Research advances on stem cell-based treatments in animal studies and clinical trials of lymphedema / 中国修复重建外科杂志

OBJECTIVE@#To summarize the progress of the roles and mechanisms of various types of stem cell-based treatments and their combination therapies in both animal studies and clinical trials of lymphedema.@*METHODS@#The literature on stem cell-based treatments for lymphedema in recent years at home and abroad was extensively reviewed, and the animal studies and clinical trials on different types of stem cells for lymphedema were summarized.@*RESULTS@#Various types of stem cells have shown certain effects in animal studies and clinical trials on the treatment of lymphedema, mainly through local differentiation into lymphoid endothelial cells and paracrine cytokines with different functions. Current research focuses on two cell types, adipose derived stem cells and bone marrow mesenchymal stem cells, both of which have their own advantages and disadvantages, mainly reflected in the therapeutic effect of stem cells, the difficulty of obtaining stem cells and the content in vivo. In addition, stem cells can also play a synergistic role in combination with other treatments, such as conservative treatment, surgical intervention, cytokines, biological scaffolds, and so on. However, it is still limited to the basic research stage, and only a small number of studies have completed clinical trials.@*CONCLUSION@#Stem cells have great transformation potential in the treatment of lymphedema, but there is no unified standard in the selection of cell types, the amount of transplanted cells, and the timing of transplantation.

Advances in treatment of lymphedema with supraclavicular vascularized lymph node transfer / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of supraclavicular vascularized lymph node transfer (VLNT).@*METHODS@#The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized.@*RESULTS@#The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction.@*CONCLUSION@#There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.

Effectiveness of tibial transverse transport combined with modified neurolysis in treatment of diabetic foot ulcers / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study.@*METHODS@#The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated.@*RESULTS@#All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05).@*CONCLUSION@#Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.

Research progress in nipple projection reconstruction based on tissue graft support / 中国修复重建外科杂志

OBJECTIVE@#To review the advances in methods for reconstructing nipple projection based on tissue graft support.@*METHODS@#The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results.@*RESULTS@#Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique.@*CONCLUSION@#There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.

Effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap harvested from superficial and deep layer of the superficial fascia / 中华显微外科杂志

Objective:To compare the effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap(ALTPF) harvested from superficial and deep layer of the superficial fascia.Methods:A retrospective analysis was performed on 31 patients who had small-and medium-sized soft tissue defects in the extremities and admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2020 to February 2021. All the patients were repaired with ALTPFs. The sizes of defect ranged from 5.0 cm×3.5 cm to 17.0 cm×6.0 cm, and the flaps sized from 6.0 cm×4.0 cm to 20.0 cm×6.0 cm. Fifteen ALTPFs were harvested from superficial layer of superficial fascia (modified group), and 16 harvested from deep layer of superficial fascia (traditional group). The flap donor sites were sutured directly using the "Zunyi suture method". Appearance of scars was assessed within the Vancouver Scar Scale (VSS) and in addition the width of scars was been recorded. The data of the 2 groups were statistically analyzed. There was statistically significant difference when P<0.05. Results:All flaps were successfully viable. All wounds healed in Ⅰ stage and donor incisions healed in Ⅰ stage at 2-3 weeks after the surgery. All patients entered postoperative follow-up for 6 to 26 months, with a mean of 10.7 months. There was no ischaemic necrosis at the donor margin. There was no significant difference between circumference of thighs between the modified group and traditional group [ (0.10±0.40) cm and (0.03±0.39) cm, respectively]( P>0.05). VSS were found lower in the modified group (2.00±1.46) than that in the traditional group (3.06±1.61)( t=2.132, P=0.039), as well as the scars were found smaller at the widest point[(6.67±3.85) cm and(16.06±6.63) cm, respectively. t=2.807, P=0.005]. The differences were statistically significant( P<0.05). Conclusion:Small-and medium-sized ALTPFs, harvested in the superficial layer of superficial fascia, can reduce the width of the donor scar, improve the surgical outcome and increase patient satisfaction.

