A Novel U-Flap Epicanthoplasty for Asian Patients.

BACKGROUND: The epicanthal fold is a distinct characteristic of the Asian upper eyelid, which may impair the beauty of the eyes and the outcome of double eyelid blepharoplasty. Although many surgical procedures have been reported, their main drawbacks include a conspicuous scar in the medial canthal area and an unnatural palpebral contour. We devised a novel surgical approach to correct the epicanthal fold with acceptable scarring. METHODS: From June 2011 to October 2014, U-flap epicanthoplasty was performed on 118 Chinese patients in our department. The U-flap was designed on the medial canthal skin. After complete dissection of the flap from the dislocated orbicularis muscle and underlying connective tissue, the flap naturally rotated upward to a line consistent with the direction of the palpebral fold. The flap was then subcutaneously fixed to the medial part of the medial canthal ligament. Finally, the redundant skin was trimmed off and the incision was sutured without tension. Patients were evaluated before and 12 months after surgery. RESULTS: The average decrease in the intercanthal distance was 4.36 ± 0.32 mm. The general satisfaction rate was 97.5 %. Three patients showed bilateral hypertrophic scar formation on both bilateral medial canthal incisions and palpebral incisions; however, the scarring subsided after three triamcinolone acetonide injections. No epicanthal fold recurrence or other complications were observed during the 12-month follow-up period. CONCLUSION: U-flap epicanthoplasty is a simple and effective method for elimination of types I-III epicanthal folds. However, its long-term effects require further study. 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 .

LncRNA-XIST promotes dermal papilla induced hair follicle regeneration by targeting miR-424 to activate hedgehog signaling.

BACKGROUND: Alopecia is a highly prevalent disease characterizing by the loss of hair. Dermal papilla (DP) cells are the inducer of hair follicle regeneration, and in vitro three-dimensional (3D) culturing DP cells have been proven to induce hair follicle regeneration. However, the molecular mechanisms behind the regulation of 3D culturing DP cells remain unclear. METHODS: 3D-cultivated DP cells were used as in vitro cell model. DP sphere xenograft to nude mice was performed for in vivo study of hair follicle regeneration. qRT-PCR, Western blotting, and immunofluorescence were used for detecting the level of XIST, miR-424 and Hedgehog pathway-related proteins, respectively. H&E staining was used to examine hair neogenesis. Cell viability, proliferation and ALP activity were measured by MTT, CCK-8 and ELISA assays, respectively. Luciferase assays were used for studying molecular regulation between XIST, miR-424 and Shh 3'UTR. RESULTS: XIST and Shh were up-regulated, and miR-424 was down-regulated in 3D DP cells. Molecular regulation studies suggested that XIST sponged miR-424 to promote Shh expression. Knockdown of XIST suppressed DP cell activity, cell proliferation, ALP activity and the expression of other DP markers by sponging miR-424. Knockdown of XIST suppressed Shh mediated hedgehog signaling by targeting miR-424. Moreover, the knockdown of XIST inhibited DP sphere induced in vivo hair follicle regeneration and hair development. CONCLUSION: XIST sponges miR-424 to promote Shh expression, thereby activating hedgehog signaling and facilitating DP mediated hair follicle regeneration.

Percutaneous endoscopy in direct real-time observation of choke vessels in rat perforator flap model.

BACKGROUND: Most of the techniques used to investigate choke vessels are indirect. The aim of the present study is to assess the effectiveness of percutaneous endoscopy in direct real-time visualization of choke vessels in rat perforator flap models. METHODS: A classic perforator flap on the rat dorsum was designed (n = 12). An additional incision was made to place the percutaneous endoscope. Evans blue dye was injected from the common carotid artery to distinguish choke arteries from veins. Blood perfusion status was assessed using full-field laser perfusion imaging (FLPI) and the oxygen/carbon dioxide levels. Photographs of choke vessels were taken and compared at 1 h, 1 day, 4 days, and 7 days postoperation. The flap survival area was examined on day 7. RESULTS: The average survival rate of perforator flaps was 70.1 ± 10.8%. The choke arteries but not choke veins were stained blue after injection of Evans blue dye. The choke arteries constricted instantly after surgery, dilated to a maximum diameter on postoperation day 4, and returned to the preoperation status on day 7. The choke veins dilated instantly after the operation, reached their largest diameters on postoperation day 4, and remained dilated on day 7. The behaviors of choke vessels were consistent with the FLPI results and oxygen/carbon dioxide statuses. CONCLUSION: Percutaneous endoscopy can provide direct real-time visualization of choke vessels in living rat perforator flap models and enable the identification of choke arteries and veins. This novel technique represents an ideal platform for investigating choke vessels in perforator flap models.