Redefining Mandibular Sub-units: The "ABC" Classification and Surgical Strategies for Lower Face Contouring.

BACKGROUND: In east Asia, lower face contouring surgeries including reduction mandibuloplasty and genioplasty are the most popular aesthetic craniofacial surgeries. Conventional selection of surgical strategies mainly relied on the visual judgment of the mandibular angle, without overall assessment of the mandibular sub-units. Furthermore, only a few studies offered quantitative assessment of the mandibular shape. METHODS: From 2010 to 2021, 1241 patients diagnosed with square faces and received customized lower face contouring surgeries by the senior author were reviewed and analyzed to propose an "ABC" classification system for facilitating surgical planning. RESULTS: Among them, 998 (80.42%) received bilateral mandible reshaping, 155 (12.49%) underwent bilateral mandible reshaping combined with genioplasty, and 88 (7.09%) received asymmetric mandible reshaping. A modified classification system composed of three critical parameters (height, morphology/thickness, divergence) in three aesthetic zones (mandibular angle, mandibular body, chin) was proposed based on quantitative summarization of the CT database and the senior author's 12-year experience. The way to facilitate surgical planning with this classification was demonstrated. CONCLUSIONS: This modified classification system ushered a decision-making process that prioritized several critical measurements and proposed an operative planning form. Meanwhile, it can also be cooperated into the three-dimensional virtual surgical plan. 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 http://www.springer.com/00266 .

Surgical Result and Identification of FGFR2 Variants Using Whole-Exome Sequencing in a Chinese Family With Crouzon Syndrome.

ABSTRACT: Crouzon syndrome is considered as one of the most common craniosynostosis syndromes with a prevalence of 1 in 65,000 individuals, and has a close relationship with variants in fibroblast growth factor receptor 2. Here the authors described a Crouzon syndrome case, which was asked for surgery treatment for the symptom of multisuture craniosynostosis. Mild midfacial retrusion, larger head circumference, proptosis, pseudo-prognathism, and dental malposition could also be found obviously. Then fronto-orbital advancement and cranial cavity expansion were performed to the child. After whole-exome sequencing (WES) and Sanger sequencing, gene variants in the exons 2 and 3 of FGFR2 were detected. And protein tyrosine 105 replaced by cysteine in the extracellular region of FGFR2 was also detected. After operation, she presented a satisfactory anterior plagiocephaly and scaphocephaly correction, and the result was satisfied by surgeons and her parents. Variants detected using WES have further research prospect.

A Simple Dressing Fixation Method Following Harvest of the Ear Cartilage Graft.

ABSTRACT: Auricular cartilage is a common autologous graft material for rhinoplasty. Even though surgical techniques for the harvest of cartilage graft are well established, the management of the postoperative dressing fixation is still limited. Therefore, the authors propose a simple dressing fixation method in which gauze strips instead of gauze block or wet cotton, the suture of tie-over dressing fixed just through the cartilage rather than the full thickness of the auricle, a vaseline gauze interposed between the stitch knot and the skin and no additional pressure dressings postauricularly. No case of hematoma, infection and skin necrosis of the donor site was observed. This simple and reproducible technique provides perfect and homogeneous adhesion of the dressing all over the conchal cartilage while decreasing the risk of postoperative hematoma and discomfort.

Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians.

BACKGROUND: Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony. METHODS: Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD. RESULTS: Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness. CONCLUSIONS: This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour. 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 .

Rapamycin and 3-Methyladenine Influence the Apoptosis, Senescence, and Adipogenesis of Human Adipose-Derived Stem Cells by Promoting and Inhibiting Autophagy: An In Vitro and In Vivo Study.