Repair of diabetic foot ulcer wound by anterolateral thigh chimeric perforator flap / 中华显微外科杂志

Objective:To investigate the clinical effect of the anterolateral thigh perforator chimeric flap in the treatment of the wound of diabetic foot ulcer (DFU) .Methods:From January, 2018 to December, 2019, 14 cases wound of DFU of type II diabetic were treated by anterolateral thigh chimeric perforator flap. The patients were 10 males and 4 females, at 49 to 58 years old. Of the 14 patients, 10 with simple peripheral neuropathy, 4 with peripheral neuropathy complicated with vascular disease, and none with single vascular disease. With strict control of patients' blood glucose, antibiotics blended bone cement was applied or filled onto grade 2 or higher grade Wagner's DFU after debridement. In addition, the anterolateral thigh chimeric perforator flap was transferred 2 to 3 weeks later. The size of flap was 8 cm×3 cm-27 cm×7 cm. Regular followed-up were made after surgery.Results:Thirteen flaps survived in one stage after surgery. The other 1 flap had venous vascular crisis, and survived completely after active exploration. The patients were followed-up for 6-12 months. All the flaps survived well in good shape and texture. The donor and recipient areas healed well. The functional recoveries of the DF were satisfactory.Conclusion:Application of anterolateral thigh perforator chimeric flap in repair of the refractory wound of DF achieves a good clinical outcome and effectively improves the life quality of patients.

Selection strategy of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair / 中华整形外科杂志

Objective@#To provide clinical guidance for clinical selection, through retrospective analysis for the advantages and disadvantages of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair.@*Methods@#From July 2016 to January 2018, 89 cases were repaired with superficial iliac circumflex artery or lateral femoral circumflex artery perforator flap, including 32 cases of superficial circumflex iliac artery perforator flap, 18 cases of upper limb, 6 cases of face and neck, and 8 cases of lower extremity. There were 52 cases of lateral circumflex femoral artery perforator flap, 21 cases of upper limb, 2 cases of neck, 3 cases of trunk, 26 cases of lower extremity, 5 cases of superficial circumflex iliac artery perforator flap combined with lateral femoral circumflex artery perforator flap, 3 cases of upper limb and 2 cases of lower extremity. The perforators of superficial circumflex iliac artery or (and) lateral circumflex femoral artery were detected by portable Doppler flow detector before operation. According to the wound size, the superficial circumflex artery perforator flap or (and) lateral circumflex femoral artery perforator flap was or (were) designed and resected. End-to-end or end-to-side anastomosis was performed in vascular pedicle. In the combined resection group, the end-to-end or end-to-side anastomosis of the perforator of the lateral circumflex thigh artery was performed, and the pedicled part of the superficial circumflex iliac artery was used for supercharging.@*Results@#All the flaps survived successfully except one combined flap had tip necrosis on the superficial iliac circumflex artery perforator flap part. and healed after 2 weeks of dressing change. Venous crisis occurred on the first day after operation of superficial iliac circumflex artery perforator flap in 1 case.10 cases of lateral femoral circumflex artery perforator flap were slightly bloated and 3 cases returned to hospital for secondary thinning. All the flaps were soft in texture, satisfactory in shape and function, and numbed in the small area of the donor region of the perforator flap of lateral femoral circumflex artery in the early stage. All the patients had no severe complications after follow-up.@*Conclusions@#The perforator flap of superficial iliac circumflex artery and lateral femoral circumflex artery are ideal donor areas for wound repair. The perforator flap of superficial iliac circumflex artery is preferred for small area wound, hand wound and small bone defect. Lateral circumflex femoral perforator flap is suitable for all trunk and limbs with large or complex wounds.

Clinical study on the design scheme of the anterolateral thigh flap with three longitudinal and five transversal methods / 中华整形外科杂志

