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Objective@#To explore the effect of applying the digital technology in the reconstruction of congenital microtia.@*Methods@#CT data of 40 patients with congenital microtia were collected by using software (Mimics 17.01) and three-dimensional printing. And the three-dimensional reconstruction of costal cartilage and ear model was performed. The effectiveness and feasibility of the digital assisted technology in the reconstruction of congenital microtia could be established, by contrasting the pre-three-dimensional reconstruction and the morphology of the costal cartilage harvested during surgery and comparing the imaging data of the auricles before and after surgery.@*Results@#40 patients were satisfied with the appearance of the auricle after the restoration. The rib cartilage obtained during the operation was consistent with the preoperative data simulation. The trauma of the operation and the operation time were reduced. There was no statistically significant difference between both auricle length and width for the reconstructed ear and those of the normal ear, auricle length mean (62.10±6.82)mm vs (60.31±6.18)mm, auricle width mean (26.10±2.26)mm vs (25.40±2.32)mm, P>0.05, respectively.@*Conclusions@#The application of digital assisted technique in congenital microtia correction could accurately display the tissue structure of the operation area, which was helpful to preoperative design, reduce intraoperative injury and achieve satisfactory surgical result .
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Objective@#To investigate the clinical efficacy and safety profile of hyaluronic acid dermal filler(Restylane®) in treating nasolabial folds in Chinese population.@*Methods@#103 subjects in this study were recruited from five Chinese clinical trial centers between July 2014 and December 2015. Subjects were treated with hyaluronic acid dermal filler in correcting nasolabial folds and an optional re-treatment was performed after 12 months according to the subjects′wishes. The improved of nasolabial folds was evaluated by the change of severity (wrinkle severity rating scale, WSRS) and aesthetic improvement (global aesthetic improvement scale, GAIS). Satisfaction of subjects on treatment was evaluated using subject satisfaction questionnaires (SSQ). Safety indicators such as pain, skin and soft tissue presentation at the injection site were continuously evaluated throughout the whole treatment process.@*Results@#Significant improvement in scores of WSRS and GAIS of all subjects was observed after treatment. Nine months after treatment, the scores of WSRS in 80 subjects (77.7%) and GAIS in 96 subjects (93.2%) were still improved. The 68 subjects (95.8%) received re-treatment after 12 months gained further improvement in nasolabial folds. Most adverse events were mild or moderate (transient/reversible local manifestations) and all resolved before study end, no severe adverse event related to products observed.@*Conclusions@#Hyaluronic acid dermal filler is effective and safe in treatment of nasolabial folds in Chinese population and the effect can last up to 12 months.
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Objective@#The incidence of complications after skin soft tissue expansion is relatively high. Occurrence of infection often means the expander has to be taken out ahead of schedule. In this retrospective study, we wanted to identify independent risk factors of infection after skin soft tissue expansion, which could be helpful to guide clinical work.@*Methods@#Demographic information of patients who underwent the skin soft tissue expansion at the department of plastic surgery of Xijing Hospital from January 2003 to December 2012 was collected. Univariate associations with infection were measured by logistic regression and represented as odds ratios. The p-value less than 0.1 was identified the potential risk factor. Multivariate logistic regression was used to calculate odds ratios for risk factors of infection. Independent risk factors were identified if the p-value was less than 0.05.@*Results@#A total of 3382 implants were included in the study. The overall infection rate of tissue expansion was 5.2% in 177 implants. The result of multivariate logistic regression showed that preoperative white blood cell count, age, numbers of expander implanted and volume of expander were independent risk factors of infection.@*Conclusions@#Independent risk factors of infection were preoperative white blood cell count, age, numbers of expander implanted and volume of expander. The lower preoperative white blood cell count, age more than 18 years old, more numbers of expander implanted and the bigger volume of the expander, the higher possibility of complications occurred. The result was helpful to guide clinical work and reduce the incidence of infection.
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The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988 in xijing Hspital. We created a new flap called the subclavicular flap, which was pedicled by the thoracic branch of supraclavicular artery. This flap shares the similar vascular territory of the deltopectoral flap and is mainly used for reconstruction of cervicofacial wounds. The supraclavicular flap has the same vessel origin of supraclavicular flap but is pedicled by the different branch, the deltoid branch. Its vascular territory locates on the shoulder region. Therefore, many differences and relations exist between the two flaps and there are also some disputes. To enhance the understanding of the two flaps, presenting a summary on the two flaps, especially for their relations and differences.
