Repair of inframammary scars with expanded skin flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate suitable treatment method for contracture of inframammary scars.</p><p><b>METHODS</b>Nine female patients with contracture of inframammary sear hospitalized in our hospital from July 2000 to July 2007 were subjected to skin expansion around the breast. The sites of incisions were mainly located on the inframammary scars. The expanders were placed around the breast and middle chest near the sternum. On the lateral side of chest, the expander should be inserted at the site parallel to upper level of the breast. The expanders should be placed under deep fascia and superficial to the gland. At II stage of operation, the scars were excised and the subcutaneous tissues should be thoroughly loosened to assure that the soft tissue and mammary gland would be restored to its anatomical position. Expanded skin was then designed as advancement or transposition flaps to repair the defects, or effects were closed with suturing.</p><p><b>RESULTS</b>Blood circulation disturbance occurred at the tip of a flap in one patient, with the size of 4.0 cm x 3.0 cm, and the resulting wound healed after skin grafting. Flaps in the other 8 patients survived, and the wounds healed satisfactorily. Nipples and mammary areola were successfully restored to the anatomical positions. Three patients were followed up for 6 months to 2 years, and the result was satisfactory.</p><p><b>CONCLUSIONS</b>Expanded flap is feasible for repairing contracture of inframammary scar and with good result.</p>

Study on the effect of CD4+CD25+ regulatory T cell adoptive transfusion on humoral immune function in rat composite tissue allotransplantation model / 中华外科杂志

<p><b>OBJECTIVE</b>To approach the effect of the donor antigenic specificity CD4+CD25+ regulatory T cell (Treg) on cellular immune tolerance function in rat composite tissue allotransplantation (CTA).</p><p><b>METHODS</b>Use the method of immunomagnetic beads to separate CD4+CD25+ Treg, (1 x 10(6))CD4+CD25+ Treg was transfused to rat CTA model. Collected peripheral blood 30 days after operation, and used nylon wool column to separate B cell and T cell. With the stimulation of IgM, detected B cell proliferation and the level of IgG and IgA in serum. Observed the effect of CD4+CD25+ Treg on B cell and T cell function and the survival of allotransplants, and analyzed the data by statistics.</p><p><b>RESULTS</b>The purity of separated CD4+CD25+ Treg was 95.6%. The CPM of T cell of normal control group, topical intervention group, systemic intervention group and non-intervention group were (2436 +/- 358), (2273 +/- 136), (2338 +/- 228) and (3749 +/- 245). The CPM of B cells of normal control group, topical intervention group, systemic intervention group and non-intervention group were (2418 +/- 348), (2252 +/- 127), (2315 +/- 218) and (3720 +/- 224), there was a significant difference in these groups (P < 0.01). The serum level of IgG and IgA of topical intervention group and systemic intervention group were (12.56 +/- 1.30), (2.38 +/- 0.21), (13.48 +/- 1.23) and (2.86 +/- 0.24) g/L, and of normal control group was (12.35 +/- 1.28), (2.36 +/- 0.12) g/L, had no significant difference (P > 0.05). But Treg of non-intervention group was (16.58 +/- 1.12), (3.75 +/- 0.37) g/L, there was a significant difference in the non-intervention group and the three above groups (P < 0.01). The survival time of CTA in intervention of local and systemic groups were (97 +/- 13) and (63 +/- 10) d, which were significant longer than the non-intervention group [(22 +/- 8) d, P < 0.01].</p><p><b>CONCLUSIONS</b>Donor antigen specific CD4+CD25+ Treg has significantly inhibited B cell and T cell function. It can induce immune tolerance and extend the survival time of CTA; as well local application is better than systemic.</p>

Expanded deltopectoral flaps for treatment of cervical cicatricial contracture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of expanded deltopectoral flaps for treatment of cervical cicatricial contracture.</p><p><b>METHODS</b>The cervical cicatricial contracture was corrected in 18 cases with unilateral expanded deltopectoral flaps and 2 cases with bilateral expanded deltopectoral flaps. The size of scar ranged from 8 cm x 5 cm to 12 cm x 13 cm. The size of the unilateral expanded deltopectoral flaps ranged from 9 cm x 16 cm to 12 cm x 18 cm. The defects in donor sites were closed directly. The infraclavicula incision was designed. The flaps were delayed 3 weeks after flap transfer. The pedicle was cut off 4 weeks later.</p><p><b>RESULTS</b>From 2007 to 2009, 20 cases with cervical cicatricial contracture were treated with expanded deltopectoral flaps. All the flaps were survived. 6 cases were followed up for 6 months with satisfactory results in 5 cases and conspicuous scar in 1 case.</p><p><b>CONCLUSIONS</b>Expanded deltopectoral flap is very suitable for large size of cervical cicatricial contracture.</p>

