ABSTRACT
Objective@#To explore the effects of local transplantation of autologous adipose-derived stromal vascular fraction (SVF) on the hyperplastic scar (HS) formation in rabbit ears and the mechanism.@*Methods@#Twenty-four New Zealand white rabbits were used to reproduce HSs by making four full-thickness skin defect wounds with a diameter of 1 cm on the ventral surface of left ear of each rabbit. Wound epithelization and local-tissue proliferation were observed, and wound healing (complete epithelization) time and formation time of HS were recorded. The 24 rabbits were divided into SVF group, pure DMEM group, and pure HS group according to the random number table, with 8 rabbits and 32 wounds in each group. On post injury day (PID) 25 (after the complete epithelization of wounds), 0.2 mL of low glucose DMEM medium containing CM-Dil labeled autologous SVF was injected into HSs of rabbits in SVF group, while the same amount of low glucose DMEM medium was injected into HSs of rabbits in pure DMEM group. The frequency of injection was once every 5 days, totally for 3 times. HSs of rabbits in pure HS group did not receive any treatment. On PID 40, HSs of rabbits′ ears in each group were harvested, then the histological form was observed by hematoxylin and eosin staining, the arrangement of collagen in HS was observed by Van Gieson staining, the distribution of CM-Dil-labeled SVF in the HS was observed with fluorescence microscope, and the mRNA expression and the protein expression of transforming growth factor β1 (TGF-β1), Smad3, and Smad7 in HS were determined by real-time fluorescent quantitative reverse transcription-polymerase chain reaction and Western blotting, respectively. Data were processed with one-way analysis of variance and Tukey test.@*Results@#(1) Complete epithelization time of wounds of rabbits′ ears was (20.0±2.0) d post injury, and HSs were formed on PID 25. On PID 40, HSs of rabbits′ ears in pure DMEM group and pure HS group were still in hyperplasia, while those in SVF group became smaller, flat, soft, and light colored. (2) On PID 40, compared with those in pure DMEM group and pure HS group, the number of epithelium foot like structures was more and the amount of inflammatory cells was less. The collagen of HSs of rabbits′ ears in SVF group was arranged more regularly with broader gap between collagens. (3) On PID 40, CM-Dil-labeled SVF could still be observed in the HSs of rabbits′ ears in SVF group. (4) On PID 40, compared with those in pure DMEM group and pure HS group, the mRNA expressions of TGF-β1 and Smad3 in the HSs of rabbits′ ears in SVF group were significantly down-regulated (P<0.05), while the mRNA expression of Smad7 was significantly up-regulated (P<0.05). There were no significant differences in the mRNA expressions of TGF-β1, Smad3, and Smad7 in the HSs of rabbits′ ears between pure DMEM group and pure HS group (P>0.05). (5) On PID 40, compared with those in pure DMEM group (0.74±0.03, 0.73±0.10, 0.54±0.09) and pure HS group (0.72±0.08, 0.71±0.12, 0.53±0.06), the protein expressions of TGF-β1 and Smad3 in the HSs of rabbits′ ears in SVF group (0.57±0.06, 0.42±0.09) were significantly down-regulated (P<0.05), while the protein expression of Smad7 (0.71±0.05) was significantly up-regulated (P<0.05). The protein expressions of TGF-β1, Smad3, and Smad7 in the HSs of rabbits′ ears in pure DMEM group and pure HS group were close (P>0.05).@*Conclusions@#Autologous SVF transplantation can inhibit the formation of HS in the early stage of scar formation of rabbit, the mechanism may be related to the TGF-β1/Smad signaling pathway.
ABSTRACT
Objective To explore the haemostatic efficacy of cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) in placenta previa.Methods Sixty patients suffering from intractable cervical canal hemorrhage during CS due to central placenta previa were chosen and divided into the cervical progressing suture(observation roup,30 cases) and the uterine cavity ribbon gauze packing group(control group,30 cases).The intraoperative operating time,intraoperative bleeding amount,postoperative 24 h hemorrhage amount,hysterectomy and puerperal infection were compared between the two groups.Results The intraoperative operation time in the observation group and control group were (3.15± 1.60)min and (6.10±2.35) min respectively,the intraoperative bleeding amount in the observation group and control group were (422.00 ±-186.98)mL and (642.25±344.42)mL respectively,postoperative 24 h bleeding amounts were (583.23±=198.33)mL and (825.23±=373.50)mL respectively,the differences between the two groups were statistically significant(P＜0.05).No hysterectomy and no complications ocurred in each group.Conclusion Adopting the cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) due to placenta previa is simple to operate and has good effect.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the curative effect of reverse bi-pedicle posterior interosseous artery perforator flap in repairing skin and soft tissue defects on the wrist.</p><p><b>METHODS</b>Seven patients with soft tissue defects on the wrist, including simple skin and soft tissue defects in 4 cases and skin and soft tissue defects combined with radial tendon injury in 3 cases, were hospitalized from December 2010 to March 2012. The area of skin defect on the volar side of the wrist ranged from 4.8 cm x 4.0 cm to 6.2 cm x 4.5 cm, while that on the dorsal side ranged from 3.5 cm x 3.2 cm to 6. 5 cm x 5.4 cm. These wounds were respectively caused by traffic injury (3 cases), reamer injury (2 cases), burn (1 case), and tumor resection (1 case). Reverse bi-pedicle posterior interosseous artery perforator flaps were used to repair these defects, with area of one pedicle ranging from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm and the area of the other pedicle ranging from 2.5 cm x 2.5 cm to 4.0 cm x 3.0 cm. The donor sites were closed by suturing.</p><p><b>RESULTS</b>All flaps survived completely. Patients were followed up for 6 to 36 months. The color, texture, and appearance of all flaps were satisfactory. At last follow-up, distances of two-point discrimination of flaps ranged from 9 to 13 mm. The dorsal extension and palmar flexion functions of wrist were satisfactory. The results of function evaluation of 7 wrists were excellent in 6 cases and good in 1 case according to the tentative standards for the evaluation of upper extremity function of Society of Hand Surgery of Chinese Medical Association. A linear scar was formed at the donor site.</p><p><b>CONCLUSIONS</b>The reverse bi-pedicle posterior interosseous artery perforator flap, with advantages of flexible design, easy to achieve, less injury to donor site, and reliable blood supply, etc., is another choice for repairing skin and soft tissue defects over the wrist.</p>