Objective To investigate the clinical effect of type A botulinum toxin and nipple retractor in correcting severe inverted nipples.Methods All the patients with bilateral severe inverted nipples that sought consulting in the Plastic and Reconstructive Surgery Center of Peking Union Medical College Hospital were included in this study and the patients were randomized into different treatment group with nipple retractor only or BTX-A (Lanzhou,China) combined with nipple retractor.In the combined therapy group,50 u BTX-A was injected into the bottom of each nipple.2 weeks later,nipple retractor was placed and kept wearing for 6 months.For the retractor only group,no BTX-A was used.All the patients were followed up at 1 month,3 months and 6 months after the operation.Nipple projection was measured according to the profile view of pre-and post-operation.Effectiveness and complication rate were compared between the two groups.Results 20 patients were included in this study.Average nipple projection in the combined therapy group was (1.12±0.13) cm,(0.95± 0.10) cm and (0.73±0.11) cm (3 months,6 months and 12 months post-operation,respectively),which had a significant difference from that of the retractor group [(0.81±0.10) cm,(0.72±0.12) cm and (0.53±0.10) cm].Total complication rate of combined group was also lower than that of retractor group.The complications of the combined therapy group included hypopigmentation (1 case),without skin ulcer or wire dislocation.However in the retractor group,complications included skin ulcer (2 cases),hypopigmentation (1 case) and dislocation (1 case).No severe complications such as nipple necrosis happened in both groups.Conclusions BTX-A combined with nipple retractor is an effective method in correcting severe inverted nipple with low complication rate.

Objective: The purpose of this study is to systematically review the literature about surgical management of lymphedema, to provide recomendations for the surgical treatment plan of the disease. Methods: Cochrane Library and EMBASE databases were searched from January 1st, 2007 to October 1st, 2017 for the literature related to the surgical treatment of lymphedema. Data were extracted from clinical studies matching our inclusion criteria. Meta-analysis was performed with R 3.4.2. Results: 71 studies were included, out of which 4 studies described were excision, 9 were liposuction, 33 were lymphvenous anastomosis(LVA), 23 were vascularized lymph node transfer(VLNT) and 5 were combined therapy. The excess volume reduction were averaged 96.86%(95%CI: 87.38%—106.33%, I²=0%)for liposuction, 34.64%(95%CI: 19.80%—49.47%, I²=72%)for LVA, 36.85%(95%CI: 12.40%—61.30%, I²=81%) for VLNT. Conclusions With further understanding of the pathophysiology of lymphedema and development of radiologic and surgical technique, surgical treatment has the potential to play an important role in lymphedema complex management.

Objective: To introduce the experience in skin defect reconstruction with keystone design perforator flap. Methods: From January 2012 to December 2012, 26 patients with different types of skin defect were repaired with keystone design perforator flaps, including 21 classic keystone design perforator flaps, 3 short incision keystone design perforator flaps, and 2 Omega variant keystone design perforator flaps. Results: One patient suffered partial flap loss and healed secondarily. All other patients recovered smoothly without complications. Conclusions Keystone design perforator flap offers a versatile technique for skin defect reconstruction except for scalp.

Objective: To report a case who had cerebral hemorrhage after facial injection with hyaluronic acid and to present the literature review about cerebrovascular infarction after cosmetic facial injection. Methods: Articles were collected from domestic and overseas database, with the key word of "filler injection, autologous fat, hyaluronic acid, stroke, cerebrovascular disease, cerebral embolism" from 1990 January to 2016 July. Information about researchers, patients, injection, complication, therapy and prognosis was collected. Results: The analysis shows cases are mostly reported by South Korea among the 18 articles in total (20 cases). 81% of injection material is autologous fat and the rest is hyaluronic acid.Glabella is mostly injected(n=9). Symptoms of cerebrovascular infarction are paralysis(n=15), disturbance of consciousness(n=7) and aphasia(n=5), whose onset were mostly within the operation(47%, n=8). 81% cases were combined with blindness. Infarction positions mostly were middle cerebral artery(n=14), anterior cerebral artery(n=6), frontal lobe(n=6)and parietal lobe(n=5). Meanwhile, there were three cases combined with cerebral hemorrhage including the case we reported in this article. Blind patients had poor prognosis while the other neurologic symptoms mostly could be improved. Conclusions Cerebrovascular infarction is a rarely severe complication of cosmetic facial injection, which we should pay close attention to.

