OBJECTIVETo investigate the clinical application of free superficial iliac circumflex artery skin flaps, as well as the management of donor site defects.

METHODS17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face, neck, foot, hand, ankle and lower leg, respectively. The donor site defects were closed directly or covered by paraumbilical island flaps.

RESULTSThe 17 flap size ranged from 5 cm x 3 cm to 19 cm x 14 cm. 16 flaps survived completely except 1 flap with partial necrosis, which was closed by free skin graft. The donor site defects were closed directly in 10 cases, and covered by paraumbilical island flaps in 7 flaps without no flap necrosis. The abdomen had a good appearance.

CONCLUSIONSGood appearance can be achieved with free superficial iliac circumflex artery skin flaps for the defects on face, neck, foot, hand, ankle and lower leg. Paraumbilical island flap can be used for the donor site defects.

Arteries ; Foot ; Free Tissue Flaps ; blood supply ; transplantation ; Humans ; Reconstructive Surgical Procedures ; Skin ; Skin Transplantation ; Transplant Donor Site ; surgery ; Wounds and Injuries ; surgery

OBJECTIVEThe objective is to obtain the information of women in the period of prepregnancy and pregnancy infected by TORCH (Toxoplasma, Rabella Virus, Cytomegalovirus, and Herpes Simplex Virus) in Kunming for preventing fetus from infection by TORCH in uterus.

METHODSThe serum IgM and IgG specific for TORCH from 1307 women in the period of pre-pregnancy and pregnancy were measured with ELISA and The reagent is the product of virion/serion.

RESULTSThe serum IgM specific for TORCH were detected in 2.83% of 1307 pregnant women for Toxoplasma, 2.37% for Rebulla Virus, 0.46% for Cytomegalovirus, 2.45% for Herpes Simplex Virus. The total positive rate of serum IgM specific for TORCH was 1.45%. The serum IgG specific for TORCH were detected in 3.98% of 1307 pregnant women for Toxoplasma, 72.3% for Rebulla Virus, 97.78% for Cytomegalovirus, 80.34% for Herpes Simplex Virus. The total positive rate of serum IgG specific for TORCH was 63.60%. There was no significant difference among the women with different pregnant situation in terms of the serum IgM and IgG specific for TORCH.

CONCLUSIONThere are some of women in the period of pre-pregnancy and pregnancy with current infection by TORCH in Kunming. It is recommended to screen for infection by TORCH in women in the period of pre-pregnancy and pregnancy to prevent fetus from infection by TORCH in uterus.

Adolescent ; Adult ; Antibodies, Protozoan ; blood ; Antibodies, Viral ; blood ; Cytomegalovirus ; immunology ; isolation & purification ; Female ; Humans ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Mass Screening ; Middle Aged ; Pregnancy ; Pregnancy Complications, Infectious ; immunology ; parasitology ; prevention & control ; virology ; Rubella virus ; immunology ; isolation & purification ; Simplexvirus ; immunology ; isolation & purification ; Toxoplasma ; immunology ; isolation & purification ; Women ; Young Adult

OBJECTIVETo investigate the protective effect of melatonin on residual hair follicle cells of scald rats at early stage.

METHODSEighteen male Sprague-Dawley rats were randomly divided into scald group, treatment group, sham group , with 6 rats in each group. The rats in scald group and treatment group were subjected to 30% TBSA partial thickness scald on the back, and were resuscitated with balanced solution after 1 hour, while those in sham group were immersed in water at 37 degrees C for 25 s to simulate scald, and did not receive fluid replacement. Rats in treatment group were intraperitoneally injected with 10 mg/kg melatonin solution at 1 minute, 8 hours and 12 hours after scald, while those in sham group and scald group were given equal volume of 1% alcohol sodium-isotonic saline instead. Tissue samples were harvested at 6, 12 and 24 post scald hours (PSH) for determination of MDA and GSH levels. Apoptosis of residul hair follicle was detected by TUNEL method and immunohistochemistry of caspase-3.