Objective@#To explore the feasibility of preoperative designing for anterolateral femoral flap using three longitudinal and five transversal strategy.@*Methods@#From September 2015 to January 2017, 71 patients (73 pieces) were treated using anterolateral thigh flap in the Affiliated Hospital of Zunyi Medical University. There were 48 males and 23 females, with the age of (36±18) years. The three longitudinal and five transversal designing was performed before operation. Portable Doppler ultrasound was used to detect the piercing-out position (P point) of perforators in Ⅰ, Ⅱ, Ⅲ, Ⅳ areas. The diameter, direction and length (lower subcutaneous segment of perforators) of perforators after leaving piercing-out position were observed during the operation. The piercing-in positions on superficial fascia and the dermis were observed.@*Results@#The data of 71 adults (73 legs) were evaluated. Before and during the operation, all the perforations were found in Ⅰ, Ⅱ, Ⅲ and Ⅳ areas. The number of perforators in region Ⅰ was 1.32±0.33, with the diameter of perforator at the piercing-out position was (0.79±0.13) mm. The length of subfascial segment of perforators was (1.54±0.97) cm, and the direction was oblique superolateral. The number of perforators in Ⅱ region was 1.21±0.53, with the diameter of perforator at the piercing-out position was (0.63±0.13) mm. The length of subfascial segment of perforators was (2.25±0.54) cm, and the direction was oblique inferoanterior. The distance form piercing-in position to line L was (0.84±0.42) cm. The number of perforators in the Ⅲ area was 2.22±0.49, with the diameter of perforators at the piercing-out position was (0.53±0.12) mm. The length of subfascial segment of perforator was (1.96±0.44) cm, and the direction was oblique inferoanterior. The distance between piercing-in positions to line L was (0.74±0.51) cm. The number of perforators in region Ⅳ was 1.41±0.72, with the length of subfascial segment of perforators was (1.22±0.45) cm and the direction was oblique inferolateral. There were 27 cases with oblique perforators, accounting for 37% of the total number of thighs.@*Conclusions@#This three longitudinal and five transversal designing is helpful to detect the expenditure point in the anterolateral femoral region, and is assistant to skin flap designing.

Repair of the defect on midface using perforator flap of facial artery / 中华整形外科杂志

Objective@#To explore the clinical application of facial artery perforator flap in repairing medium-size midfacial defects.@*Methods@#Sixteen patients with facial tumors or trauma were admitted in the Affiliated Hospital of Zunyi Medical University, from October 2017 to March 2018. The patients were 41—74 years of age, including 8 males and 8 females. The tissue defects were caused by basal cell carcinoma(BCC, n=10), trauma (n=4), and squamous cell carcinoma (SqCa, n=2). The size of tumor and trauma ranged from 0.3 cm×2 cm to 2 cm×4 cm. Patients with skin tumors undergone extended radical resection, according to the nature of the tumor. Debridement was performed routinely in patients with trauma. Facial artery perforator flap was designed based on the size and shape of defect area. The scar of donor site was as parallel or hidden in the nasolabial groove. The perforator branch of the lateral nasal artery was used as the pivot point, to cover the wound surface without tension. The ipsilateral secondary relay flap pedicled with the perforator of the nasal artery was designed, which was in triangular shape and slightly larger in size than the primary flap. The pedicle was located in the middle of the flap, then the flap was pushed to cover the donor site of primary flap. The postoperative results were evaluated by patients.@*Results@#All primary and secondary relay skin flaps survived. The follow-up period of the first stage was 3—12 months, with an average of 7.5 months. There was no obvious scar, no eyelid eversion or angular deviation, and no recurrence of tumor was observed. The primary and secondary flaps have similar appearance and matched color with normal skin. Ten patients were very satisfied with the surgical outcome, and 6 were satisfied, at the latest follow-up.@*Conclusions@#The facial artery perforator relay skin flap is an alternative method to repair medium facial defect.

Effects of adipose-derived mesenchymal stem cells from type 2 diabetes mellitus patients on wound healing of pressure ulcers in mice / 中华烧伤杂志