OBJECTIVE: We aimed to clarify the changes in apoptosis, proliferation, senescence, and adipogenesis after promoting and inhibiting autophagy in adipose-derived stem cells (ADSCs) by rapamycin and 3-methyladenine in vitro and in vivo. METHODS: After rapamycin and 3-methyladenine pretreatment, ADSC autophagy was detected by immunofluorescence for LC3, RT-PCR for ATG genes, and western blotting (WB) for the LC3 II/I and p62 proteins. TUNEL staining, PCR of BAX, and WB of Caspase-3 were preformed to assess ADSC apoptosis. The adipogenesis of ADSCs was evaluated by Oil red O staining and PCR of PPAR-γ. CCK8 assays were conducted to detect proliferation. Senescence was tested by Sa-ß-gal staining and PCR of the P16/ 19/21 genes. Moreover, the mass and volume retention rate were determined, and perilipin and CD31 staining were performed in vivo. RESULTS: Rapamycin and 3-methyladenine pretreatment increased and decreased autophagy of ADSCs, respectively, under normal and oxygen-glucose deprivation conditions. Apoptosis and senescence of ADSCs were decreased, and adipogenesis was increased along with the upregulation of autophagy. However, the proliferation of ADSCs was inhibited after either rapamycin or 3-methyladenine pretreatment. In vivo, the volume and mass retention rate and the angiogenesis of the grafts were also improved after rapamycin pretreatment. CONCLUSIONS: Rapamycin pretreatment reduced apoptosis, delayed senescence, and promoted adipogenesis of ADSCs. These effects were inhibited by 3-methyladenine, indicating that the changes may be mediated by autophagy. Moreover, the survival rate and angiogenesis of the grafts were increased after upregulation of ADSC autophagy in vivo, which may help improve the efficiency of clinical fat transplantation. NO LEVEL ASSIGNED: 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 Modified Procedure for Single-eyelid Asian Females with Lacrimal Gland Prolapse: Lacrimal Gland Reposition combined with Fat Transposition in Double-eyelid Operation.

BACKGROUND: The awareness and treatment of lacrimal gland prolapse (LGP) have been primarily improved with a further understanding of lateral eyelid bulging over the decades. However, for Asian single-eyelid females with LGP, a tailor-made procedure applicable to their comparatively young puffy eyes is needed. METHODS: This is a retrospective study. From Jan. 2009 to Jan. 2019, two hundred and three Asian single-eyelid females with LGP, who met the inclusion criteria, underwent double-eyelid surgeries and adjunctive lacrimal gland repositions with preaponeurotic fat transposition. Pertinent demographics, complications, pre-and post-operative photography were collected. RESULTS: A total of 167 patients completed the 4-24 months' follow-up (average: 16.3 months). One hundred and thirty-two cases (79.0%) were diagnosed as LGP preoperatively, and the rest (35/167, 21.0%) were diagnosed intraoperatively. All patients (average: 28.4 years old) received modified blepharoplasty. Postoperative symptoms involving local mild pain (2.9%, 5/167), upper eyelid tightness (3.6%, 6/167), and moderate epiphora (9.0%, 15/167) were all recovered spontaneously within one month. Prolapse recurrence and severe complications such as dry eye syndrome were not observed. CONCLUSIONS: We proposed a modified procedure to enhance the diagnosis and treatment of LGP during Asian blepharoplasty. The lacrimal gland suspension and fat transposition assured the cosmetic outcome for selected young, puffy Asian eyes. The supratarsal creases were satisfactory, and the complication rate was low. Furthermore, the rearrangement of preaponeurotic fat smoothed the contour transition and preserved the orbital volume. Therefore, this is a safe and effective technique worth recommending.

The Relationship Between the Facial Proportion Changes in Hard Tissue and the Satisfaction of Patients After Reduction Malarplasty: a Research Based on Three-Dimensional Cephalometry.