RESULTSThe level of MDA in scald group at each time point was much higher than that in sham group (P < 0.01) and treatment group (P < 0.05), and it peaked at 12 PSH. The changes in GSH were just opposite to that of MDA. Under fluorescence microscope, the residual hair follicle cells were blue, and the apoptotic cells appeared green. The apoptosis rate in scald group at 6, 12, 24 PSH was obviously higher than that in sham (P < 0.01) and treatment groups (P < 0.05), which was (20.2 +/- 3.4)% vs (4.3 +/- 2.3)% vs (10.9 +/- 3.2)%, (31.2 +/- 3.6)% vs (5.1 +/- 2.5)% vs (19.1 +/- 3.7)%, (22.4 +/- 2.7)% vs (4.1 +/- 2.4)% vs (13.1 +/- 3.4)%, respectively. The score of caspase-3 positive cell in scald group was higher than those in sham group (P < 0.01) and treatment group (P < 0.05).

CONCLUSIONSThere is obvious correlation between oxidative stress and apoptosis rate of hair follicle cells in rats with partial thickness scald. Early administration of melatonin may have anti-apoptosis ability for residual hair follicle cells by attenuation of oxidative stress.

Animals ; Apoptosis ; Burns ; drug therapy ; metabolism ; Hair Follicle ; cytology ; metabolism ; Male ; Melatonin ; therapeutic use ; Oxidative Stress ; Rats ; Rats, Sprague-Dawley

Scar, either hypertrophic scar or keloid, is one of the most common complications due to proliferative disorder of fibrosis in the process of wound healing after burn injuries, trauma, and surgical operations. To repair the cosmetic and functional impairments caused by scars poses a great challenge to all the burn surgery workers. With the advances in both basic research and clinical treatment, the understanding of scar formation and the therapeutic strategies of scar have been improved significantly. However, the remaining problems are still outstanding. In this discussion, the advances and problems in the scientific research in this field, including genetic predisposition, candidate gene, dysfunction of fibroblasts, interaction between fibroblasts and keratinocytes, as well as animal models for hypertrophic scar and keloid were summarized. In addition, the progresses in the clinical therapies are also discussed, including pressure treatment, silicone gel sheeting, corticosteroids, laser, and other emerging treatment strategies. The understanding and treatment of scar will improve in the future with further deepening basic research and clinical trials with stricter standard of assessment.
Burns ; pathology ; Cicatrix ; genetics ; pathology ; therapy ; Fibroblasts ; cytology ; Humans ; Keratinocytes ; cytology

The restoration of destroyed skin tissue in extensive deep burn injury has been perplexing burn surgeons for a long time due to impossibility of de novo formation of true skin in the process of burn wound healing with the current treatment methods. Stem cells possess the capacity to repair the damaged tissue through regeneration of the original structure and function, and it is considered as the expected ideal outcome of burn wound healing and also the final goal of multidisciplinary wound managements. In the skin tissue, the resident stem cells do exist, and they retain an autonomous self-renewal potential, and they respond to guiding signals to differentiate in repairing burn wound. Besides, the remote mesenchymal stem cells and the adjacent adipose-derived stem cells have been shown to be involved in burn wound healing. The basic studies demonstrated that the microenvironmental feature or extracellular regulators, the selective activation of intracellular signaling pathways, and the expression of specific genes have a significant influence on the proliferation, differentiation or function of stem cells in wound repair. Therefore, further investigation and manipulation of the molecular mechanisms by which stem cells could participate well in regenerating skin tissue would be a valuable and promising way in burn wound treatment. The recent discovery of reprogramming a mature body cell into a pluripotent stem cell, which can then be converted to any type of human body cell sheds a new light to regenerative medicine. Stem cell-based regeneration is offering the next coming frontier of medical therapy by yielding new treatment through delivery of pluripotent stem cells to achieve structural and functional repair in the damaged tissues or organs due to trauma or chronic diseases. Therefore, it is a pressing task for us to expedite the study on the role and utility of stem cells in burn wound treatment, especially aiming to explore the possibility in regenerating skin appendages or even the entire structure of the normal skin, and avoiding the formation of hypertrophic scar or chronic wound after burn.
Regeneration ; Stem Cells ; Wound Healing

