Experimental research on DNA methylation profile in congenital microtia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To screen for abnormal methylation in CpG islands and CpG sites through whole genome of congenital microtia to identify their associated genes. To discuss the relationship between abnormal methylation level of genes and the etiology of congenital microtia.</p><p><b>METHODS</b>Residual ear cartilage of 50 patients with microtia was collected with ear cartilage of 34 patients without ear malformations as control. Nimblegen CpG promoter array was chosen to screen the 28,226 CpG islands in the whole genome of both experimental and control groups. The genes with differential methylated CpG islands were selected. SpectroCHIP array was chosen to detect the methylation level of each CpG site in abnormal methyletion CpG islands of both experimental and control groups. The CpG sites with differential methylation level were selected.</p><p><b>RESULTS</b>There were 36 CpG islands with differential methylated level in whole genome between experimental group and control group, among which 29 CpG islands were connected with 29 named genes. In the abnormal methylated CpG islands of COL18A1, MYH14, RBMY1A1 and ZIC3, 6 differentially methylated CpG sites were found with statistical significance. The methylation level of these 6 CpG sites in experimental group and control group were COL18A1_2_CpG_170.9783 +/- 0.0235 and 0.9526 +/- 0.0589; MYH14_CpG_170.9600 +/- 0.0414 and 0.9284 +/- 0.0655; RBMY1A1_1_CpG_3.40.9966 +/- 0.0055 and 0.9914 +/- 0.0069; RBMY1A1_1_CpG_130.9648 +/- 0.0118 and 0.9757 +/- 0.0127; ZIC3_3_CpG_150.0867 +/- 0.0212 and 0.0543 +/- 0.0399; ZIC3_2_CpG_270.3775 +/- 0.1816 and 0.472 3 +/- 0.0439.</p><p><b>CONCLUSIONS</b>The DNA methylation profile of the entire genome is initially established. The abnormal methylated CpG islands of COL18A1, MYH14, RBMY1A1 and ZIC3 might be related to the pathogenesis of microtia.</p>

Ear reconstruction after rupture of postauricular expanded flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the principles of ear reconstruction after rupture of postauricular expanded flap.</p><p><b>METHODS</b>The rupture of the postauricular expanded flap was graded as I-IV degree. For flap rupture of I and II degree, the ear reconstruction was performed immediately with autogenous cartilage framework. For flap rupture of III degree, topical and systemic treatment should be done to relieve the redness and swelling. Then the ear reconstruction was performed. For flap rupture of IV degree, the expanded postauricular flap was smoothened. Ear reconstruction was performed 3 months later.</p><p><b>RESULTS</b>There were 67 cases with flap rupture, including 43 cases as I and II degree, 17 cases as III degree and 7 cases as IV degree. Ear reconstruction with autogenous cartilage framework was performed in 43 cases, with Medpor framework in 17 cases. Flap smoothing and secondary ear reconstruction with autogenous cartilage framework was performed in 7 cases. The results were satisfactory with complications in 4 cases (7%), which resolved after treatment. Primary healing was achieved in all the patients.</p><p><b>CONCLUSIONS</b>Good result could be achieved in ear reconstruction, even after flap rupture. Proper treatment should be adopted according to the rupture degree.</p>

The significance of the biomechanical properties of costal cartilage in the timing of ear reconstruction surgery.

BACKGROUND: We aimed to investigate the biomechanical changes of costal cartilage in a broad age range in order to provide a theoretical reference as to the optimal age to use costal cartilage in ear reconstruction surgery. METHOD: Ninety patients (age 5-25 years) were categorised into three groups according to age: children, adolescent and adult. We investigated the biomechanical properties of rib cartilage including stress-strain relation, stress-induced relaxation, creep and maximum resistance to stretch. The results were analysed using one-way analysis of variance. RESULT: The children's groups performed best and the adolescent groups performed worst in terms of the four biomechanical properties (tensile strength, stress-stain, stress relaxation and creep) of rib cartilage. After statistical analysis, it was found that the differences were significant (P<0.05). CONCLUSION: Significant differences in the biomechanical properties of costal cartilage exist with age. We recommend that when autogenous rib cartilage is used in ear reconstruction it is most favourable to operate in childhood (age 5-10).

