Inhibition of microRNA-21-5p reduces keloid fibroblast autophagy and migration by targeting PTEN after electron beam irradiation.

Electron beam (EB) irradiation is useful to reduce the recurrence of keloids; however, the underlying mechanism remains unknown. MicroRNA-21 (miR-21), which regulates autophagy during cancer radiation therapy, was identified as a potential therapeutic target for keloids. Here, we investigate the regulatory mechanism(s) of miR-21-5p on keloid fibroblast autophagy and migration after EB irradiation. The microRNA expression profile of the keloid dermis was examined by performing a microRNA microarray. Levels of LC3B and Beclin-1 were detected by immunohistochemical and western blot analysis in the keloid dermis and fibroblasts. Autophagy and apoptosis were tested in keloid fibroblasts after EB irradiation or transfection with an miR-21-5p inhibitor using electron microscopy, a Cyto-ID Green Autophagy Detection Kit, and an Annexin V PE Apoptosis Detection Kit. Migration was analyzed by an in vitro scratch-wound healing assay. Mechanistic tests were performed using small interfering RNAs to phosphatase and tensin homolog (siPTEN). Levels of miR-21-5p, PTEN, programmed cell death 4 (PDCD4), p-AKT, and apoptosis- and autophagy-associated genes were examined by qRT-PCR and western blotting. LC3B expression and migration ability were enhanced in fibroblasts and the keloid margin dermis compared with those in the adjacent normal skin. Both EB irradiation and an miR-21-5p inhibitor reduced keloid fibroblast autophagy, which was accompanied by decreased expression of miR-21-5p, p-AKT, and LC3B-II and increased expression of PTEN, PDCD4, and apoptosis-related genes. MiR-21-5p downregulation inhibited migration and suppressed LC3B expression and this was reversed by PTEN reduction. In conclusion, with increasing apoptosis, EB irradiation inhibits autophagy in keloid fibroblasts by reducing miR-21-5p, which regulates migration and LC3B expression via PTEN/AKT signaling. These data suggest a potential mechanism wherein miR-21-5p inhibition regulates autophagy and migration in EB-irradiated keloid fibroblasts, effectively preventing local invasion and recurrence. Therefore, miR-21-5p could be a new therapeutic target, to replace EB irradiation, and control keloid relapse.

The use of micro-plasma radiofrequency technology in secondary skin graft contraction: 2 case reports.

Secondary skin graft contraction leading to cosmetic deformity remains a great challenge. These two case reports present serious skin graft contraction and the treatment with micro-plasma radiofrequency technology. Two patients presented with complaints of post-burn depigmentation on the forehead and the hand, respectively, and received dermabrasion and thin split-thickness skin grafting. Then, many localized contraction lesions occurred after 4 weeks. The treatment selected was non-surgical removal using micro-plasma radiofrequency technology with the following energy parameters: a roller tip at 80 watts, three passes in different directions. No complications were observed. The contracted skin was ablated without affecting the pigment distribution. The consequents were that the color, appearance, and texture of the grafted skin matched the adjacent skin well and had better patient acceptance.

Treatment of facial post-burn hyperpigmentation using micro-plasma radiofrequency technology.

Management of facial post-burn hyperpigmentation is a common and challenging problem for dermatologists and plastic surgeons. The recent development of micro-plasma radiofrequency technology, which allows precise and rapid treatment with controlled thermal injury, can be an effective treatment of post-burn hyperpigmentation. This study aimed to evaluate the effectiveness and complications of micro-plasma radiofrequency treatment of post-burn hyperpigmentation. The study included 35 patients with Fitzpatrick skin type III or IV and facial post-burn hyperpigmentation. Patients received three to five treatments at 8-week intervals. A roller tip was used with the power setting at 60-90 W, and 3-4 passes were made in different directions. The degree of improvement and complications were recorded. Improvement of hyperpigmentation was evaluated by patient self-assessment and by plastic surgeons who compared digital photographs taken before treatment and 2 months after the last treatment. The results showed that post-burn hyperpigmentation responded favorably to micro-plasma radiofrequency treatment with very few complications. The average pain score using a visual analog scale from 0 to 10 was 6.7 ± 0.7. After a series of treatments, 32 of the 35 patients had achieved a >51% improvement of their hyperpigmentation, and 3 patients had achieved a fair improvement. The mean score for improvement of hyperpigmentation was 4.28. Patient self-evaluations indicated good satisfaction with the cosmetic outcomes, and some softening of the scars. Micro-plasma radiofrequency technology is appropriate, effective, and safe for the treatment of facial post-burn hyperpigmentation, and provides a promising noninvasive treatment for superficial facial injuries.

Forty-five cases of chest keloids treated with subcutaneous super-tension-reduction suture combined with postoperative electron-beam irradiation.

