Astaxanthin Promotes the Survival of Adipose-Derived Stem Cells by Alleviating Oxidative Stress via Activating the Nrf2 Signaling Pathway.

The survival of free fat grafts is dependent primarily on adipose-derived stem cells (ADSCs); however, ADSCs are susceptible to oxidative stress in the recipient area. Astaxanthin (Axt) is a natural xanthophyll carotenoid with potent antioxidant properties and numerous clinical applications. To date, the therapeutic potential of Axt in fat grafting has not been explored. The purpose of this study is to investigate the effects of Axt on oxidatively stressed ADSCs. An oxidative model of ADSCs was developed to simulate the host's microenvironment. Oxidative insult decreased the protein levels of Cyclin D1, type I collagen alpha 1 (COL1A1), and type II collagen alpha 1 (COL2A1), while increasing the expression of cleaved Caspase 3 and secretion of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in ADSCs. Axt pre-treatment significantly reduced oxidative stress, increased the synthesis of an adipose extracellular matrix, alleviated inflammation, and restored the impaired adipogenic potential in the present model. Furthermore, Axt immensely activated the NF-E2-related factor 2 (Nrf2) pathway, and ML385, an inhibitor of Nrf2, could negate Axt's protective effects. Additionally, Axt alleviated apoptosis by inhibiting bcl-2-associated X protein (BAX)/Caspase 3 signaling and improving the mitochondrial membrane potential (MMP), which could also be abolished by ML385. Our results suggest that Axt may exert its cytoprotective effect on ADSCs through the Nrf2 signaling pathway and could be therapeutic in fat grafting.

Iatrogenic mandibular fracture associated with third molar removal after mandibular angle osteotectomy.

The extraction of mandibular third molars is a common dental procedure. The complications include hemorrhage, pain, dental fracture, the displacement of teeth or fragments, iatrogenic damage or luxation of the second molar, neurologic injuries, soft tissue damage, subcutaneous emphysema, trismus, swelling, infection, and iatrogenic mandibular fracture. Fracture of the angle of the mandible associated with third molar removal is a rare but severe complication. This article describes a case of mandibular angle fracture associated with third molar extraction after mandibular angle osteotectomy, including a brief review of the literature. The removal of the mandibular angle and the outer cortex of the mandible, especially the external oblique ridge, may contribute to the bone fracture. We conclude that the extraction of the lower third molar must be before the removal of the mandibular angle, and a soft diet for at least 4 weeks postoperatively is essential to prevent late mandible fracture.

Optimal time to initiate early oral feeding in postoperative patients with upper gastrointestinal malignancy: A network meta-analysis.

BACKGROUND: With the development of enhanced recovery after surgery, early oral feeding is likely to become the preferred mode of nutrition after surgery for upper gastrointestinal tract malignancies. However, the optimal time to initiate early oral feeding remains unknown. OBJECTIVE: We aimed to compare the effects of different introduction times of early oral feeding in patients with upper gastrointestinal malignancies in terms of safety, tolerance, and effectiveness and to identify the optimal time for early oral feeding after surgery. METHODS: A random-effects meta-analysis was performed to identify evidence from relevant randomized controlled trials. Ten electronic databases were searched for randomized controlled trials from their earliest records to May 2023. Data were analyzed using the Stata 16.0 software. RESULTS: A total of 22 randomized controlled trials including 2510 patients and seven time points for oral feeding after surgery were considered. Regarding safety, oral feeding initiated on postoperative day 3 may be the safest (high-quality evidence) compared with other times. Regarding tolerance, oral feeding initiated on postoperative day 5 may be the most well-tolerated (moderate-quality evidence) compared with other times. Regarding effectiveness, oral feeding initiated on postoperative day 3 may be the most effective (moderate-quality evidence) compared with other times. CONCLUSIONS: Early oral feeding is safe, tolerable, and effective in postoperative patients with upper gastrointestinal malignancies. The optimal time to initiate early oral feeding after surgery was most likely postoperative day 3. The results of this meta-analysis provide evidence-based guidelines for clinical decision-making.

Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically?

BACKGROUND: Fibrous dysplasia (FD) is a tumor-like growth that consists of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. The most commonly affected bones are facial bones, causing a number of facial cosmetic and functional problems. METHODS: From December 2008 to July 2012, 10 patients with craniomaxillofacial fibrous dysplasia were treated by conservative resection and local recontouring. The patients were followed up yearly, with an average of 3 years; the longest follow-up period was 5 years. RESULTS: All the 10 patients received appropriate treatment and histopathological examinations were performed to confirm the diagnosis of FD. Four patients with zygoma involved had received partial zygoma osteoectomy and 2 patients received mandibular partial osteoectomy. Average time of follow-up was 3 years, with a range from 1 to 5 years, and all patients obtained satisfactory aesthetic and functional results. CONCLUSION: In most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.

Dura cells in the etiopathogenesis of Crouzon syndrome: the effects of FGFR2 mutations in the dura cells on the proliferation of osteoblasts through the hippo/YAP mediated transcriptional regulation pathway.

BACKGROUND: FGFR2 (fibroblast growth factor receptor 2) mutations are implicated in the etiopathogenesis of syndromic craniosynostosis, and C278F- or C342Y-FGFR2 mutations can lead to Crouzon syndrome. The dura mater exerts crucial effects in the regulation of cranial suture development. However, the underlying mechanisms of these biological processes are rarely studied. This research explored and analyzed the biological function of FGFR2 overexpressed by dura cells on cranial osteoblasts. METHODS: Dura cells and cranial osteoblasts from C57BL/6 mice aged 6 days were obtained and cultured respectively. Lentivirus-FGFR2 constructs were engineered with C278F- and C342Y-FGFR2 mutations. The dura cells were infected with the constructs and co-cultured with osteoblasts in a trans-well system. Four experimental groups were established, namely the Oste group, the Oste+Dura-vector group, the Oste+Dura-C278F group, and the Oste+Dura-C342Y group. FACS, CCK8, and EdU assays were used to evaluate the osteoblast proliferation levels. Western blot and RT-qPCR were used to measure the expressions of the factors related to proliferation, differentiation, and apoptosis. Furthermore, the expression levels of the key factors in the Hippo/YAP-PI3K-AKT proliferation pathway were measured and analyzed. Finally, rescue experiments were performed with an RNA interfering assay. RESULTS: The proliferation and differentiation levels of the osteoblasts in the Oste+Dura-C278F and Oste+Dura-C342Y groups were significantly up-regulated, but the apoptosis levels in the four groups were not significantly different. The YAP, TEADs1-4, p-PI3K, and p-AKT1 expressions in the mutant FGFR2 groups were higher than the corresponding expressions in the control groups, and the results of the rescue experiments showed a reverse expression tendency, which further confirmed the effects of the FGFR2 mutations in the dura cells on the proliferation of the osteoblasts and the underlying possible mechanisms. CONCLUSION: Our studies suggest that the Crouzon mutations (C278F- and C342Y-) of FGFR2 in dura cells can enhance osteoblast proliferation and differentiation and might influence the pathogenesis of craniosynostosis by affecting the Hippo/YAP-PI3K-AKT proliferation signaling pathway.

Skeletal muscle-derived cells repair peripheral nerve defects in mice.

