Localization and expression of R-cadherin in skeletal muscle following nerve injury.

Rats in which the sciatic nerves were cut were divided into two groups: animals with nerve sutured and animals with nerve not sutured. In the unsutured group, the levels of R-cadherin expression increased and then decreased to values lower than those of controls. In the sutured group, the levels of R-cadherin expression increased and then decreased to almost control values. These results suggest that R-cadherin plays some role in cells of normal and regenerating muscles.

Clinical comparison of the scanning CO2 laser and conventional surgery in the treatment of ingrown nail deformities.

AIM: To compare statistically the clinical effects and postoperative course of the scanning CO(2) laser and conventional surgical method to evaluate the clinical effectiveness of the former for the treatment of ingrown nail deformities. METHODS: We performed vaporization of the nail matrix using the scanning CO(2) laser in 25 cases with ingrown nail deformities. RESULTS: In 21 cases, the recurrence of ingrown nail deformity was not observed during follow-up. All cases were free of postoperative infection. Use of the scanning CO(2) laser reduced postoperative pain, and all patients were able to return to their daily activities by day 3 post-surgery without any problems. CONCLUSIONS: Statistically, the operating time and the duration of postoperative pain were reduced significantly by the scanning CO(2) laser. Furthermore, patients treated with CO(2) laser were able to return to daily life significantly sooner.

Use of facial artery musculomucosal flap for closure of soft tissue defects of the mandibular vestibule.

We present the use of the inferiorly based facial artery musculomucous (FAMM) flap to repair a defect of the mandibular vestibule, and discuss the advantages and disadvantages of this procedure. The FAMM flap an effectively cover defects of the mandibular vestibule and other regions of the oral cavity, and its softness, toughness, and minimal shrinkage allow for the use of dental prostheses.

Molecular response to ischemia-reperfusion of rat skin: study of expression of p53, p21WAF-1, and Bax proteins, and apoptosis.

The authors investigated the expression of p53, p21WAF-1, and Bax proteins, and apoptosis to elucidate the cellular response to ischemia-reperfusion of the skin. The rat left lower limb was dissected at the inguinal region retaining the bone and femoral vessels, and the vessels were clamped to produce an ischemic condition. After 6 hours the clamps were removed, and the plantar skin was resected at various times up to 72 hours after reperfusion. Five skin specimens were obtained at each time point from 5 rats. When a rat died during the study, additional rats were used until five specimens could be obtained from 5 rats at each time point. The expression of the three proteins was detected by Western blot analysis. The apoptotic cells were detected using the terminal deoxytransferase-mediated dUDP nick-end labeling assay. After reperfusion, the levels of p53 and p21WAF-1 were significantly higher in the ischemia-reperfusion rats compared with the sham-operated rats. However, the levels of Bax protein did not show a noticeable increase at any period. The apoptotic cells in both the epidermis and dermis were not evident compared with the sham skin, which were similar to those in the nontreated, normal skin. These results demonstrate that p53 and p21WAF-1 proteins accumulate after 6 hours of ischemia of the skin during reperfusion. Moreover, it is speculated that accumulation of these proteins plays an important role in the survival of the skin by inducing growth arrest of the cells, but not apoptosis.

The differential expression of N-cadherin in vascularized and nonvascularized nerve grafts: a study in a rat sciatic nerve model.

The authors investigated N-cadherin expression in vascularized and nonvascularized nerve grafts using a rat sciatic nerve model. The vascularized and nonvascularized nerve grafts were elevated, and then both nerves were sutured to the original site. At various periods after the operation, the entire graft was removed. N-cadherin expression was detected via Western blot analysis and histochemical staining using anti-N-cadherin antibody. In both grafts, the level of N-cadherin expression increased after the operation, but during postoperative weeks 6, 9, and 12, the level in the vascularized graft was significantly (p = 0.00023, 0.0018, and 0.0010, respectively) higher than that in the nonvascularized graft. At postoperative week 14, the level of both grafts returned to the control level. Histochemical findings showed that N-cadherin was expressed around the regenerated axons in both grafts, and the degree of regeneration was greater in the vascularized graft than in the nonvascularized graft. These results demonstrate that the expression of N-cadherin increases during the process of axonal regeneration in both grafts, and that the degree of the expression is augmented by vascularization of the nerve graft.

