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Objective:To explore the choice of skin flap design and clinical effects of skin soft tissue expansion in the treatment of body surface lesions.Methods:From January 2018 to December 2020, the Department of Plastic Surgery, the First Affiliated Hospital of the Air Force Medical University performed skin and soft tissue expansion in 148 patients with scars and nevus, including 83 males and 65 females. The age ranged from 4 to 52 years. According to the distance of the donor area, the expanded flap was divided into adjacent local flap and distal pedicled axial flap. An appropriate volume expander was embedded under the donor area flap. The expander was expanded regularly for 8-24 weeks, and the displacement of expander and other complications were avoided.Results:A total of 212 dilators were implanted in 148 patients, and the damaged area was completely repaired after 1 or 2 dilation operations. The expanded flaps were effectively used. The flap transfer was consistent with the first-stage design, with fewer auxiliary incisions, hidden and inconspicuous scars, and maximum repaired area was 22 cm×18 cm; the incidence of dilator complications (16 cases with 21 dilators) was 9.90%.Conclusions:Paying attention to the reasonable design and selection of flap in stage Ⅰ operation can make effective use of expanded flap in stage Ⅱ operation, fully repair body surface lesions, reduce auxiliary incision and achieve the best repair effect.
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Objective@#To explore the clinical effects of expanded forehead flaps in repairing midfacial defects.@*Methods@#From January 2003 to December 2018, 19 patients with midfacial defects were admitted to our unit, including 8 males and 11 females, aged 7 to 52 years. One cylindrical expander with rated capacity ranged from 100 to 170 mL was placed in the forehead of patients in the first stage of expansion, and the total water injection volume was about 2 times of the rated capacity of the expander during 1 to 2 months. The area of midfacial defects was 4 cm×2 cm to 9 cm×5 cm after resection in the second stage surgery. Expanded forehead flaps with vascular pedicle of supratrochlear vessels or frontal branch of superficial temporal vessels were used to repair the midfacial defects, with flap size ranging from 5 cm×2 cm to 16 cm×6 cm. The donor sites were closed by direct suturing. Three weeks later, the pedicle was divided. The complications, blood supply after flap transfer and pedicle division, and the treatment effects during follow-up were observed.@*Results@#Among the patients, flaps of 11 patients had vascular pedicle of supratrochlear vessels; flaps of 8 patients had vascular pedicle of frontal branch of superficial temporal vessels. All the flaps survived with no complications and good blood supply after flap transfer and pedicle division. During the follow-up of 6 to 12 months after the third stage surgery of pedicle division of 12 patients, no lower eyelid ectropion occurred, the appearance of the flaps was similar to the surrounding tissue with no swelling.@*Conclusions@#The application of expanded forehead flaps can not only repair the defects but also effectively avoid the complication of lower eyelid ectropion, which is a promising method in repairing midfacial defects.
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Objective@#To investigate the functional recovery and cosmetic effects of pre-expanded pedicled deltopectoral flap.@*Methods@#From January 2008 to December 2018, 42 patients with 56 pre-expanded pedicled deltopectoral flaps from Xijing Hospital of Air Force Military Medical University were followed up at least 6 months. 18 of them were male, the remaining were female. And the average age was (24.7±7.3) years. Then the indicators were tested and evaluated. Tubes with different temperatures were used for temperature sensation test. The flaps were stabbed using a 27 G blunt needle to test algesthesia. Tactile threshold was measured by Semmes-Weinstein monofilament. Two-point discrimination was measured by Disk-Criminator. Elasticity of skin flaps was measured by CK-MC®960. Colors of skin flaps were analyzed by ANTERA®3D system, including L*a*b*, melanin and hemoglobin content. And the postoperative scars were evaluated by the Patient and Observer Scar Assessment Scale (POSAS). The flap retraction rate [(flap area immediately after operation-flap area at the follow-up time)/flap area immediately after operation]was calculated. The satisfaction of patients, doctors and third parties was investigated as well. Statistical analysis of data was performed with SPSS 23.0, satisfaction rate was expressed as percentages. Scar scores were compared by Wilcoxon rank sum test. The values of elasticity, color L*a*b*, melanin and hemoglobin between skin flaps and normal skin were analyzed by paired t test. The difference was statistically significant at P<0.05.@*Results@#The scores of pain, heat and cold sensation were (4.61±0.78), (3.48±0.90) and (4.39±0.81), the tactile threshold was (0.26±0.23) g/mm2, and the distance of two-point discrimination was (10.09±4.79) mm. There was no significant difference in elasticity, color b*and melanin content between skin flap and normal skin of face and neck (P>0.05). The color of flap L*, a*and hemoglobin content of flaps were significantly different from those of normal skin from face and neck (P<0.05). The result of self-assessment of patients (POSAS) showed that there were significant differences (P<0.05) in pain, itch and stiffness between facial and chest donor scar. The result of observer evaluation (POSAS) showed that the scar score for all items around facial flap was better than that of chest donor area, the difference was statistically significant (P<0.05), and the retraction rate of flaps was (10.44 ±3.36)%. The satisfaction rates of doctors, patients and the third party were 92.86% (39/42), 71.43% (30/42) and 61.90% (26/42), respectively.@*Conclusions@#Excellent functional recovery and reliable cosmetic effect were observed in the facial-cervical scar repair with pre-expanded pedicled deltopectoral flap. Transfer of pre-expanded pedicled deltopectoral flap is an effective method for the treatment of facial-cervical scars.