OBJECTIVE: We aim to measure the zygomatic width and protrusion changes in hard tissue after reduction malarplasty and then calculate facial proportion changes and analyze the relationship between facial proportion changes and patients' satisfaction. METHODS: We retrospectively reviewed our database and selected 36 eligible patients who underwent isolated reduction malarplasty in our department from March 2015 to July 2018. The preoperative and postoperative facial width and protrusion, as well as head height, in hard tissue were measured using ProPlan software. Patients' satisfaction was evaluated by questionnaire. The correlations between the facial proportion changes and patients' satisfaction were analyzed using Spearman correlation analysis. RESULTS: The preoperative and postoperative midface widths were 135.87 ± 4.09 mm and 129.06 ± 4.95 mm. The relative zygomatic protrusion was reduced by 3.29 ± 1.54 mm in the left and 2.88 ± 1.73 mm in the right after surgery. The ratio of the midface width to lower face width changed from 1.43 ± 0.05 to 1.36 ± 0.06 after surgery. And the ratio of the head height to midface width changed from 1.53 ± 0.05 to 1.61 ± 0.05 after surgery. The ratios were indeed close to the ideal ratios we presumed (4:3 and 1.618). Moreover, patients' total and morphology satisfaction were both significantly higher with the postoperative ratio of the midface width to lower face width closer to 4:3 (R = - 0.732, P < 0.001; R = - 0.906, P < 0.001, respectively). But only morphology satisfaction was higher with the ratio of the head height to midface width closer to 1.618 (R = - 0.404, P = 0.014) and the ratio of the postoperative midface to lower face width decreased (R = - 0.434, P = 0.008). CONCLUSIONS: We found patients' morphology satisfaction was higher with the proportion of the postoperative midface to lower face width decreased. What's more, the proximity degree between the postoperative facial proportion and the ideal facial proportions we presumed was significantly correlated with patients' high satisfaction. Therefore, 4:3 and 1.618 may be the ideal postoperative facial ratios for the patients who underwent reduction malarplasty. 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 https://www.springer.com/00266.

Comparison of Bilateral Mandibular Angle Ostectomy Between East Asian Males and Females: A Study Based on Three-Dimensional Computed Tomography Reconstruction.

BACKGROUND: Mandibular angle ostectomy is a common plastic surgery for facial contouring in East Asians. However, rarely we could find reports on differences between East Asian males and females undergoing this surgery. OBJECTIVE: To describe the differences between East Asian males and females before and after mandibular angle ostectomy. METHODS: A total of 22 Asian males and 52 Asian females who underwent mandibular angle ostectomy from April 2015 to November 2018 were enrolled. Three-dimensional computed tomography was used to evaluate the preoperative and postoperative data of the mandible. Thirteen clinical data were measured on reconstructed mandibular models. The differences in data between males and females were analyzed to identify the causes of the differences before and after surgery. The follow-up was 6-12 months, and patient satisfaction was also evaluated. RESULTS: The ostectomy volume was positively correlated with the distance from the intersection of the occlusal plane and the anterior margin of the mandibular ramus to gonion (MR-Go; female, p < 0.01; male, p = 0.02). There was a positive correlation between the ostectomy volume and the postoperative drainage fluid (The drainage fluid is mainly blood) volume after surgery in females (p < 0.05), while there is no significant correlation between these two data in males (p = 0.19). Patients with a long distance from the second molar to the lower edge of the mandibular body (SM-MB) tended to have a higher risk of postoperative bleeding (female, r = 0.56, p < 0.01; male, r = 0.73, p = 0.01). CONCLUSION: Because of the difference in the anatomical size of the mandible and different aesthetic requirements for facial contouring between males and females, surgeons encounter different intraoperative conditions resulting in difficulties during surgery. Understanding differences in mandibular angles predicts differences in ostectomy volume and postoperative bleeding risk, thus aiding surgeons and leading to better operative outcomes. 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.

En-Bloc U-Shaped Osteotomy of the Mandible and Chin for the Correction of a Prominent Mandibular Angle With Long Chin.