Sectional anatomical analysis of auricular and middle ear malformation in patients with microtia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery.</p><p><b>METHODS</b>From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured.</p><p><b>RESULTS</b>The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group.</p><p><b>CONCLUSIONS</b>According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.</p>

Application of bi-pedicled frontal expanded flap for cervical cicatricial contracture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of bi-pedicled frontal expanded flap for cervical cicatricial contracture.</p><p><b>METHODS</b>Tissue expanders were implanted under frontal muscle. After expansion, the frontal flaps were designed based on bilateral superficial temporal vessels and were transferred to the neck wound. The cervical spine movement and the mento-cervical angle was measured and analyzed by SPSS16.0 and t test.</p><p><b>RESULTS</b>From September 2006 to May 2010, 7 patients were treated by this method. The range of active cervical movement was improved in all direction. The mento-cervical angle decreased from (152.7 +/- 1.9) to (90.7 +/- 2.2) degrees after operation. The patients were followed up for 5 months to 3 years with satisfactory result and no contracture recurrence.</p><p><b>CONCLUSIONS</b>The bi-pedicled expanded frontal flap has a reliable blood supply and is very suitable for cervical cicatricial contracture with good functional and esthetic results, leaving less morbidity at donor site.</p>

Double-edged effects of neuropeptide substance P on repair of cutaneous trauma.

To explore further the role of substance P (SP) in wound healing and scar formation, SP concentrations in wounds of scalded rats were assayed. Expressions of apoptosis-associated genes in fibroblasts cultured with SP were detected. SP concentrations in superficial wounds increased earlier than those in deep wounds. SP was associated with an increased proliferation and a decreased apoptosis of fibroblasts. It had a greater influence on keloid fibroblasts than on hypertrophic scar fibroblasts by elevating the expression of proliferating cell nuclear antigen and BCL-2 in fibroblasts. Spantide completely suppressed the effects of SP on hypertrophic scar fibroblasts, and partly inhibited its effects on keloid scar fibroblasts. SP may play an important role in wound healing by promoting wound fibroblast proliferation and inhibiting apoptosis. It may also participate in pathological scar formation by modulating the expression of apoptosis-associated genes. SP is postulated to play a dual role in wound repair.

Fabrication and application of three-dimensional autogenous cartilage framework in auricular reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the fabrication and application of three-dimensional autogenous cartilage framework in auricular reconstruction.</p><p><b>METHODS</b>The process of fabrication of three-dimensional cartilage framework consisted of cartilage harvesting, carving and assembling the cartilage. The rib cartilage was harvested separately. The three-dimensional framework was composed of three main parts:the helix, the base and the pad, at different layer. The framework was fabricated according to the development of rib cartilage and contour and height of the reconstructed ear.</p><p><b>RESULTS</b>From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 autogenous cartilage frameworks.</p><p><b>CONCLUSIONS</b>The three-dimensional framework is easily manipulated. The reconstructed ears look natural and had an erect contour. This method can effectively use the cartilage.</p>

Application of the remnant in repairing the reconstructed ear in microtia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the application of the remnant in repairing the reconstructed ear in microtia.</p><p><b>METHODS</b>From October 2000 to July 2006, 1,823 patients with reconstructed ear underwent the second operation for repairing. The remnants were used to reconstruct tragus, antitragus, crus of helix, concha cavum, or relax the adhesion between the reconstructed auricle and cranio wall, or insert into the reconstructed lobule or under the basement of the costal cartilage frame to restore the cranio-auricular angle or to the preauricular subcutaneous to correct the facial local depression.</p><p><b>RESULTS</b>In 1,823 cases, the tragus, antitragus and concha cavum was reconstructeded by remnant auricle in 1,180 cases; helix crus was repaired by remnant auricle in 743 cases; the wound was repaired by remnant auricle flap resulted from relaxing the adhesion between the reconstructed auricle and cranial wall in 68 cases; Subcutaneous and cartilage flap was formed and transferred in 95 cases, and among them the flap was transferred under the basement of the frame to restore the cranio-auricular angle in 77 cases and was transferred to the preauricular subcutaneous to correct the facial local depression in 18 cases; the skin flap was formed by remnant auricle to repair the lobule in 37 cases. All flaps survived completely. The appearance of reconstructed ear was satisfied.</p><p><b>CONCLUSION</b>The remnant is very useful in repairing the reconstructed ear in microtia. It should be preserved propriately in auricular reconstruction.</p>