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Objective@#To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications.@*Methods@#211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology.@*Results@#211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard debridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction.@*Conclusions@#Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.
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Objective To review the clinical features of the patients received massive transfusion (MT) in plastic surgery department.Methods Ten cases were reviewed.The reason of massive transfusion,the type and dosage of transfusion,the reaction of patients were included.For all the patients,consultation of related department preoperatively was necessary.Based on the through and detailed analysis of the patients' condition,necessary blood product should be prepared ahead of operation.During the therapy,adjustment of treatment plan was made from time to time,according to the patient's condition.Therefore efficient and prompt therapeutic result was achieved.Results In all the 10 MT cases suffered from acute blood loss,2 of them were in hemorrhagic shock before administration.Coagulation disorders happened in 2 patients,and recovered after appropriate treatment.RBC,which was 58.3％ of total amount of transfusion,used most commonly;the second was fresh frozen plasma (FFP),which was 38.6％ according to the total amount.All the patients had satisfactory recovery,without hemolysis or any other functional disorder.Conclusions For MT patients in the Department of Plastic Surgery,the main proposes are to restore and maintain an effective circulatory blood volume,while preventing the coagulation disorder.Also,detailed analysis,through consultation and timely adjustment are of great importance for the MT patients.It is also the essential of an effective perioperative management.
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Objective@#To investigate the feasibility of one-stage thinning of latissimus dorsi muscle, rectus abdominis muscle and gracilis flap in reconstruction of the hand and foot defects.@*Methods@#From June 2009 to April 2015, 24 free muscle flaps were thinned during transfer operation by removing their superficial muscle layers on the basis of their vessel pedicles running in the deep surface of flaps. The surface of the muscle flaps were covered by split-thickness skin grafts. There were 16 latissimus dorsi muscle flaps, 4 gracilis flaps and 4 rectus abdominis muscle flaps. Flap size ranged from 6 cm×4 cm to 20 cm×12 cm. Thinned muscle flaps were used to resurface 7 hand defects and 17 foot defects.@*Results@#All muscle flaps survived the thinning procedures without any circulation problems except for one case which suffered total flap necrosis due to venous thrombosis. Skins grafts on muscle flaps also took well. One patient experienced partial skin loss. Two patients underwent secondary debridement and thinning procedure for infection and bulkiness. During the 0.3-20 months follow-up, the contour of thinned muscle flaps matched well with the recipient areas. Reconstructed feet are able to wear regular shoes.@*Conclusions@#Intraoperative immediate thinning of free muscle flaps can be safely accomplished during the primary reconstruction procedure. This procedure prevents the limitations of muscle flap bulkiness and may provide an alternative for surface coverage.
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BACKGROUND:Mouse pluripotent stem cel s are induced to differentiate into insulin-secreting cel s that can effectively improve blood glucose levels in diabetic mice. OBJECTIVE:To detect mRNA and protein levels of insulin-like cel clusters from induced pluripotent stem cel s and to investigate the function of insulin-secreting cel s in vitro and in vivo. METHODS:Mouse induced pluripotent stem cel s cultured in vitro were induced to differentiate into insulin-secreting cel s using combined inducers through three stages. The morphology of endodermal cel s, islet-derived progenitor cel s and mature islet cel s in each stage was observed and relative gene expression levels were detected by PCR. Mature insulin-like cel clusters underwent dithizone staining and functions of insulin released in vitro were observed by ELISA assay. Final y, the insulin-secreting cel s were transplanted into the subrenal capsule of diabetic mice, and then blood glucose levels were observed. RESULTS AND CONCLUSION:The mature spherical insulin-like cel clusters were successful y obtained in vitro, which were in iron red by dithizone staining, and expression of insulin mRNA was determined by PCR. The insulin-like cel clusters could secrete insulin in response to various blood glucose levels by ELISA assay. In addition, after the cel s clusters were transplanted into the subrenal capsule of mice with type 1 diabetes, the blood glucose levels were marbedly improved.
