Objective To evaluate the validity of botulinum toxin type A (BTXA) injections for the treatment of scar contracture.Methods 26 patients with scar contracture were randomly assigned into BTXA group and triamcinolone acetonide (TAC) group.Pinpoint tattooing was performed on each side of each scar in the plane of its longest axis.A template was used to ensure consistent length.These two tattoo points were measured to assess scar contraction at baseline,at every month for a total of 6 months.Histological analysis was conducted to study the physiological environment and immunohistochemistry to detect the expression of α-SMA and myosin-Ⅱ at different groups.Results Scar contraction was more relaxed in BTXA group than that in TAC group after 1 month (P＜0.05),especially in the 6th month (the D value in BTXA group and TAC group was (1.23±0.42) cm,and (0.56±0.33) cm respectively).For immunohistochemistry,the expression of α-SMA and myosin-Ⅱ also decreased in BTXA group (P＜0.05).Conclusions The treatment of scar contracture by suitable BTXA injections is safe and effective.

OBJECTIVETo investigate the effects of botulinum toxin type A (BTXA) on the expression of alpha smooth muscle actin(alpha-SMA) and myosin-II of fibroblasts in scars. Methods Fibroblasts were isolated from tissue specimens of scars contracture. Cells from passages 3-5 were randomly divided into 3 groups (control group, low BTXA group (1 U/10(6) Cells), and high BTXA group (2.5 U/ 10(6)Cells)). Growth condition of fibroblasts was observed at 1 , 4, 7 day after BTXA treated. Changes of alpha-SMA and myosin-II in fibroblasts were detected by Western blot.

RESULTSFibroblasts grew well in control group. The proliferation was decreased 4 days later in BTXA groups. Lots of apoptotic cells were seen in high BTXA group at 7th day. Proteins of alpha-SMA and myosin-II in fibroblasts were statistically different between BTXA group and control groups at 4th day (P < 0.05). The expression of alpha-SMA and myosin-II in low BTXA group was higher than that in high BTXA group at 7th day (P < 0.05).

CONCLUSIONSBTXA could induce the apoptosis of fibroblasts and decrease the expression of alpha-SMA and myosin-II in fibroblasts. The inhibitory effect was strengthened with BTXA concentration increase within a certain range.

Actins ; metabolism ; Botulinum Toxins, Type A ; pharmacology ; Cicatrix ; Fibroblasts ; drug effects ; metabolism ; Humans ; Muscle, Smooth ; metabolism ; Myosin Type II ; metabolism ; Random Allocation

With the increasing application of autologous fat grafting and adipose-derived stem cells (ASC) in regenerative medicine, more researchers pay attention to its effects on scar, which may provide a promising alternative for scar treatment. In this article, a systemic review of available literature was undertaken, regarding the current progress in repairing scars with autologous granule fat, the introduction of nanofat grafting and its effects on scar, and the mechanism of ASCs in the treatment of scar. This review provides a reference for the clinical application and basic research of fat transplantation in scar treatment.

Objective To explore the diagnosis and treatment of non-tuberculosis mycobacteria (NTM) infection after cosmetic injection via scientific debridement surgery combined with regular application of anti-NTM drugs.Methods 14 patients who were infected with NTM after cosmetic injection and were not cured over a long period of time in other hospitals from 2012 to 2016.The patients were treated with VSD thorough surgical debridement,the bacterial type of NTM was identified by bacterial culture and PCR identification and anti-NTM drugs were systematically used according to the results of drug sensitivity.Results Fourteen patients who were treated with scientific debridement surgeries combined with regular anti-NTM drug treatment in our hospital for 2-4 months were discharged after their skin lesions were cleared and healed and they were continually treated with antiNTM drugs for 12 months.Fourteen patients were completely cured by using the above treatments without severe side effects,such as liver and kidney dysfunction,nervous system disorders and so on.Only colpitis mycotica occurred in 3 patients.In addition,one patient presented the decrease of leukopenia after using anti-NTM drugs for 2 months and continued to complete the treatment after we adjusted the treatment plan to returning the level of leukopenia to the normal.These 14 patients were followed up for 1-5 years with no recurrence of the lesion.The facial appearance of 12 patients were almost normal with slight scars.The facial surgery area of 2 patients were uneven and nearly recovered to normal facial appearance by tissue transplantation and photoelectric therapy.Conclusions For the NTM patients caused by invasive procedures such as injection,the comprehensive treatment program,which combined scientific debridement surgery and systematically targeted drug treatment,not only can effectively cure NTM infection,but also minimize secondary injury and restore the patients' appearance,which is worthy of clinical application.