To investigate the effects of adipose-derived mesenchymal stem cells (AMSCs) from type 2 diabetes mellitus patients on wound healing of pressure ulcers in mice.Methods@#(1) In September 2016, the subcutaneous adipose tissue of a 60-year-old woman with type 2 diabetes mellitus was harvested, and then AMSCs were extracted by collagenase digestion and cultured. The third passage of cells were used for subsequent experiments. The morphology of cells was observed, and their osteogenic, chondrogenic, and adipogenic differentiation abilities were identified. The expressions of cell surface markers CD90, CD105, CD73, and CD34 were detected by flow cytometer (n=3). (2) Sixteen female C57BL/6 wild-type mice aged 6-8 weeks were selected, and one pressure ulcer wound was created on each side of the spine of each mouse by pressing the skin with two magnets. The two wounds of each mouse were paired and divided into diabetic AMSCs group and negative control group, injected with 100 μL phosphate buffer solution (PBS) containing green fluorescent protein-labeled AMSCs (1×106 cells) and 100 μL PBS, respectively. The wound healing status of the two groups within post injection day (PID) 21 was observed, and their wound healing rates on PID 5, 13, and 17 were calculated. Three mice were sacrificed on PID 11 and 21, respectively, and tissue of three wounds was harvested from each group. The skin structure was observed by hematoxylin-eosin staining, the collagen deposition was evaluated by Masson staining, and the positive expression of CD31, i. e., the number of new blood vessels was counted by immunohistochemistry. Wound tissue samples of two groups prepared on PID 21 as above-mentioned were harvested, and the positive cell rate of S100, representing the regeneration of Schwann cells, was detected by immunohistochemistry. Wound tissue samples of diabetic AMSCs group prepared on PID 11 as above-mentioned were harvested, and the colonization of AMSCs was observed by fluorescence tracer method. Data were processed with paired t test and Bonferroni correction.@*Results@#(1) The third passage of cells isolated and cultured from the subcutaneous adipose tissue of a type 2 diabetes mellitus patient grew adherently to the wall in a long spindle and vortex-like manner. After induction, the cells showed osteogenic, chondrogenic, and lipogenic differentiation abilities. The positive expression rates of CD90, CD105, and CD73 on the cell surface were higher than 90.00%, and the expression rate of CD34 was 0.46%. The cells were identified as AMSCs. (2) The mice wounds of diabetic AMSCs group healed quickly, and all the wounds healed completely on PID 17, while the mice wounds in negative control group were not completely closed at this time, and there was still scab on the surface. On PID 5, 13, and 17, the healing rates of mice wounds of diabetic AMSCs group were (35.6±6.5)%, (87.1±2.5)%, and 100.0%, respectively, significantly higher than (19.8±7.2)%, (66.2±5.2)%, and (86.9±5.3)% of negative control group (t=6.49, 14.31, 9.73, P<0.05). Compared with that of negative control group, the inflammatory cell infiltration was reduced in mice wounds tissue of diabetic AMSCs group on PID 11, and thicker epidermis and dermis as well as regenerated skin appendages were observed on PID 21. On PID 11 and 21, the collagen percentages of mice wounds tissue in diabetic AMSCs group was (48.3±1.3)% and (54.1±1.7)%, respectively, significantly higher than (41.4±1.7)% and (50.3±1.2)% of negative control group (t=6.98, 3.99, P<0.01). On PID 11 and 21, the numbers of new blood vessels in mice wounds tissue of diabetic AMSCs group were 17.2±1.3 and 18.0±2.1, respectively, significantly more than 8.0±1.4 and 14.0±1.5 of negative control group (t=10.69, 3.38, P<0.01). On PID 21, the S100 positive cell percentage in mice wounds tissue of diabetic AMSCs group was (1.76±0.12)%, significantly higher than (0.55±0.03)% of negative control group (t=21.68, P<0.001). On PID 11, the colonization of AMSCs in mice wounds tissue of diabetic AMSCs group was observed.@*Conclusions@#Transplantation of AMSCs from type 2 diabetic mellitus patients can accelerate wound healing of pressure ulcers in mice by promoting angiogenesis, collagen deposition, and Schwann cell regeneration.

Effect of human adipose-derived stem cells on pressure ulcer healing in mouse / 中国修复重建外科杂志

Objective: To investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse. Methods: The subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups ( n=15). The wounds were injected with 100 μL of hADSCs (1×10 6 cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day. Results: The cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group ( t=5.781, P=0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group ( P<0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group ( P<0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days ( P<0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection. Conclusion: Local transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.

Advances in the research of influence of diabetes in biological function of adipose-derived stem cells / 中华烧伤杂志

Adipose-derived stem cells (ADSCs) are adult mesenchymal stem cells in adipose tissue with self-renewal and multi-directional differentiation potential. The application of ADSCs in the treatment of wounds has achieved good results. Because of its extensive sources, high content in vivo, low immunogenicity, slight injury to body when obtained, the clinical application prospect of ADSCs is promising. The reasons why diabetic wound is difficult to heal may be closely related to the increase of advanced glycation end products, long-term chronic inflammatory response, and peripheral neurologic dysfunction. The abnormal internal environment of diabetic patients can affect the biological function of ADSCs, which further affects wound healing. This article reviews the general feature, differentiation, proliferation, migration, secretion, and pro-angiogenic function of diabetic ADSCs.

