Reconstruction of upper lip defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience for the reconstruction of upper lip defects in different degrees.</p><p><b>METHODS</b>Different treatment methods were selected to reconstruct the upper lip defects according to the subunit, size or location of defects on the upper lip. The therapeutic results were analyzed and compared.</p><p><b>RESULTS</b>From Jan. 1998 to Apr. 2012, 243 cases with upper lip defects were treated, including 85 cases of traumatic defects, 110 cases of defects secondary to lip cleft and 48 cases of defects after tumor resection. 48 cases were treated with direct closure, 69 cases with cross-lip flaps, 5 Cases with orbicularis oris muscle flaps, 53 cases with unilateral labial flaps, 42 cases with bilateral labial flaps, 22 cases with lower lip flaps, and 1 case with forehead flap, 1 case with forearm flap and 2 with nasolabial fold flaps. The patients were followed up for 3-18 months with satisfactory results.</p><p><b>CONCLUSIONS</b>Satisfactory results could be achieved for upper lip defects with appropriate treatment methods according to the defects degree and characters.</p>

Repair of nose and adjacent tissue defect deformities after burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To look for the best method of repairing nose and adjacent tissue defect after burn and observe the effect.</p><p><b>METHODS</b>Twelve patients with post-burn nose and adjacent tissue defect deformities hospitalized from January 1999 to December 2008 were repaired with expanded forehead flap, pedicled upper-arm flap, axial post-auricular reversed flow island flap, and nasolabial groove flap. Among them, 4 cases with total nasal defect, 8 cases with partial nasal defect; and 3 cases were accompanied with scars on cheek, 5 cases accompanied with scars on forehead, 5 cases accompanied with upper lip ectropion and subtotal upper lip defect. The skin flap size ranged from 3.0 cm x 1.5 cm to 10.0 cm x 8.0 cm.</p><p><b>RESULTS</b>Five cases were repaired with expanded forehead flap, 3 cases with pedicled upper-arm flap, 1 case with axial post-auricular reversed flow island flap, and 3 cases with nasolabial groove flap respectively. All the 12 flaps survived. Patients were followed up for 1 to 7 years, and nasal function and appearance were obviously improved.</p><p><b>CONCLUSIONS</b>Optimal repairing method shall be chosen to repair nasal defect after burn according to its extent, and forehead flap is preferred. Pedicled upper-arm flap and reversed flow axial post-auricular island flap can be employed if local flap and ortho-position skin flap are unavailable when obvious scar is present on face as a result of severe burn.</p>

Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore repair methods of skin and soft tissue defects in lower extremities with free latissimus dorsi flaps.</p><p><b>METHODS</b>Forty-two patients with wounds and soft tissue defects in lower extremities, including 4 cases on knee, 22 cases on leg, 15 cases on ankle and foot, 1 case with extensive avulsion from knee to dorsum of foot, were hospitalized in our unit from February 1996 to February 2008. Wounds or soft tissue defects were respectively repaired with latissimus dorsi musculocutaneous flaps, latissimus dorsi muscle flaps, latissimus dorsi perforator flaps with preserved vascular sleeves, 2 double-leaf segmental latissimus dorsi compound flaps after debridement. The flaps ranged from 18 cm x 8 cm to 40 cm x 18 cm in size. The donor sites were covered by skin grafting in 19 cases.</p><p><b>RESULTS</b>All wounds were healed primarily except vascular crisis occurred in 3 cases, partial necrosis of skin at donor site in 2 cases, and graft site (1 case). Follow-up for 3 to 24 months of 31 patients showed: six cases received two-stage plastic operation on account of bulkiness with trouble in wearing shoes, and mild contraction of muscular flap in 3 cases.</p><p><b>CONCLUSIONS</b>Latissimus dorsi flap in various forms can be satisfactory for repair of large skin and soft tissue defects in lower extremities.</p>

