BACKGROUND: After trauma, dermal sheath cells can directly participate in the repair of dermal injury or transfer into fibroblasts, which join in skin repair. OBJECTIVE: To establish models of rat hair follicles, to investigate and analyze the histology and ultrastructure of dermal component during wound healing, and to explore the potential of hair follicle tissues for dermal healing. DESIGN, TIME AND SETTING: The control animal experiment was conducted at the Zhongshan Hospital Affiliated to Fudan University from September 2007 to April 2008. MATERIALS: Eighteen Sprague Dawley (SD) rats weighing 200-250 g were used to prepare models of hair follicle units and mini-epidermis transplantation on wound. METHODS: Rat hair follicle units were cut from lateral vibrissa pad skin. Incision was sutured. Vibrissa pad hair follicles were cut with a sharp tool to collect hair follicle with papilla, surrounding tissues and partial surface. Hair follicle units were implanted into the wound, 5-7 units in each wound. Epidermis and some dermic skin were obtained from full-thickness skins of rats in the mini-epidermis transplantation group, and then trimmed into 3?3 mm size, 5-7 mini-epidermis in each wound. MAIN OUTCOME MEASURES: The wound specimens were obtained at the 2nd, 3rd, 4th, 5th weeks postoperatively. Hematoxylin-eosin stain, Picric-sirius red stain and AWMSEM (alkaline water maceration scanning electron microscope) were performed, and observed under a polarization microscope and scanning electron microscope. The images were processed and analyzed with computerized image analysis system. RESULTS: No significant difference in type and quantity of collagen matrix was detected in both groups at the early phase after wounding. The type Ⅲ collagens kept reducing as time elapsed, but type Ⅰ increased. At 5 weeks after wounding, the ratios of types Ⅰ and Ⅲ collagen increased in both groups, especially in the control group. Significant differences were detected between both groups (P

Objective With the social and economic advancement, the morbidity of breast hypertrophy is increasing. Inverted T technique was the traditional breast reduction mammaplasty method. It left severe scar after operation. The aim of this study was to introduce our experience about breast reduction with pure liposuction that significantly reduced the operative scar after operation. Methods After using tumescent anesthesia, a small incision about 5 mm was performed at inframammary fold for proper selected patients, The entire breast and subcutaneous fat were thoroughly suctioned with small caliber cannulas for breast reduction. No surgical excision was applied. Compression garment was applied after the operation. Results A total of 11 patients were successfully treated. Only one patient had a unilateral seroma that was responded to multiple aspiration. All the patients were satisfied with the results. The morphology was good. The texture of the breast was improved. Conclusion Reduction mammaplasty with pure liposuction is simple and effective for those who had mild to moderate breast hypertrophy with no severe ptosis and more fatty tissue. The scar is invisible. It deserves to be recommended.

Objective To detect the feasibility of patients with specific behaviors in the facial trauma clinical teaching. Method 47 medical students were randomly divided into experimental group ( n = 22 ) and control group(n=25). Students from experimental group at least dealed with 5 ～ 10 facial trauma patients with specific behaviors, while specific behaviors patients in control group were not more than 2. Teaching results were compared. Results There was no significant difference in operation test scores between the two groups ( (84.68 ±3.41 ) vs ( 83.96 ± 3.46 ), P = 0. 476 ). Composite score of teachers in the experimental group was significantly higher than that in control group( (90.09 ± 5.69 ) vs (83.48 ± 5.19), P ＜ 0.01 ). The results of questionnaire survey showed that two in five self-assessment results were higher in the experimental group(P ＜ 0. 01 ). Conclusion Medical students are more appropriately involved in treating special behaviors patients, which can improve the overall quality of students. Teaching with special behaviors patients has good effect, and is feasible.

Objective To evaluate immediate breast reconstruction with extended latissimus dorsi flap after mastectomy for patients of breast cancer. Methods One hundred and sixty-two women with breast cancer underwent surgery from Jan, 2000 to Dec, 2007. Masteetomy was carried out including traditional modified mastectomy in 32 cases, skin sparing mastectomy in 51 cases and nipple-areolar sparing mastectomy in 79 cases. Immediate breast reconstruction was performed with latissimus dorsi flap and surrounding fat tissue. Results Operation was successful in 161 cases. The morphology of reconstructed breasts was excellent in 91.93% cases as evaluated by patients themselves. After operation 6 cases had partial nipple necrosis, 5 cases had rhacoma of the chest, but cured conservatively. Eleven cases had seroma on the back, among them 8 cases cured by puncture and drainage. Two cases cured by erasion of the pseudomembrane and 1 case cured by exairesis of the fibrous capsule. Three cases had limited skin necrosis around the incision. One case had necrosis on part of the donor side, cured by reoperation. One case had implant necrosis necessitating removal of the implant. The patients were followed up for 7～90 months, and the 23 cases were free of tumor recurrence before they lost to follow-up. Among those followed-up cases there were bone metastasis in 2 cases, lung metastasis in 1 case and supra clavicular lymph node metastasis in one. No local recurrence was found. Conclusions Immediate breast reconstruction with extended latissimus dorsi flap after masteetomy is safe and effective, especially suitable for small and medium size breasts.

Objective To introduce the clinical manifestations and treatment methods of concealed penis, which is relative rare in plastic surgery. Methods Vertical preputiotomy was performed. The hypoplastic tissuely was excised. After that, there was no prepuce redundant, so that no prepuce excision was needed. Results 7 patients were treated. All were satisfied with the results. Conclusion Concealed penis should be distinguished from phimosis. Circumcision should be avoided in concealed penis patient.