Skeletal muscle-derived cells have strong secretory function, while skeletal muscle-derived stem cells, which are included in muscle-derived cells, can differentiate into Schwann cell-like cells and other cell types. However, the effect of muscle-derived cells on peripheral nerve defects has not been reported. In this study, 5-mm-long nerve defects were created in the right sciatic nerves of mice to construct a peripheral nerve defect model. Adult female C57BL/6 mice were randomly divided into four groups. For the muscle-derived cell group, muscle-derived cells were injected into the catheter after the cut nerve ends were bridged with a polyurethane catheter. For external oblique muscle-fabricated nerve conduit and polyurethane groups, an external oblique muscle-fabricated nerve conduit or polyurethane catheter was used to bridge the cut nerve ends, respectively. For the sham group, the sciatic nerves on the right side were separated but not excised. At 8 and 12 weeks post-surgery, distributions of axons and myelin sheaths were observed, and the nerve diameter was calculated using immunofluorescence staining. The number, diameter, and thickness of myelinated nerve fibers were detected by toluidine blue staining and transmission electron microscopy. Muscle fiber area ratios were calculated by Masson's trichrome staining of gastrocnemius muscle sections. Sciatic functional index was recorded using walking footprint analysis at 4, 8, and 12 weeks after operation. The results showed that, at 8 and 12 weeks after surgery, myelin sheaths and axons of regenerating nerves were evenly distributed in the muscle-derived cell group. The number, diameter, and myelin sheath thickness of myelinated nerve fibers, as well as gastrocnemius muscle wet weight and muscle area ratio, were significantly higher in the muscle-derived cell group compared with the polyurethane group. At 4, 8, and 12 weeks post-surgery, sciatic functional index was notably increased in the muscle-derived cell group compared with the polyurethane group. These criteria of the muscle-derived cell group were not significantly different from the external oblique muscle-fabricated nerve conduit group. Collectively, these data suggest that muscle-derived cells effectively accelerated peripheral nerve regeneration. This study was approved by the Animal Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences (approval No. 040) on September 28, 2016.

The genetic relationships of Indian jujube (Ziziphus mauritiana Lam.) cultivars using SSR markers.

The genetic relationships among 24 Indian jujube cultivars (Ziziphus mauritiana Lam.) were evaluated by genotyping the microsatellite loci using simple sequence repeat (SSR) markers. The SSR loci were scored by fluorescent labelling and automated detection systems for the high-throughput capillary electrophoresis and high-resolution gel electrophoresis. Out of the 29 newly characterized SSR loci, 26 were considered as polymorphic with a total of 181 alleles obtained. The number of alleles ranged from 2-12, while the polymorphism information content ranged from 0.08-0.83, and the expected and observed heterozygosity were 0.04-0.83 and 0.04-0.82, respectively. The allele pattern of Indian jujube for all SSR loci confirmed its karyotype as tetraploid. Similarity coefficients and UPGMA dendrogram revealed that the Taiwanese cultivars consisted of a large 'A' clade, which is further divided into 'A1' and 'A2' groups, and the 'B' clade where both are rooted by the wild accession, 'Chad native'. These four genetic clusters were supported by the results of PCoA and the assignment test. The excess of heterozygotes based on F-statistics was attributed to its mating system as outcrossing and self-incompatible, and the introgression of the presumed mutation-derived cultivars with genetic admixture. Based on this study, SSR markers offer valuable information on the genetic relationship of this tropical fruit tree which is basically in agreement with the genealogy of its breeding history.

Genetic Diversity and Phylogeography of the Important Medical Herb, Cultivated Huang-Lian Populations, and the Wild Relatives Coptis Species in China.