Repair of facial and cervical scars with expanded deltopectoral flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods for repair of facial and cervical scars after burn.</p><p><b>METHODS</b>One hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later.</p><p><b>RESULTS</b>Among 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting.</p><p><b>CONCLUSION</b>Expanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars.</p>

Effect of METH1 gene transfection on the proliferation of rabbit's ear scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of METH1 gene transfection on fibroblast proliferation and I, III collagen synthesis in rabbit ear scar.</p><p><b>METHODS</b>The hypertrophic scar model on the rabbit ears was reproduced. 10 days after epithelization, Ad-METH1 was injected into the scar tissue. 30 days later, the effect of METH1 gene transfection on the angiogenesis, fibroblast proliferation and the ratio of collagen I/III in the scar tissue was detected by microcirculation microscope, AgNOR particle count and collagen dyeing.</p><p><b>RESULTS</b>30 days after injection of Ad-METH1, angiogenesis, fibroblast proliferation and the ratio of collagen I/III in the scar tissue were obviously suppressed.</p><p><b>CONCLUSION</b>Early application of Ad-METH1 after epithelization can markedly inhibit the formation of the hypertrophic scar.</p>

A new model of skin avulsion injuries in rats / 中华整形外科杂志

<p><b>OBJECTIVE</b>To create a stable and reliable model of skin avulsion in rats.</p><p><b>METHODS</b>30 male, SD rats were randomly divided into axial pattern skin flap (9 cm x 3 cm) group and random pattern skin flap group (6 cm x 4 cm), each having the control groups and avulsion groups. Flaps were subjected to avulsion force of 6 kg in axial pattern skin flaps or 8 kg in random pattern skin flaps, and the lasting time was 8 s or 12 s, respectively. Retraction of wounds and necrosis of skin flaps were observed.</p><p><b>RESULTS</b>There was more significant wound retraction in avulsion groups than that in control groups on post-operation day 7 (P < 0.05). The proportion of the wound retraction increased by 1 fold in avulsion groups on post-operation day 14 as compared to post-operation day 7 (P < 0.01). Interestingly, necrosis of partial or most of skin flaps was observed in all animals of avulsion groups, while slight necrosis happened in one of six in control animals. The necrosis area of flaps was 38% - 77% when avulsed for 8 s, and was 40% - 80% when avulsed for 12 s in axial pattern skin flaps. However, the necrosis area in random pattern skin flaps was smaller than that in axial pattern skin flaps, from 17% - 40% when avulsed for 8 s to 24% - 43% when avulsed for 12 s.</p><p><b>CONCLUSIONS</b>It might be possible to create animal model of skin avulsion injuries with rats.</p>

Expanded skin flaps for the treatment of large scalp and face scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method to repair large scalp and face scars.</p><p><b>METHODS</b>1-3 expanders under the scalp were needed for repair the scalp scar. The expanded deltopectoral flaps were transferred to repair the face scar.</p><p><b>RESULTS</b>12 cases were treated with satisfactory results. All the flaps survived and the donor sites were closed primarily. 2 cases had expander exposure which didn't affect the treatment results. Atrophic cutaneous striae was occurred because of overexpansion.</p><p><b>CONCLUSIONS</b>Skin expansion is a good method for large scalp and face scar.</p>

Expression and significance of Ang1, Ang2 and receptor Tie2 in hemangioma / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship of angiogenesis and the Ang family members/ receptor (Ang/Tie2) in hemangioma.</p><p><b>METHODS</b>Expression of Ang1, Ang2 and the receptor Tie2 was detected with immunohistochemical SP method and RT-PCR method in 17 cases of proliferating hemangioma, 13 involuting cases and 10 cases of normal children skin.</p><p><b>RESULTS</b>The expression of Ang2 and Tie2 was higher markedly in proliferating hemangiomas than in involuting hemangiomas (P < 0.01), and was rare or negative in normal skin. Expression of Ang1 was rare or negative both in hemangioma and normal skin without significant difference between them (P > 0.05).</p><p><b>CONCLUSION</b>Ang/Tie2 system may play an important role in the proliferating and involuting process of hemangioma.</p>