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<p><b>OBJECTIVE</b>To investigate the effects of Dragon' s blood extract on proliferation and secret extracellular matrix function of fibroblasts in vitro.</p><p><b>METHODS</b>Dragon' s blood was extracted by chloroform, acetoacetic ester, alcohol. Human fibroblast were cultured in vitro in media containing gradient dilutions of Dragon' s blood extracts (0.002, 0.02, 0.2, 2, 20 mg/ml) , which was followed by cell proliferation assessed with MTT assay on 0, 12, 24, 36, 48, 60, 72 h. Under the optimal concentration, the cell growth curves were drawn and the flow cytometry (FCM) was used to determine the changes of cell cycle. On 0, 12, 24, 36, 48, 60, 72 h, the concentration of hyaluronic acid in the supernatant of fibroblast culture was measured by radioimmunoassay.</p><p><b>RESULTS</b>0.2-2 mg/ml Dragon' s blood extracts enhanced the proliferation of fibroblasts in a dose-dependent manner. 2 mg/ml was the optimal dilution of Dragon's blood extract, and it increased the ratio of S cells in cell cycle [(25.80 ± 3.10)%] than control group [(7.50 ± 0.70)%, P < 0.01]. From 12 h to 72 h, in 2 mg/ml Dragon's blood group, concentration of Hyaluronic acid secreted by fibroblasts gradually increased, but were less than control (P < 0.01).</p><p><b>CONCLUSIONS</b>Dragon's blood acetoacetic ester extract improved the proliferation of cultured human fibroblasts in vitro, might be beneficial to promote wound healing.</p>
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Humans , Cell Cycle , Cell Proliferation , Culture Media , Chemistry , Dose-Response Relationship, Drug , Extracellular Matrix , Fibroblasts , Cell Biology , Bodily Secretions , Flow Cytometry , Hyaluronic Acid , Bodily Secretions , Plant Extracts , Pharmacology , Resins, Plant , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To reconstruct a simpler and reliable composite tissue transplantation model-the femur osteomyocutaneous flap for the replacement of hindlimb transplantation.</p><p><b>METHODS</b>Ten femur osteomyocutaneous flaps from 5 Lewis rats were transplanted into 10 syngeneic recipients' inguinal region. Their nutrient vessels were anastomosed with recipients vessels. The graft of this model was consisted of the groin flap and partial femur. To verify the feasibility of this model, gross and histological appearance were studied after transplantation to evaluate the viability of grafts.</p><p><b>RESULTS</b>The operative time was (159.0 +/- 8.3) min with the harvesting time of (68.0 +/- 4.8) min and the ischemia time of (55. 8 +/- 6.8) min. The methylene blue injection showed rich blood supply of transplanted femur osteomyocutaneous flap. All the 10 flaps survived completely with pink skin color and hair regrowth. The histologic examination of the flaps also revealed the normal appearance of the viable skin and bone marrow.</p><p><b>CONCLUSIONS</b>The femur osteomyocutaneous flap is a simple and reliable model for composite tissue transplantation, and its establishment will provide a new tool for the study of composite tissue allografts.</p>
Subject(s)
Animals , Male , Rats , Bone Transplantation , Femur , Transplantation , Models, Animal , Muscle, Skeletal , Transplantation , Rats, Inbred Lew , Skin Transplantation , Surgical Flaps , Tissue TransplantationABSTRACT
BACKGROUND:Dragon’s blood is the main ingredient of traditional medicine prescription for promoting granulation, which has been used in clinical treatment of a variety of refractory wounds and achieved the exact effects. But the Dragon’s blood effect on colagen secretion from normal fibroblasts has not been reported. OBJECTIVE: To investigate the effects of Dragon’s blood extract on the proliferation and secret function of fibroblastsin vitro. METHODS: Dragon’s blood was extracted by extracts chloroform, acetoacetic ester, and alcohol in turn. Normal human fibroblasts were respectively cultured in Dragon’s blood extracts of chloroform, acetoacetic ester, and alcohol, DMEM containing 1% dimethyl sulfoxide, and normal culture medium. Then, the fibroblasts were cultured in vitro in different media containing gradient dilutions of Dragon’s blood extracts (0.002, 0.02, 0.2, 2, 20 g/L), which was folowed by cel proliferation determination assessed with MTT assay. Under the optimal concentration, the cel growth curves were drawn and the flow cytometry was used to determine the changes of cel cycle. The concentration of procolagen type III in the supernatant of the fibroblast culture systems was measured by radioimmunoassay. RESULTS AND CONCLUSION:0.2 g/L-2 g/L dilution of Dragon’s blood extracted by acetoacetic ester enhanced the proliferation of fibroblasts in a dose-dependent manner. The 2 g/L was the optimal dilution of Dragon’s blood extracted by acetoacetic ester, and it increased the ratio of S cels in cel cycle than control group and decreased procolagen type III. These findings indicate that Dragon’s blood acetoacetic ester extract can improve the proliferation of cultured human fibroblastsin vitro, and decrease the secretion of procolagen type III of fibroblasts, and it can be beneficial to improve wound healing and inhibit hypertrophic scar.
