BACKGROUND:As a mixture of several kinds of stem cels and progenitor cels, autologous bone marrow concentrate has been a research hotspot because of the advantages including easy to obtain, time saving and relatively low cost, which can avoid cel extraction, culture and amplification, and can preferably maintain the bioactivity of cels. OBJECTIVE: To review the current basic research and clinical research on bone marrow concentrate in regenerative medicine. METHODS: A computer-based search of CNKI and PubMed databases was performed for articles relevant to bone marrow concentrate published from January 2000 to February 2015. The key words were bone marrow concentrate, bone marrow mesenchymal stem cels, endothelial progenitor cel in Chinese and English, respectively, which appeared in the title and abstract. Finaly, 62 articles were included in result analysis. RESULTS AND CONCLUSION: Bone marrow concentrate can be harvested by density gradient centrifugation technique, with the advantages of easy to obtain and minimal risk of infection and immunological rejection. Currently, the bone marrow concentrate has been proved to be beneficial to wound healing, tissue regeneration and angiogenesis by numerous studies. Meanwhile, it has been successfuly introduced in clinical application. However, studies about the amount of transplantation are stil in need.

Objective To evaluate the clinical results of biofeedback and pelvic electric stimulation therapy for stress urinary incontinence in women. Methods Totally 36 women with stress urinary incontinence were prospcctively studied by treating with biofeedback and pelvic electric stimulation therapy (MeprasolBIO2001). All the patients were follow-up for 3 months. Results About 70% of the patients were completely dry and 22% reported subjective improved,the recurrence rate at 3 months follow-up was 60%. Conclusion Biofeedback and pelvic electric stimulation therapy is a safe method for treating stress urinary incontinence. It is effective and easy to perform as an outpatient treatment. But the therapy should be performed for a longterm.

Objective To observe the clinical effects of autologous fat injection augmentation with external tissue expander.Methods 26 cases wore the Brava device,a bra-like vacuum-based external tissue expander for 4 weeks before autologous fat injection augmentation.Patients resumed Brava wear for 14 more days after fat injection.Results 26 women had a mean augmentation volume at 3 months of 76 ml per breast after single fat injection.Follow-up ranged from 1 month to 12 months.There were no complications such as nodules,masses,or cysts occurred.Patient satisfaction was as sessed:25 cases (95.6 ％) were satisfied with the cosmetic results.Conclusions The addition of Brava expansion before autologous fat grafting leads to significantly larger breast augmentations,with more fat graft placement,higher graft survival rates,and minimal graft necrosis or complications,demonstrating high safety and efficacy for the procedure.

Objective To establish a preoperative evaluation system for breast reconstruction,and to simplify the selection of surgical methods for breast reconstruction in a standard way.Methods We investigated respectively 192 successful cases that underwent breast reconstruction from July 2003 to July 2009.The factors influencing selection of methods for breast reconstruction were studied.The results presented in more than 50 ％ were collected.Results A special table of the preoperative evaluation system for breast reconstruction was established by analyzing statistical results. Conclusions The selection of methods for breast reconstruction is simplified according to this preoperative evaluation system.

Objective When implantation of a prosthesis is performed for patients with a local defect of the breast after the removal of polyacrylamide hydrogel,incomplete coverage of the surface of the prosthesis occurs in these cases.The aim of this study was to explore the effectiveness of acellular allogeneic dermis in the repair of defects after prosthesis implantation.Methods Breast prosthesis implantation together with acellular allogeneic dermis repair was performed in 46 cases.Acellular allogeneic dermis was applied to cover the surface of the prosthesis,and interrupted suture was used between the margin of the dermis and the incisional margin of the gland,while appropriate tension was maintained.Results There were no complications occurred postoperatively.Correction of local depression in the breast was excellent in all cases.Histological examination showed the implanted acellular allogeneic dermis was integrated into the peripheral tissue.Conclusions Acellular allogeneic dermis can be used for repairing breast and muscle defects,in order to cover the prosthesis.Although it cannot significantly increase the thickness of the subcutaneous tissue,it can maintain the integrity of the peripheral tension around the prosthesis.In this way,it can avoid bulging of the prosthesis caused by a sudden reduction of local tension.Moreover,donor site injury is avoided.Acellular allogeneic dermis is an effective method for the repair of local breast defects.

Objective To set up a method of three-dimensional breast volume measurement, to observe the effect of the artificial influencing factors on the final data, which are used for 3-D reconstruction of breast volume. Methods The CT data were used to reconstruct a digital prototype of the breast implant and the chest. The 3-D models were established firstly, and then the model was reasonablly cut to get single breast volume, breast implant volume, differences of the both sides of chest and breast volume. These methods were put up by the repeated test when the reference frame and the ranges were fixed. And the analysis of the artificial influencing factors was performed on 10 women whose breasts were unsym-metrical. The effects of the artificial influencing factors were analyzed by moving the coordinate axis, revolving the chest around the coordinate axis and changing the selected area. Results The repeatable test showed that the error was less than 4. 08 ml. The average volume differences between both sides of the breast before and after the given influencing factors were set, were 10. 339 ml and 7. 73 ml, as moved ± 4mm along the axis X; as revolving ±2° along the axis Z, that were 8. 654 ml and 7. 971 ml; as increasing or decreasing of the selected diameter of ± 4 mm, that were 6. 764 ml and 4. 267 ml, respectively. Conclusion Using the 3-D reconstruction technique for breast volume measurement is more simple, accurate and repeatable.