Detection of E-cadherin expression after nerve repair in a rat sciatic nerve model.

The authors investigated E-cadherin expression during nerve regeneration after nerve suture using the rat sciatic nerve model. Five rats were used during each postoperative period. E-cadherin expression was detected by Western blot analysis and immunofluorescent staining with an anti-E-cadherin monoclonal antibody. The level of E-cadherin expression was calculated as the amount relative to that found in normal control nerve. The level of E-cadherin expression was decreased at first, and then gradually increased. The maximum level of E-cadherin was 1.92 +/- 0.07 fold in the sutured nerve. The level of E-cadherin expression in the sutured nerve was significantly greater (p < 0.0001) than that of the normal control nerve from postoperative day 3 to 21, and that of sutured nerve returned to the control level by postoperative day 28. The immunofluorescent staining results indicated that E-cadherin expression was almost negative or decreased immediately after the operation, but the degree of expression increased gradually in Schwann's cells. The degree of E-cadherin expression was significantly greater than that of normal control nerves from postoperative day 7 to 14, and returned to the control level by postoperative day 21. These results demonstrate that E-cadherin expression increases during nerve regeneration, and the expression was observed mainly in Schwann's cells. The degree of E-cadherin expression may affect the rate of nerve regeneration.

The difference in E-cadherin expression between nonvascularized and vascularized nerve grafts: study in the rat sciatic nerve model.

BACKGROUND: We investigated the expression of E-cadherin during nerve regeneration after nonvascularized and vascularized nerve grafts. MATERIALS AND METHODS: We used the rat sciatic nerve model. E-cadherin expression was detected by Western blot analysis and immunofluorescent staining with anti E-cadherin monoclonal antibody. The level of E-cadherin expression was calculated as the amount relative to that of E-cadherin expression of normal control nerve. Furthermore, repair of the neural tissue structure was examined by toluidine blue staining. RESULTS: In both cases, the level of E-cadherin expression decreased at first, and then gradually increased. The maximum level was 1.61 +/- 0.066-fold in the nonvascularized nerve graft and 2.254 +/- 0.071-fold in the vascularized nerve graft. From the 1st to the 16th postoperative weeks, the level of E-cadherin expression in the vascularized nerve graft was significantly higher than that in the nonvascularized nerve graft. In the immunofluorescent staining, E-cadherin expression was almost negative or decreased immediately after the operation, but the degree of expression was gradually increased in Schwann cells. The degree of E-cadherin expression in the vascularized nerve graft was greater than that in the nonvascularized nerve graft. In toluidine blue staining, the velocity of tissue repair was more rapid in the vascularized nerve graft than in the nonvascularized graft. CONCLUSION: These results demonstrate that the E-cadherin expression of grafted nerve was increased during the nerve regeneration, and the expression was mainly observed in Schwann cells. Because the level of E-cadherin expression was significantly higher in the vascularized nerve graft than in the nonvascularized nerve graft, the level of E-cadherin expression may affect the rapidity of nerve regeneration.

E-cadherin expression in wound healing of mouse skin.

BACKGROUND: E-cadherin has been studied extensively in other systems but little attention has been paid to its role in wound healing. We investigated E-cadherin expression in epithelial wound healing in vivo by focusing on the migrating cells in the epithelial tongue and the mitotic cells in the non-injured side apart from the original wound edge. METHODS: Round full-thickness excisional wounds (6 mm in diameter) and full-thickness incisional wounds were prepared dorsally in mice. On various days after the operation, E-cadherin expression was examined by immunohistochemical staining using a monoclonal antibody specific for E-cadherin. RESULTS: In both models, the level of E-cadherin expression did not decrease on the 1st postoperative (P.O.) day. After the 2nd P.O. day, E-cadherin expression decreased in cells at a site 500 microm apart from the original wound edge. After the 3rd P.O. day, decreased expression was also observed in cells at the top and in the basal layer of the epithelial tongue. This decreased expression continued for 1 or 2 days after the meeting of the epithelial tongue. There was no significant difference in the expression of E-cadherin between two models. CONCLUSIONS: The results suggested that E-cadherin expression decreases in epithelial cells. This decrease may depend on the activity of migration and mitosis. In addition, the change was similar in both the excisional and incisional wounds.