Objective:To analyze the clinical effect of hyaluronidase injection through the facial artery in the treatment of vascular embolism such as skin ulceration and necrosis after cosmetic injection.Methods:Hyaluronidase was injected through facial artery in 13 patients who were diagnosed with vascular embolism after facial injection from January 2019 to May 2020. The facial artery was punctured with 22-gauge arterial blood collection needle or 19/23-gauge disposable venous infusion needle. The angle between the needle body and the skin varies depending on the patients’ weight, ranged 30°-45°. The needle was advanced slowly and pushed forward by 2-3 mm when blood backflow appeared in the needle core. After confirming the successful puncture of the facial artery, 0.5-1.5 ml hyaluronidase was slowly injected into the facial artery. The time of skin relaxation, tenderness relief, ulcer healing and wound recovery were observed. The pigmentation was observed and the Vancouver Scar Scale (VSS) was used to score the scars after 3-12 months.Results:A toal of 13 patients with vascular complications of hyaluronidase filler were retrospectively reviewed. The patients were 18-45-year-old(mean age, 35 years) and received hyaluronidase filler at private clinics. There were 12 women and 1 man. The time from onset to visit was 14 h to 4 d, with an average time of 2.5 d. Hyaluronidase was most commonly injected into the nasolabial folds (54%, 7 of 13). The second-ranked area is the nasalroot (23%, 3 of 13). These patients had skin swelling, necrosis, ecchymosis or black scabs during or after hyaluronidase injection. Some patients showed skin lesions combined with oral ulcer. After percutaneous facial arterial hyaluronidase injection, the local skin tissue injuries of the 13 patients were improved in time. The time of skin relaxation was (0.77±0.25) d, the time of tenderness relief was (1.23±0.64) d, the time of ulcer healing was (3.14±0.64) d and the time of wound recovery was (5.85±0.86) d. Patients were followed up for 3-12 months, with an average of 7 months. One patient had slight scar (VSS score of 1), two patients had only mild pigmentation (VSS score of 0), and the other ten patients had no scar and pigmentation (VSS score of 0).Conclusions:It is effective to improve local microcirculation and reduce skin tissue injury after percutaneous facial artery hyaluronidase injection in the treatment of skin injury caused by facial filler injection.

Objective:To analyze the clinical effect of hyaluronidase injection through the facial artery in the treatment of vascular embolism such as skin ulceration and necrosis after cosmetic injection.Methods:Hyaluronidase was injected through facial artery in 13 patients who were diagnosed with vascular embolism after facial injection from January 2019 to May 2020. The facial artery was punctured with 22-gauge arterial blood collection needle or 19/23-gauge disposable venous infusion needle. The angle between the needle body and the skin varies depending on the patients’ weight, ranged 30°-45°. The needle was advanced slowly and pushed forward by 2-3 mm when blood backflow appeared in the needle core. After confirming the successful puncture of the facial artery, 0.5-1.5 ml hyaluronidase was slowly injected into the facial artery. The time of skin relaxation, tenderness relief, ulcer healing and wound recovery were observed. The pigmentation was observed and the Vancouver Scar Scale (VSS) was used to score the scars after 3-12 months.Results:A toal of 13 patients with vascular complications of hyaluronidase filler were retrospectively reviewed. The patients were 18-45-year-old(mean age, 35 years) and received hyaluronidase filler at private clinics. There were 12 women and 1 man. The time from onset to visit was 14 h to 4 d, with an average time of 2.5 d. Hyaluronidase was most commonly injected into the nasolabial folds (54%, 7 of 13). The second-ranked area is the nasalroot (23%, 3 of 13). These patients had skin swelling, necrosis, ecchymosis or black scabs during or after hyaluronidase injection. Some patients showed skin lesions combined with oral ulcer. After percutaneous facial arterial hyaluronidase injection, the local skin tissue injuries of the 13 patients were improved in time. The time of skin relaxation was (0.77±0.25) d, the time of tenderness relief was (1.23±0.64) d, the time of ulcer healing was (3.14±0.64) d and the time of wound recovery was (5.85±0.86) d. Patients were followed up for 3-12 months, with an average of 7 months. One patient had slight scar (VSS score of 1), two patients had only mild pigmentation (VSS score of 0), and the other ten patients had no scar and pigmentation (VSS score of 0).Conclusions:It is effective to improve local microcirculation and reduce skin tissue injury after percutaneous facial artery hyaluronidase injection in the treatment of skin injury caused by facial filler injection.