BACKGROUND: Lower face contouring surgery has become a popular aesthetic surgery in East Asian countries. Various surgical methods have been used to improve lower face aesthetics. When a patient has a wide as well as long lower face, procedures like chin polishing or T-type osteotomy are traditionally performed, but these surgical methods have several disadvantages. The authors devised a simple and reliable method to correct the wide and long lower face, without the complications associated with the traditional methods. METHODS: From July 2015 to January 2018, 30 patients with a prominent mandibular angle, long chin, and no malocclusion underwent en-bloc mandibular U-shaped osteotomy through an oral incision, in order to shorten the mandibular angle, body of the mandible, and the chin, and to improve the facial contour. The authors assessed the effectiveness of surgery through comparisons between pre- and postoperative radiographs, patient satisfaction, and surgical complications in the postoperative period. RESULTS: It was observed that all oral incisions healed by primary intention, and did not develop hematoma, infection, or osteonecrosis. Lower lip numbness occurred in 16 patients. After 6 to 12 months, all patients showed complete recovery from the numbness. All the patients were satisfied with their appearance after surgery. CONCLUSIONS: En-bloc mandibular U-shaped osteotomy is an improved form of mandibular surgery. The osteotomy line involves the whole mandible, which makes the length and width of the mandible considerably smaller. This surgery can effectively correct a prominent mandibular angle with long chin.

Single-Stage Mandibular Curved Ostectomy on Affected Side Combined with Bilateral Outer Cortex Grinding for Correction of Facial Asymmetry: Indications and Outcomes.

BACKGROUND: Facial asymmetry combined with a prominent mandibular angle is common in the population. Its treatment involves two or three stages of surgeries. Generally, orthognathic surgery is a top priority. However, some patients with no severe occlusion disorders focus on the appearance and could not accept complex therapeutic procedures. This study evaluated the surgical effect of en bloc mandibular angle-body-chin curved ostectomy (MABCCO) combined with traditional mandibular angle curved ostectomy (MACO) and bilateral outer cortex grinding (OCG) to correct facial asymmetry and a prominent mandibular angle. METHODS: From September 2013 to November 2017, a total of 40 patients with facial asymmetry and prominent mandibular angle were chosen for this study. The authors performed single-stage surgery of en bloc MABCCO combined with traditional MACO and bilateral outer cortex grinding to correct facial asymmetry. Patient satisfaction was investigated by questionnaires at 6 months postoperation. The effectiveness was then evaluated through cephalometric radiographs, three-dimensional computed tomography, and preoperative and postoperative standard facial photographs. RESULTS: The postoperative results of all 40 cases showed that facial asymmetry was effectively corrected without serious complications, and the square face was also significantly improved with a harmonious mandibular contour. There was a statistical difference between the patient's preoperative and postoperative satisfaction scores (p < 0.05). The objective esthetic outcomes evaluated by both surgeons and patients were quite satisfactory. CONCLUSION: Single-stage surgery of en bloc MABCCO combined with traditional MACO and bilateral OCG was an adaptable option for correction of facial asymmetry and prominent mandibular angle with slight occlusion disorders, which can both largely shorten treatment time and shape a harmonious face. 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 .

Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction.

BACKGROUND: Mandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction. METHODS: From May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed. RESULTS: Twenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision. CONCLUSIONS: When performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent. 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 .

Salvage Free Anterolateral Thigh Composite Flap Transfer Based on the Musculocutaneous Perforator Retrograde Blood Flow Principle.

An anterolateral thigh myo-adipofascial flap was used in the definitive management of a patient presented with chronic infective process associated with a large fronto-nasal defect. Unfortunately, the risk of free flap transfer failure emerged when intraoperative dissection showed absence of a reliable ipsilateral superficial temporal artery as the recipient artery. This rare incident happened at the stage whereby the anterolateral thigh flap was nearly completely raised with a distal perforator in situ. In this article, the authors presented an innovative strategy to salvage the flap by transforming the flap into a modified composite flap based on the retrograde blood flow principle. To the best of our knowledge, this is the first report of using such a technique in reconstructive microsurgery. This successful salvage strategy has clinical application and could potentially minimize free flap transfer failure.

A Modified Method Combining Z-Epicanthoplasty and Blepharoplasty to Develop Out-Fold Type Double Eyelids.

