. Twenty-one elderly patients (9 males, 12 females) with complex wounds were treated with standardized platelet-rich plasma (S-PRP). The platelet count in PRP after the second centrifugation was 1,069-1,436 × 109 /L. We adjusted the platelet concentration in PRP after a second centrifugation to 1,000 × 109 /L according to a formula using platelet-poor plasma (PPP). The standardized preparation method that we developed gave S-PRP with a relatively uniform platelet concentration. The wounds of 21 patients showed accelerated healing after S-PRP treatment, and there were no obvious side effects during treatment. These data suggest that our preparation method of S-PRP, using platelet indices as quality-control indicators with platelet count of 1,000 × 109 /L could be used for the treatment of complex wounds in the elderly. The preparation method of S-PRP proposed in the present study may be a simple and effective method of PRP quality control.

Lumbar sympathectomy reduces vascular permeability, possibly through decreased adenosine receptor A2a expression in the hind plantar skin of rats.

BACKGROUND: The effect of lumbar sympathectomy for the treatment of lower limb ischemia remains a matter of controversy. METHODS: Sprague-Dawley rats were subjected to lumbar sympathectomy, after which Evans blue dye was injected into the hind plantar skin. Extravasation of dye was measured and compared with rats undergoing sham operation. Hind plantar skin was processed for HE staining, immunohistochemistry, and Western blot. RESULTS: In sympathectomized rats, blue stained areas in hind plantar skin and concentrations of Evans blue were significantly less than that of sham sympathectomy (control) rats, both 2 weeks and 3 months after surgery. Expression of prostaglandin E2, bradykinin, bradykinin B2 receptor, and adenosine triphosphate were not significantly different between the sympathectomized and control groups. Adenosine receptor A2a expression was significantly reduced in the sympathectomized group both 2 weeks and 3 months after surgery. CONCLUSION: Vascular permeability in the hind plantar skin of rats decreases following lumbar sympathectomy, possibly via reduced expression of adenosine receptor A2a.

Sympathetic Denervation Accelerates Wound Contraction but Inhibits Reepithelialization and Pericyte Proliferation in Diabetic Mice.

Previous studies focused on the effects of sympathetic denervation with 6-hydroxydopamine (6-OHDA) on nondiabetic wounds, but the effects of 6-OHDA on diabetic wounds have not been previously reported. In this study, treated mice received intraperitoneal 6-OHDA, and control mice received intraperitoneal injections of normal saline. Full-thickness wounds were established on the backs of mice. The wounds were sectioned (four mice per group) for analysis at 2, 5, 7, 10, 14, 17, and 21 days after injury. The wound areas in the control group were larger than those in the treatment group. Histological scores for epidermal and dermal regeneration were reduced in the 6-OHDA-treated group on day 21. The mast cells (MCs) in each field decreased after sympathectomy on days 17 and 21. The expression levels of norepinephrine, epidermal growth factor (EGF), interleukin-1 beta, NG2 proteoglycan, and desmin in the treatment group were less than those in the control group. In conclusion, 6-OHDA delays reepithelialization during wound healing in diabetic mice by decreasing EGF, but increases wound contraction by reducing IL-1ß levels and the number of MCs. Besides, 6-OHDA led to reduced pericyte proliferation in diabetic wounds, which might explain the vascular dysfunction after sympathetic nerve loss in diabetic wounds.

Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso.

Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia, but the restoration of cutaneous sympathetic nerve functions is less clear. This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy. The skin temperature of the left feet, using a point monitoring thermometer, increased intraoperatively after sympathectomy. The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamine ß-hydroxylase, visualized by immunofluorescence, indicated the accuracy of sympathectomy. Iodine starch test results suggested that the sweating function of the hind feet plantar skin decreased 2 and 7 weeks after lumbar sympathectomy but had recovered by 3 months. Immunofluorescence and western blot assay results revealed that norepinephrine and dopamine ß-hydroxylase expression in the skin from the sacrococcygeal region and hind feet decreased in the sympathectomized group at 2 weeks. Transmission electron microscopy results showed that perinuclear space and axon demyelination in sympathetic cells in the L5 sympathetic trunks were found in the sympathectomized group 3 months after sympathectomy. Although sympathetic denervation occurred in the sacrococcygeal region and hind feet skin 2 weeks after lumbar sympathectomy, the skin functions recovered gradually over 7 weeks to 3 months. In conclusion, sympathetic functional recovery may account for the recurrence of hyperhidrosis after sympathectomy and the normalization of sympathetic nerve trunks after incomplete injury. The recovery of sympathetic nerve function was slower in the limbs than in the torso after bilateral L2-4 sympathectomy.

Lumbar sympathectomy regulates vascular cell turnover in rat hindfoot plantar skin.

BACKGROUND: Sympathetic denervation and impaired angiogenesis cause skin diseases. However, the relationship between the sympathetic nervous system and vascular cell turnover in normal skin remains unclear. OBJECTIVE: To determine the effects of sympathetic denervation on vascular cell turnover in normal skin. METHODS: Rats underwent bilateral L2-4 sympathetic trunk resection (sympathectomy group) or sham operation (control). Hindfoot plantar skin was analyzed 2 weeks and 3 months postoperatively. RESULTS: Mural cell marker (α-smooth muscle actin; p < 0.001, and desmin; p = 0.047) expression decreased 2 weeks after sympathectomy, but recovered 3 months after sympathectomy (p > 0.05). CD31 levels were lower in the experimental group than in the control group at 2 weeks (p = 0.009), but not at 3 months. Von Willebrand factor, vascular endothelial growth factor, and angiopoietin-2 expression were not significantly different between the groups (p > 0.05). Angiopoietin-1 expression levels were higher in the experimental group than in the control group at 2 weeks (p = 0.035), but not at 3 months. CONCLUSIONS: Lumbar sympathectomy regulates vascular cell turnover in rat hindfoot plantar skin by inhibiting mural cell proliferation and increasing angiopoietin-1 expression. Sympathetic nerves therefore play an important role in plantar skin vascular cell turnover.

Topical 1% propranolol cream promotes cutaneous wound healing in spontaneously diabetic mice.

Diabetic foot ulcers (DFUs) are a constant threat to diabetic patients and can lead to amputations and even death. Intralesional administration of propranolol in diabetic wounds has not been reported previously. This study aimed to investigate the efficacy of propranolol cream in diabetic wounds. Fifty-six spontaneously diabetic mice were divided into the propranolol group and the control group. After preparing full-thickness wounds on the back of the mice, 1% propranolol cream was topically applied to wounds in the experimental group and 0% propranolol cream in controls. The wound sizes were measured and calculated against the original area. The wounds were analyzed up to 21 days after injury. At all evaluation time-points, the wound size (%) in the propranolol group was significantly smaller than in the controls. Epidermal growth factor (EGF) protein expression increased in the experimental vs. CONTROL GROUP: Vascular endothelial growth factor (VEGF) expression was significantly lower in the experimental vs. control group whereas NG2 proteoglycan was increased throughout the study. However, matrix metallopeptidase (MMP)-9 expression was at first significantly higher in the experimental vs. control group then the MMP-9 protein level in the control group increased and surpassed that in the experimental group. In conclusion, intralesional administration of 1% propranolol cream promotes reepithelialization and regulates abnormal angiogenesis in diabetic wounds. Propranolol cream may become a new drug for the treatment of DFUs.

Sympathetic nerves: How do they affect angiogenesis, particularly during wound healing of soft tissues?