Effects of local transplantation of autologous adipose-derived stromal vascular fraction on the hyperplastic scar formation in rabbit ears and the mechanism / 中华烧伤杂志

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.

Use propeller perforator flap to repair the skin malignancies wound on the back of the shoulder / 中华显微外科杂志

Objective To discuss the therapeutic effect of free perforator flap of the humeral back and the healing of the wound after the removal of the malignant tumor.Methods From January,2012 to June,2016,12 cases were treated as soft tissue tumors on shoulder,including 8 cases of skin juga fibrosarcoma,3 cases of basal cell carcinoma,squamous cell carcinoma of the skin in 1 case.Preoperative using doppler ultrasound probe design perforator flap to expand resection,intraoperative cut edge basal tag frozen pathological examination without taking skin flap after the tumor invasion,according to the wound and wear the appropriate adjustment design of perforator flap.Followed-up to observe recurrence,flaps or ulcers,and the texture of the flap and the feel of the flap.All patients were followed-up regularly.Results All 12 patients were followed-up for 6-48 months.The flaps were all alive.The tumor did not relapse,and the flap was not swollen.The texture was consistent with the surrounding tissue.There was no ulceration of the flap.No obvious depression deformity.The outlook of flaps was satisfied,but the feeling was not.The doror sites were closed directly.Conclusion Adjacent using humeral back free perforators flap to repair the defect after tumor resection on shoulder is an easy operation.It is one of the ideal flaps to repair a malignant tumor on the back of the shoulder.

Clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle / 中华烧伤杂志

Objective@#To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle.@*Methods@#Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm×4 cm to 23 cm×10 cm. Patients were treated with debridement and vacuum sealing drainage (VSD) after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroneal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm×5 cm to 25 cm×12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side.@*Results@#After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well.@*Conclusions@#Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.

The optimization of propeller flap with low peroneal artery perforator for defects at ankle and heel / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of propeller flap with low peroneal artery perforator for defects at ankle and heel.@*Methods@#From January 2009 to March 2016, 28 cases with skin defects at ankle and heel were treated with propeller flap pedicled by low peroneal artery perforator, including 15 cases of car accidents, 8 cases of pressure injury, 3 cases of wring injury and 2 cases of electricity shock injury. Defects size ranged from 3 cm×3 cm to 4 cm×6 cm. The fibular was divided into 9 segments from head to external ankle. Doppler ultrasound was used to locate the low peroneal artery perforator from the lower 6-9 segments. The flap pivot point was at perforator point at skin surface, with the peroneal artery as flap axis. The length of big blade was the distance from rotate point to distal end of defects. The flap width was half of the length. The ratio of big blade length to width should not exceed 2∶1. The flaps size was from 3 cm×5 cm to 4 cm×10 cm, based on the defect size. The defects at donor site could be closed with small blade directly.@*Results@#Partial necrosis happened in 1 case due to veneous crisis, which healed after dressing. All the other 27 flaps survived completely. During the follow-up period, the flaps had good match in color and thickness. No secondary operation was needed.@*Conclusions@#The optimization of propeller flap with low peroneal artery perforator is an idealmethod for defects at ankle and heel, which can avoid the necrosis at distal end of flap.

Free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area / 中华整形外科杂志

Objective@#To investigate the feasibility and efficacy of free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area.@*Methods@#From January 2008 to June 2016, 28 cases with foot and ankle skin and soft tissue defects at non-weight bearing area were treated, including 16 cases with traffic accident, 8 cases with machine injury, and 4 cases with falling injury. There were 10 cases with Achilles tendon exposure, 16 cases with dorsalis pedis tendons exposure and 12 cases with bone exposure. The defect size ranged from 10 cm×8 cm to 16 cm×13 cm. Doppler ultrasound detector was used to select two perforators of lateral femoral circumflex artery. The lobulated perforator flap was designed and harvested as one flap. After clip test was performed to make sure the blood supply of flap, the flap was segmented and repositioned to cover the wound. The width of lobulated flaps was less than 8cm, in order to close the defect at donor sites directly. Postoperative rountine anti-inflammatory, anticoagulant, anticonvulsive treatment and function exercise were adopted. The patients were followed up for 6-28 months.@*Results@#The flap size ranged from 9.0 cm×4.5 cm to 17.0 cm×7.0 cm. Partial necrosis happened at the end of one flap lobe due to pressure, which healed after dressing. All the other 27 flaps survived completely with satisfactory cosmetic and functional result. The wounds at donor sites all healed primarily.@*Conclusions@#Free lobulated lateral circumflex femoral artery perforator flap is one of the ideal flaps with high survival rate and low complication for foot and ankle defect at non-weight bearing area.

