Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage.Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting,and adjacent expander implantation in the early stage and expanded flap transposition in the second stage.Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean,(19.4±12.2) years],with average 15 months follow-up (range,3-67 months).The average expansion time was 74.3 days (range,53-96 days).The total of 18 patients with 22 expanders were treated with satisfactory results.All the flaps survived and the skin color,texture and contour well matched to those of the peripheral tissue.Only one complication of infection happened in the 18 cases (5.56％) and total 22 expanders (4.55％),which was similar to the rate reported in the literature.There were no any other complications related to the expander.Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face,which can not only achieve satisfactory color,unbulky and well matched texture similar to normal,but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion.

Objective To investigate the possibility of performing epicanthoplasty with same stage small incision blepharoplasty. Methods At the same stage of designing small incision blepharo-plasty, modified "Z" plasty without flap transposition was designed. The upper lid incisive line of epi-canthoplasty was bided in the double eyelid fold, while the lower eyelid incision located at the edge of eyelid. Results A series of 56 patients were treated with this method. Satisfactory esthctical result of double eyelid fold and inner canthus shape was achieved. Conclusion This modified method including epicanthoplasty combined with same stage small incision blepharoplasty has the advantages of minimal scar formation, easy to design perform and in accordance with physiology.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Objective To discuss the clinical application of using trimmed latissimus dorsi free muscle flap together with skin grafting to resurface soft tissue defects on the dorsum of the foot. Methods From June 2005 to October 2011,eleven patients (8 males and 3 females,aged from 4-46 years) with large soft tissue defects of the foot dorsum were treated in our department. The size of the defects after debridement ranged from 5.0 cm × 6.0 cm-8.0 cm × 12.0 cm,all with exposed tendons or bones.Trimmed free latissimus dorsi muscular flap with split thickness skin grafting was used for reconstruction for all the 11 patients. Results All the flaps survived with no complications after surgery.During 3-10 months' follow-up,the appearance and walking function were satisfying, no further debulking procedures were needed. Conclusion Trimmed latissimus dorsi free flap with skin grafting is a good option for dorsal defect reconstruction.

Objective:To evaluate the efficacy of combined fascia sheath suspension (CFS) and frontalis muscle flap suspension in the treatment of severe congenital blepharoptosis.Methods:We searched PubMed, EMbase, Cochrane Library, web of science and Chinese Hownet, Wanfang, VIP, CBM and other databases to collect randomized and non-randomized controlled trials comparing the efficacy of CFS and frontalis muscle flap suspension in the treatment of severe congenital ptosis, from the establishment of literature retrieval database to March 2020; two researchers used RevMan 5.3 software to select and exclude the literature, extract the data and evaluate the quality, set up appropriate effect index and conduct Meta-analysis.Results:Eleven studies included 661 patients, There were 312 cases in study group and 349 cases in control group. The results of Meta analysis showed that the OR of the two groups was 4.88 with 95% CI (2.69, 8.85); the OR of failure rate was 0.20, with 95% CI (0.11, 0.37); the OR of complications was 0.22, with 95% CI (0.14, 0.34). All three groups of data were statistically significant ( P<0.05). Conclusions:The available evidence shows that the combined fascia sheath suspension (CFS) is effective in the treatment of severe congenital blepharoptosis compared with frontalis muscle flap suspension, but the complications of CFS are lower and the satisfaction is higher; these findings have yet to be validated by more high-quality studies due to limitations in the quality and quantity of studies included.