Application of quantitative tissue expansion in ear reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the application of tissue expander in ear reconstruction and to deal with the complications.</p><p><b>METHODS</b>50 ml kidney-shape tissue expanders were implanted subcutaneously in the mastoid area. The drainage tube was removed 3 days after operation. The suture was removed 10 days later. Since 7 days after operation, 5 ml NS was injected into the expander every time, three times a week. The total injection volume was about 60 ml. After that, the expander was maintained for one month.</p><p><b>RESULTS</b>From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 expander. After the maintaining period, the expanded skin was thin and well-vascularized. The complication rate was 7.79%, including hematoma, malunion and infection.</p><p><b>CONCLUSIONS</b>The quantitative tissue expansion is easily manipulated with few complications. It can provide hairless, thin skin with reliable blood supply for ear reconstruction.</p>

Surgical treatment and etiological analysis of polyotia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment and pathologic mechanism of polyotia.</p><p><b>METHODS</b>The operative methods for polyotia were flexible. The main procedures were aimed at the remodeling of tragus with the redundant tissue. Tissue transplantation was used to correct the depression deformity. Compound auricular tissue transplantation and Z-plasty were used for correction of the malformation at the posterior part of polyotia.</p><p><b>RESULTS</b>From 2003 to 2008, 9 patients with polyotia were treated. The tragus was reconstructed after resection of redundant tissue. The depression deformity was corrected with tissue infilling in 6 cases. The compound auricular tissue transplantation was performed in 4 cases. Z-plasty at the lower ear lobe was performed in 2 cases. The appearance and the location of the reconstructed ears looked symmetric to the healthy ear.</p><p><b>CONCLUSIONS</b>Natural and symmetric appearance of reconstructed ear can be achieved in polyotia. The abnormal migration of neural crest cell might be the pathologic mechanism of polyotia.</p>

Study of methylation of promoter of EYA1 gene in microtia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the methylation of CpG islands in promoter of eye absent gene 1 (EYA1) in microtia.</p><p><b>METHODS</b>The methylation of CpG islands in EYA1 gene in 64 microtias and 36 healthy controls were measured using the technique of matrix-assisted laser desorption/ionization-time of flight.</p><p><b>RESULTS</b>The methylation of CpG_Unit3 and CpG_Unit5 of EYA1 gene in microtia were 0.09258 +/- 0.033846 and 0.0922 +/- 0.02379, respectively, which were significantly lower than those in control.</p><p><b>CONCLUSIONS</b>Hypomethylation in microtia may be related to the pathogenesis of the disease.</p>

Biomechanical properties of the costal cartilage and its significance in the timing of ear reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the age-related change in biomechanical properties of the costal cartilage and its relevance to the timing of ear reconstruction with costal cartilage framework.</p><p><b>METHODS</b>The patients of 5 to 25 years old were divided into three groups according to their age. The biomechanical properties of costal cartilage harvested from these patients during ear reconstruction were tested, including stree-strain relationship, stress relaxation and creep, tensile strength. All the results were analyzed statistically.</p><p><b>RESULTS</b>The costal cartilage from children group had the best biomechanical properties, while the costal cartilage from the adolescent group had the worst. The difference had a statistically significance (P < 0.05).</p><p><b>CONCLUSIONS</b>The biomechanical properties of costal cartilage are age-related. So it is recommended that ear reconstruction with costal cartilage framework should be performed in childhood when the costal cartilage has the best biomechanical properties.</p>

Design and application of the expanded transposition flaps in the treatment of cheek skin defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the design and application of the expanded transposition skin flap in the treatment of cheek skin defects.</p><p><b>METHODS</b>The expanded transposition flaps were divided into three types: the regular expanded transposition flap (ERT flap), the expanded transposition-advancement-transposition flap (TAT flap) and the expanded rotation-advancement-transposition flap (RAT flap). 135 cases of cheek skin defects resulted from hemangioma, scar and naevi were treated with these three types of flaps. Delay surgery was needed when the ratio of length to width was bigger than 2 : 1.</p><p><b>RESULTS</b>There were 139 expanded transposition flaps, including 17 ERT flaps, 69 TAT flaps, 53 RAT flaps. Blood supply disturbance was happened at the end of the flaps in 6 cases, including 2 ERT flaps and 4 other flaps. Other flaps had no complication. The results were satisfactory.</p><p><b>CONCLUSIONS</b>The expanded transposition skin flap is a reliable method to repair the cheek skin defect. The preoperative flap design is very important for successful reconstruction.</p>