BACKGROUND: The epicanthus can weaken the effect of blepharoplasty, which makes it difficult to form the out-fold type double eyelids preferred by Asian women. The integration of blepharoplasty and Z-epicanthoplasty has become increasingly popular. Although many techniques have been introduced to remove the epicanthus during blepharoplasty, there are still some surgical complications. METHOD: This study aimed to evaluate the practicability and effectiveness of combining Z-epicanthoplasty and blepharoplasty. Removing a slice of skin from the upper eyelid to the inner canthus makes the epicanthus crease along the vertical axis of Z-plasty. The up-outward triangular flap points to the lower eyelid margin instead of the inner canthus. By cutting off the fibrous tissue and orbicularis oculi muscle, the tension that causes epicanthus is completely released; therefore, the inner canthus ligament anchor is unnecessary and avoids damage to the inner canthus. RESULT: From January 2008 to June 2014, this modified surgical method was carried out on 1108 patients. One hundred and twelve patients were evaluated at a follow-up visit ranging from 6 to 72 months. In 2 cases, the double-eyelid fold developed into an in-fold type, while, in 110 cases, it developed into an out-fold type. The outlines of the upper eyelids were natural and symmetric, and the inner canthus and lacrimal caruncle were fully exposed with no visible scar. CONCLUSION: This modified method is simple in design and practice. The inner canthus and lacrimal caruncle can be fully exposed, giving a natural, smooth, Westernized, appealing look. This technique is suitable for all types of epicanthus in Asian women. 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.

Analysis of Characteristics Similar to Autoimmune Disease in Keloid Patients.

BACKGROUND: Keloid is a fibrotic skin disease for which immune cell infiltration is a primary pathological hallmark. Meanwhile, in autoimmune diseases, triggering of the inflammation response can lead to tissue injury and subsequent organ fibrosis. When the skin is involved in autoimmune disease, skin fibrosis such as that seen in scleroderma can occur. In this study, we propose that keloid possesses features of autoimmune disease. METHODS: To verify whether keloid possesses features of autoimmune disease, immune cell infiltration and immune complex deposits were detected with immunohistochemical staining and immunofluorescence, respectively, in keloid and normal skin tissues. A routine antinuclear antibody profile was tested in sera from 28 keloid patients and 28 healthy controls. Lastly, the anti-hnRNPA2B1 autoantibody in sera was evaluated by enzyme-linked immunosorbent assay. RESULTS: The numbers of CD1α(+) Langerhans cells, CD3(+) T lymphocytes, CD68(+) macrophages, and CD20(+) B lymphocytes increased in keloid tissues compared to normal skin. IgA, IgM, C3, and C1q deposits were found in keloid tissues but not in normal skin, while anti-hnRNPA2B1 levels in sera from keloid patients were elevated. CONCLUSION: The above findings suggest that keloids have some characteristics that are similar to autoimmune disease and might be mediated by autoimmune responses. 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 .

[Structural and biomechanical properties of accelular dermal matrix derived from human scar tissue].