Huang-lian (Coptis plants in China) are essential medicinal plants in China, C. chinensis var. chinensis and C. deltoidea have been domesticated and cultivated for 700 years. In this study, the genetic diversity patterns and biogeographical information of cultivated Huang-lian and their wild relatives Coptis species were assessed using three plastids DNA regions. A total of 186 individuals from twenty-seven populations representing two species of cultivated Huang-lian and four species of wild relatives were collected and analyzed. Twenty-four haplotypes of six species were identified when three plastid spacers were combined. Historical biogeography inference revealed multiple dispersal events in the groups of cultivated Huang-lian and C. omeiensis. This evidence can infer that large initial population size and interbreeding with co-existing wild relatives in expanding new planting areas might be the main reason for maintaining the high genetic diversity of cultivated Huang-lian. Nevertheless, the multimodal curve of mismatch analysis and positive or negative differed among species and populations by neutrality tests indicated some groups of cultivated Huang-lian experienced genetic bottlenecks. Phylogeny analysis (NJ, MP, BI) showed that cultivated Huang-lian and C. omeiensis were clustered into a monophyletic group while C. chinensis var. brevisepala was paraphyletic, having earlier divergence time from C. chinensis var. chinensis (7.6 Ma) than C. omeiensis. Parsimony network demonstrated that C. deltoidea had more shared haplotypes with C. omeiensis than C. chinensis var. chinensis, and other haplotypes of C. deltoidea and C. omeiensis had less mutation steps than that of C. chinensis var. chinensis and C. omeiensis. This evidence suggests that C. omeiensis has a closer relationship with cultivated Huang-lian and might be a potential wild relative to C. deltoidea. The results reported here provide the baseline data for preserving genetic resources of Huang-lian and also evaluating the genetic impacts of long-term cultivation on medicinal plants, which could be instructive to future cultivation projects of traditional Chinese medicinal plants.

Porous polyethylene implants in orbital blow-out fractures and enophthalmos reconstruction.

OBJECTIVE: To evaluate the efficacy of porous polyethylene sheet implants in reconstruction of orbital blow-out fractures. METHODS: Sixty-eight patients with orbital blow-out fractures were admitted in our center from December 1996 to June 2005. Porous polyethylene sheet implants were used to repair the defects of orbital wall and to correct the enophthalmos. The clinical results of extrinsic eye movement, enophthalmos, hypoglobus (vertical dystopia), visual acuity, and infraorbital nerve anesthesia were analyzed preoperatively and postoperatively. RESULT: Patients stayed in the hospital between 4 and 10 days. The enophthalmos and hypoglobus of all 68 patients was corrected except for one. The patient needs another surgery 6 months after operation to remove a piece of Medpor because the hypoglobus was overcorrected. Diplopia was resolved in 36 of 45 patients postoperatively. Persistent diplopia was found in 9 cases that were complicated orbitozygomaticomaxillary fractures. Visual acuity was improved in 13 of 45 patients, whereas no change was observed in the others. Infraorbital nerve hypoesthesia was resolved in 32 of 43 cases 6 months after operation. Only 1 patient developed postoperative ectropion, for which local suspending was required. No infections and Medpor outcrop were seen after operation. CONCLUSION: Porous polyethylene sheet implant is a very reliable material for reconstruction of the orbital blow-out fractures and restoration of the orbital volume. Overcorrection of 1 to 2 mm is necessary during operation to neutralize the tissue swelling or atrophy.

Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty.

AIM: To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient's perspective using patient-reported outcome measures (PROMs) and patient satisfaction scores. METHODS: A total of patients (n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms (total score, 40) and validated PROMs questionnaires (total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues. RESULTS: All patients were female, ranging from 18 to 35 years old (mean=24). The response rate was 73.3% (n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar (85.6%) and the inner canthus (80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120 (P<0.05). CONCLUSION: Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.

Therapeutic potential of human minor salivary gland epithelial progenitor cells in liver regeneration.

Liver disease is a serious problem affecting millions of people with continually increasing prevalence. Stem cell therapy has become a promising treatment for liver dysfunction. We previously reported on human minor salivary gland mesenchymal stem cells (hMSGMSCs), which are highly self-renewable with multi-potent differentiation capability. In this study, keratinocyte-like cells with self-regeneration and hepatic differentiation potential were isolated and characterized, and named human minor salivary gland epithelial progenitor cells (hMSG-EpiPCs). hMSG-EpiPCs were easily obtained via minor intraoral incision; they expressed epithelial progenitor/stem cell and other tissue stem cell markers such as CD29, CD49f, cytokeratins, ABCG2, PLET-1, salivary epithelial cell markers CD44 and CD166, and the Wnt target related gene LGR5 and LGR6. The cells were induced into functional hepatocytes in vitro which expressed liver-associated markers ALB, CYP3A4, AAT, and CK18. Upon transplantation in vivo, they ameliorated severe acute liver damage in SCID mice caused by carbon tetrachloride (CCl4) injection. In a two-thirds partial hepatectomy mouse model, the transplanted cells survived at least 4 weeks and exhibited hepatic potential. These findings demonstrate that hMSG-EpiPCs have potential as a cellular therapy basis for hepatic diseases, physiological and toxicology studies and regenerative medicine.

