BACKGROUND:Recent studies have demonstrated that growth factor, as a molecular signal, regulates cellular proliferation, differentiation, immigration and metabolism. Its expression and regulation play an important role in the chronic wound healing.OBJECTrVE: To observe the effect of vascular endothelial growth factor (VEGF) on the expression of VEGF receptor (VEGFR), basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) mRNA in wound tissue, and elucidate the mechanism of VEGF in promoting wound healing.DESrGN: Controlled animal experiment.SETTING: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA. MATERIALS: Six New Zealand rabbits, aged 48-60 months, were involved in the experiment. Nanosphere-coated recombinant plasmid DNA eukaryotic expression vector pcDNA3.1/myc-hisA-VEGF166 was donated by Master Jia Ning, who was from Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA. METHODS: This experiment was carried out in the laboratory of Department of Plastic Surgery, Xijing Hospital from October 2004 to June 2005. ①VEGF (VEGF165) was taken as target gene to construct eukaryotic expression vector pcDNA3.1/myc-hisA- VEGF165. Nanosphere- VEGF165 complex was used. Three round excisional wounds, 6 mm in diameter, were created over the ventral surface of ears of anesthetized rabbits, and cartilage was exposed. Gelatin sponge thin slice dipping 100 μL nanosphere-VEGF165 complex was spread on unilateral wounds of each rabbit, and aseptic sealing membrane was spread on outer layer, serving as VEGF group; Gelatin sponge thin slice dipping 100 μL nanosphere without plasmid load was spread on contralateral wound, serving as control group; Skin of rabbit ear subterminal to circumcise region served as normal group. ② At postoperative 14 days, reverse transcription-polymerase chain reaction (RT-PCR) was used to observe the changes in the expression of VEGFR, bFGF and PDGF mRNA in wound tissue. ③ At postoperative 14 days, wound was took as center, and square tissue mass with size of 1 cm×1 cm (full-thickness rabbit ear included) was excised and prepared into sample, then which was stained by haematoxylin & eosin (HE). Under the optical microscope, the growth of newly regenerated granulation tissue was observed. MAIN OUTCOME MEASURES: Expression of VEGFR, bFGF and PDGF mRNA in wound tissue. RESULTS: ①HE staining results showed the growth speeds of granulation tissue and epithelium tissue in VEGF group were obviously faster than those in the control group. ②RT-PCR detected a significantly higher expression of VEGFR, bFGF and PDGF mRNA in the wound tissues in VEGF group than that in the control group (P ＜ 0.05) and normal group (P＜ 0.01).CONCLUSION: Exogenous VEGF up-regulates the expression of VEGFR, bFGF and PDGF mRNA in wound tissue. VEGF may act on its receptor and play an important role in promoting wound healing through its interaction with other cytokines.

Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

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 develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.

OBJECTIVETo investigate suitable treatment method for contracture of inframammary scars.

METHODSNine female patients with contracture of inframammary sear hospitalized in our hospital from July 2000 to July 2007 were subjected to skin expansion around the breast. The sites of incisions were mainly located on the inframammary scars. The expanders were placed around the breast and middle chest near the sternum. On the lateral side of chest, the expander should be inserted at the site parallel to upper level of the breast. The expanders should be placed under deep fascia and superficial to the gland. At II stage of operation, the scars were excised and the subcutaneous tissues should be thoroughly loosened to assure that the soft tissue and mammary gland would be restored to its anatomical position. Expanded skin was then designed as advancement or transposition flaps to repair the defects, or effects were closed with suturing.

RESULTSBlood circulation disturbance occurred at the tip of a flap in one patient, with the size of 4.0 cm x 3.0 cm, and the resulting wound healed after skin grafting. Flaps in the other 8 patients survived, and the wounds healed satisfactorily. Nipples and mammary areola were successfully restored to the anatomical positions. Three patients were followed up for 6 months to 2 years, and the result was satisfactory.

CONCLUSIONSExpanded flap is feasible for repairing contracture of inframammary scar and with good result.

Adolescent ; Breast ; Child ; Cicatrix ; surgery ; Female ; Humans ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Tissue Expansion ; methods ; Young Adult

Objective To investigate the effect of laparoscopic totally extraperitoneal (TEP) on sexual function in young and middle-aged patients with inguinal hernia. Methods 147 male with inguinal hernia treated by TEP from January 2014 to Feberary 2016 were included in the observation group, while 133 male with inguinal hernia treated by laparoscopic transabdominal preperitoneal (TAPP) during the same time were included in the control group. The effect of surgery and changes on sexual function between the two groups were retrospective analyzed and compared. Results The operative time, length of hospital stay, time of postoperative pain and in the observation group shorter than in the control group. The differences between the two groups were statistically significant (P < 0.05). The level of seminal alpha glucosidase, fructose contents and acid phosphatase in the observation group were higher than in the control group at 12 months after surgery. The differences between the two groups were statistically significant (P < 0.05). There were a small number of complications in both groups. After symptomatic treatment, all complications were cured. The ratio of complications and recurrences of the two groups have no significantly differences (P > 0.05). Conclusion Compared with laparoscopic TAPP, laparoscopic TEP can shorten the time of postoperative recovery, and will not increase the complications and recurrences. It is good for recovery of semen quality. It is worthy of attention.

OBJECTIVETo explore the method to repair large scalp and face scars.

METHODS1-3 expanders under the scalp were needed for repair the scalp scar. The expanded deltopectoral flaps were transferred to repair the face scar.

RESULTS12 cases were treated with satisfactory results. All the flaps survived and the donor sites were closed primarily. 2 cases had expander exposure which didn't affect the treatment results. Atrophic cutaneous striae was occurred because of overexpansion.

CONCLUSIONSSkin expansion is a good method for large scalp and face scar.

