Objective To investigate the value of combined therapy for hand post-burn scars.Methods We retrospectively analyzed 78 hands post-burn scars in 46 cases from 2007 to 2011.A mong them,scar contracture releasing,scar excision,free skin grafting and fixation with Kirschner's pins were performed in 38 hands,scar excision and regional flat transfer were performed in 18 hands,scar excision and skin grafting were performed in 18 hands,abdominal expanded flap transplantation and scar excision were performed in 4 hands.All patients received elastic sleeve pressure therapy,sili cone gel for external application and function training.Within six months after the operation,52 hands received drug delivery by wax therapy,16 hands incision with scar proliferation received drug injection into scar.We followed up all patients from half a year to three years after the treatment to observe the recovery of the appearance and function of the hands.Results We mainly chose surgery,elastic sleeve pressure therapy,silicone gel for external application,drug injection into scar,wax therapy,function training and so on treating the hand post-burn scars and found that the joins deformities caused by scar contracture were largely or totally corrected.The function and appearance were satisfying.Conclusions It is a good method to treat hand scars by surgery and post-surgery combined physical rehabilitation therapy,which deserves to popularization.

OBJECTIVETo investigate the effect of epidermal stem cells from human hypertrophic scar (HS-ESCs) on the skin wound healing in nude mice.

METHODS40 mice were randomly divided into two groups as experimental group (n = 20) and control group (n = 20). Wounds, 1 cm in diameters, were made on every mouse back. The wounds were treated with HS-ESCs and erythromycin ointment in experimental group, or only with erythromycin ointment in control group. The wound healing was observed during the following 14 days. The expression of collagen-I, collagen-III, epidermal growth factor (EGF), fibroblast growth factor (FGF2) , transforming growth factor (TGFbeta1, and TGFbeta2) were studied.

RESULTSThe wound healing time in the experimental group was (20.8 +/- 0.84) d, which was (25.6 +/- 0.89) d in the control group. HE staining revealed that the extent of vascularization in the experimental group was 11.60 +/- 0.55, while it was 8.04 +/- 0.33 in the control group. Immunochemistry analysis showed the expression of collagen-I, collagen-III, EGF, FGF2, TGFbeta1, and TGFbeta2 in the experimental group were significantly higher, compared with those in control group (P < 0.05).

CONCLUSIONHS-ESCs may promote wound healing through enhancement of the vascularization of the wound tissue and the expression of growth factors.

Animals ; Cicatrix, Hypertrophic ; pathology ; Epidermis ; cytology ; Female ; Humans ; Male ; Mice ; Mice, Nude ; Skin ; injuries ; Stem Cell Transplantation ; Stem Cells ; Wound Healing

Objective To lay a foundation for the clinical application and tissue engineering research of hypertrophic scar (HS)-derived DMSCs by comparing the biological characteristics of dermis mesenchymal stem cells (DMSCs) from human maturing-phase HS and normal skin.Methods Twenty maturing-phase HS specimens (scar group) and 20 normal skin specimens (control group) were selected to extract and sort DMSCs by two-step enzyme digestion.When cells in both groups were subcultured to 3rd generation,cell morphology and growth curve were observed; expressions of cell surface proteins CD29,CD49 and vimentin were tested by immunocytochemistry; cells with positively expressed surface proteins CD34,CD73,CD90,and CD105 were examined by flow cytometry; expressions of genes Oct4 and Nanog were tested by RT-PCR; cell potential to differentiate into lipoblasts,osteoblasts,and chondroblasts was assayed in inductive medium.Results DMSCs in both groups showed similar shape and growth curve.Cell markers CD29,CD49 and vimentin expressed positively.Of scar and control groups,expressions of CD34,CD73,CD90,and CD105 were (0.60±0.03)％ vs (0.61 ±0.02)％,(98.90±0.80)％vs (99.00±0.70)％,(98.30±0.30)％vs (98.20±0.40)％,and (93.10± 0.40) ％ vs (93.00 ± 0.20) ％ respectively (P ＞ 0.05) ; expressions of genes Oct4 and Nanog were 0.506±0.024 vs0.512±0.024 and 0.496 ±0.018 vs 0.494 ±0.023 (P＞0.05).Both types of DMSCs were able to differentiate in vitro into lipoblasts,osteoblasts,and chondroblasts in invitro conductive medium.Conclusion DMSCs exist in maturing-phase HS and present biomechanical characteristics basically similar with those of normal human skin.

Objective: To identify the special biomarkers and the differentially expressed proteins in keloid tissue and to explore the pathogenesis characteristics of familial keloid by comparing the protein expression differences among familial keloid(FK), sporadic keloid(SK), hypertrophy scar (HS), normal scar (NS). Methods: The tissue specimens of FK, SK, HS and NS(6 specimens in each group), were digested, taged and analysed using quantitative proteomic isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology. A difference greater than 1.2 folds and P<0.05 were selection criteria for differencial expression proteins. Then bioinformatics analysis was applied.The expressions of 2 differential proteins were validated using Western Blot analysis. Results: A total of 2 450 differentially expressed proteins were identified. Compared with NS, 250 up-regulated and 281 down-regulated proteins were identified in FK; 281 up-regulated and 232 down-regulated proteins were identified in SK; 199 up-regulated and 233 down-regulated proteins were identified in HS.Compared with SK, 64 up-regulated and 164 down-regulated proteins were identified in FK; 79 up-regulated and 169 down-regulated proteins were identified in HS.Compared with HS, 124 up-regulated and 115 down-regulated proteins were identified in FK.These different proteins were concentrated in several vital signal pathways such as the extracellular matrix protein, cell adhesion and biological metabolism pathways. The variation trend of 2 differentially expressed proteins (P3H1 and RCN-3) were validated by Western Blot. Conclusions Proteomic analysis can identify the proteins with variance of keloid, hypertrophy scar and normal skin. Further investigations of these differential proteins may reveal the pathogenesis of keloid and provide new treatments for it.