[Study on differentially expressed gene of the liver of treble fatty metabolism genes mutant mice using cDNA microarray].

OBJECTIVE: To study the gene expression profile of liver of young apoE(-/-)/LDLR(-/-)/Lepr(db/db) treble genes mutant mice and disclose its relationship to hyperlipidemia and the following atherosclerotic lesion. METHODS: The gene expression profile was investigated using cDNA microarray technique; the plasma total cholesterol(TC) and triglyceride(TG) levels were analyzed by COD-PAP and GPO-PAP method. And morphological observations of the aorta were made. RESULTS: Among the 4000 target genes, 92 genes were up-regulated and 105 genes were down-regulated in the treble genes mutants, compared with wild type control. Among the differentially expressed lipid metabolism related genes, cholesterol synthesis gene coding for farnesyl diphosphate farnesyl transferase was down-regulated, while triglyceride metabolism gene e.g. pancreatic lipase related protein 1 gene (Pnliprp1) was up-regulated. Expression profile of carbohydrate, cell skeleton and immune related genes were also altered. On the other hand, in the plasma from the treble genes mutant mice at 5 weeks of age, hyperlipidemia was found to be combined with atheroslerotic lesion. All these biochemical and pathological changes were aggravated following aging. CONCLUSION: The data suggested that the multiple genes mutations, especially those involved in lipid metabolism, were contributing to the alteration of liver gene expression profile that might lead to hyperlipidemia and atherosclerotic lesion in the young apoE(-/-)/LDLR(-/-)/Lepr(db/db) mutants.

Single stage surgery for contouring the prominent mandibular angle with a broad chin deformity: en-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG).

BACKGROUND: Various surgical options are reported to address the Asian 'squared face', characterized by a prominent mandibular angle (PMA) associated with an oversized chin deformity; but shortcomings lie in the requirement of multi-stage procedures with the risk of further revision surgery. We have developed a single-stage "Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG)" surgical technique to shorten the period of the surgical treatment and minimize the inherent surgical risks in the multi-staged procedures. METHODS: A retrospective study involving patients (n = 36) presented with prominent mandibular angle and an oversized chin who underwent the operation described from 2010 to 2012 with at least 12 months of follow-up. The surgical and aesthetic outcomes were evaluated through clinical assessment, photography, imaging analysis including preoperative and post-operative patient satisfaction rates. RESULTS: All the patients were satisfied with the improvement in their appearance following surgery; specifically the 'smoothness' of the mandibular inferior border with no 'second mandibular angle'. The width of the mandible was reduced with G-G distance reduced from 119.9 mm ± 3.9-109.7 mm ± 3.5 (p < 0.05). A significant preoperative and post-operative gonial angle (G-A) was found at the left (110.7° ± 9.6 vs 139.9° ± 11.5, p < 0.05) and right side of mandible (111.3° ± 10.7 vs 140.7° ± 11.8, p < 0.05). There was no iatrogenic inferior alveolar nerve or mental nerve injury and a stable aesthetic outcome beyond the first year. CONCLUSION: We demonstrated favourable surgical and aesthetic outcomes with our single-stage en-bloc curved osteotomy surgical technique to reshape the prominent mandibular angle with a broad chin deformity with no increased in surgical risks but a high satisfaction rate and stable outcomes.