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Objective To study the temporal distribution of macrophage and its phenotype markers in fibrous capsules around silicone implants.Methods Thirty rats were randomly divided into five groups:days 1,3,7,14 and 35.Silicone prostheses (10 ml) were implanted subcutaneously into backs of rats.On each indicated day,the tissue specimens were collected,fixed in 4％ paraformaldehyde for 24 hours and embedded in paraffin.Immunofluorescence was used to detect temporal distribution of M1/M2 macrophages.Results The number of CD68+ macrophages at day 1 (65.8±12.9) was smaller than that at day 3 (102.8±14.5,P＜0.05) and day 7 (116.8±14.2,P＜0.05);and the number of CD68+ macrophages at day 7 was larger than that at day 14 (56.8±12.9,P＜0.05) and day 35 (21.40±6.35,P＜0.05);the proportion of iNOS+ CD68+ M1 cells at day 1 and day 3 was 0.48±0.13,0.60±0.13,respectively,and they were higher than that at day 7 (0.21±0.03,P＜0.05),day 14 (0.21±0.03,P＜0.05) and day 35 (0.17±0.04,P＜0.05);the proportions of CD206+ CD68+ M2 cells at day 1,day 3,day 7,day 14,day 35 were 0.70±0.06,0.60±0.07,0.70±0.08,0.67±0.02 and 0.60±0.06,respectively.Conclusions After the implantation of silicone prostheses,M1 cells increase in early stages and M2 cells maintain in high level throughout the experiment period.
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Objective To observe the effect of botulinum toxin type A (BTX-A) on the rate of skin expansion and the immediate retract rate of skin flaps in rats,and to explore new methods for drug-assisted skin expansion.Methods 18 Sprague-Dawley rats were randomly divided into two groups.After BTX-A or normal saline was injected intradermally into the back marking area,an expander was implanted.The expanders were inflated periodically by injecting normal saline to reach the designated intraexpander pressure.The inflation volume was recorded and the area of marked region was measured regularly.After 4 weeks of expansion,the expanded tissues were harvested and the immediate retract rates were measured.The hematoxylin-eosin staining was performed to observe the thickness of epidermis,dermis and the fibrous capsule,while Masson staining for detection of fibrous capsule collagen.Immunohistochemical staining with α-smooth muscle actin for myofibroblasts was also performed.Results The mean inflation volume and area of marked region of BTX-A group were significantly greater than those of the control group.There were lower immediate retract rate,thinner fibrous capsule,less collagen content and fewer α-SMA positive myofibroblasts in the fibrous capsule of the BTX-A group with statistically significant differences (P ＜ 0.05).There was no signigicant difference in the thicknesses of epidermis and dermis between the two groups (P＞0.05).Conclusions BTX-A can inhibit the formation of fibrous capsule to promote skin expansion,while reducing the immediate retract rate.It possess a potential for assisting effectively skin expansion.
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The long-term use of immunosuppressive agents after organ transplantation is associated with many undesirable side effects which may limit the survival of patients and transplanted organs.To patients and transplant surgeons,organ transplantation tolerance is the ultimate goal to improve patient's quality of life.The clinical state of allograft acceptance termed operational tolerance has remained infrequent in clinical transplantation because of the lack of validated assays or biomarkers predictive of tolerance and the concerns about the safety and ethics of complete withdrawal of immunosuppression.Despite these barriers,a number of investigators have continued to conduct well-designed studies with the long-term goal of inducing clinical transplantation tolerance.This review provides an overviewof the currently successful approaches to achieve clinical operational tolerance,including using immunosuppression slow withdrawal in organ transplantation,transplantation tolerance through mixed chimerism and clinical application of T regulatory cells in tolerance.