Localized scleroderma (LoS) is a chronic autoimmune skin disorder characterized by fibrosis and hardening of the skin and subcutaneous tissues, potentially affecting deeper tissues and other organs. Currently, China lacks evidence-based guidelines for the diagnosis and management of LoS, which poses a challenge to disease recognition and leads to significant variation in treatment strategies across medical centers. To address this problem, we plan to establish a nationwide, multidisciplinary expert team through the Chinese Society of Plastic Surgery to initiate the development of the Chinese Guideline for the Diagnosis and Management of Localized Scleroderma. The guideline aims to standardize the diagnosis and treatment procedures for LoS, improve clinical diagnostic and therapeutic capabilities, and enhance patient outcomes through early identification and intervention. The guideline will adhere to international standards, with recommendations formed through evidence evaluation and multiple rounds of expert discussions. Although evidence-based data on LoS specific to the Chinese population is currently limited, and no unified gold standard for disease assessment exists, the clinical expertise of multidisciplinary specialists will play a pivotal role in the guideline's formulation. We anticipate that this guideline will provide LoS patients with higher-quality medical care and enhance patient awareness and engagement, which may ultimately help reduce social and healthcare burden. This proposal outlines the background, methodology, and anticipated value of the guideline, with the hope of providing guidance for its rigorous development and successful publication.

Objective:To investigate the efficacy and safety of a simple three-step excision for combined reduction plastic surgery of labia minora clitoral hood complex.Methods:We selected the clinical data of patients with labia minora and clitoral prepuce hypertrophy treated in the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from May 2017 to November 2021. All the patients underwent composite labia minora and clitoral hood reduction using a simple three-step excision. In the first step, a longitudinal shuttle incision was designed to remove the redundant lateral prepuce of the clitoris; In the second step, the hypertrophic part of labia minora was removed by wedge resection; The third step was to trim the triangular flap formed by the excess skin at the junction of the labia minora and the clitoral hood, and then complete the incision suture. Patients were asked to return for examinations on days 1, 7, and 10 postoperatively. After that, the patients were followed up in the outpatient department or online, and the satisfaction questionnaires were conducted. The contents included appearance improvement, preoperative symptom improvement, postoperative discomfort symptoms, sexual life quality, partner’s evaluation of surgical effect, and patient’s evaluation of surgical impact.Results:A total of 295 patients were enrolled, with an average age of 29 years, ranged from 9 to 52 years old. Patients were divided into 4 categories according to the surgeries they received, including 21 patients (7.1%) with unilateral labia + unilateral prepuce hypertrophy, 12 patients (4.1%) with unilateral labia + bilateral prepuce hypertrophy, 50 patients (16.9%) with bilateral labia + unilateral prepuce and 212 patients (71.9%) with bilateral labia + bilateral prepuce hypertrophy. The incidence of complications was 3.4%(10/295), hematoma occurred in 8 cases, scar hyperplasia with obvious pain in 1 case, and blood supply disorder in 1 case. After the complementary treatments, all patients recovered well from surgeries. 219 questionnaires were obtained three months after surgeries, and 76 cases were lost to follow-up. The overall satisfaction rate of patients was 94.5%(207/219).Conclusions:The preoperative design of three-step resection is simple, which can safely and effectively carry out composite labia minora and clitoral hood reduction, with less complications, concealed incision, slight scar, and high satisfaction.