Epicanthoplasty with double eyelidplasty incorporating modified Z-plasty for Chinese patients.

BACKGROUND: Blepharoplasty, without correction of the epicanthal folds, weakens the aesthetic appearance of the results. Hence, a modified Z-plasty procedure with double eyelidplasty was carried out for different degrees of epicanthus. METHODS: From 2005 to 2010, the authors performed epicanthoplasties using the modified Z-plasty and double eyelidplasty for 322 Chinese patients. The conventional double eyelidplasty incisions were made with conterminous modified 'Z' formation on the medial canthus as well as cutting off the malpositioned superficial head of preseptal musculus orbicularis oculi. RESULTS: Epicanthoplasty, using this technique, showed good results in most cases. There were no recurrences of the epicanthal fold and the scars were inconspicuous. CONCLUSION: The modified 'Z' plasty is indicated for all types and degrees of medial epicanthi, except epicanthus inversus. The easy design and operation, and the excellent and reproducible results satisfy both the plastic surgeons and the Chinese patients.

[Application of free anterolateral thigh adipofascial flap in the correction of facial depression].

OBJECTIVE: To investigate the operative technique and therapeutic effect of free anterolateral thigh adipofascial flap in the correction of facial depression. METHODS: From Oct. 1996 to Jan. 2007, 32 patients with facial depression deformities were treated with free anterolateral thigh adipofascial flaps. The bone defects in 8 cases were corrected with Medpor implants at the same stage. RESULTS: 33 free anterolateral thigh adipofascial flaps were used in 32 patients. 2 flaps were used bilaterally in one patient. The size of the flaps ranged from 12 cm x 8 cm to 20 cm x 11 cm (average, 16.5 cm x 10.5 cm). 30 flaps survived completely. Flap edge resorption happened in 3 flaps within half a year postoperatively. Satisfactory results were achieved in 23 patients after one-stage treatment. Another 9 patients underwent secondary operation 6 months postoperatively. Among them, 6 patients underwent flap liposuction because of fatty appearance, 3 patients underwent fat transplantation because of flap edge resorption. The patients were followed up for 6 months to 2.5 years. All the deformities were improved greatly, and the faces were almost symmetrical. The wounds at the donor sites were primarily healed with no functional morbidity. CONCLUSIONS: Free anterolateral thigh adipofascial flap is a large size flap. The flap thickness can be adjusted for three-dimensional reconstruction. The vascular anatomy is relatively stable. The bone defects can also be corrected at the same stage.

[Expression of the P450arom mRNA in the glandular tissue of the pubertal mammary hypertrophy].

OBJECTIVE: To investigate the expression status of the P450arom mRNA in breast tissue of pubertal mammary hypertrophy and then explore the possible etiology of pubertal mammary hypertrophy. METHODS: 15 patients were selected for pubertal mammary hypertrophy group. Breast hypertrophy tissue specimens were collected from the gland excised during reduction mammaplasty. 15 patients with pathologically simple fibroadenoma were used as another control group. Patient approval of participation in this study was obtained preoperatively. The expression of P450arom mRNA was detected by RT-PCR in all the cases above. RESULTS: There was no significant difference between the pubertal mammary hypertrophy groups and normal groups on the expression rates of P450arom mRNA. But among the positive cases, the expression of P450arom mRNA within breast tissue were 0.202 +/- 0.048 in pubertal mammary hypertrophy group; and 0.159 +/- 0.068 in normal group. There was significant difference between the pubertal mammary hypertrophy and normal groups (P < 0.05). CONCLUSION: The expression of P450arom mRNA in pubertal mammary hypertrophy are significantly higher than in normal mammary glandular tissue. The pubertal mammary hypertrophy may be related to the expression status of P450arom mRNA within breast tissue.

[Repairing traumatic partial helical defect with postauricular tube flap].