BACKGROUND: Due to adipose-derived stem cells (ASCs) being easy to obtain, their rapid proliferation rate, and their multidirectional differentiation capabilities, they have been widely used in the field of regenerative medicine. With the progress of decellularized adipose tissue (DAT) and adipose tissue engineering research, the role of DAT in promoting angiogenesis has gradually been emphasized. METHODS: We examined the biological characteristics and biosafety of DAT and evaluated the stem cell maintenance ability and promotion of growth factor secretion through conducting in vitro and in vivo studies. RESULTS: The tested ASCs showed high rat:es of proliferation and adhered well to DAT. The expression levels of essential genes for cell stem maintenance, including OCT4, SOX2, and Nanog were low at 2–24 h and much higher at 48 and 96 h. The Adipogenic expression level of markers for ASCs proliferation including PPARγ, C/EPBα, and LPL increased from 2 to 96 h. Co-culture of ASCs and DAT increased the secretion of local growth factors, such as VEGF, PDGF-bb, bFGF, HGF, EGF, and FDGF-bb, and secretion gradually increased from 0 to 48 h. A model of full-thickness skin defects on the back of nude mice was established, and the co-culture of ASCs and DAT showed the best in vivo treatment effect. CONCLUSION The application of DAT promotes wound healing, and DAT combined with ASCs may be a promising material in adipose tissue engineering and regenerative medicine.

BACKGROUND: Due to adipose-derived stem cells (ASCs) being easy to obtain, their rapid proliferation rate, and their multidirectional differentiation capabilities, they have been widely used in the field of regenerative medicine. With the progress of decellularized adipose tissue (DAT) and adipose tissue engineering research, the role of DAT in promoting angiogenesis has gradually been emphasized. METHODS: We examined the biological characteristics and biosafety of DAT and evaluated the stem cell maintenance ability and promotion of growth factor secretion through conducting in vitro and in vivo studies. RESULTS: The tested ASCs showed high rat:es of proliferation and adhered well to DAT. The expression levels of essential genes for cell stem maintenance, including OCT4, SOX2, and Nanog were low at 2–24 h and much higher at 48 and 96 h. The Adipogenic expression level of markers for ASCs proliferation including PPARγ, C/EPBα, and LPL increased from 2 to 96 h. Co-culture of ASCs and DAT increased the secretion of local growth factors, such as VEGF, PDGF-bb, bFGF, HGF, EGF, and FDGF-bb, and secretion gradually increased from 0 to 48 h. A model of full-thickness skin defects on the back of nude mice was established, and the co-culture of ASCs and DAT showed the best in vivo treatment effect. CONCLUSION The application of DAT promotes wound healing, and DAT combined with ASCs may be a promising material in adipose tissue engineering and regenerative medicine.

Objective:To investigate the clinical significance of suction blister transplantation in improving the efficacy of ReCell technique in the treatment of vitiligo.Methods:Patients were divided into three groups, namely, vitiligo patients without history of suction blister therapy, patients with ineffective suction blister therapy and patients with effective suction blister therapy. There were 30 patients in each group. All patients were treated with standard procedure of ReCell technique. The color recovery effect of leukoplakia was observed 3 and 6 months after operation, and the incidence of complications was also observed.Results:The effective rate of color recovery 3 and 6 months after operation were as follow: in patients without history of suction blister group, the effective rate of three months was 53.3%, and that of six months was 63.3%; in patients with ineffective suction blister group, the effective rate was 43.3% in three months and 50.0% in six months, and in patients with effective suction blister group, the effective rate was 76.7% in three months and 90.0% in six months. No obvious complications were observed in the three groups.Conclusions:For the treatment of stable vitiligo with ReCell technique, suction blister method is a simple and effective method for screening patients.

Objective:To observe the effect of a new modified double-eyelid operation.Methods:From February 2018 to January 2021, modified tarsal plate-orbicularis oculi muscle-orbital septum (TMS) suture was performed in 193 double-eyelid operation in the plastic surgery department of Peking Union Medical College Hospital, including 14 males and 179 females. The patients aged from 18 to 45 years with an average of (22.3±4.2) years. The patients were followed up for 6-24 months to observe the morphology of the double eyelid fold and complications.Results:The 193 patients were included. The double eyelid lines of 173 patients were smooth, natural, durable and the scar was shallow; both doctors and patients were satisfied. There were no obvious complications after the operation. The double eyelid line became shallow or disappeared in 11 patients, and the double eyelid asymmetry occurred in 7 patients after the operation. However, the folds were symmetrical and natural after secondary operation, and both doctors and patients were satisfied.Conclusions:TMS suture not only establishes a firm adhesion, but also effectively transmits the force of the levator aponeurosis with significant advantages. After the operation, the double eyelid line is smooth, natural and stable. Both doctors and patients are highly satisfied. It is an improved double eyelid procedure worthy of clinical promotion.