Experimental study on gelatin/polycaprolactam composite nanofiber scaffold in wound healing / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effects of the gelatin (Gt)/(polycaprolactam) PCL composite nanofiber scaffold on wound healing of full-thickness defect in rabbits.</p><p><b>METHODS</b>Sixteen rabbits were inflicted with full-thickness skin open wounds on the back, and they were divided into A group (with treatment of Gt/PCL nanofiber membrane, 8 wounds), B group (with treatment of PCL fiber membrane, 8 wounds), and C group (with treatment of vaseline gauze, 8 wounds), the wounds in A , B groups served as self controls. Wound healing time was recorded. Wound healing rates were calculated on 3, 7, 10 post operation day (POD). Wound specimens and their adjacent skin were examined histologically on 3, 7, and 10 POD.</p><p><b>RESULTS</b>There was obvious difference in wound healing time among A, B, C groups, and they were (18.2 +/- 1.3) d, (20.3 +/- 1.1) d, (22.0 +/- 0.6) d, respectively. Wound healing rate in A group was obviously higher than that in B, C group on 3, 7, 10 POD (P < 0.05). Compared with those in other groups, the proliferation of granulation tissue in dermis in A group was less, the epidermal cells were proliferated quickly, and collagen was arranged regularly.</p><p><b>CONCLUSION</b>Gt/PCL composite nanofiber membrane can promote wound healing of full-thickness skin defect in rabbits, which is an ideal material for tissue engineering.</p>

Repair of claw hand deformity after burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize methods for repair of claw hand deformity after burn.</p><p><b>METHODS</b>Ninety-seven patients with 136 claw hands after burn hospitalized from May 1992 to May 2007 were repaired with skin grafting (104 hands) and transposition of skin flap (32 hands), among which 21 hands were minor-grade, 92 hands moderate, 23 hands severe. The metacarpophalangeal joint was repaired after scar release in dorsum of hand with manual extraction reduction, release of collateral ligament and joint capsula, separation of adhesion in joint, tendon lengthening for obvious contracture. Restitution of finger flexion deformity, lysis of adhesion and grafting among first web and finger webs, repair of central slip extensor tendon or phalangeal arthrodesis were performed according to the abnormal condition after lysis of dorsal scar of hand. The metacarpophalangeal joint from 31 patients were not repaired with above methods for severe finger flexion deformity, their palmar scar were loosened and transplanted firstly, then scar in dorsum of hand were loosened, metacarpophalangeal joint were repaired, flap or skin were transferred or transplanted. General rehabilitation were performed routinely after operation.</p><p><b>RESULTS</b>The ending of flaps (4 hands) due to the scar were necrosis after transposition and healed through dressing change, other skins or flaps all survived. Most articular deformities were corrected completely or basically. Functions including palmar opposition, grasp were also recovered with satisfactory results.</p><p><b>CONCLUSION</b>Skin transplantation and transferring of skin flap with overall planning and individual isatin are the key points for repair of claw hand after burn.</p>

Repair of large defects in upper extremities with pedicled combined flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the flap transposition for repairing large defects in upper extremities.</p><p><b>METHODS</b>12 cases with large defects in elbow, forearm, wrist or palm caused by high-voltage electricity, hot-pressure or crush, were treated. 4 cases were treated with latissimus dorsal myocutaneous flaps combined iliolumbar flaps. 2 cases were treated with latissimus dorsal myocutaneous flaps combined lateral thoracic flaps. 6 cases were treated with large combined thoracic-abdomen flaps.</p><p><b>RESULTS</b>All the flaps survived except for one flap with 2 cm distal necrosis and sub-flap infection. Satisfactory results were achieved.</p><p><b>CONCLUSIONS</b>Early debridement and reconstruction with pedicled combined flaps are feasible and reliable for large defects in the upper extremities.</p>