OBJECTIVE: To investigate the effect of postauricular tube flap for repairing traumatic partial helical defect. METHODS: The tube flaps were designed according to the site and size of helical defects. The length of tube flaps was 1.2 - 1.5 times as the length of the defects. The length-to-width ratio of tube flap was 3 - 4:1. The procedures required three stages for completion: (1) fabrication of tube flap; (2) 2 - 3 weeks later, division of one pedicle and insetting the flap; (3) 2 - 3 weeks later, complete division of pedicle and repairing the defects. RESULTS: From January 1998 to June 2006, 47 cases of traumatic partial helical defects were treated with postauricular tube flaps. All the tube flaps survived completely with no vascular disturbance, infection or necrosis. The patients were followed up for 2 months to five years with satisfactory results. CONCLUSIONS: Postauricular tube flap is a reliable and simple procedure for traumatic partial helical defects with good cosmetic result and less donor site morbidity.

[Reduction mammaplasty with the superomedial glandular pedicle].

OBJECTIVE: To explore a new technique that keep function and good aesthetic shape after reduction mammaplasty. METHODS: The superomedial glandular pedicle technique was applied with differing patterns of skin incision according to the degree of the mammary hypertrophy. The extra glandular tissue was removed from the lateral and inferior segment of the breast. The remaining superomedial glandular tissue was remodeled a conical shape. The skin incision was sutured after excision of excess skin. RESULTS: 36 cases (72 breasts) were treated with this technique. The results were satisfactory and there were no complications. The breasts maintained a lasting and aesthetically pleasing shape and the nipple-areola preserved good sensation. CONCLUSIONS: The superomedial glandular pedicle is a safe and effective technique that can provide long-lasting outcome. The design of the procedure can be adapted to a variety of skin incision patterns and breast morphologies.

Correction of inverted nipple: an alternative method using continuous elastic outside distraction.

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation and interferes with nursing. In addition, its abnormal appearance may cause psychologic distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. Most of these techniques involve extensive skin incision around the nipple that may jeopardize the blood and nerve supply to the nipple or create much scar tissue that is esthetically objectionable. For correcting the inverted nipple, the authors introduce an alternative, simple method using continuous elastic outside distraction. Compared with other methods using outside distraction, the authors used an adjustable elastic instrument made of steel wire, spring, and plastic syringe; continuous distraction of the inverted nipples; and sustaining 3 to 6 months. From August 2002 to December 2003, 14 patients (26 nipples) were treated. 12 patients had bilateral inverted nipples. Patient age at operation ranged from 14 to 40 years (mean age, 24 years). All nipples were congenital, and they had no previous operation. Six nipples were grade I, 9 nipples were grade II, and 11 nipples were grade III according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 7.3 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. All patients were satisfied with their results. The authors conclude that their procedure is reliable, a simple, safe, and effective method for correction inverted nipple. But a long-term follow-up is needed. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

[Vertical mammaplasty using the skin wrinkling suture techniques].

OBJECTIVE: To reduce the incision scar produced by reduction mammaplasty. METHODS: The periareola incision and the vertical incision below the areola were made when performing breast reduction. The incision in the submammary fold was avoided. The breast was suspended and moulded. The redundant skin and the long skin incision below the areola were sutured utilizing the skin wrinkling suture techniques. The wrinkling skin and incision became flat gradually due to the elasticity of the tissue itself. RESULTS: 13 cases have been treated with the techniques mentioned above. All incisions healed primarily and there were no complications such as hematoma, infection and necrosis of skin or areola. Of them, 3 patients with very large and ptotic breasts needed small corrective operations to excise the redundant skin that still existed 6 months postoperatively. The shape of the breasts and the vertical incision scars of the other patients were satisfactory. CONCLUSIONS: The vertical mammaplasty using the skin wrinkling suture techniques can be used in breast reduction of various sizes, owing to the advantages of consistent, good and stable result, simplicity to perform and grasp and no scar in the submammary fold.