OBJECTIVE: To explore the structural and biomechanical properties of acellular dermal matrix (ADM) of human scar tissue. METHODS: Randomly choose 8 human mature scar tissue, 8 human hypertrophic scar tissue, and 4 normal human tissue as experimental samples respectively. Then 0.5 mm split-thickness skin grafts were obtained by drum-type scalpel, further acellularized by 2.5 g/L trypsin-0.5% TritonX-100. Structural analyses were performed by macroscopic observation, hematoxylin and eosin histological staining and scanning electron microscope. Then human epithelial stem cells were inoculated, cultured on those materials and observe their adhesive properties. Finally the biomechanical properties of ADM were analyzed through the detection of stress-strain relation, stress relaxation, creep and ultimate stress strength to distinguish different origins. RESULTS: Prepared ADM was milky white in color despite their distinct origins, physiological and mature scar tissue derived ADM was soft and flexible in texture while ADM from hypertrophic scar showed a more tenacious character. Optical microscopic and electron microscopic analyses showed no sign of visible cellular structures. ADM from physiological group had relatively homogeneous and inerratic collagenous fibers, ADM from hypertrophic group presented with fibers of various diameters and arrayed in a compact and disordered manner. ADM from mature scar tissue possessed traits between the other two groups. Adhesion growth could be observed 2 weeks after inoculating human epithelial stem cells on ADM and cells grew in a cohesive fashion on ADM both from normal skin and mature scar tissue and in an adhesive fashion on hypertrophic scar tissue ADM. Stress-strain ß value (3.024 ± 0.413, 2.595 ± 0.443, 2.590 ± 0.366), creep slope (0.018 ± 0.003, 0.019 ± 0.009, 0.023 ± 0.010) and ultimate stress strength (8.971 ± 2.434, 11.011 ± 1.492, 15.567 ± 2.931) of ADM showed no significant differences in hypertrophic scar, mature scar and normal skin tissues (all P > 0.05). ADM from mature scar and normal skin tissue showed no differences in stress-strain stretch ratio (0.238 ± 0.083 vs 0.291 ± 0.048), relaxation slope (-0.041 ± 0.009 vs -0.047 ± 0.008), total relaxation (0.775 ± 0.194 vs 0.968 ± 0.211) or total creep (0.033 ± 0.022 vs 0.049 ± 0.020) (all P > 0.05). However, the above related indices of ADM from hypertrophic scar tissue (0.188 ± 0.036, -0.033 ± 0.006, 0.481 ± 0.058, 0.020 ± 0.005) were significantly lower than those from normal tissue (all P < 0.05). CONCLUSIONS: No significant differences exist between mature scar and normal skin tissues derived ADM both in structural and biomechanical properties. However ADM from mature scar appears to be superior in biomechanical properties than hypertrophic scar derived ADM so that it may become a replacement for original dermis in wound repair.

[Comparison of biological characteristics and quantity of epidermal stem cells from hypertrophic scar skin and normal skin of human beings].

OBJECTIVE: To compare the biological characteristics of epidermal stem cells (ESCs) from hypertrophic scar and normal skin. METHODS: Epidermal stem cells were separated, enriched and adhered from 20 hypertrophic scars (scar group) and 20 normal skins (control group). The morphology and growth characteristics of primary epidermal stem cells were observed. The absorbance (A) values of expression of Keratin 19, nucleoprotein p63 and integrin ß1 were tested by Western blot. And the genes of Oct-4 and Nanog were tested by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Flow cytometry was used to examine the markers of integrin CD29, integrin CD49f and Keratin 19 of ESCs. RESULTS: The primary cultured cells showed the similar shape and growth curve. By comparing the epidermal stem cells from scar groups and control groups, the absorbance values of the expression of Keratin 19, nucleoprotein p63 and integrin ß1 were 860 ± 4, 712 ± 3, 422 ± 6 and 862 ± 3, 707 ± 9, 413 ± 6 (all P > 0.05). The expression values of Oct-4, Nanog were (7.79 ± 0.44)×10(-4), (5.96 ± 0.36)×10(-4) and (7.93 ± 0.29)×10(-4), (6.06 ± 0.35)×10(-4) (all P > 0.05). Percentages of positive cells expressing CD29, CD49f and Keratin 19 were (97.3 ± 0.7)%, (94.6 ± 1.1)%, (92.5 ± 0.8)% and (98.8 ± 4.6)%, (98.9 ± 0.4)%, (94.4 ± 0.7)% respectively (all P < 0.05). CONCLUSIONS: The ESCs in hypertrophic scar have the same characteristics with ESCs in normal skin. However, the ESCs from hypertrophic scar are lower than that from normal skin.

Would hyaluronic acid-induced mental bone resorption be a concern? A prospective controlled cohort study and an updated retrospective cohort study.