Inhibitory effect of epidermal growth factor on apoptosis in HaCaT keratinocytes induced by TNF-alpha / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effect of epidermal growth factor (EGF) on apoptosis induced by TNF-alpha and the expression of PPARbeta in HaCaT keratinocytes.</p><p><b>METHODS</b>HaCaT keratinocytes were cultured and randomly divided into A (normal control), B (with treatment of 10 ng/ml TNF-alpha for 24 hours), C (with treatment of 20 ng/ml TNF-alpha for 24 hours), D (with treatment of 10 ng/ml TNF-alpha after 20 ng/ml EGF treatment for 4 hours), E (with treatment of 20 ng/ml TNF-alpha after 20 ng/ml EGF treatment for 4 hours) groups. The apoptosis of HaCaT keratinocytes was observed by flow cytometry. The proliferative activity of HaCaT keratinocytes was evaluated by MTT method. The activity of caspase-3 was analyzed with caspase colorimetric assay Kit. The changes in the mRNA and protein expression of PPARbeta in HaCaT keratinocytes were observed by RT-PCR and western-blotting after treatment with different concentrations (5, 10, 20, 40 ng/ml) of EGF for 4 or 24 hrs.</p><p><b>RESULTS</b>Compared with A and B groups [(32 +/- 6)%, (57 +/- 6)%], the apoptosis of HaCaT keratinocytes in D and E groups were significantly increased [(20 +/- 3)%, (28 +/- 4)%, respectively, P < 0.01], while the survival rate of HaCaT keratinocytes in D and E groups increased, and the caspase-3 activity were decreased (P < 0.01). The expression of PPARbeta mRNA and protein in HaCaT keratinocytes reached the peak with the treatment of 20 ng/ml EGF.</p><p><b>CONCLUSION</b>EGF can inhibit the apoptosis of HaCaT keratinocytes induced by TNF-alpha, and it can also increase the expression of PPARbeta.</p>

The influence of succinic acid on the apoptosis of polymorphonuclear neutrophil in peripheral blood / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of succinic acid on the apoptosis of polymorphonuclear neutrophil (PMN) in human peripheral blood, and to explore its role in infection.</p><p><b>METHODS</b>PMNs were incubated in vitro, and its concentration was adjusted to 5 x 10(6)/mL. Then the cells were divided into normal control group and 5,10, 20, 30 mmol/L succinic acid groups according to different concentrations of succinic acid added into the medium. The supernatant of the cultures in each groups were collected to determine the superoxide content. 1 mL cell suspension was collected from 5, 20 mmol/L succinic acid groups before treatment and at 2, 4, 6, 8, 10 post-treatment hours (PTH) for the determination of caspase-3 activity and the apoptosis rate.</p><p><b>RESULTS</b>The content of superoxide in 5, 10, 20, 30 mmol/L succinic acid groups (0.437 +/- 0.056, 0.432 +/- 0.024, 0.395 +/- 0.049, 0.386 +/- 0.010) was significantly lower than that in control group (0.505 +/- 0.028, P < 0.05). The caspase-3 activity in each group increased along with the incubation time, but was in lower concentration in 5 mmol/L succinic acid group and in higher concentration in 20 mmol/L succinic acid group when compared with that in control group (P < 0.05). The apoptosis rate of PMN in control group was (6.1 +/- 1.1)% before incubation, and it reached (13.2 +/- 2.0)% at 2 PTH, and (27.7 +/- 3.7)% at 10 PTH. The apoptosis rate of PMN in 5 mmol/L succinic acid group was lower than that in control group except that at 4 PTH (P < 0.05). On the other hand, the apoptosis rate in 20 mmol/L succinic acid group (during 4-10 PTH) were obviously higher at each time points compared with the control group (P < 0.05).</p><p><b>CONCLUSION</b>Low concentration of succinic acid can suppress the apoptosis of PMN, while high concentration of succinic acid has an opposite effect. It is known that bacteria can produce succinic acid.</p>

Repair of skin and soft tissue defect around the malleolus by superior regressive island fasciocutaneous skin flap graft / 中南大学学报(医学版)

