Successful replantation of amputated facial tissues by supermicrosurgery.

BACKGROUND: Although replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes. METHODS: From May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts. RESULTS: Facial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up. CONCLUSIONS: Supermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes.

Tissue expansion techniques in reconstructive surgery: a 10-year bibliometric analysis.

Background: Tissue expansion (TE) has attracted significant attention from researchers over the past decade. However, there are currently no bibliometric analyses in this field. We aimed to quantitatively and visually analyze the literature to explore the hotspots and frontiers in TE research. Methods: We extracted all the documents on this topic published from the Web of Science Core Citation (WOSCC) database between 2012 and 2021. CiteSpace (version 5.8 R3) and VOSviewer (version 1.6.18) were used to perform the visualization analysis. Results: A total of 1,085 documents were included in the analysis. The publication trend fluctuated over time. The United States led the research, and Harvard University was the most productive institution. Plastic and Reconstructive Surgery published the largest number of documents and had the most citations. Kim JYS was the most prolific and most cited author. The high-frequency keywords were "complications", "breast reconstruction", "outcomes", "tissue expander", "mastectomy", and "acellular dermal matrix" (ADM). "Surgical site infection", "tissue expander/implant", "bilateral prophylactic mastectomy", and "activated controlled expansion" were the keywords with the strongest citation bursts until 2021. Conclusions: This study provided a complete analysis of the research on TE. The effect of ADM on the complication rates after breast reconstruction is the current hotspot of TE research in surgery. Patient-activated controlled expansion might be a promising future research direction for TE.

Single-Cell Transcriptomics Uncover Key Regulators of Skin Regeneration in Human Long-Term Mechanical Stretch-Mediated Expansion Therapy.

Tissue expansion is a commonly performed therapy to grow extra skin in vivo for reconstruction. While mechanical stretch-induced epidermal changes have been extensively studied in rodents and cell culture, little is known about the mechanobiology of the human epidermis in vivo. Here, we employed single-cell RNA sequencing to interrogate the changes in the human epidermis during long-term tissue expansion therapy in clinical settings. We also verified the main findings at the protein level by immunofluorescence analysis of independent clinical samples. Our data show that the expanding human skin epidermis maintained a cellular composition and lineage trajectory that are similar to its non-expanding neighbor, suggesting the cellular heterogeneity of long-term expanded samples differs from the early response to the expansion. Also, a decrease in proliferative cells due to the decayed regenerative competency was detected. On the other hand, profound transcriptional changes are detected for epidermal stem cells in the expanding skin versus their non-expanding peers. These include significantly enriched signatures of C-FOS, EMT, and mTOR pathways and upregulation of AREG and SERPINB2 genes. CellChat associated ligand-receptor pairs and signaling pathways were revealed. Together, our data present a single-cell atlas of human epidermal changes in long-term tissue expansion therapy, suggesting that transcriptional change in epidermal stem cells is the major mechanism underlying long-term human skin expansion therapy. We also identified novel therapeutic targets to promote human skin expansion efficiency in the future.