Research advances on the characteristics of fibroblast in keloid / 中华烧伤杂志

In re-cent 20 years, the development of cell biology technology has promoted the research of keloid. Keloid fibroblasts (KFbs) are the main effector cells in keloid, which are closely related to the occurrence and development of keloid. It is significantly different in terms of biological characteristics and gene expression between KFbs and normal fibroblasts. This articles reviews the characteristics of KFbs from multiple perspectives, describing its biological character- istics in details including microstructures, metabolic character- istics, and proliferation properties, and introducing the main characteristics of heterogeneity and genomics of KFbs. The further research on KFbs will help to elucidate the pathogenesis of keloids and provide valuable strategies for the prevention and treatment of keloids.

Functional evaluation of a "two in one" urethroplasty for hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the functional result of a "Two in One" urethroplasty which combined oral mucosa graft and local flap.</p><p><b>METHODS</b>17 patients with hypospadias underwent a "Two in One" urethroplasty, which combined buccal mucosa and local flap for urethral reconstruction. Uroflowmetry was performed 1 day before and 1 year after operation. The urine flow rate, voided volume and urine flow curves were detected using a rotating sensor. The results of maximum urine flow rate (Qmax) were expressed as percentiles and compared to the Toguri value from normal children.</p><p><b>RESULTS</b>Before corrective operation, 12 of 17 patients (70.6%) produced a plateau urine flow curve. 5 patients (29.4%) produced a very low flow curve. The average maximum flow rate was (7.89 +/- 2.29) ml/s per second compared to Toguri values, 12 of 17 patients (70.6%) had a Qmax below the normal 5th percentile. After a "Two in One" urethroplasty, a hell-shaped curve was obtained in 10 patients (58.8%). The maximum flow rate was (11.30 +/- 3.01) mL/s per second. 7 of 17 patients (41.2%) had a Qmax above the normal 25th percentile, 8 patients (47.1%) had a Qmax between the normal 25th percentile and 5th percentile, only 2 patients (11.8%) had a Qmax below the 5th percentile.</p><p><b>CONCLUSIONS</b>The functional result of the "Two in One" urethroplasty is ideal. The maximum urine flow rate of the patients increases after the operation.</p>

Clinical application of the scapular free flap extended to the upper arm / 中华整形外科杂志

<p><b>OBJECTIVE</b>To apply the scapular free flap extended to the upper arm for resurfacing the face and neck, as well as the upper lip in one stage.</p><p><b>METHODS</b>The scapular free flap was designed with extended portion to the posterior and interior part of the upper arm. Then the free flap was transferred to resurface the face and neck with the routine portion and to resurface the upper lip with the extended portion.</p><p><b>RESULTS</b>6 cases with extensive upper lip, facial and cervical burn scar were treated with the extended scapular free flaps. The flap size ranged from 22 cm x 11 cm to 40 cm x 9.5 cm (36.57 cm x 10.20 cm in average) for the routine portion and from 7 cm x 4 cm to 12 cm x 4 cm (10.32 cm x 3.67 cm in average) for the extended portion. All flaps survived completely.</p><p><b>CONCLUSIONS</b>There are direct communicating branches ("choke vessel") between the circumflex scapular artery (CSA) and the posterior humeral circumflex artery (PHCA). When the blood supply of PHCA is cut off, the CSA can provide blood supply through the communicating branches to the upper arm skin area previously nourished by PHCA. So the blood supply of the extended portion of the scapular free flap is not only from the branches of CSA, but also from the direct communicating branches between the CSA and PHCA. The extended scapular free flap has a reliable blood supply and can be applied to construct the facial and cervical scar contraction with the extended portion to resurface the upper lip. The satisfactory result can be expected.</p>

The penis prolongation and augmentation combined with autologous granular fat injection and silicone implantation / 中华整形外科杂志

<p><b>OBJECTIVE</b>To prevent the retraction of the penis after prolongation and augmentation.</p><p><b>METHODS</b>After all the superficial and part of the deep suspensory ligament amputation, we implanted the silicon sheet (the length 2.3-3.6 cm, the width 1.5-2.5 cm, the thickness 2-3 mm) and injected autologous granular fat (30-48 ml) into penis.</p><p><b>RESULTS</b>16 patients (age 22-63 years, averagely 38 years) underwent this kind operation, the prolongation length is 1.8-5.1 cm, the average was 2.91 cm, the increased diameter of penis was 0.6-1 cm, the average is 0.85 cm, the following period is 3 months to 2 years. The results are satisfactory with the penis retraction less than 8%, and less than 10% decrease in diameter.</p><p><b>CONCLUSIONS</b>This method is an ideal way of the penis prolongation and augmentation, the implantation of the silicon sheet is effective way to prevent the retraction of the penis.</p>