BACKGROUND: Chest keloids are challenging to surgeons because of their high recurrence rate. OBJECTIVE: To investigate the effectiveness of the subcutaneous super-tension-reduction suture technique with postoperative electron-beam irradiation in the treatment of chest keloids. MATERIALS AND METHODS: Forty-five patients with chest keloids underwent excision. To minimize the wound-closing tension, subcutaneous super-tension-reduction suture was used. The maximum tension reduction was placed on both dermis and subcutaneous tissue, which were far away from the incision. The consequence of such suturing was that the wound edges were moved centrally to elevate them like a bump after tying the buried knot. All patients received fractionated electron-beam radiation therapy starting within 24 hours after surgery, in a 5-Gy dose daily for 3 to 4 consecutive days, to a total dose of 15 to 20 Gy. RESULTS: The wounds healed primarily in all 45 cases. The bump at the incision began to flatten out after 2 to 3 months and was almost completely flat by 12 months postoperatively. Only 1 case of relapse (2.2%) was observed within 2 years of follow-up examination. CONCLUSION: The use of subcutaneous super-tension-reduction suture after chest keloids excision can greatly decrease tension on the dermis and the subcutaneous tissue and can, in combination with postoperative electron-beam irradiation, decrease the rate of relapse.

[Cleft lip nasal deformity corrected by an alar flap and the alar cartilage sling method].

OBJECTIVE: To search an effective method to correct the secondary nasal deformity. METHODS: The "spilth" tissue asymmetry to the another side on the cleft side alar is formed as a flap, which is used to drive up or reconstruct the nostril base (sill), readjust nostril size and shape. The cleft side alar cartilage lateral foot is disassociated, replaced and fixed into the normal place. RESULTS: Nineteen patients were received this operation, their nasal alar, nostril, sill, on the two sides are symmetry, and the result is good. CONCLUSIONS: The cleft side alar flap and alar cartilage sling procedure is effective to correct secondary cleft lip nasal deformity.

[Full face dermabrasion for acne scars].

OBJECTIVE: Dermabrasion has been of great value in plastic surgery. Dermabrasion was developed for a specific indication; however, within a very short time, the concept of dermabrasion found wide applicability. This study was to investigate the application of dermabrasion in the treatment of acne scars. METHODS: From Feb. 1996 to May 2004, a total of 110 patients with acne scar were treated with dermabrasion. RESULTS: Postoperatively, the curative results were achieved in 45 cases; good results in 40 cases and effective results in 25 cases. The study revealed that the patients at 18-46 years of age have good results. CONCLUSIONS: Dermabrasion is a good and safe technique to treat the scar of acne.

[Minimizing the antigenicity of tracheal allografts by using a technique of cryopreservation].

OBJECTIVE: To investigate the proper time of cryo-preserving tracheal allograft so as to minimize its antigenicity. METHODS: On a dog model, this study was carried out by allografting a tracheal into a muscular flap formed with sternocephalic muscle and sternohyoid--sternothyroid muscle. The tracheal was treated with cryopreservation in defferent intervals. The viability of the graft was evaluated by the examination of fiberoptic bronchoscopy, histopathology and microangiography. The blood flow of the tracheal mucous was measured with a blood flowmeter and the survival area was decided in the calculation of the percentage. RESULTS: There are no significant differences in the mucous membrane appearance and the mucosal blood flow one week after the surgery among the non-cryopreservation group and the groups treated with cryopreservation in 1 day, 2 weeks, 4 weeks, 6 weeks and 8 weeks. The graft was found to start necrosis 2 weeks after the transplantation with the infiltration of mononuclear cells examined under light microscope in almost all of the groups, especially in the non-cryopreservation group and the groups treated with cryopreservation in 1 day, 2 weeks. However, there was no significant difference among the autograft group and the allograft groups cryopreservated in 6 weeks and 8 weeks, and the infiltration of the mononuclear cells was not found in these groups either. CONCLUSION: The antigenicity of the tracheal allografts could be significantly decreased by the treatment of cryopreservation over 6 weeks.

[The investigation of tracheas transplantation by wrapping in a muscle flap].

OBJECTIVE: To investigate the possibility of tracheas transplantation by wrapping it in a muscle flap. METHODS: With a dog model, a number of tracheas were separately wrapped in the unilateral sternocephalic muscle flap and the bilateral sternohyoid-sternothyroid muscle flap, and placed in the original site. The tracheas autografting was used as a control. The viability was evaluated by the examination of fiberoptic bronchoscopy, histopathology and microangiography, the measurement of tracheal mucosal blood flow and the calculation of survival rate and percentage of patency. RESULTS: The submucosal blood flow of the transplanted tracheas was detected in the unilateral sternocephalic muscle flap group and the bilateral sternohyoid-sternothyroid muscle flap group 1 week after the surgery and gradually reached the level close to the normal in 4 weeks, while the vascular ingrowth was also shown from the wrapped muscle flap into the transplanted tracheas by using a microangiography technique. The histopathological examination demonstrated that the structure of the transplanted tracheas was quite same as the original one and its inner surface was also covered with pseudostratified columnar ciliary epithelia. However, in the control group, the mucous membranes turned black one week after the transplantation and all dogs died from the graft necrosis. CONCLUSION: The tracheas wrapped in a muscular flap could survive well for a long time.