Objective The vertical mammaplasty improves the breast morphology,and reduces the operative scar.However,the nipple-and-areola complex (NAC) has the risk of necrosis on those severe patients.In this report,we performed the vertical incision scar reduction mammaplasty based on Würinger's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejour mosque-dome design was performed.The inferior part of glandular tissue and skin were excised.The NAC was elevated to normal position with medial-superior pedicle based on the horizontal septum.The breast morphology was modified with lateral and medial glandular pillar suturing using nonabsorbent thread.For reducing the vertical scar,the lower breast flap was thinned to induce the skin contraction.Results 27 patients with breast hypertrophy were operated from May 2009 to October 2012.1 patient had unilateral breast reduction,and 6 patients with 8 breasts had partial wound dehiscence.They were treated conservatively with topical dressings.No complete NAC necrosis occurred.Conclusions The vertical reduction mammaplasty based on Würinger's horizontal septum is a safe and effective approach,and the NAC necrosis possibility is reduced with this procedure.

OBJECTIVETo evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.

METHODS35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.

RESULTS34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.

CONCLUSIONPedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.

Combined Modality Therapy ; methods ; Empyema, Pleural ; surgery ; Humans ; Myocutaneous Flap ; transplantation ; Pectoralis Muscles ; transplantation ; Reoperation ; Retrospective Studies ; Superficial Back Muscles ; transplantation ; Thoracotomy ; methods ; Wound Healing

Purpose　To introduce our experience about the skin-sparing mastectomy and immediate breast reconstruction using transverse rectus abdominis myocutaneous flap(TRAM).　Methods　For early stage breast cancer,we preserved the breast skin,performed the subcutaneous glandular excision and axillary dissection,immediately reconstructed the breast using TRAM flap.　Results　9 patients were treated by skin-sparing mastectomy and immediate TRAM breast reconstruction.The morphology of reconstructed breasts was excellent.　Conclusions　The skin-sparing mastectomy and immediate TRAM breast reconstruction is safe and effective for treating early stage breast cancer.The incision is relative small and more aesthestic.

Objective To assess clinical features and treatment of angiosarcoma.Methods A retrospective study was carried out among seven patients hospitalized for angiosarcoma in the Department of Plastic Surgery,Zhongshan Hospital of Fudan University from January 2004 to March 2012.Clinical behaviors,therapeutic strategies and outcomes of angiosarcoma were analyzed in these patients.Results Of the seven patients,four were male,and three were female,with a median age of 67 years (range,37-77 years).Clinical presentations were various,including irregular ulcerous nodular masses in four patients,localized ulcer in one patient,and irregular erythematous nodules in two patients.All the patients were treated surgically with or without postoperative adjuvant therapy.Pathological examination revealed various degrees of differentiation and atypia of tumor cells,as well as obvious proliferation of endothelial cells,and all of these patients were diagnosed as angiosarcoma.Immunohistochemical analysis revealed a positive staining for CD31 and CD34.After surgical treatment,angiosarcoma recurred in four patients with the median time to the first recurrence being 3.5 months (range,1-6 months),cerebral metastasis occurred in one patient 5 months later,and two patients died.Conclusions Angiosarcoma is a rare and heterogeneous sarcoma with diverse clinical presentations.Local wide resection is the cornerstone of angiosarcoma treatment,and adjuvant therapy may improve its prognosis.

Objective To verify the role of aldehyde dehydrogenase 2(ALDH2)in wound healing and to explore the underlying mechanisms.Methods A murine excisional wound model was developed and mice were randomly assigned to control group and Alda-1(ALDH2 agonist)group.Wound healing rate and activity of ALDH2 were measured.Masson staining was used to observe the collagen fiber content,and immunohistochemistry was used to detect the expression of ALDH2 and α-smooth muscle actin(α-SMA).The expression of collagen typeⅠandⅢ(Col-Ⅰ,Col-Ⅲ),and the number of F4/80,inducible nitric oxide synthase(iNOS)and CD206 positive(F4/80+,iNOS+,CD206+)cells were analyzed using immunofluorescences.Furthermore,interleukin(IL)-4-stimulated RAW264.7 cells were treated with Alda-1 or CVT-10216(an ALDH2 inhibitor)in vitro.The proportion of F4/80+CD206+cells were analyzed using flow cytometry.Anti-inflammatory and pro-inflammatory cytokines were examined using ELISA.The expression of protein associated with the AKT/mTOR pathway were detected via western blotting.Results Compared with control group,the wound healing rate of mice in the Alda-1 group was significantly improved,and the expression of Col-Ⅰ,Col-Ⅲ,and α-SMA in the wound surface increased.Although the number of F4/80+cells in wounds did not significantly differ,there was a decrease in iNOS+cells and an increase in CD206+cells.In vitro,compared to IL-4 group,IL-4+Alda-1 group exhibited an increased proportion of F4/80+CD206+macrophages and higher levels of anti-inflammatory factors,alongside a reduction in levels of pro-inflammatory factors.Conversely,IL-4+CVT-10216 group demonstrated a decreased proportion of F4/80+CD206+macrophages,lower levels of anti-inflammatory factors with a concomitant increase in pro-inflammatory factors.Additionally,the protein expressions of p-AKT and p-mTOR were significantly elevated in IL-4+Alda-1 group and diminished in IL-4+CVT-10216 group.Conclusion ALDH2 induces M2 macrophage polarization via AKT/mTOR pathway to promote wound healing in mice.