Signal roles of protein tyrosine kinase in transforming growth factor-beta1, or interferon-gamma regulated proliferation and collagen synthesis by fibroblasts from hypertrophic scar and normal dermis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the signal roles of protein tyrosine kinase (PTK) on proliferation and collagen synthesis of fibroblasts derived from hypertrophic scar(HS-FB) and normal skin (NS-FB) by interferon-gamma (IFN-gamma) or transforming growth factor beta1 (TGF-beta1).</p><p><b>METHODS</b>HS-FB and NS-FB were cultured and passaged in Dulbecco's modified Eagle's medium(DMEM). The PTK activity in unstimulated or IFN-gamma or TGF-beta1-stimulated HS-FB and NS-FB (10,30,60 and 120 min) were assayed by phosphorus (32P) incorporation. Cell proliferation was determined with MTT stain. The type III procollagen was measured by radioimmunoassay.</p><p><b>RESULTS</b>TGF-beta1 did not change PTK activity but it increased predominately proliferation and collagen synthesis of HS-FB and NS-FB in time-dependent fashion. Genistein, an inhibitor of PTK, inhibited HS-FB and NS-FB to proliferate and synthesize collagen but it could not change the roles on proliferation and collagen synthesis by TGF-beta1. IFN-gamma activated transiently PTK (P < 0.05) and increased proliferation and collagen synthesis of both fibroblast (P < 0.05, at 30 min, 60 min). As the recovery of PTK activity, the proliferation and collagen synthesis were inhibited by IFN-gamma at 120 min. Furthermore, Genistein abrogated the transient increased roles and partly reversed the longterm inhibitory functions by IFN-gamma (P < 0.05) . There were no difference on PTK activity, proliferation and collagen synthesis between HS-FB and NS-FB.</p><p><b>CONCLUSIONS</b>PTK did not mediate the signal of TGF-beta1 but transduced the signal of transient increased roles of IFN-gamma. Inhibited or activated PTK might mediate the signal of decreasing or increasing proliferation and collagen synthesis of fibroblast.</p>

Management of severe postburn scar contracture in the lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience in the management of severe postburn scar contracture in the lower extremities.</p><p><b>METHODS</b>The scars in popliteal fossa and ankle joint were excised. Traction and skin grafting were employed in the management of contracture deformity in these areas.</p><p><b>RESULTS</b>Severe postburn scar contracture deformity in sixty postburn patients could be corrected by constant traction and skin grafting.</p><p><b>CONCLUSION</b>Scar excision and lysis with constant traction might be an optimal method in the management of severe postburn scar contracture deformity of joints in the lower extremities and satisfactory results could be obtained without tendon grafting and elongation.</p>

Cloning of human angiogenesis inhibitor METH1 and its expression in mammalian cells / 中华整形外科杂志

<p><b>OBJECTIVE</b>To get the full length of human METH1 cDNA and express it steadily in mammalian cell stably.</p><p><b>METHODS</b>METH1 was amplified by RT-PCR, and cloned into pCDNA3.0 after confirmed by sequence analysis. HepG2 cells were transfected by Lipofectamine reagent and then selected in medium with G418. The expression level of METH1 was detected by RT-PCR and Western blot.</p><p><b>RESULTS</b>METH1 with expected length was effectively amplified, and completely matched the published sequence of encoding mature peptide [GI:5725505] as shown by sequence analysis. Eukaryotic vector expressing METH1 was obtained by gene cloning, cells expressing METH1 was got by selection with G418 at 3 weeks after transfection. RT-PCR and Western blot showed high level expression of METH1.</p><p><b>CONCLUSION</b>Full length of human METH1 gene is cloned successfully and expressed in HepG2 steadily, The results set up a basis for the study of effects of METH1 on hypertrophic scar angiogenesis.</p>

The design of the expanded flap for the repair of the temporal and cheek area / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the design of an expanded flap at the temporal and cheek area.</p><p><b>METHODS</b>The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision. In the frontal area, the rotational flap was usually used. For the repair of the cheek, the applied flap included the rotational, advanced, and transposition flap from the neck, as well as the pedicle flap from the thoracic area.</p><p><b>RESULTS</b>Eight thoracic-deltoid flaps had distal necrosis of 1 approximately 5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0.5 approximately 1 cm. Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases (6.62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases.</p><p><b>CONCLUSIONS</b>According to our experience, careful design of the flap is very important for obtainingbetter surgical results and decreasing complications.</p>