Adolescent ; Adult ; Cicatrix ; surgery ; Humans ; Scalp Dermatoses ; surgery ; Skin Transplantation ; Surgical Flaps ; Tissue Expansion ; methods ; Young Adult

OBJECTIVETo investigate the effect of METH1 gene transfection on fibroblast proliferation and I, III collagen synthesis in rabbit ear scar.

METHODSThe hypertrophic scar model on the rabbit ears was reproduced. 10 days after epithelization, Ad-METH1 was injected into the scar tissue. 30 days later, the effect of METH1 gene transfection on the angiogenesis, fibroblast proliferation and the ratio of collagen I/III in the scar tissue was detected by microcirculation microscope, AgNOR particle count and collagen dyeing.

RESULTS30 days after injection of Ad-METH1, angiogenesis, fibroblast proliferation and the ratio of collagen I/III in the scar tissue were obviously suppressed.

CONCLUSIONEarly application of Ad-METH1 after epithelization can markedly inhibit the formation of the hypertrophic scar.

ADAM Proteins ; genetics ; Angiogenesis Inhibitors ; genetics ; Animals ; Cicatrix, Hypertrophic ; genetics ; pathology ; Disease Models, Animal ; Ear ; pathology ; Ear, External ; pathology ; Female ; Male ; Microcirculation ; Neovascularization, Pathologic ; Rabbits ; Transfection ; Wound Healing

OBJECTIVETo investigate the application of expanded deltopectoral flaps for treatment of cervical cicatricial contracture.

METHODSThe cervical cicatricial contracture was corrected in 18 cases with unilateral expanded deltopectoral flaps and 2 cases with bilateral expanded deltopectoral flaps. The size of scar ranged from 8 cm x 5 cm to 12 cm x 13 cm. The size of the unilateral expanded deltopectoral flaps ranged from 9 cm x 16 cm to 12 cm x 18 cm. The defects in donor sites were closed directly. The infraclavicula incision was designed. The flaps were delayed 3 weeks after flap transfer. The pedicle was cut off 4 weeks later.

RESULTSFrom 2007 to 2009, 20 cases with cervical cicatricial contracture were treated with expanded deltopectoral flaps. All the flaps were survived. 6 cases were followed up for 6 months with satisfactory results in 5 cases and conspicuous scar in 1 case.

CONCLUSIONSExpanded deltopectoral flap is very suitable for large size of cervical cicatricial contracture.

Adolescent ; Adult ; Child ; Child, Preschool ; Cicatrix ; surgery ; Dilatation ; methods ; Female ; Humans ; Male ; Neck ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Thorax ; Young Adult

ObjectiveTo assess the clinical efficacy and regulation of skin microbiota in children with atopic dermatitis and damp-heat accumulation syndrome treated by Zhaqu Xiaofeng Powder （楂曲消风散， ZXP）. MethodsNinety children were randomized into a treatment group and a control group， each with 45 children. The treatment group received ZXP orally， while the control group received levocetirizine hydrochloride syrup， both for 4 weeks. The atopic dermatitis severity index （SCORAD）score， visual analog scale （VAS）score for itching， children dermatology life quality index （CDLQI）score， and traditional Chinese medicine syndrome score were assessed before and after 2- and 4-week treatment. Simultaneously， adhering to the principles of sample size in microbial sequencing， 25 children were randomly selected from each group （total 50 children）； skin samples were collected before and after treatment， and skin specimen DNA was extracted for 16S rRNA gene amplifier sequencing； the skin microbiota levels were detected， and the distribution of bacteria， diversity of flora， and differences between groups were compared. ResultsThere were five drop-outs in each group， and 40 cases in each group were included in final analysis. After 2- and 4-week treatment， both groups showed a significant reduction in SCORAD scores， VAS scores， and CDLQI scores， and more reductions were shown after 4-week treatment than 2-week treatment （P＜0.01）. The SCORAD score， VAS score， and CDLQI score of the treatment group were significantly lower than those in the control group after 4-week treatment （P＜0.01）. The scores of upset， thirsty， poor appetite， short red urine， and dry stool were reduced in the treatment group （P＜0.05）， while the scores of thirsty， poor appetite， short and red urine decreased after treatment （P＜0.05）. After 4 weeks of treatment， among the differential genera with abundances ＞0.5% in the treatment group， The cumulative relative abundances of Staphylococcus aureus， Streptococcus_mitis， Escherichia coli and Gemella_haemolysans in the treatment group were downregulated after treatment； in the control group， there was a relative cumulative decrease in the abundance of Streptococcus_mitis. The control group had reduced relative abundance of Streptococcus_mitis， Escherichia coli， Staphylococcus aureus and Gemella_haemolysans， after treatment （P＜0.05）. Alpha diversity analysis revealed an increase in both Chaol index and Shannon index after treatment （P＜0.05）， while there was no significant difference in Chaol index and Shannon index in the control group before and after treatment （P＞0.05）. Higher Chaol index and Shannon index were found in the treatment group （P＜0.05）. Beta diversity analysis showed that there were significant differences in the microbial community structure at the lesion site between the treatment group and the control group before treatment. The microbial community structure in the treatment group was similar after treatment， while there was no significant change in the microbial community structure in the control group before and after treatment. There were significant structure differences of key bacteria genus in both groups before and after treatment. ConclusionZXP used in the treatment of pediatric atopic dermatitis （AD）with the syndrome of damp-heat accumulation， has shown efficacy in reducing the severity of skin lesions， alleviating itching， and enhancing the quality of life in children. This modulation aims to decrease the abundance of pathogenic bacteria while promoting the colonization of beneficial bacteria， thereby altering the skin microbiota and contributing to the treatment of pediatric AD.