Repair of the facial defects using the expanded induced prefabricated skin flap of the retroauricular and mastoid process region based on the superficial temporal vascular bundle / 中华整形外科杂志

<p><b>OBJECTIVE</b>To provide an ideal method for flap prefabrication.</p><p><b>METHODS</b>The superficial temporal fascial flap has been elevated based on the superficial temporal vessels during the first-stage procedure. A subcutaneous tissue pocket with appropriate site was formed in the retroauricular and mastoid process region. The fascial flap was transferred into the pocket and fixed properly. The tissue expander was placed under the fascial flap. When the expanding process has been finished, the expander was removed and the expanded induced prefabricated skin flap of the retroauricular and mastoid process region pedicled on the superficial temporal vascular bundle was elevated and transferred to repair the facial skin defect.</p><p><b>RESULTS</b>There were nine cases in the group. Facial defects after resection of the melanotic nevus was repaired in 2 cases and facial defects after resection of the facial haemangioma and scar were repaired in 2 and 5 cases respectively. Pedicle length of the superficial temporal fascial flap was ranged from 5.5 cm to 7 cm (mean length 6.2 cm). The size of the fascial flaps was ranged from 4 cm x 3 cm to 7 cm x 7 cm (mean size 5.7 cm x 4.9 cm). The size of the prefabricated skin flaps was ranged from 5 cm x 5 cm to 8.0 cm x 7.5 cm (mean size 6.4 cm x 6.1 cm). The average time of the tissue expansion process is 16.1 weeks. All flaps survived postoperatively and the donor sites of the flaps were appropriated directly in 5 cases. The split-thickness skin grafting was used to recover the donor site defects in 4 cases.</p><p><b>CONCLUSIONS</b>The superficial temporal fascial flap owns the following advantages: the vascular pedicle is much longer and vascular supply is plentiful, and it is convenient to transfer. Meanwhile, the skin of the retroauricular and mastoid process region is most similar to that of the face in texture, color and depth. For the patients selected strictly, the technique mentioned above is somewhat an ideal method for facial defect repair.</p>

An experimental study on the culture of human oral mucosa epithelium using autologous serum / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the biological properties of cultured human oral mucosa epithelium using autologous serum in order to provide a new material for tissue engineering urethra.</p><p><b>METHODS</b>The cultured oral mucosa epithelium was respectively transplanted beneath the skin, above the deep fascia and in the wound of the athymic mice. The specimens were taken at 2, 3, 4, and 6 weeks posttransplantation, and processed for (1) immunofluorescence anti-HLA staining to determine graft acceptance, and (2) anti-human IV collagen and antihuman laminin immunohistochemical staining procedures to indicate the basement membrane formation.</p><p><b>RESULTS</b>All the grafts survived and grew very well. The grafts were positive to anti-HLA. Collagen type IV and laminin were detected at the dermo-epidermal junction in all groups from day 14, and increasing in density up to day 21.</p><p><b>CONCLUSIONS</b>he cultured human oral mucosa epithelium by autologous serum could develop an excellent functional epithelium tissue, which would be used to reconstruct urethra and repair wound.</p>

Autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>Applicate autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias by staging.</p><p><b>METHODS</b>From 1999 to 2003, 40 patients have been treated by method of autologous buccal mucosal graft pre-placing. There were two models: graft onlay and graft-tube for urethral reconstruction, and the 2rd operation was accomplished half year later.</p><p><b>RESULTS</b>All patients healed without urethral fistula.</p><p><b>CONCLUSION</b>The method is valuable for treatment of complicated hypospadias.</p>

Inner preputial skin grafts combined with preputial island flap for treatment of penile hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate new methods of treatment for penile hypospadias. METHODS Urethroplasty was performed for penile hypospadias using inner preputial skin grafts combined with preputial island flap.</p><p><b>RESULTS</b>A total of 10 patients have received this procedure. After a mean follow up of one year, no fistula or urethral stricture was found. All patients obtained excellent cosmetic results.</p><p><b>CONCLUSIONS</b>This method allows for adequate correction of severe chordee. It is a useful procedure for selected cases of primary hypospadias with severe incurvation.</p>

Bacteriology study of hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>This clinical study was to explore why the neo-urethra is liable to be infected after hypospadias operation, find the source and the common floras of infection, and accordingly, improve the peroperation procedures so as to reduce postoperative infection rate.</p><p><b>METHODS</b>The pathogenic floras were examined and analyzed by germiculture and karyotype analysis.</p><p><b>RESULTS</b>The bacteria in the neo-urethra mostly came from the orifice and the reconstruction material of the urethra. The most common floras that caused infection were gram-positive coccus. The most sensitive antibiotics for hypospadias infection were demethylvancomycin.</p><p><b>CONCLUSION</b>The postoperative infection of hypospadias is incisional, not the urinary system infection. Because the microenvironment of the neo-urethra is more suitable for infection than that of the skin or mucosa, the reconstructed urethra is likely to be infected.</p>