Destructive burns and traumas which create composite tissue damages, as well as intractable wounds, usually cause the difficulties or inefficacy in the repair and management through ordinary skin grafting or tissue transplantation owing to the complex defects, unhealthy healing condition, or high requirements for the function and appearance reconstruction of the injured local tissues. The advantages of free tissue transplantation with microsurgical techniques in the tissue repair and reconstruction have been demonstrated as meeting the composite tissues restoration, improving blood supply, avoiding further damage to the wound surrounding tissues, and simplifying the distant tissue transplantation procedure, and therefore significantly decreasing the deformities with good functional and morphological outcomes, and dramatically reducing the hospitalization duration with less complications and faster restitution. In the present discussion, basing on the general literature review and the summary of our long-time clinical application of microsurgical techniques in dealing with serious injuries, we put forward the view that the microsurgical techniques should be considered as the first option for the treatment of destructive burns and traumas, and intractable wounds. And in some cases, only microsurgical techniques can be used, otherwise amputation would be unavoidable, or the optimal treatment would be abandoned or delayed. Meanwhile, it should be emphasized that the risk and the failure rate of performing microsurgical operation can be overcome through strictly hard training.
Burns ; surgery ; Humans ; Microsurgery ; Reconstructive Surgical Procedures ; methods

With the advances in resuscitation, infection control, and metabolic management, the treatment strategies for burn patients have improved remarkably in the last half century. As a result, more patients with deep burn wound survived, and how to optimize the burn wound care aiming at recovery of the normal appearance and physiologic function of patients has been investigated and discussed widely through both the whole treatment strategy making and the new techniques performing. In the present discussion, early tissue reconstruction as well as early wound covering and repair are emphasized by summarizing the improved aesthetic and functional effects obtained by applying the principles of plastic surgery in early burn wound repair, the use of composite skin grafting, the grafting with split-thickness autografts on the preserved denatured dermis or on the preserved healthy fat tissue, etc. Besides these, more attention should be given to the repair and reconstruction in specialized functional parts of the body, such as head and face, neck, hand, female breast, perineum, and joint areas, after a deep burn. The role of rehabilitation during and after the burn wound treatment process is elucidated by demonstrating its potential biophysical mechanism and preventing scar deformity. Adequate treatment of deep burn wound demands a number of important measures including the timing of surgery, adoption of essential techniques, suitable types of wound covering materials, motivated rehabilitation, and necessary psychological therapy. The optimal recovery of damaged part of body after burn should depend on the similarity of rebuild tissue structure to simulate the nature of the original tissue in the cellular, histological, anatomic characteristics, which is the aim of all burn wound care and the basis of the appearance and function repair or reconstruction.
Burns ; rehabilitation ; surgery ; Humans ; Reconstructive Surgical Procedures ; Wound Healing

OBJECTIVETo study the mechanism underlying the inhibitory effects of peroxisome proliferator-activated receptor γ (PPARγ) agonists on transforming growth factor β1 (TGF-β(1))-induced scarring of skin.

METHODSFibroblasts isolated from healthy adult skin were cultured in vitro and divided into blank control group (serum-free DMEM culture), TGF-β(1) group (with stimulation of 10 ng/mL TGF-β(1) for 48 hours), troglitazone group (with the same treatment as in TGF-β(1) group after stimulation of 10 µmol/L troglitazone for 2 hours), and 15-dioxygen prostaglandin J2 (15d-PGJ2) group (with the same treatment as in TGF-β(1) group after stimulation of 10 µmol/L 15d-PGJ2 for 2 hours) according to the stimulation added into DMEM. The expression of connective tissue growth factor (CTGF) was determined with Western blot. The mRNA levels of CTGF, matrix metalloproteinase-1 (MMP-1) and platelet-derived growth factor (PDGF) were determined with real-time fluorescence RT-PCR. Data were processed with one-way analysis of variance.