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Objective To study the method and effect of deep inferior epigastric perforator flap(DIEP)in repairing the large defects of lower limbs.Methods Eight cases,from July 2009 to November 2011,including 3 cases of plantar skin defects with bone exposure after foot injuries,three cases of plate exposure after tibia fracture surgery and 2 cases of heel repeated ulceration after skin graft,were repaired by deep inferior epigastric perforator flap.Results All deep inferior epigastric perforator flaps survived with good functions,except 1 case whose distal with poor blood supply and the flap survived after treatmenting,three cases of flap bloated with good appearances after second operation.Conclusion DIEP is a proper option for repair of large defects of lower limbs.It has the advantages of abundant blood supply,large flap area,abdomen can suturing without abdominal complications.
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Objective To explore the potential applications of a chamber for in vivo tissue engineering,and to establish a novel model for in vivo tissue-engineered cartilage.Methods Auricular chondrocytes were isolated,cultured and identified from the ears cartilages of New Zealand white rab bits; rabbit auricular chondrocytes(RACs) were seeded into the scaffolds:(1) RACs were seeded into collagen gel scaffold; (2) RACs were seeded into PLGA/collagen gel scaffold in vitro,and the compos ites were placed into the chambers and implanted in the donor rabbit.As control groups,the composites were implanted directly subcutaneously in the donor rabbit without using chambers,and the contents were harvested at 8 weeks after implantation.Gross examination,histologic and immunohistochemical staining and RT-PCR test were performed to evaluate the harvested contents.Results Under the same conditions inside the chambers,the contents formed into new cartilage-like tissue by histo logical and immunohistochemical staining and RT-PCR.In contrast,in the control groups without chambers displayed vascular invasion and inflammatory reaction in the subcutaneous layer of skin,which eventually led to fibrous tissue or absorption.Conclusions Cartilage is successfully constructed in an immunocompetent animal model using a bioinert perforated chamber.This method is effective in creating a relatively favorable environment for cartilage regeneration,which may provide a valuable reference for the clinical application of tissue regeneration.
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Objective To study the effect of autogeneic platelet-rich fibrin (PRF) on proliferation and adipogenic differentiation of human adipose-derived stem cells (ADSCs) in vitro.Methods ADSCs were isolated from adipose tissue obtained from donors undergoing liposuction and were cultured,and underwent identification.ADSCs at passage 3 were divided into three groups:test groups were cultured with 1PRFM and 2PRFM,and control group was cultured without PRF membrane.Then the growth of the cells was observed by inverted microscope.MTT method was used to observe cell proliferation activity at days 1,2,3,4,5,6 and 7 after culture.Adipogenic differentiation of ADSCs was observed and quantified by oil red O staining at days 3,5,7,9,11 and 14.Results Cell proliferation and adipogenic differentiation would be increased with the PRFM,There were significant differences among three groups.Conclusions PRF could significantly promote proliferation and adipogenic differentiation of ADSCs.