In October 2017, a female patient, 3 years and 5 months of age, with Crouzon syndrome, associated with multiple craniosynostoses was admitted to Plastic Surgery Hospital. Combined intracranial and extracranial approaches of fronto-orbital advancement and cranial suture release were performed to treat plagiocephaly and scaphocephaly. The patient′s families were investigated. Corresponding mutations were detected by DNA sequencing. Therapeutic effect was satisfactory. The mutation was inherited for 5 generations. Genomic sequencing results showed that the exons of fibroblast growth factor receptor 2 gene in the child was mutated, which excessively activated downstream signals and caused craniosynostosis.

Objective: To evaluate the clinical outcomes of a series of patients who have undergone reconstruction of craniofacial defects after resection of intracranial tumors or craniofacial trauma with free composite anterolateral thigh flaps. Methods: Retrospective analyses the clinical cases from September 2007 to September 2016. Data included flap survival rate, complication, satisfaction survey was reviewed to evaluate the efficacy and safety of this surgical strategy. Results: Totally 10 free anterolateral thigh flaps including 3 cases of fasciocutaneous flaps, 2 case of adipofascial flaps, 4 cases of myocutaneous flaps, 1 case of chimeric flap, were adopted to reconstruct craniofacial defects. Follow-up ranged from 3 to 17 months (average, 12 months). All flaps were transferred successfully. There were no cranial spinal fluid(CSF) leaks, intracranial infections or donor site complications. All patients were satisfied. Conclusions Because of its abundance of tissue, matched vessels to recipient site, versatility of muscular flaps to fill irregularly intracranial defects, reliable blood supply, feasibility of simultaneous fascia lata harvesting, free composite anterolateral thigh flap is the reconstructive method of choice for craniofacial defects reconstruction after resection of intracranial tumors or craniofacial trauma. The use of ALT flap was reliable in the decrease of CSF leak and infection rate and dependable according to long time follow-up.

Objective:To explore the soft tissue composition underlying upper eyelid puffiness and the experience in treating it with tailor-made procedure during upper blepharoplasty.Methods:In a retrospective study from January 2017 to December 2018, 165 patients with upper eyelid puffiness underwent full-incision upper blepharoplasty. During the procedure, the anterior wall of orbital septum was exposed, and the volume of the retro-orbicularis oculus fat (ROOF) and preaponeurotic fat was observed. The orbital septum would be opened if lacrimal gland prolapse was suspected. The puffy upper eyelid would be targeted with tailor-made procedure such as partial ROOF resection, removal or transposition of the preaponeurotic fat, as well as lacrimal gland refixation.Results:All 165 cases were healed by first intention. No relapse was found after a 6 to 24 months follow-up. Persistent mild pain and local skin tightness epiphora chemosis were presented in isolated cases with self-resolution within a short time. There were no severe adverse reaction or complications occurred during the operation and follow-up.Conclusions:The tailor-made procedure during upper blepharoplasty targets the soft tissue anatomy underlying upper eyelid puffiness. It is safe and effective in maintaining a natural look of upper eyelids while retaining the appropriate amount of adipose tissue in the upper eyelid.

Objective To discuss a surgical treatment to correct prominent mandibular angle with long chin.Methods From July 2015 to October 2017,21 patients with malocclusion who suffered from prominent mandibular angle with long chin underwent en-bloc mandibular U-shaped osteotomy through oralincision in order to shorten mandibular angle,the body of mandible and the chin and to improve the facial contour.We assessed the surgical effect through comparison of radiologic images,satisfaction of patients and surgical complications between pre-operation and post-operation.Results In this group,all oral incisions had healing by first intention,without hematoma,infection and osteonecrosis.Low lip numbness occurred in 16 patients.After following up for 6-12 months,the lower lip numbness was recovered in 14 patients and relieved in 2 patients.All patients satisfied with the appearance after the operation.Conclusions En-bloc mandibular U-shaped osteotomy is an improvement for mandible surgery treatment.Its osteotomy line involves the whole mandible,which makes the length and width of mandible smaller apparently.This procedure can effectively correct prominent mandibular angle with long chin.

Objective To investigate clinical characteristics and treatment of upper eyelid lipogranuloma cases that developed after facial autologous fat injection.Methods This retrospective study involved 8 patients who presented with upper eyelids symptoms (final diagnosis of lipogranulo ma) and had history of facial autologous fat injection.The collected data included information on patient sex,age,clinical presentation,laboratory findings,treatment and outcome.Results All 8 cases were managed by exploration and surgical removal through double eyelid surgery.All patients showed complete resolution over 1-12 months follow up period.Conclusions Lipogranuloma can develop in the upper eyelid after autologous fat injection into the face.and surgical removal can yield satisfactory outcomes in cases of repeated failure of conservative therapies.