Angiogenesis is essential for wound healing, and angiogenesis impairment can result in chronic ulcers. Studies have shown that the sympathetic nervous system has an important role in angiogenesis. In recent years, researchers have focused on the roles of sympathetic nerves in tumor angiogenesis. In fact, sympathetic nerves can affect angiogenesis in the wound healing of soft tissues, and may have a similar mechanism of action as that seen in tumorigenesis. Sympathetic nerves act primarily through interactions between the neurotransmitters released from nerve endings and receptors present in target organs. Among this, activation or inhibition of adrenergic receptors (mainly ß-adrenergic receptors) influence formation of new blood vessels considerably. As sympathetic nerves locate near pericytes in microvessel, go along the capillaries and there are adrenergic receptors present in endothelial cells and pericytes, sympathetic nerves may participate in angiogenesis by influencing the endothelial cells and pericytes of new capillaries. Studying the roles of sympathetic nerves on the angiogenesis of wound healing can contribute to understanding the mechanisms of tissue repair, tissue regeneration, and tumorigenesis, thereby providing new therapeutic perspectives.

Effects of diethylstilbestrol on the proliferation and tyrosinase activity of cultured human melanocytes.

The aim of the present study was to observe the effects of different exogenous estrogen diethylstilbestrol (DES) concentrations on the human melanocyte proliferation and tyrosinase activity. Skin specimens were obtained following blepharoplasty, and the melanocytes were primary cultured and passaged to the third generation. The melanocytes were seeded in 96-well plates, each well had 5×103 cells. The medium was changed after 24 h, and contained 10-4-10-8 M DES. After the melanocytes were incubated, the proliferation and tyrosinase activity were detected by the MTT assay and L-DOPA reaction. DES (10-8-10-6 M) enhanced the proliferation of cultured melanocytes. The intensity was positively correlated with the concentration of drug. DES, >10-5 M, inhibited the melanocytes proliferation or even produced the toxicity effect. Following the addition of 10-6 M DES to the medium, the tyrosinase activity of melanocytes was significantly increased, with P<0.05. In conclusion, a certain concentration of DES promoted the proliferation of melanocytes, enhanced the activity of tyrosinase and promoted pigment synthesis of melanocytes, with the optimal concentration of 10-6 M.

Primary culture of human face skin melanocytes for the study of hyperpigmentation.

Facial epidermal pigmentation and skin tumors can be caused by UV exposure and other physical and chemical irritations. In this report we describe the primary culture of melanocytes from human face skin. The ability to culture these melanocytes will enable their morphological and biological properties to be investigated. Skin specimens were obtained from patients who had undergone lower blepharoplasty procedures. Digestion with neutral protease and trypsin was used to obtain single cell suspensions of epidermal cells. The cells were cultured in M254 medium supplemented with human melanocyte growth solution. Cell morphology was observed using inverted microscopy. Melanocytes were positively identified using both L-DOPA staining and S-100 protein immunohistochemical staining. Immunofluorescence was used to confirm the expression of tyrosinase-related protein-1, a melanocyte-specific protein. The cellular ultrastructure of the melanocytes was observed by transmission electron microscopy. The cultured human melanocytes from face skin were multi-dendritic, and many mature melanosomes were observed. Therefore, using a specific culture medium, melanocytes from face skin can be successfully cultured and made available for further investigations.

The scalping forehead flap for 1-stage reconstruction of large facial defects after tumor resection.

Skin tumors often occur in the face or other sun-exposed areas in the aged population, and cancerous ulceration in the face leads to facial damage. Regarding the aesthetic character of the facial unit and the age or concomitant pathologies of these patients, it is necessary to use quick, reliable methods to debride malignant ulcer and cover the wound or suture the incision. We report 2 cases of large facial malignant ulcer that were treated with forehead flap based on the supratrochlear artery or the frontal branch of a side superficial temporal artery in a 1-stage operation. Both of them got satisfying functional and aesthetic results.

[Expression of beta-endorphin in hypertrophic scar and its relationship with pruritus].