Repairing traumatic partial helical defect with postauricular tube flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of postauricular tube flap for repairing traumatic partial helical defect.</p><p><b>METHODS</b>The tube flaps were designed according to the site and size of helical defects. The length of tube flaps was 1.2 - 1.5 times as the length of the defects. The length-to-width ratio of tube flap was 3 - 4:1. The procedures required three stages for completion: (1) fabrication of tube flap; (2) 2 - 3 weeks later, division of one pedicle and insetting the flap; (3) 2 - 3 weeks later, complete division of pedicle and repairing the defects.</p><p><b>RESULTS</b>From January 1998 to June 2006, 47 cases of traumatic partial helical defects were treated with postauricular tube flaps. All the tube flaps survived completely with no vascular disturbance, infection or necrosis. The patients were followed up for 2 months to five years with satisfactory results.</p><p><b>CONCLUSIONS</b>Postauricular tube flap is a reliable and simple procedure for traumatic partial helical defects with good cosmetic result and less donor site morbidity.</p>

Clinical application of three methods for total ear reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the indication and results of three methods for total ear reconstruction.</p><p><b>METHODS</b>960 cases of total ear defect were treated with skin expansion and autogenous rib cartilage framework (n = 786), or skin expansion and Medpor framework (n = 150), or ear prosthesis (n = 24). The indication and results of the three methods were analysed.</p><p><b>RESULTS</b>Good cosmetic results were achieved with all three methods. Autogenous rib cartilage framework was suitable for patients under 30 years old with unaffected skin at mastoid region. Medpor framework was good for grown-up, especially over 30 years old, or with mild infection at mastoid region. Patients with severe skin injury at mastoid region or unwilling to accept surgery should choose ear prosthesis.</p><p><b>CONCLUSIONS</b>Satisfactory results can be achieved with suitable methods for total ear reconstruction.</p>

Clinical study of chest contour deformity after harvesting of costal cartilage for total ear reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the chest contour deformities after harvesting of costal cartilage for total ear reconstruction, so as to prevent donor site morbidity.</p><p><b>METHODS</b>107 cases of microtia who underwent ear reconstruction with costal cartilage during the period from 1994 to 2003, were retrospectively studied. Both the chest depression deformity and the costal arch deformity were evaluated. The possible related factors to the chest contour deformities were analyzed statistically with Stata software.</p><p><b>RESULTS</b>The incidence of chest depression was 54.55% (48/88), including 35 cases of mild depression (39.77%) and 13 cases of severe depression (14.77% ). The incidence of costal arch deformity was 52.77% (46/88), including 33 cases of mild deformity (37.50%) and 13 cases of severe deformity (14.77%). The incidence of both deformities was significantly different at different age (P < 0.01), but not at different follow-up period (P = 0.294 and P = 0.225, respectively). Gender was related to the incidence of chest depression (P < 0.01), but not to the costal arch contour deformity (P = 0.619). Comparing resection of the 6th and 7th rib cartilage with resection of 7th and 8th rib cartilage, the incidence of costal arch deformity was significantly different (P < 0.01), but the incidence of depression deformity was not (P = 0.657).</p><p><b>CONCLUSIONS</b>The incidence of chest deformities increases with early operation time (< 13 years old). The male patients have higher incidence of depression deformity than female. The arch deformity is higher when the 6th and 7th rib cartilage were resected. The follow-up period is not related to the chest deformities.</p>

Histologic study and type II collagen expression in the rib cartilage of patients at different age / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the difference of histologic examination and type II collagen expression in the rib cartilage of patients at different age.</p><p><b>METHODS</b>The patients were divided into three groups, as children group (5 to 10 years old), teenager group (11 to 17 years old), and adult group (18 to 29 years old). Histologic examination of rib cartilage and quantitative analysis of type II collagen with immunohistochemical stain were carried out in the three groups. Motic Med 6.0 A system was used to quantitate immunohistochemical image through measurement of mean photodensity. The results were statistically analyzed.</p><p><b>RESULTS</b>Among the three groups, the children's rib cartilage had the most blood vessels, the most chondrocytes, well-distributed stain of matrixes, and the type II collagen was expressed actively and highest in photodensity. The rib cartilage of teenager group had less blood vessels, unhomogeny distributed stain of matrixes, the enlarged and separated cartilage lacunae. The rib cartilage in adult group showed the least blood vessels, the least chondrocytes, the hyalinization of perichondrium, the most deposition of calcium salt, and the type II collagen was expressed at the lowest level in photodensity. Statistical analysis showed significant differences among the three groups (P < 0.01).</p><p><b>CONCLUSIONS</b>Histologic structure in human rib cartilage changes during the aging process and the type II collagen is decreased with the increase of age.</p>