BACKGROUND: Hyaluronic acid (HA) is a widely used filler for face contouring and is generally believed to be safe and effective. However, there have been reports of HA-related bone erosion in the chin area without clear scientific data regarding its existence, incidence, and severity. This exploratory study was to evaluate HA-related mental bone resorption through a prospective, controlled, observer-blind, nonrandomized clinical trial and a retrospective cohort study. METHODS: On the one hand, a prospective, controlled, nonrandomized, single-shot HA-injection clinical trial was conducted. Computed tomographic scans were collected at baseline and at 6-12 months of follow-up for both HA-injection and control groups. On the other hand, an updated retrospective cohort study compared the HA-injection with a blank control group. The primary outcomes composed of three quantitative parameters [bone resorption index (BRI M and BRI N ), bone resorption thickness ratio] and one subjective evaluation index (severity ranking). Information about demographics, complications, and injection volume were also recorded. RESULTS: From June 2021 to March 2023, 78 patients were prospectively recruited for the study. There was a significant association between HA-injection and bone resorption [BRI M : pre (84.24±8.10%) vs post (79.21±8.70%), P <0.001; BRI N : pre 92.50% (73, 144%) vs 87.99% (63, 132%), P <0.001; bone thickness ratio: HA 24.08% (0, 48%) vs control 0 (0, 17%), P <0.001]. However, there was no difference in large-volume (>1 ml) and small-volume (≦1 ml) injection subgroups [bone resorption thickness ratio: (21.50±10.91%) vs (24.51±11.92%), P =0.350]. The imaging manifestation revealed discernible bone resorption in 35.90% of the patients, with an median bone resorption thickness ratio of 24.08%. Between October of 2019 and March 2023, 95 HA-injection patients (190 semimandibular cases), 95 normal controls were enrolled. The BRI M was significantly lower in the HA-injection group compared to the controls ( P <0.001). CONCLUSIONS: HA may induce bone resorption in the mentum. Large-scale randomized controlled clinical trial is warranted for further confirmation. Patients should be informed of this potential complication.

[Construction of keratinocyte growth factor phage active peptides for the promotion of epidermal cell proliferation].

OBJECTIVE: To construct and display the keratinocyte growth factor (KGF) phage active peptides so as to detect the promoting effects of epidermal cell. METHODS: KGF sequences were chosen and their primers were designed. The selected genes of P1, P2 and P4 were obtained by reverse transcription (RT)-PCR. P3 was obtained by direct synthesis. And the KGF genes were subcloned into pComb3 vector. The technique of phage display was employed to display the genes on phage surface. Methyl thiazolyl tetrazolium (MTT) assay was used to evaluate the promoting effects of KGF phage active peptides on the proliferation of epidermal cell. Optical density (A) was determined at 570 nm. Immunofluorescent assay was employed to evaluate the cell affinity of KGF phage active peptides. RESULTS: The four KGF genes were obtained and subcloned into pComb3 vector. The proteins of the KGF genes were expressed on the surface of the pComb3 vector. The MTT data of optical density (A) showed that significant differences existed between the negative control and KGF control (0.293 ± 0.017 vs 0.520 ± 0.043) and KGF phage active peptide groups (0.293 ± 0.017 vs 0.469 ± 0.057, 0.441 ± 0.048, 0.438 ± 0.035, 0.446 ± 0.037) (all P < 0.01). The results of immunofluorescent assay indicated that KGF and KGF phage active peptides had excellent cell affinity. CONCLUSION: KGF phage active peptides are successfully constructed and displayed and they may promote the proliferation of epidermal cell.

Successful Treatment and Long-term Follow-up of Parry-Romberg Syndrome with Anterolateral Thigh Adipofascial Flap.

BACKGROUND: Anterolateral thigh (ALT) adipofascial free flap transfer is a frequently used method to reconstruct the facial symmetry and restore facial soft-tissue contour in PRS patients. While its long-term prognosis and patient outcomes assessment are still lack of understanding. METHOD: The authors report their treatment experience in 42 patients between 2001 and 2017 using microsurgical free anterolateral thigh adipofascial flap transfer. The long-term follow-up results and final reconstructive outcomes were evaluated. RESULTS: A total of 42 patients were included. The follow-up ranged from 5 to 21 years. All patients were satisfied with the surgery. Photographic evaluation revealed significant enhancement of postoperative appearance. Numbness or hypesthesia of the local area was the most common symptom in the long-term follow up. CONCLUSION: This study has evaluated the long-term treatment results of Parry-Romberg disease with microsurgery using ALT free flap in our department. Over 20 years' experience and the significant enhancement of the overall appearance indicate a long-lasting, excellent outcome.