Objective:To explore the regulatory effect of exosomes derived from healthy human adipose stem cells (ADSC) on the fibrosis of localized scleroderma fibroblasts (LSFs) in vitro. Methods:From January 2021 to January 2022, fat from 10 healthy donors in Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences was collected by liposuction. Adipose stem cells were isolated and cultured in vitro, and exosomes (ADSC-Exo) were collected. Fibroblasts were isolated from skin tissue of 15 patients with localized scleroderma during the same period and cultured in vitro. Induced differentiation and staining, nanoparticle tracking analysis, transmission electron microscopy, PKH26 staining and Western blotting were used to identify ADSC and their exosomes. The effect of ADSC on the expression of fibrosis markers [collagen Ⅰ, collagen Ⅲ, α-smooth muscle actin (α-SMA)] in LSFs through its exosomes was examined by extracellular vesicle secretion inhibition assay. The proliferation and migration abilities of LSFs treated with ADSC-Exo were tested by CCK-8 method and scratch test. Real-time quantitative PCR, immunofluorescence staining and Western blotting were used to detect the expression levels of collagen Ⅰ, collagen Ⅲ, α-SMA, transforming growth factor β (TGF-β) and p-Smad2/3 in LSFs. Independent sample t-test was used to compare between the two groups. One-way ANOVA was used for multi-group comparison, and SNK- q test was used for pairwise comparison. Results:ADSC and LSFs were successfully isolated and cultured in vitro, and ADSC-Exo was extracted. Extracellular vesicle secretion inhibition assay demonstrated that ADSC decreased fibrotic markers of LSFs by secreting extracellular vesicles. Results of CCK-8 and scratch test showed that the proliferation and migration ability of LSFs was decreased by ADSC-Exo treatment. The results of real-time quantitative PCR, immunofluorescence staining and Western blotting showed that compared with the control group, the expressions of collagen Ⅰ, α-SMA, TGF-β and p-Smad 2/3 in the ADSC-Exo treatment group were significantly decreased. Conclusion:In vitro, ADSC-Exo can affect the biological behavior and reduce the expression of fibrosis markers in LSFs by inhibiting the TGF-β/Smad pathway.

Objective:To investigate the efficacy and safety of a simple three-step excision for combined reduction plastic surgery of labia minora clitoral hood complex.Methods:We selected the clinical data of patients with labia minora and clitoral prepuce hypertrophy treated in the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from May 2017 to November 2021. All the patients underwent composite labia minora and clitoral hood reduction using a simple three-step excision. In the first step, a longitudinal shuttle incision was designed to remove the redundant lateral prepuce of the clitoris; In the second step, the hypertrophic part of labia minora was removed by wedge resection; The third step was to trim the triangular flap formed by the excess skin at the junction of the labia minora and the clitoral hood, and then complete the incision suture. Patients were asked to return for examinations on days 1, 7, and 10 postoperatively. After that, the patients were followed up in the outpatient department or online, and the satisfaction questionnaires were conducted. The contents included appearance improvement, preoperative symptom improvement, postoperative discomfort symptoms, sexual life quality, partner’s evaluation of surgical effect, and patient’s evaluation of surgical impact.Results:A total of 295 patients were enrolled, with an average age of 29 years, ranged from 9 to 52 years old. Patients were divided into 4 categories according to the surgeries they received, including 21 patients (7.1%) with unilateral labia + unilateral prepuce hypertrophy, 12 patients (4.1%) with unilateral labia + bilateral prepuce hypertrophy, 50 patients (16.9%) with bilateral labia + unilateral prepuce and 212 patients (71.9%) with bilateral labia + bilateral prepuce hypertrophy. The incidence of complications was 3.4%(10/295), hematoma occurred in 8 cases, scar hyperplasia with obvious pain in 1 case, and blood supply disorder in 1 case. After the complementary treatments, all patients recovered well from surgeries. 219 questionnaires were obtained three months after surgeries, and 76 cases were lost to follow-up. The overall satisfaction rate of patients was 94.5%(207/219).Conclusions:The preoperative design of three-step resection is simple, which can safely and effectively carry out composite labia minora and clitoral hood reduction, with less complications, concealed incision, slight scar, and high satisfaction.