OBJECTIVE@#To discuss the repairing procedure of skin and soft tissue defect around the malleolus, achilles tendon exposure, or calcaneus tendon exposure by superior regressive island fasciocutaneous skin flap graft.@*METHODS@#We used the superior regressive island fasciocutaneous skin flaps to repair 13 cases of skin and soft tissue defect or achilles tendon exposure around malleolus after trauma, scar ulcer, tumor, or other occasions. The maximal size of skin and soft tissue defect was 6 cm x 14 cm. The maximal size of calcaneus exposure was 5 cm x 10 cm.@*RESULTS@#Twelve cases obtained complete success with satisfactory results, and 1 case of necrosis delayed wound healing by latissimus dorsal myocutaneous flap graft. The follow-up lasted from 6 months to 4 years with satisfactory results.@*CONCLUSION@#The superior regressive island fasciocutaneous skin flap graft is an effective and convenient method to repair skin and soft tissue defect around the malleolus, achilles tendon exposure, or calcaneus tendon exposure.

In vitro study on the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells / 中南大学学报(医学版)

OBJECTIVE@#To explore the feasibility of the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells.@*METHODS@#Human bone mesenchymal stem cells (BMSCs) were isolated from the bone marrow of volunteers' ilium, and were purified and cultured in vitro and induced by supernatant liquid of HaCat cells. The morphologic changes of BMSCs were observed with electron microscope, and immunohistochemical examination was carried out to detect the positive staining of cytokeratin 10, cytokeratin 19 and integrin beta1 after one week induction.@*RESULTS@#Large numbers of flat-polygon cells were closely connected and developed like road metal. The plenty threadlike keratins were observed in the cytoplasm. The immunohistochemical examination showed the positive staining of few cytokeratin 10, a great deal of cytokeratin 19 and integrin beta1 after the one week induction.@*CONCLUSION@#Human BMSCs can differentiate into epidermal stem cells with supernatant liquid of HaCat cells and EGFs in vitro.

Repair of the scar in the midface by skin expansion with parallel juxtaposed skin expanders / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore a new method for the repair of the scar in the midface.</p><p><b>METHODS</b>Parallel juxtaposed expansion of the skin and soft-tissue of jaw, face, neck and posterior aspect of auricle was performed to repair the scar in the midface of 15 patients. The operation consisted of two steps. In the first step, two expanders were placed subcutaneously under the subskin of jaw, face, neck and posterior aspect of the auricle, respectively, and they were expanded timely to create adequate superfluous skin and soft tissue. In the second step, the expanded skin flap was rotated and advanced to repair the the scar in the midface.</p><p><b>RESULTS</b>Parallel juxtaposed expansion was performed to repair the scar in the midface of 15 patients. The incision was comparatively concealed, the colour and elasticity of the skin transplant, and the facial contours were satisfactory.</p><p><b>CONCLUSION</b>Parallel juxtaposed expansion of the skin soft-tissue of jaw, face, neck and posterior auricular is beneficial for the repair of the scar in the midface.</p>

Effect of antisense oligonucleotide against Smac/DIABLO on inhibition of hydrogen peroxide induced myocardial apoptosis of neonatal rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of antisense phosphorothioate oligonucleotides against Smac/DIABLO (asODN) on hydrogen peroxide (H2O2) induced myocardial apoptosis in neonatal rats.</p><p><b>METHODS</b>Primary myocardial cells from neonatal rats were cultured in vitro, and randomly divided into A (normal control, without transfection), B (with treatment of single liposome), C (with transfection of scrODN), D (with transfection of asODN), E (with H2O2, stimulation), F (with H2O2 stimulation after scrODN transfection), and G (with H2O2 stimulation after asODN transfection) groups. The expression of asODN mRNA and protein were determined with RT-PCR and Western blotting, respectively. The changes in cellular nuclear morphology were observed with 33258 fluorescent staining, and the percentage of nuclear apoptosis was calculated. DNA fragmentation was observed by agarose gel electrophoresis. Activation of caspase-3 and caspase-9 were evaluated by caspase colorimetric analysis kit.</p><p><b>RESULTS</b>The expression of Smac/DIABLO mRNA and protein was obviously inhibited by asODN, which was about 80% percent lower than the protein level in A,B and C groups, but there was no difference noted among A,B and C groups( P > 0.05). Not only the nuclear apoptotic percentage, but also the activity of caspase-3 and caspase-9 in A, C and D groups were in very low levels. But these indices in G group 24 hours after H2O2 stimulation were obviously lower than that in E and F groups [the nuclear apoptotic percentage were (19 +/- 5) %, (52 +/- 3) %, (55 +/- 5) %, respectively, P < 0.01)]. The DNA ladders in G group were also decreased markedly.</p><p><b>CONCLUSION</b>Myocardial apoptosis induced by H2O2 can be inhibited by asODN in rat.</p>