Systemic influence after an island flap with venous congestion-reperfusion injury / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the systemic influence after an island flap with venous congestion-reperfusion.</p><p><b>METHODS</b>An island flap was formed in a Rat model. The vein in the pedicle was clamped for 2 hours, 6 hours and 10 hours and released. The ear microcirculation, levels of TNF alpha and IL-10 were measured, and the neutrophils sequestration in tissues were counted. The vascular structure of the lung and intestine were evaluated.</p><p><b>RESULTS</b>There were significant changes in the ear microcirculation, neutrophils sequestration of the lung and the intestine in the 2 hours, 6 hours and 10 hours groups, and became more serious by the time increasing. The TNF alpha level reached in maximum at 1 hour after the reperfusion, while the IL-10 became to the lowest level at 3 hours after the reperfusion. However, the TNF alpha and IL-10 levels were significant high in the 6 hour and 10 hours groups, compared with the 2 hours group and the control, but there was no differences between the2 hours group and the control.</p><p><b>CONCLUSIONS</b>Venous congestion-reperfusion of flap could injury the remote organs such as lung, intestinal etc. The injury could be more serious with the time increasing.</p>

Local application of bFGF and sucralfate during continuous tissue expansion / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of local application of bFGF and sucralfate during continuous tissue expansion (CTE).</p><p><b>METHODS</b>CTE combined with local administration of bFGF and sucralfate was used in twelve patients with scar and nasal tip defects. Twenty three expanders were placed in the subcutaneous pockets through intralesion short incisions. Continuous expansion began at 1-3 days after expander implantation. The histomorphological changes and epidermal cell proliferation were observed. The clinical results were investigated.</p><p><b>RESULTS</b>The average inflation time was 8.9 days. The average interval of the two operations was 13.5 days. The average hospitalization was 28.4 days. The average immediate stretch-back rate of the expanded skin was 25.7%. The clinical results were satisfactory without any complications. Histological examinations showed that the epidermal, granular and spinous layer became thicker. The basal cells increased significantly. The dermis thinned slightly and the collagen fibers became thicker. The elastic fiber regenerated significantly. Fibroblast and capillary density increased obviously. The immunohistochemistry analysis showed that the proliferation of epidemic basal cells was significant postoperatively.</p><p><b>CONCLUSION</b>Local application of exogenous bFGF and sucralfate during CTE was feasible in patients. It could accelerate tissue expansion and improve the quality of expanded skin flap.</p>

Modulation of the neutrophil died process-mechanisms of the flap protection from ischemia-reperfusion with dexamethasone / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the modulation of neutrophil apoptosis and necrosis, elucidate the protecton mechanisms of dexamethasone.</p><p><b>METHODS</b>50 rats were divided into 5 groups. I: normal island flap. II: artery occlusion for 8 hours, saline given into peritoneal. III: venous occlusion for 8 hours, saline given into peritoneal. IV: artery occlusion for 8 hours, dexamethasone injected through peritoneal. V: venous occlusion for 8 hours, dexamethasone injected through peritoneal. Flap survived areas were measured, neutrophil apoptosis and necrosis values were ananlyzed with FCM. Their morphology were observed with light microscopy. The swallows of apoptotic neutrophil by mascrophages were studied with transmission electron microscopy.</p><p><b>RESULTS</b>Flap survived areas I, IV and V groups were higher than that in II and III groups, which in I, IV, V had no significant values. Apoptotic neutrophils values in II and III groups on 1, 3 days were less than that in, but on 6 days, higher than that in I, IV and V. Necrotic neutrophils showed another tendency postoperatively when compared with its apoptotic values. There were more swallows of apoptotic neutrophils in flaps of IV, V groups than that in II, III flaps.</p><p><b>CONCLUSION</b>Dexamethasone's flap protection results from modulating of neutrophils apoptosis, decreasing it's necrosis, increasing swallowings values of apoptotic neutrophils by macrophages.</p>