Objective:To investigate the expression of oxidative stress and related pathway factors in fibroblasts from human hypertrophic scar and normal skin tissue.Methods:Select and collect the scar tissue and normal full-thickness skin tissue of the donor area from 8 hypertrophic scar patients who were treated with surgical resection at the Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital from June 2019 to July 2020, extract and culture primary fibroblasts by weaving method, subculture them, and perform the following experiments when the cells were subcultured to the third generation: (1)Detect the proliferation ability of hypertrophic scar fibroblasts(HSF)and normal skin fibroblasts(NSF)with CCK-8 method.(2)Detect the number of reactive oxygen species in HSF and NSF by flow cytometry.(3)Colorimetric method for detecting relative activity of superoxide dismutase(SOD)in two kinds of cells.(4)Detect the NQO1 gene expression in two kinds of cells with RT-PCR.(5)Detect the Nrf2 gene expression in two kinds of cells with RT-PCR.(6)Detects Nrf2 and Bcl2 protein content in two kinds of cells with Western blotting.(7)Detect the expression and distribution of Nrf2 in cells with cellular immunohistochemical staining. The results were analyzed by SPSS 25.0 statistical software, independent sample t test was performed, and P<0.05 was considered as the difference was statistically significant. Results:(1) Compared with NSF, the number of the two kinds of cells is statistically different from the third day (The statistical results from the third day to the seventh day were as follows: t=2.631, P=0.039; t=7.025, P<0.001; t=5.031, P<0.001; t=4.241, P=0.002; t=6.525, P=0.003). (2) The reactive oxygen species content in HSF was 75.39%±3.06%, which was significantly higher than 45.36%±3.66% in the NSF group ( t=-17.804, P<0.001). (3) The relative activity of SOD of the HSF group was (50.76±0.52) U/ml, which is higher than that of the NSF group (42.76±1.35) U/ml ( t=15.674, P<0.001). (4) The relative expression of NQO1 mRNA in HSF was 0.859±0.076, which was lower than that in the NSF group at 1.595±0.181 ( t=3.763, P=0.020). (5) The relative expression of Nrf2 mRNA in HSF was 0.590±0.055, which was lower than that in the NSF group at 1.595±0.146 ( t=6.445, P=0.003). (6) The relative expression of Nrf2 protein of HSF was 0.314±0.035, which was significantly lower than 0.912±0.039 in the NSF group ( t=22.554, P<0.001). The relative expression of Bcl2 protein of HSF was 0.466±0.020, which was significantly lower than 0.734±0.066 in the NSF group ( t=7.780, P<0.001). (7) Nrf2 protein express in NSF and HSF cells, and protein expression was found in both nucleus and cytoplasm. Conclusions:HSF has a high degree of oxidative stress, which may be due to some reasons that reduce the content of Nrf2, resultsing in a decrease in the expression of various antioxidant enzymes, and ultimately leading to the accumulation of reactive oxygen species. Compared with NSF, HSF has stronger proliferation and apoptosis abilities, and reactive oxygen species can cause cell apoptosis, indicating that oxidative stress may be one of the pathogenesis of hypertrophic scars.

Objective:To investigate the expression of oxidative stress and related pathway factors in fibroblasts from human hypertrophic scar and normal skin tissue.Methods:Select and collect the scar tissue and normal full-thickness skin tissue of the donor area from 8 hypertrophic scar patients who were treated with surgical resection at the Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital from June 2019 to July 2020, extract and culture primary fibroblasts by weaving method, subculture them, and perform the following experiments when the cells were subcultured to the third generation: (1)Detect the proliferation ability of hypertrophic scar fibroblasts(HSF)and normal skin fibroblasts(NSF)with CCK-8 method.(2)Detect the number of reactive oxygen species in HSF and NSF by flow cytometry.(3)Colorimetric method for detecting relative activity of superoxide dismutase(SOD)in two kinds of cells.(4)Detect the NQO1 gene expression in two kinds of cells with RT-PCR.(5)Detect the Nrf2 gene expression in two kinds of cells with RT-PCR.(6)Detects Nrf2 and Bcl2 protein content in two kinds of cells with Western blotting.(7)Detect the expression and distribution of Nrf2 in cells with cellular immunohistochemical staining. The results were analyzed by SPSS 25.0 statistical software, independent sample t test was performed, and P<0.05 was considered as the difference was statistically significant. Results:(1) Compared with NSF, the number of the two kinds of cells is statistically different from the third day (The statistical results from the third day to the seventh day were as follows: t=2.631, P=0.039; t=7.025, P<0.001; t=5.031, P<0.001; t=4.241, P=0.002; t=6.525, P=0.003). (2) The reactive oxygen species content in HSF was 75.39%±3.06%, which was significantly higher than 45.36%±3.66% in the NSF group ( t=-17.804, P<0.001). (3) The relative activity of SOD of the HSF group was (50.76±0.52) U/ml, which is higher than that of the NSF group (42.76±1.35) U/ml ( t=15.674, P<0.001). (4) The relative expression of NQO1 mRNA in HSF was 0.859±0.076, which was lower than that in the NSF group at 1.595±0.181 ( t=3.763, P=0.020). (5) The relative expression of Nrf2 mRNA in HSF was 0.590±0.055, which was lower than that in the NSF group at 1.595±0.146 ( t=6.445, P=0.003). (6) The relative expression of Nrf2 protein of HSF was 0.314±0.035, which was significantly lower than 0.912±0.039 in the NSF group ( t=22.554, P<0.001). The relative expression of Bcl2 protein of HSF was 0.466±0.020, which was significantly lower than 0.734±0.066 in the NSF group ( t=7.780, P<0.001). (7) Nrf2 protein express in NSF and HSF cells, and protein expression was found in both nucleus and cytoplasm. Conclusions:HSF has a high degree of oxidative stress, which may be due to some reasons that reduce the content of Nrf2, resultsing in a decrease in the expression of various antioxidant enzymes, and ultimately leading to the accumulation of reactive oxygen species. Compared with NSF, HSF has stronger proliferation and apoptosis abilities, and reactive oxygen species can cause cell apoptosis, indicating that oxidative stress may be one of the pathogenesis of hypertrophic scars.