Recontruction of facial aesthetic subunit with kite flap after resection of benign tumor at supraorbital ridge / 中华整形外科杂志

Objective@#To investigate the recontruction of facial aesthetic subunit with kite flap after resection of benign tumor at supraorbital ridge.@*Methods@#From June 2012 to September 2015, 12 cases(8 male and 4 female, aged 34-68 years) with benign tumor at supraorbital ridge underwent tumor resection, following by reconstruction with kite flap. The tumor size ranged from 0.3 cm×1.0 cm to 0.5 cm× 1.0 cm, and the defects size ranged from 0.5 cm× 1.2 cm to 0.8 cm×1.2 cm. The kite flaps were 0.6 cm×1.2 cm to 1.0 cm×1.5 cm.@*Results@#All the 12 flaps survived completely with primary healing and no complication. The scar was inconspicious, which was hidden into brows. The brows showed good symmetric cosmetic effect.@*Conclusions@#The kite flap has reliable blood supply and survival rate, which does not affect the brows symmetry. Aesthetic result can be achieved by Kite flap in the reconstruction of defect after resection of benign tumor at supraorbital ridge.

Application of anterolateral thigh free flap with multiple perforators descending from lateral circumflex femoral artery in reconstruction of complex defects of children extremities / 中华显微外科杂志

Objective To investigate the application of anterolateral thigh (ALT) free flap preserving multiple perforators descending from lateral circumflex femoral artery (LCFA) in reconstruction of complex defects of children extremities.Methods From January,2016 to January,2017,7 children admitted with soft tissue defects were reconstructed with ALT free flap preserving multiple perforitors descending from LCFA.According to body surface projection and distribution patterns of perforators descending from LCFA,preoperative portable Doppler was used to localize these perforators.Fascia lata harvest was spared for those without ligament and articular joint reconstruction.Defects and fascia lata was closed primarily.All patients were followed up at regular intervals.Results Follow-up period was 3-9 months(mean,6.5 months.Follow-up methods include on-site follow-up,wechat follow-up,telephone follow-up,etc.).The color of ALT flaps was normal.The texture of ALT flap was good.The linear scar in donor sites was found.The paresthesia around incision in donor sites was complained of.Postoperative appearance and function of injured limbs was satisfactory.Conclusion Design of Unipaddled or multipaddled ALT free flap with multiple perforators descending from LCFA is flexible.Perforators are thick and consistent.ALT flap with multiple perforators descending from LCFA is an ideal one to be used in reconstruction of complex soft tissue defects.

Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger.</p><p><b>METHODS</b>Thirteen patients with skin and soft tissue defects at distal end of 13 fingers were hospitalized from September 2013 to January 2015. After debridement, the wound area of finger ranged from 1.2 cm × 0.8 cm to 1.8 cm × 1.5 cm. Serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger were used to repair the defect. The flaps were interruptedly sutured. The areas of bilaterally pedicled V-Y advancement flap and serrated flap with digital proper artery and nerve pedicle ranged from 0.52 to 1.11 and 2.60 to 5.23 cm(2,) respectively.</p><p><b>RESULTS</b>All flaps of 13 patients survived completely. The patients were followed up for 6 to 24 months. The color and texture of the flaps were good. After reconstruction, the finger tips were in round in shape. The appearance of the fingers was consistent with that of the normal fingers, and joint motility was normal. No hook-nail deformity or knuckle dysfunction was found. Sensation of the flaps was estimated as S4, and the distance of two-point discrimination ranged from 2 to 3 mm. The recovery of the joint motion function of the fingers was excellent.</p><p><b>CONCLUSIONS</b>Serrated flap with digital proper artery and nerve pedicle, combined with bilaterally pedicled V-Y advancement flap from the injured finger can repair the skin and soft tissue defects at distal end of finger with reliable blood supply and simple operative technic. It also could avoid the formation of deformity subsequent to a linear scar, and a satisfactory appearance with good function could be obtained.</p>