OBJECTIVE: To identify the effect of beta-endorphin in the development of paresthesia in hypertrophic scar by detecting the expression and content of beta-endorphin in human normal skin and hypertrophic scar. METHODS: Hypertrophic scar samples were collected from 42 patients with hypertrophic scar for 1-20 years (mean, 4.5 years), including 15 males and 27 females with an average age of 32.6 years (range, 16-50 years). According to the kind of paresthesia, they were divided into 3 gourps: non-pain-pruritus group (n=20), pruritus group (n=14), and pain-pruritus group (n=8). Normal skin samples (normal skin group) were harvested from 5 patients undergoing skin grafting surgery, including 3 males and 2 females with an average age of 24.6 years (range, 15-37 years). The immunofluorescence method was used to observe the expression of beta-endorphin and ELISA method to detect the concentrations of beta-endorphin in the tissues. RESULTS: The beta-endorphin expressed in all samples, and it expressed around peripheral nerve fibers in the dermis, fibroblasts, and monocytoid cells principally; and it expressed significantly stronger in pruritus group and pain-pruritus group than in non-pain-pruritus group and normal skin group. The beta-endorphin content was (617.401 +/- 97.518) pg/mL in non-pain-pruritus group, (739.543 +/- 94.149) pg/mL in pruritus group, (623.294 +/- 149.613) pg/mL in pain-pruritus group, and (319.734 +/- 85.301) pg/mL in normal skin group; it was significantly higher in non-pain-pruritus group, pruritus group, and pain-pruritus group than in normal skin group (P < 0.05); it was significantly higher in pruritus group than in non-pain-pruritus group and pain-pruritus group (P < 0.05); and there was no significant difference between non-pain-pruritus group and pain-pruritus group (P > 0.05). CONCLUSION: The expression of beta-endorphin is high in hypertrophic scar, it may play an important role in process of pruritus in these patients.

[Secondary reconstruction of posttraumatic orbital deformities with canthus dislocation].

OBJECTIVE: To explore the secondary surgical reconstruction for orbital bone deformities accompanied with canthus dislocation after trauma. METHODS: From June 1998 to July 2007, 37 patients with secondary orbital bone fracture deformity accompanied with medial or lateral canthal ligament dislocation posttraumatically were treated, among whom there were 22 males and 15 females, aged 13-46 years old (21 on average). There were 29 cases of traffic accident, 6 of boxing injury and 2 of beating injury by sticks. The latest reconstruction was performed on these 37 cases during 3 months to 8 years after injuries. There were 11 cases of orbital maxillary zygoma (OMZ) fracture, 15 of naso-orbito-ethmoid (NOE) fracture, 8 of OMZ and NOE fracture and 3 of frontal fracture. There were 31 patients who were reconstructed for the first time and 6 for the second time. Typical bicoronal and subciliary incisions and intra-oral approach were employed to expose all the fractured sites. According to the fractured position and the degree of deformity and dislocation, the orbito-zygomatic fracture was repositioned after osteotomy and rigid fixation, or the healed fragments were trimmed with a burr and the depressed fragments were filled with autogenous bone such as ilium, cranial outer table or Medpor in order to reconstruct orbital wall framework; the orbital walls were repaired to correct the enophthalmos with autogenous bone or Medpor after the herniated orbital contents were released. The medial canthal ligament was anchored superior-posteriorly to the lacrimal fossa with transnasal wires fixation or fixed with titanium miniplates and nails. RESULTS: The 36 patients' incisions obtained healing by first intention after the operation, and 1 case failed because of wound infection from maxillary sinusitis. There were 24 patients who were cured successfully with facial appearance and function improved significantly. During the follow-up for 3-6 months, no complication was found such as dislocation of the implant, rejection and infection. Two patients still showed slight enophthalmos while 3 patients with canthus dislocation regained improved appearances but not satisfactory. At 6 months after operation, the CT scan conducted in 3 patients with autogenous bone and Medpor grafting showed all fractures were fixed rigidly. CONCLUSION: Surgical reduction combined with bone grafting is a satisfactory method for the correction of secondary orbital bone deformity, and the repair of canthus dislocation and correction of enophthalmos should be considered at the same time. An ideal result could be achieved only through all-round consideration and comprehensive treatment.