The affect of the skin stretch on the biomechanical changes of skin / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the biomechanical changes in skin after employing the skin stretch.</p><p><b>METHODS</b>Skin samples were took from the test group which was stretched for 7 days and control group without stretch respectively in the end of 1, 2, 3, 4, 6, 8 week. The biomechanical index were measured by tensiometer.</p><p><b>RESULTS</b>The mean destroy stress, breaking load, stretch rate of the test group decreased obviously in the first week (the breaking load was increasing at the beginning) and the three index increased subsequently, they reached the climax during the fourth week and turned to normal subsequently to the level of some higher than control group and normal value in the sixth week. The stiffness of the test group reached the climax at the first week and than decreased gradually to the level of some higher than normal value and control group. The biomechanical changes of te control group was not evident by comparing with the test gropu.</p><p><b>CONCLUSIONS</b>Skin stretch may injured the biomechanical property during the early time and turned to normal soon afterwards. The stiffness of the skin was increased and its elasticity was decreased after performing skin stretch.</p>

The effect of bFGF and sucralfate on cell proliferation during continuous tissue expansion / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of local application of bFGF combined with sucralfate on the cell proliferation during continuous tissue expansion (CTE).</p><p><b>METHODS</b>Nine white pigs were selected to undergo the continuous tissue expansion in this study and treated with bFGF and sucralfate, respectively as the following groups: group 1 with both bFGF and sucralfate, group 2 only with bFGF, group 3 with only sucralfate, and group 4 with saline as control. Fifteen samples were taken in each pig for immunohistochemistry analysis 1-14 days and 6 weeks after the operation.</p><p><b>RESULTS</b>In the group with both bFGF and sucralfate, the epidermic basal cells proliferated significantly after the operation and reached top level in 3 days, which was statistical higher than the control group, but the multiplication of basal cell was the lowest 14 days after the operation, still more than the control group. In dermal layer, proliferation of fibroblasts, vessel endothelial cells, hair follicles epidermic cells and sweat gland epicytes was also significant higher in the group with both bFGF and sucralfate than that the control group and reached top level 7 day after the operation, but the proliferation of cells decreased obviously 14 days after the operation, still higher than the control group. The mitotic activity of cells returned to the basal level in 42 days. There were no significant differences among the group 2, group 3 and group 4.</p><p><b>CONCLUSION</b>Local application of both bFGF and sucralfate could be more effect to induce cells multiplication during early skin expansion to facilitate the growth of neoformed skin soft tissue.</p>

Change of expression of P-selectin in avulsion-injured vessels / 中华整形外科杂志

<p><b>OBJECTIVE</b>To determine the change of P-selectin in avulsion-injured vessels.</p><p><b>METHODS</b>Different stretch forces of 60, 70, 80 and 90 g were applied to a vascular injury model. The expression changes of P-selectin were evaluated by RT-PCR.</p><p><b>RESULTS</b>The expression of P-selection mRNA in the injured vessels increased with the stretch force.</p><p><b>CONCLUSION</b>The result associated with our previous study indicated that P-selectin may be involved in thrombosis.</p>

A clinical study of flap necrosis protection with dexamethasone / 中华整形外科杂志

<p><b>OBJECTIVE</b>This clinical study was to find an effective method to prevent flap from necrosis.</p><p><b>METHODS</b>When a flap showed blood flow problems, dexamethasone of 0.3 mg/kg was given intravenously for 2 days. Then the dose was decreased to 0.2 mg/kg at the third and the fourth day. At the fifth and the sixth day, dexamethasone of 0.1 mg/kg was given.</p><p><b>RESULTS</b>A total of 51 flaps with blood flow problems was treated with this method. Thirty of them recovered completely; 18 survived mostly and 3 failed.</p><p><b>CONCLUSION</b>Early application of dexamethasone can effectively ameliorate blood flow problems of the flap.</p>

Significance of detecting TNFα and IL-1 after skin avulsion o f hind leg in pigs / 第三军医大学学报

Objective　To study the role of TNFα in the plasm a and skin and IL-1 in the serum in the formation of secondary thrombosis after skin avulsion. Methods　After avulsive flap at size of 12 cm×4 cm was inflicted on the hind legs of pigs, skin specimens and venous blood sam ples were taken at various time points. The contents of TNFα in plasma and skin were determined with radio-immunoassay, and the activity of serum IL-1 wi th 3［H］-TdR. Results　The TNFα contents in the plasma and skin were increased significantly after avulsion（P<0.01），which were (41 5±24) ng/L and (298±18.5) ng/L respectively on the 3rd day after the injury. T he activity of IL-1 in the serum was increased (P<0.05) and was (2.59± 0.85 ) ng/L on day 3. Conclusion　The changes of TNFα contents and I L-1 activity in blood and skin play important roles in the inducetion and aggra vation of secondary tissue necrosis and early thrombosis after skin avulsion.