Lip reconstruction of comparatively large defect including the commissure using remaining lip tissue: a modification of reconstructed method.

We present two reconstructed cases after malignant skin tumor of comparatively large defects of lip including the commissure using remaining lip tissue alone. After resecting a tumor including wedge-shaped full-thickness lip tissue, a full thickness oblique incision is made at the site 5 mm distant from the contralateral commissure. The rhomboid-shaped lower lip flap is created, transposed to the defect, and sutured with the defect margin, including the upper lip, to reconstruct the commissure. The cross lip flap is created at the contralateral side of the lower lip, 5 mm from the commissure, and the defect is closed with the crosslip flap. Although our method is applicable only to selected cases, we believe that it is useful in terms of maintaining symmetry of the lip and function of the commissure in the reconstruction of comparatively large defects including the commissure.

The use of latissimus dorsi muscle flap in the aesthetical reconstruction of heat-press injury of the hand.

We present a successful case of aesthetic reconstruction utilizing free latissimus dorsi muscle flap transfer. A large quantity of skin of the dorsum of hand and finger was lost. The dorsum of the index, long and ring fingers was severely damaged, such that extensor tendons were necrotic and all digital bones and the second metatarsal bone were exposed with partial necrosis. In addition, the proximal interphalangeal joints (PIP) were also exposed. To cover exposed bones and the tendons of dorsum of the hand, a free latissimus dorsi muscle flap was transferred, and then meshed skin covered the muscle, resulting in a mitten-like condition. After cutting the grafted muscle and skin to divide fingers, the grafted muscle was shaved to create the contour of fingers and dorsum of the hand, and then sheet grafting was performed. Six years after the operation, although the movement of fingers was restricted, an acceptable contour of the hand was obtained. The patient is satisfied with the result and does not desire any further surgery. In conclusion, the use of latissimus dorsi muscle flap is a method of choice not only to cover damaged hand but also to give contour in the aesthetic reconstruction of a hand presenting after heat-press injury.

Experience with surgical treatment of hidradenitis suppurativa.

The authors report their experience with 23 sites of hidradenitis suppurativa, including cases with musculocutaneous flap repair, and discuss the surgical methods applied. Twenty-three sites in 19 patients with chronic inflammatory skin lesions were reviewed. The lesions were divided into two groups: The limited group was comprised of mild lesions, which appear isolated and have limited abscesses without sinus tract formations. The severe group was compromised of severe lesions, which included diffuse, multiple abscesses with severe sinus tract formation and fibrosis. Nine sites were limited and 14 sites were severe. After resecting the lesion, the defect was covered with a split-thickness skin graft (four sites were limited, nine sites severe), a musculocutaneous flap (five sites severe), primary closure (four sites limited), and a local skin flap (one site limited). In six sites in 6 severe-group patients, local recurrence occurred. The local recurrence rate differed significantly between the limited and the severe groups. The reason for this may be because the lesions in the limited group could be resected completely, whereas the lesions in the severe group were diffuse and total resection was sometimes difficult for various reasons. The method of surgical repair did not affect the local recurrence rate. In recurrent cases, four sites treated with skin grafting required further surgical treatment, and two sites treated with musculocutaneous flaps were controlled with oral antibiotics. In conclusion, sufficient resection of the lesion is the most important issue in treating follicular occlusion triad disease. In lesions that can be resected completely, the surgical procedure to cover the lesions should be selected to suit the size and site of the defect. However, in cases that cannot be resected completely, a musculocutaneous flap is recommended instead of a skin graft for enhanced postoperative management of the recurring wound, and its contribution to aesthetic and functional improvement.