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Objective To discuss the clinical application of using trimmed latissimus dorsi free muscle flap together with skin grafting to resurface soft tissue defects on the dorsum of the foot. Methods From June 2005 to October 2011,eleven patients (8 males and 3 females,aged from 4-46 years) with large soft tissue defects of the foot dorsum were treated in our department. The size of the defects after debridement ranged from 5.0 cm × 6.0 cm-8.0 cm × 12.0 cm,all with exposed tendons or bones.Trimmed free latissimus dorsi muscular flap with split thickness skin grafting was used for reconstruction for all the 11 patients. Results All the flaps survived with no complications after surgery.During 3-10 months' follow-up,the appearance and walking function were satisfying, no further debulking procedures were needed. Conclusion Trimmed latissimus dorsi free flap with skin grafting is a good option for dorsal defect reconstruction.
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Objective To investigate the operative technique and outcome of the expanded flap to repair the full thickness defects of nose and upper lip simultaneously.Methods Three kinds of ex panded flaps were chosen to reconstruct the full thickness defects of nose and upper lip.They were designed according to the location and the size of the defects,and also the circumstances of the donor site.Treatment effectiveness were observed by long-term follow-up.Results 7 patients were treated with the expanded flap.All cases received satisfactory results with no complications such as flap necrosis.And for male patients,the frontal expanded flap could reconstruct upper lip and beard simultaneously that reached better shape.Conclusions It is an ideal approach of repairing nasal-lip defects by the tissue expanded flap.
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Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.
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A facial allotransplanted patient presented hyperglycemia with blood glucose ranged 14. 3 -33. 3 mmol/L after receiving immunosuppressive drugs and glucocorticoids. To control the blood glucose level, the patient was treated with two subcutaneous doses of 10 U human neutral protamine hagedorn (NPH) insulin, and the fasting glucose level came down to 3. 6 - 9. 4 mmol/L. Then the continuous subcutaneous infusion of insulin aspart ( Novo Industri) was administrated (from 96 to 21 U/d) , and the fasting blood glucose levels were 3. 9 -4. 6 mmol/L. With oral administration of Metformin and Repaglinide, the fasting blood glucose was maintained to 4. 3 -5.9 mmol/L. With these medications, the blood glucose level of the patient was under good control and the acute and chronic complications of hyperglycemia were effectively prevented.
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Objective To examine how ischemic time under common temperature affects acute rejection by using a rat vascularized skin transplantation model.Methods Vascularized groin flaps were transplanted from BN to Lewis rats with 1,2,3 and 4 h of ischemic time (Isc-1 h,2 h,3 h,4 h groups) under common temperature,and the allografts in each group were evaluated daily.Groin flaps were transplanted from Lewis to Lewis rats as control group.Biopsy samples taken from the each group on the postoperative day 2-8 were graded for signs of acute rejection.Biopsy samples taken from each group on the postoperative day 6 were stained for chemokine receptor CXCR3.Results When the ischemia time was 1,2,3 and 4 h,the survival time of the grafts was (9.0 ± 1.2),(8.6 ±1.1),(8.8 ± 1.3),and (7.0 ± 0.8) days respectively.The survival time in Isc-4 h group was significantly shorter than in other groups (P＜0.05).Histological evaluation showed acceleration of activated lymphocyte infiitration in the Isc-4 h group as compared with other g.roups.Furthermore,the proportion of CXCR3 positive cells in the Isc-4 h group was (50.1 ± 8.4) ％,significantly higher than that in the other groups on the day 6 after transplantation.Conclusion When ischemic time was over 3 h,the immune response is accelerated.The acceleration is associated with the higher expression of CXCR3 in the infiltrated cells.
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Objective To explore a better method to repair cervical cicatricle contracture deformity.Methods The cervicai cicatrical contraction deformity was repaird by the cervico-shoulder island skin flap with blood supply crossing and abundant anastomotic branches of the neck-shoulder blood vessels. After removing the cervical scar, the flaps were designed according to the size of the wound to be repaired, and the clinical anatomy of crossing and abundant anastomotic branches of the neck-shoulder blood vessels. The secondary wound of donor site was closed directly if the donor region was small, or closed by skin graft. Results Sixteen patients in this clinic were operated with this method, and venous return dysfunction occurred in 1 case, but blood circulation was improved after treatment. All the flaps survived with good appearance and texture. The extensive flap was created and transferred to the anterior neck by one stage without pre-expansion which met some patients'requirement of repairing cervical cicatricle contracture deformity. Conclusion The cervico-shoulder island skin flap, with abundant blood supply, is a new method to repair cervical cicatricle contracture deformity.