RESULTSThe expression of CTGF at mRNA and protein levels in skin fibroblasts were significantly increased in TGF-β(1) group as compared with control group; while expression of CTGF at mRNA and protein levels in 15d-PGJ2 and troglitazone groups were significantly decreased as compared with that in TGF-β(1) group. The mRNA level of MMP-1 in TGF-β(1) group (0.193 ± 0.051) was obviously lower than that in blank control group (1.281 ± 0.195, F = 12.811, P < 0.01), while the mRNA levels of MMP-1 in troglitazone group (0.417 ± 0.043) and 15d-PGJ2 group (0.485 ± 0.027) were significantly increased as compared with that in TGF-β(1) group (F = 12.811, P values all below 0.01). The mRNA level of PDGF in TGF-β(1) group (1.044 ± 0.237) was obviously higher than that in control group (0.349 ± 0.057, F = 16.848, P < 0.01), while the levels in troglitazone group (0.677 ± 0.055) and 15d-PGJ2 group (0.511 ± 0.017) were significantly decreased as compared with that in TGF-β(1) group (F = 16.848, P values all below 0.01).

CONCLUSIONSThe inhibitory effect of activated PPARγ on the expression of CTGF induced by TGF-β(1) may be the main mechanism of its inhibitory effect on TGF-β(1)-induced scarring on skin, and its influence on MMP-1 and PDGF may also be one of the underlying mechanisms.

Cell Line ; Connective Tissue Growth Factor ; metabolism ; Fibroblasts ; drug effects ; metabolism ; Humans ; Matrix Metalloproteinase 1 ; metabolism ; PPAR gamma ; agonists ; Receptors, Platelet-Derived Growth Factor ; metabolism ; Signal Transduction ; Transforming Growth Factor beta1 ; metabolism

Differentiation, the stepwise specialization of cells, and transdifferentiation, the apparent switching of one cell type into another, capture much of the stem cell spotlight. But dedifferentiation, the developmental reversal of a cell before it reinvents itself, is an important process too. In multicellular organisms, cellular dedifferentiation is the major process underlying totipotency, regeneration and formation of new stem cell lineages. In humans, dedifferentiation is often associated with carcinogenesis. The study of cellular dedifferentiation in animals, particularly early events related to cell fate-switch and determination, is limited by the lack of a suitable, convenient experimental system. The classic example of dedifferentiation is limb and tail regeneration in urodele amphibians, such as salamanders. Recently, several investigators have shown that certain mammalian cell types can be induced to dedifferentiate to progenitor cells when stimulated with the appropriate signals or materials. These discoveries open the possibility that researchers might enhance the endogenous regenerative capacity of mammals by inducing cellular dedifferentiation in vivo.
Animals ; Cell Differentiation ; Cells, Cultured ; Epidermal Growth Factor ; physiology ; Humans ; Regeneration ; Salamandridae ; physiology ; Serum ; physiology ; Thrombin ; pharmacology

Translational medicine is an emerging arena in the 21st century, and it bridges research results of basic sciences to clinical applications. The importance of translational research attracted considerable concern of scientists worldwide, including clinicians and researchers in the field of burn surgery in China. This review highlights some key points on translational medicine practised in the basic and clinical research of burn surgery, and they are summarized here as: the motive of the research project should be focused on how to solve problems of patients; much attention should be drawn to the difference between the cell biology and biochemical reaction in vitro and that in vivo; an animal model which simulates human pathology as much as possible should be reproduced; collaboration and sharing of resources among different disciplines should be strengthened; national and standardized criteria should be established for evaluation of the experimental result and guiding for clinical application. The aforementioned suggestions would be helpful for the application of new medicine and therapeutic approach in treating severe burn.
Burns ; surgery ; Humans ; Translational Medical Research