Application of artificial dermis graft to correct a depression after tissue resection.

The authors present 7 cases of artificial dermis implantation to correct a depression after tissue resection. Four of the seven cases resulted from resection of a malignant tumor (N = 3) and from a benign subcutaneous tumor (N = 1). The other 3 cases were the result of temporal muscle harvest to reconstruct facial palsy. In 1 patient a mild degree of bone deformity also existed. The pieces of artificial dermis employed varied from 35 x 40 to 40 x 80 mm in size. In 5 patients two sheets were implanted, and in 2 patients three sheets were implanted. In 2 patients the dermis sheets were covered by a pedicled temporal fascial flap with a free split-thickness skin graft because whole skin was resected as a result of a malignant skin tumor. There was no postoperative infection or allergic reaction in any of the patients. In all cases there was no postoperative contracture, and the implanted area was soft. An adequate or acceptable thickness of subcutaneous tissue was obtained. Artificial dermis may be a useful option as implantation material to correct a depression after tissue resection, especially for wide and comparatively shallow depressions.

An evaluation of hard palate mucosa graft as a lining material in alar reconstruction: a 7-year experience applied to the full-thickness alar defect.

The authors present their experience with 25 hard palate mucosa grafts used as lining material in the reconstruction of full-thickness alar defects. Good "take" was obtained in 22 grafts; the other three grafts incurred necrosis of the overriding skin flaps and postoperative infection. Degree of shrinkage was 11 to 15 percent of grafted size in patients with the type of defect that did not include the alar margin; shrinkage was 26 to 35 percent in patients with the type that included more than 50 percent of the alar margin. In all patients who had a good graft take, the nasal cavities were maintained and there was no nasal obstruction or collapsing during strong breathing. The healing time of the palate donor site varied from 7 days to 5 weeks, depending on the size of the defect. No patients experienced any symptoms at the donor site after healing. The authors concluded that hard palate mucosa can be considered a useful material in alar reconstruction because of the ease in graft harvesting and its support features. When the defect is large enough to involve the total unilateral ala nasi, even though the degree of postoperative shrinkage is comparatively high, hard palate mucosa may be the most suitable material to ensure good take of the graft and less possibility of donor-site morbidity.

Effect of epinephrine and combination treatment of epinephrine and heat on melanoma cell lines. Study of cytotoxicity and kinetics of 72-kD stress protein.

To elucidate the effect of epinephrine and the combination with heat on malignant cells, using two melanoma cell lines, HM6KO and G361, we have examined the cytotoxicity and induction of 72-kD stress protein (HSP72) after the treatments. After epinephrine treatment, in both cell lines, cell survival rates decreased gradually in a concentration-dependent manner. After the combination treatment, cell survival rates decreased more than those when two treatments were done separately. The cytotoxicity of epinephrine was more enhanced in G361 than in HM6KO by heat. After epinephrine treatment, in both cell lines, the level of HSP72 did not elevate. After combination treatment, in HM6KO, the level of HSP72 were higher than those of heat alone. In G361, the kinetics of HSP72 level was similar to that of heat alone. These results suggest that epinephrine has a cytotoxicity to melanoma cells and the cytotoxicity is enhanced by the combination. In addition, it is probable that epinephrine does not have HSP72 inducibility in HM6KO and G361, and the different kinetics of HSP72 between the cell lines in the combination treatment may play an important role to determine the degree of enhancement.

Correction of a posttraumatic nasal deformity using a hard palate mucosa graft.

We report corrected cases of posttraumatic nasal deformity using a hard palate mucosal graft as covering material of the inner-side defect. In all cases, the deformity was corrected satisfactorily. The nasal cavity was preserved, and because of the stiffness of the grafted mucosa, it did not collapse in the course of breathing. In all cases, the palate donor site healed in approximately 2 weeks, and after healing, none of the patients complained of irritation or ulceration. These results indicate that hard palate mucosa is also applicable in the correction of a traumatic deformity of the nose as an alternative to the auricular composite graft equally in the case of a nontraumatic deformity.