[Repairing of lower eyelid ectropion with expanded flap].

OBJECTIVE: To investigate the effect of reconstruction of lower eyelid ectropion with expanded flap. METHODS: Fourty patients with lower eyelid ectropion were reconstructed using tissue expander. The volume of the smallest expander was 30 ml, and that of the biggest one was 150 ml. The expand time was from 2-months to 3-months, then advancement or transposition flaps were created and employed in the defected lesion where the scar was removed just in one operation. RESULTS: All patients have been followed up for 2-year with satisfactory results and no recurrences was appearance. CONCLUSIONS: Application of expander reasonable may get satisfactory result in reconstruction of lower eyelid ectropion. The incision in donor site is hidden and the symptom seldom recurs.

[The treatment of deformity of axillary scar contracture after burns].

OBJECTIVE: To explore the best methods to repair the deformity of axillary scar contracture after burns. METHODS: Ninety cases in 78 patients with axillary scar contracture after burns from January 1998 to January 2002 were analyzed. According to the severity of the deformity and its influence on the function of the shoulder joint. 46 cases suffered from mild degree axillary scar contracture, 26 cases with moderate and 18 with severe degree. The deformities of axillary scar contracture were repaired by Z plasty (18 cases), five-flap plasty (14 cases), skin graft (23 cases), Z plasty and skin graft (14 cases), transfer of scapular skin flaps (5 cases), lateral throatic skin flaps (4 cases) and scar flaps (12 cases), respectively. Exopexy, anti-scar drug and functional exercises were applied postoperationally. RESULTS: All the flaps were survived with first intention, except for necrosis of the split skin graft occurring in 4 cases. The function and configuration in all the cases were satisfactory after 6 months to 4 years follow-up. CONCLUSION: Appropriate methods should be chosen to restore the function and configuration of the shoulder joint and improve patients' living condition according to the size, degree of the deformity of axillary scar contracture after burns.

[A comparative study of PDGF and EGF expression in skin wound healing between human fetal and adult].

OBJECTIVE: To explore the differences of PDGF and EGF expression in the wound healing between fatal and adult. METHODS: With the established animal model of fetal scarless healing and the adult samples, an immunohistochemical technique was used to evaluate the expression of PDGF and EGF in the normal adult skin, normal fetal skin, and the process of their wound healing. RESULTS: 1. The expression of the PDGF was not found in the fetal skin, but a mild amount of the PDGF was shown in the epidermis and the upper dermal layer 12 hours and 1 day after the wounding process. In the normal adult skin, expression of PDGF was shown in the dermal fibroblasts, macrophagocytes and blood capillaries, and a strong expression was presented during its wound healing process. 2. In the fetal skin, the expression of the EGF was seen in the epidermis, hair follicles, sebaceous glands and sweat glands, but there were no markedly changes during the wound healing. In the adult skin, a positive stain of the EGF was shown in the basal layer of the epidermis while the mild stain in hair follicles and sweat glands. The level of the expression became gradually decreasing with the time going in the wounded adult skin. CONCLUSION: The different expression of growth factors between fetal and adult skin in wound healing may be one of the important reasons that the fetal wound could produce scarless healing.

[Expression of hyaluronic acid and its receptor in the process of wound healing in different skin tissues and its significance].