Application of bridged free latissimus dorsi musculo-cutaneous flap on the soft tissue defects in lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of bridged free latissimus dorsi musculo-cutaneous flap on repairing of soft tissue defect in the lower extremity.</p><p><b>METHODS</b>Seven patients with extensive soft tissue defects in the lower extremities were enrolled in the clinical investigation. The defects were all repaired with bridged free latissimus dorsi musculo-cutaneous flaps. The condition of the blood vessels in the flaps and the healthy extremities was examined with ultrasound Doppler before the operation to assure the blood circulation of grafted flap. After debridement, the flap was designed in accordance with the size and the depth of the wound. Then the transplantation of the flaps were done. The operative indication and points for attention were summarized thereafter.</p><p><b>RESULTS</b>All the 7 flaps survived. All patients recovered well with satisfactory function and external appearance, except flap reduction was done in 2 patients due to undue thickness of the flaps. Indications for operation: (1) Patients with anterior or posterior tibial artery injury in the injured lower extremity in which arterial transplantation was not possible to allow the free transplantation of a skin flap. (2) The injury was extensive and deep, with the injurious condition of the blood vessels indeterminable and no healthy artery could be found for anastomosis with a donor artery. (3) No vascular injury could be identified in the contralateral healthy extremity. Points for attention included that the blood supply of the flap to be transferred should be adequate, and the survival of the flap after division of the pedicle should be assured. The length of the flap to be transferred should be longer by 10% than the distance between the site of transplantation in the lower extremities and the donor area; and the donor area should be larger by 20% than the recipient area. The skin area of the flap to be transferred should be broad enough avoid tension so that there would be no pressure on the blood vessels. Pay attention to the blood supply of the flap after operation, and the recipient limb should be properly immobilized.</p><p><b>CONCLUSION</b>The repair of extensive soft tissue defect in the lower extremity with bridged free latissimus dorsi musculo-cutaneous flap could be satisfactory. Proper wound management, broad flap, stable immobilization were the pivotal points for the success of the operation.</p>

Repair of rabbit tendon by autologous bone marrow mesenchymal stem cells / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of rabbit bone marrow mesenchymal stem cells (MSCs) as seed cells for the repair of tendon defect.</p><p><b>METHODS</b>The MSCs were isolated, amplified and identified by detection of surface protein CD44 mRNA. A 3 cm long defect was made in the Achilles tendon of the rabbit. The rabbits were divided into experimental (E) and control (C) groups. The autologous MSCs were implanted into a collagen-polyglycolic acid (PGA) scaffold to form a tissue-engineered tendon, which was then transplanted to bridge the defect in the E group, while only collagen-PGA was transplanted to bridge the defect in the C group. The transplanted tendon was observed grossly and microscopically at 4, 8, 12 weeks after operation.</p><p><b>RESULTS</b>The cultured MSCs exhibited positive staining of CD44 on 11 days after in vitro culture. A tendon-like tissue could be discerned at the operation site in the E group 4 weeks after operation. Tendon-like cells similar to normal tendon tissue, being axially arranged in collagen matching the mechanical direction, with uniform morphology could be seen in E group 12 weeks after operation. The newly regenerated tissue in C group adhered to the adjacent tissue and was smaller than that in E group. The collagen fibers in the regenerated tissue were loose with reticular and filiform structure, and the cells were arranged disorderly 12 weeks after the transplantation.</p><p><b>CONCLUSION</b>It is feasible to repair the tendon defect with autologous MSCs as seed cells.</p>