Rabbit urethral defect repair with freeze-dried acellular bladder submucosa / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the result of urethral defect repair using freeze-dried acellular bladder submucosa.</p><p><b>METHODS</b>The freeze-dried acellular bladder submucosa was obtained from human cadaveric bladder submucosa using freeze-thawed enzymatic treatment and the freeze-drying technique. 18 male New Zealand rabbits were used in this experiment. A defect of 1.0 cm x 0.5 cm was created in the ventral urethra of the animal. The acellular matrix was grafted to the urethral defect in 14 rabbits. The other 4 animals underwent a sham operation as the controls. From postoperative one to twenty-four weeks, the animals underwent retrograde urethrography at certain intervals. The grafts of the acellular matrix were taken and prepared for histological evaluation.</p><p><b>RESULTS</b>No obvious urethral stricture was observed in the 14 matrix-grafted animals. Histological examinations of the specimens showed progressive infiltration of cells and vascular vessels. Complete epithelization was obtained at 2 weeks. The orientation of collagen fibers in the matrix-grafted area tended to be regular with time.</p><p><b>CONCLUSIONS</b>Freeze-dried acellular bladder submucosa may be a suitable material for urethral defect repair, which induces urethral mucous cells to migrate, grow and epithelialize.</p>

The inherent liability to infection of various tissue for urethra reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>Observing the long-term results of reconstructed urethra to reduce the postop infection rate of hypospadias. To explore the standard of selecting tissue for urethra reconstruction by comparing the different inherent liability to infection in use of different kinds of tissue for urethra reconstruction.</p><p><b>METHODS</b>Neo-urethra inner wall and normal urethra were observed through urography and urethroscope. The tissue section of neo-urethra, normal urethra and tissue for urethra reconstruction were observed through light microscope, scanning electron microscope and transmission electron microscope.</p><p><b>RESULTS</b>The structure and liability to infection of neo-urethra made of bladder mucosa, buccal mucosa or skin never changed after long time. Metaplasia never took place in neo-urethra.</p><p><b>CONCLUSIONS</b>The structure and liability to infection of neo-urethra were the same as those of the congeneric tissue. Bladder or buccal mucosa is the best tissue for urethra reconstruction considering urethra microenvironment. Neo-urethra made of skin is more liable to infection by nature. The best opportunity of hypospadias operation should be before puberty.</p>

Long-term results of whole piece, full-thickness skin grafting for facial post-burn reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method for repair of the whole facial burn scar and evaluate the long-term results of skin grafting.</p><p><b>METHODS</b>18 patients with facial burn scar were treated with whole piece, full-thickness skin grafting. All of them have been followed-up for 5 to 20 years. The color, elasticity, sensation and gland secretion of the grafted skin were evaluated. The skin samples were taken for light and electron microscope examinations.</p><p><b>RESULTS</b>The long-term results of whole piece, full-thickness skin grafting were satisfactory. The grafted skin was smooth and elastic, with sebaceous and sweat glands. The histological structure of the grafted skin was similar to that of the normal facial skin and different from that of the donor site.</p><p><b>CONCLUSION</b>Whole piece and full-thickness skin grafting may be a valuable method for the treatment of facial burn scar. The morphological and histological structure of the grafted full-thickness skin is similar to the normal facial skin through the long-term follow-up.</p>

Treatment and pathologic change of pachydermoperiostosis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment and possible pathogenesis of pachydermoperiostosis.</p><p><b>METHODS</b>Facelift was performed on five patients with pachydermoperiostosis. Histological studies were performed to check the affected skin for possible pathogenesis.</p><p><b>RESULTS</b>After the surgery of facelift, appearances of the patients were markedly improved. Histological studies revealed significant changes in the skin, characterized by hyperplasia and thickening of the subcutaneous collagen, as well as an increase of PAS-positive substance.</p><p><b>CONCLUSION</b>Alterations of fibroblast bioactivity might be responsible for the pathogenesis of pachydermoperiostosis. There have been no satisfying treatments to the disease. Facelift is a feasible method to improve the aging appearance of the patients.</p>

Clinical applications of the buried-guided-suture method in the treatment of facial depression / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop a method for the treatment of facial depression without incision scar.</p><p><b>METHODS</b>In repairing the facial depression, the ruptured subdermal adipocellular tissue was approximated and reunite with the buried-guided-suture method through an intraoral or a concealed skin incision.</p><p><b>RESULTS</b>17 patients with facial depressions from trauma were treated. Postoperative follow-up of 10 patients for one year showed satisfactory results without recurrence.</p><p><b>CONCLUSION</b>The buried-guided-suture method for repair of facial depression from trauma is simple, reliable and worth recommendation.</p>