Partial necrosis of expanding postauricular flaps during auricle reconstruction: risk factors and effective management.

BACKGROUND: Tissue expansion has gradually become accepted as a useful adjunct to auricular reconstruction. Necrosis of postauricular flaps during the expansion phase may hinder auricular reconstruction. This study was designed to investigate the risk factors for partial necrosis of expanding postauricular flaps during reconstruction of the auricle and to provide effective management strategies. METHODS: Data were gathered retrospectively for cases of partial necrosis of expanding postauricular flaps from the overall group of patients undergoing auricular reconstruction after preliminary tissue expansion at a treatment center from January of 2002 to January of 2005. Demographic data, ulcer occurrence, treatment procedure, and results were analyzed statistically. RESULTS: The authors observed that 2.5 percent of congenital microtia cases and 13.8 percent of acquired auricular defect cases suffered from partial necrosis of expanding postauricular flaps. Necrosis in more cases occurred during static expansion and was located on the inferior part of the expanded flap. Treatment included the following: (1) auricular reconstruction with autologous costal cartilage or a porous polyethylene framework for a limited term; (2) continuing static expansion, with the postauricular flap extended and fixed in place after expander removal; and (3) removal of the expander and reinsertion of a similar expander more than 6 months after the wound had healed. Each method was applied to different types of cases. Most cases obtained a satisfactory contour and profile of the reconstructed auricle. CONCLUSIONS: Some individual and iatrogenic factors are involved in partial necrosis of expanding postauricular flaps, which can be prevented and minimized. An optimal method can be chosen to treat every case of partial necrosis of the expanding postauricular flap.

The design and transposition principles of expanded flap for treatment of cheek skin-soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore an ideal method for repairing the skin-soft tissue defects according to the different anatomical units of cheek, and find reasonable design principles to transfer the expanded flaps.</p><p><b>METHODS</b>According to the location of the defect, we placed 1-3 appropriate expanders nearby, when the flap expanded enough we adopted advanced skin flaps, rotation-advanced skin flaps or transposition skin flaps to repair the defect. In this group of 269 cases, the defects were secondary to hemangioma, various scars, nevus or nevus excision.</p><p><b>RESULTS</b>In all 269 cheek defects, 305 expanded flaps were developed which included 145 rotation-advanced flaps, 121 advanced skin flaps and 39 transposition skin flaps. 52 of them generated complications, including blood circulation disorder of the distal part of flaps, hematoma, infection, injection, lower eyelid ectropion, expander extrusion and capsule contracture. Mostly, these complications didn't affect the final results.</p><p><b>CONCLUSIONS</b>The principles presented in this article are the guidelines to treat the skin-soft tissue defect of check with tissue expansion. The satisfied results come from the reasonable flap designs.</p>

Surgical treatment of acquired ear defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore surgical procedure for the treatment of acquired ear defect.</p><p><b>METHODS</b>The ear reconstruction was carried out by using soft tissue skin expander and autogenous rib cartilage framework, Medpor framework, auricular prosthesis, and so on.</p><p><b>RESULTS</b>The long-term follow-ups showed that the flap of reconstructed ear was ruddy, soft, with normal sensory function. The cartilage framework had no degeneration, absorption and deformation. The Medpor framework had no deformation. The contour of auricular prosthesis was vivid and the implant system was stable. In addition, the reconstructed ears were coincidence with the normal side on location, form and dimension.</p><p><b>CONCLUSIONS</b>It may be a major method for traumatic ear reconstruction that the soft tissue skin expander with autogenous rib cartilage framework could be applied at present time. In some special circumstances, the soft tissue skin expander with Medpor framework and auricular prosthesis may be other helpful choices.</p>