Long-term result of repair of deeply burned hands with large sheet of split-thickness autoskin grafting with the preservation of denatured dermis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the long-term results of repair of burn hands with large sheet of split-thickness autoskin grafting with the preservation of denatured dermis.</p><p><b>METHODS</b>One hundred and fifty-two hands in 86 burn patients with deep partial thickness and full thickness burn were enrolled in the study. The burned hands were treated by tangential excision and grafted with large sheet of split-thickness autoskin with the preservation of denatured dermis. The patients were followed-up from 3 months to 3 years. The skin color, elasticity, degree of contracture and the functional grading of the operated hands were observed.</p><p><b>RESULTS</b>Good function was found in one hundred and forty-one out of the 152 burn hands (92.8%). For the rest 11 hands, pigmentation was found in 4, poor appearance in 4, and 3 hands with both poor appearance and function.</p><p><b>CONCLUSION</b>Large sheet of split-thickness autoskin grafting with the preservation of denatured dermis could be an optimal choice for the management of hands with deep partial thickness burn, and it could restore the appearance and function of the hands satisfactorily.</p>

Effects of succinic acid on the function of in vitro cultured human fibroblasts / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the mechanism of injurious effect of succinic acid on human fibroblast and it's role in bacteroides fragilis infection.</p><p><b>METHODS</b>In vitro cultured human fibroblasts were challenged by succinic acid in concentrations of 5, 10, 20 and 30 mmol/L (pH5.5), respectively. The cellular activity, apoptosis rate, the collagen synthesis in the supernatant of the cell culture, and the activity of caspase-3 were determined 24 hours after challenge. Isotonic saline challenged fibroblast were employed as control and the changes in the indices before and after succinic acid challenge were observed.</p><p><b>RESULTS</b>Along with the increase in the concentration of succinic acid, the fibroblast proliferation rate was decreased and so was the collagen synthesis. But the apoptosis rate and caspase-3 activity were increased. The activity of caspase-3 was markedly higher than that in normal control when the succinic acid concentration was 10-30 mmol/L. The cellular activity and collagen synthesis were significantly lower and the apoptosis rate was obviously higher than those in control group when the succinic acid concentration was 20 or 30 mmol/L (P < 0.05).</p><p><b>CONCLUSION</b>The proliferation and collagen synthesis in fibroblast culture could be significantly inhibited and the cellular apoptosis could be promoted by succinic acid. The process of wound healing of the wounds infected by bacteroides fragilis would be delayed due to the production of succinic acid by the bacteria.</p>

Clinical analysis of brain injury in patients injured by high voltage electricity / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the pathogenic characteristics and management of brain injury in patients injured by high voltage electricity.</p><p><b>METHODS</b>One hundred and thirty eight patients injured by electricity were enrolled in this study. Postburn brain injury was diagnosed by clinical sighs and imaging analysis. The brain injury was graded as mild, moderate, severe and most severe. The relationships among the inlet of the electric current and the electric voltage and the degree of brain injury were analyzed, and the causes and pathogenesis of the brain injury were suggested. Treatment modality was optimized for the patients according to the diagnostic data.</p><p><b>RESULTS</b>In this group of patients, brain injury was identified in 106 cases, mostly rated as mild and moderate. Only 4 cases were ranked as severe degree with positive imaging findings. The electric voltage seemed to be not correlated with the incidence of postburn brain injury. But the intensity of electric current and the locations of electrical current inlet and outlet were closely related to the degree of brain injury. Among all the patients in this group, 131 survived and 7 died after treatment. But there was no death due directly to brain injury.</p><p><b>CONCLUSION</b>There was high incidence of postburn brain injury in patients injured by high voltage electricity. The injury might be related to the direct effect of electrical current on the brain tissue, to mechanical injury, to the cardio-pulmonary lesions caused by electrical current, or to massive skin burn. Early and accurate diagnosis of the injury was of key importance for lowering both mortality and disability.</p>