Objective To present a method for breast reconstruction with the superficial inferior epigastric artery (S1EA) flap and to summarize the operative experiences. Methods The diameter and distribution were evaluated with multipledetector-row computed tomography (MDCT) angiography and doppler perfusion flowmeter. Bipedicle superficial inferior epigastric artery flap was designed below umbilicus. Superficial inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2007, we have used the superficial inferior epigastric artery flap in 4 cases of breast reconstruction. Four flaps survived completely. With the follow-up of 6-12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia, bulge and weakness in donor sites. Conclusions Breast reconstruction using the superficial inferior epigastric artery flaps can not only preserve the advantages of the traditional method using the deep inferior epigastric perforator flaps, but also retain the maximal function of the fascia and the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal alternative method of breast reconstruction on condition that definitive preoperative assessment of vessels and skilled surgical technique are provided.

Objective To evaluate the methods of correction for secondary deformity after removal of polyacrylamide hydrogel in breast.Methods From June 2006 to December 2007,the Center of Breast Plastic and Reconstruction at Chinese Academy of Medical Sciences admitted and treated 36 patients who experienced deformity after polyacrylamide hydrogel remoral in breasts.The average age of the patients was 27.5 years,and the time of consultation for the correction was from 6 months postoperatively.The patients who had preoperative MRI examinations showed that no visible polyacrylamide hydrogel remained in the breast were included in the study.The patients were classified according to the deformity of the breast and the chest wall tissue.Autologous fat injection grafting,silicon gel implant augmentation,and dermis grafting were performed for treating the deformity of the breasts after polyacrylamide hydrogel removal.Results During 3 to 18 months follow-up,the shape of the breast was improved and no complications such as infection,the sclerotic nodules,implant exposure occurred.35(97.2%) patients were satisfied with the result of the operations.Conclusions The correction for secondary deformity of breast after removal of PAHG should be performed at least 6 months after removal of polyacrylamide hydrogel.The optimal and nature contour of the breast may be recovered by combination of various surgical methods which are carefully selected according to the individual situation.

Objective To present our experience in two-stage procedure immediate breast reconstruction,which aimed to retain local tissue condition for breast reconstruction,overcome the limitation of radiotherapy on implant reconstruction,and simplify the procedure as well as improve cosmetic result.Methods The proceduces of our method were divided into two stages:in the first stage,the round-shaped expander was implanted in the subpectoral major space during the procedure of mastectomy; at the same time as expander implanted,the first saline injection was performed; with 4 to 8 weeks of inflation,the tissue expander offered adequate tissue for breast reconstruction; in the second stage,silicon gel implant,latissimus dorsi muscle flap,extended latissimus dorsi muscle flap and deep inferior epigastic perforatior flap were used for breast reconstruction after the tissue expander was exchanged.Results Thirty-four patients had undergone the two-staged breast reconstruction using tissue expansion.The average time of therapy was 5.5 months.There were no postoperative complications such as implant exposure,additional scar,and flap necrosis.The follow-up time was 6 to 18 months and the result showed excellent contour of the breast at a satisfactory rate of 97.1％.Conclusions Two-staged technique using tissue expansion in breast reconstruction is easily done and the complications are rare.The technique possesses advantages such as avoiding affection of radiotherapy on silicongel implant and elasticity of skin,retaining maximal local tissue for breast reconstruction.There is no necessary for correction of skin defect and additional scarring,thus the patch-like appearance of breast is avoided.The patients need not to experience depression post mastectomy.Two-staged procedure immediate breast reconstruction is a safe and reliable technique that is especially applicable to the patients who need radiotherapy.

Objective To evaluate the implication and necessity of deepithelialization in mastopexy.Methods A total of 124 patients with mastoptosis were randomly divided into 2 groups:group Ⅰ and group Ⅱ,62 cases each.A double-circle incision technique was used for all the patients.In group Ⅰ,full thickness skin around nipple-areola was resected.While in group Ⅱ,deepithelialization was performed and the peri nipple-areola dermis was preserved.Results The average full skin resection time was 4.5 minute per side in group Ⅰ and the skin deepithelialization time was 15.8 minute per side in group Ⅱ.Postoperative follow-up was carried out for all the 124 patients with duration of 2 weeks to 4 years.In group Ⅱ,sebaceous cysts,epidermal inclusion cyst and suture knot exclusion were found at the incision site in 8 patients (12.9 ％) at 3 weeks to 1.5 years after operation.Conclusions The blood supply to the nipple-areola complex is not affected by full-thickness skin removal during mastopexy,while the incidence of complication at the incision site decreases significantly.We conclude that deepithelialization has not much clinical significance in mastopexy.