BACKGROUND: Cutaneous wound healing represents a common fundamental phenomenon requiring the participation of cells of distinct types and a major concern for the public. Evidence has confirmed that photobiomodulation (PBM) using near-infrared (NIR) can promote wound healing, but the cells involved and the precise molecular mechanisms remain elusive. METHODS: Full-thickness skin defects with a diameter of 1.0 cm were made on the back of rats and randomly divided into the control group, 10 J, 15 J, and 30 J groups. The wound healing rate at days 4, 8, and 12 postoperatively was measured. HE and Masson staining was conducted to reveal the histological characteristics. Immunofluorescence staining was performed to label the epidermal stem cells (ESCs) and hair follicle stem cells (HFSCs). Western blot was performed to detect the expressions of proteins associated with ESCs and HFSCs. Cutaneous wound tissues were collected for RNA sequencing. Gene ontology and the Kyoto Encyclopedia of Genes and Genomes analysis was performed, and the hub genes were identified using CytoHubba and validated by qRT-PCR. RESULTS: PBM can promote reepithelialization, extracellular matrix deposition, and wound healing, increase the number of KRT14+/PCNA+ ESCs and KRT15+/PCNA+ HFSCs, and upregulate the protein expression of P63, Krt14, and PCNA. Three hundred and sixty-six differentially expressed genes (DEGs) and 7 hub genes including Sox9, Krt5, Epcam, Cdh1, Cdh3, Dsp, and Pkp3 were identified. These DEGs are enriched in skin development, cell junction, and cadherin binding involved in cell–cell adhesion etc., while these hub genes are related to skin derived stem cells and cell adhesion. CONCLUSION PBM accelerates wound healing by enhancing reepithelialization through promoting ESCs and HFSCs proliferation and elevating the expression of genes associated with stem cells and cell adhesion. This may provide a valuable alternative strategy to promote wound healing and reepithelialization by modulating the proliferation of skin derived stem cells and regulating genes related to cell adhesion.

OBJECTIVE: To compare the efficacy difference among acupuncture at "seven acupoints on neck", acupuncture at regular acupoints and betahistine mesilate tablet for cervical spondylosis of vertebral artery type, and to explore the effective treatment for cervical spondylosis of vertebral artery type. METHODS: Ninety patients were randomly divided into a regular acupuncture group, a medication group and a neck-seven-acupoint group, 30 cases in each group. According to the acupoints prescription for vertigo in "11th Five-Year" Nation Textbook , the patients in the regular acupuncture group were treated with acupuncture at Fengchi (GB 20) and Baihui (GV 20), etc.; the patients in the neck-seven-acupoint group were treated with Fengfu (GV 16), Fengchi (GB 20), Tianzhu (BL 10) and Wangu (GB 12); the two groups were treated once a day, 6 treatments were taken as one course; there was an interval of 1 day between course and totally two course were given. The patients in the medication group were treated with betahistine mesilate tablets, 1 tablet each time, 3 times a day, for 2 weeks. The vertigo symptom and function score, mean blood flow velocity of left vertebral artery (LVA), right vertebral artery (RVA), basilar artery (BA) as well as pulsatile index (PI) and resistance index (RI) were observed, and the clinical efficacy of the three groups was compared. RESULTS: The total effective rate was 93.3% (28/30) in the neck-seven-acupoint group, which was superior to 76.7% (23/30) in the regular acupuncture group and 70.0% (21/30) in the medication group (both <0.05). The vertigo symptom and function score were all improved after treatment in the three groups (all <0.05), and the improvement in the neck-seven-acupoint group was superior to those in the regular acupuncture group and medication group (both <0.05). The mean blood flow velocity of LVA, RVA and BA was all improved after treatment in the neck-seven-acupoint group and regular acupuncture group (all <0.05), which was not significant in the medication group (all >0.05). The improvement of mean blood flow velocity in the neck-seven-acupoint group was superior to those in the medication group and regular acupuncture group (all <0.05); the improvement in the regular acupuncture group was superior to that in the medication group (all <0.05). PI and RI were all reduced after treatment in the three groups (all <0.05); the reduction in the neck-seven-acupoint group was more significant those those in the medication group and regular acupuncture group (all <0.05), and the reduction in the regular acupuncture group was superior to that in the medication group (all <0.05). CONCLUSION Acupuncture at "seven acupoints on neck" has better clinical efficacy than regular acupuncture and betahistine mesilate tablets, which could obviously improve vertigo and brain blood supply.
Acupuncture Points ; Humans ; Moxibustion ; Spondylosis ; Vertebral Artery