OBJECTIVE: To explore the expression of hyaluronic acid (HA) and its receptor, Cluster of differentiation 44 (CD44) in proliferative scar and in the process of wound healing of normal human adult skin and fetal skin, and the effect of HA and its receptor on the process of human fetal skin scarless healing. METHODS: An incision and then a hypodermic cavity were made on each side of the dorsal median line of 32 female adult BALB/c rats. Skin grafts from 8 human fetuses delivered by natural abortion, full-thickness skin grafts from 8 normal adults undergoing plastic operation, skin wound sample from the donor sites in legs of 8 patients undergoing dermatoplasty with intermediate split thickness skin graft, and proliferative scar from 8 patients of plastic surgery, non-adult and adult, were grafted into the hypodermic cavities. The levels of HA and its receptor were examined by radioimmunoassay, immunohistochemistry and flow cytometry. RESULTS: The level of HA in normal fetal skin was 143 micro g/g +/- 10 micro g/g, 283 micro g/g +/- 12 micro g/g 12 hours after injury, 315 micro g/g +/- 12 micro g/g one days after injury, reached the peak (321 micro g/g +/- 12 micro g/g) 3 days after injury, and then decrease, became 319 micro g/g +/- 11 micro g/g one week after injury (P > 0.05 in comparison with that 3 days after injury). The level of HA in normal fetal skin was 143 micro g/g +/- 10 micro g/g, significantly higher than that in normal adult skin (51 micro g/g +/- 4 micro g/g), skin wound of normal adult (92 micro g/g +/- 6 micro g/g), and proliferative scar (72 micro g/g +/- 5 micro g/g, all P < 0.01). The level of HA in wounded adult skin was significantly higher than that in the proliferative scar, and even much higher than that in normal skin (P < 0.01). The level of CD44 in normal fetal skin was significantly higher than that in proliferative scar and adult skin (all P < 0.01). The level of CD44 in wounded fetal skin 24 hours after injury decreased, significantly lower than that in normal fetal skin. There was no statistically significant difference between the level of CD44 in fetal skin one week after injury and that 24 hours after injury (P > 0.05). The level of CD44 in wounded adult skin was significantly higher than that in the normal adult skin (P < 0.01). The level of CD44 in the proliferative scar was between the level of CD44 in normal adult skin and that in wounded adult one. In normal fetal skin, CD44, positively stained at a moderate level, was distributed in keratinized cells, basic cells of hair follicle, and fibroblast of dermis. After injury, staining of CD44 became milder, especially by the incision. Immunohistochemistry showed that in normal adult skin, CD44 was distributed mainly in fibroblast of dermis and basic cells of hair follicle, weakly positively stained. After injury, the staning became stronger. CONCLUSION: The expression of HA and its receptor during the process of wound healing in human fetal skin is different from that in proliferative scars and adult skin, which might be one of the important causes of scarless healing of wounded fatal skin.

[The significance and the expression of homeobox genes during human burn wound healing].

OBJECTIVE: To investigate the expression of several homeobox genes during the wound healing in fetal and adult skin and their roles in fetal scarless wound healing. METHODS: The expressions of PRX-2, HOXB13, HOX2.2 and HOX2.3 during wound healing in fetal and adult skin were determined with in situ hybridization. RESULTS: (1) PRX-2 positive expression could be identified in normal fetal and adult skin, especially in the fetus. But there was difference in location sites of the genes. The positive expression in normal fetal skin was mainly found in the peripheral cells at the hair shafts within dermal papilla layers and was also found in the epithelium. Nevertheless, weak positive expression of PRX-2 was found in the epithelial basal layer cells in normal adult skin but not in dermal tissue. There was strong positive expression of the PRX-2 in the tissue around the wound in fetus but not of that in adults except the epithelial basal layers. (2) Positive expression of HOXB13 could be identified in both normal fetal and adult skins. And the expression was concentrated mainly in hair follicle cells in the dermis and in the basal layer cells in the epithelium. Furthermore, the expression became weak after trauma, especially in fetal skin. (3) The positive expression of HOX2.2 and HOX2.3 in normal fetal skin was observed mainly in the whole layer of the epithelium and especially in the epithelial basal layers. Weak positive expression could be found in the dermis and strong expression found in the tissue near the wound. But there was no positive expression of the HOX genes in normal adult skin and wounds. CONCLUSION: The difference in the HOX expression in fetal and adult skin wound healing might be the key factor leading to different wound healing. Homeobox genes might be closely related with the developmental biology.