Objective:To explore the regulatory effect of exosomes derived from healthy human adipose stem cells (ADSC) on the fibrosis of localized scleroderma fibroblasts (LSFs) in vitro. Methods:From January 2021 to January 2022, fat from 10 healthy donors in Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences was collected by liposuction. Adipose stem cells were isolated and cultured in vitro, and exosomes (ADSC-Exo) were collected. Fibroblasts were isolated from skin tissue of 15 patients with localized scleroderma during the same period and cultured in vitro. Induced differentiation and staining, nanoparticle tracking analysis, transmission electron microscopy, PKH26 staining and Western blotting were used to identify ADSC and their exosomes. The effect of ADSC on the expression of fibrosis markers [collagen Ⅰ, collagen Ⅲ, α-smooth muscle actin (α-SMA)] in LSFs through its exosomes was examined by extracellular vesicle secretion inhibition assay. The proliferation and migration abilities of LSFs treated with ADSC-Exo were tested by CCK-8 method and scratch test. Real-time quantitative PCR, immunofluorescence staining and Western blotting were used to detect the expression levels of collagen Ⅰ, collagen Ⅲ, α-SMA, transforming growth factor β (TGF-β) and p-Smad2/3 in LSFs. Independent sample t-test was used to compare between the two groups. One-way ANOVA was used for multi-group comparison, and SNK- q test was used for pairwise comparison. Results:ADSC and LSFs were successfully isolated and cultured in vitro, and ADSC-Exo was extracted. Extracellular vesicle secretion inhibition assay demonstrated that ADSC decreased fibrotic markers of LSFs by secreting extracellular vesicles. Results of CCK-8 and scratch test showed that the proliferation and migration ability of LSFs was decreased by ADSC-Exo treatment. The results of real-time quantitative PCR, immunofluorescence staining and Western blotting showed that compared with the control group, the expressions of collagen Ⅰ, α-SMA, TGF-β and p-Smad 2/3 in the ADSC-Exo treatment group were significantly decreased. Conclusion:In vitro, ADSC-Exo can affect the biological behavior and reduce the expression of fibrosis markers in LSFs by inhibiting the TGF-β/Smad pathway.

Objective:To investigate the efficacy and safety of a simple three-step excision for combined reduction plastic surgery of labia minora clitoral hood complex.Methods:We selected the clinical data of patients with labia minora and clitoral prepuce hypertrophy treated in the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from May 2017 to November 2021. All the patients underwent composite labia minora and clitoral hood reduction using a simple three-step excision. In the first step, a longitudinal shuttle incision was designed to remove the redundant lateral prepuce of the clitoris; In the second step, the hypertrophic part of labia minora was removed by wedge resection; The third step was to trim the triangular flap formed by the excess skin at the junction of the labia minora and the clitoral hood, and then complete the incision suture. Patients were asked to return for examinations on days 1, 7, and 10 postoperatively. After that, the patients were followed up in the outpatient department or online, and the satisfaction questionnaires were conducted. The contents included appearance improvement, preoperative symptom improvement, postoperative discomfort symptoms, sexual life quality, partner’s evaluation of surgical effect, and patient’s evaluation of surgical impact.Results:A total of 295 patients were enrolled, with an average age of 29 years, ranged from 9 to 52 years old. Patients were divided into 4 categories according to the surgeries they received, including 21 patients (7.1%) with unilateral labia + unilateral prepuce hypertrophy, 12 patients (4.1%) with unilateral labia + bilateral prepuce hypertrophy, 50 patients (16.9%) with bilateral labia + unilateral prepuce and 212 patients (71.9%) with bilateral labia + bilateral prepuce hypertrophy. The incidence of complications was 3.4%(10/295), hematoma occurred in 8 cases, scar hyperplasia with obvious pain in 1 case, and blood supply disorder in 1 case. After the complementary treatments, all patients recovered well from surgeries. 219 questionnaires were obtained three months after surgeries, and 76 cases were lost to follow-up. The overall satisfaction rate of patients was 94.5%(207/219).Conclusions:The preoperative design of three-step resection is simple, which can safely and effectively carry out composite labia minora and clitoral hood reduction, with less complications, concealed incision, slight scar, and high satisfaction.

Objective:To investigate the efficacy and safety of a simple three-step excision for combined reduction plastic surgery of labia minora clitoral hood complex.Methods:We selected the clinical data of patients with labia minora and clitoral prepuce hypertrophy treated in the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from May 2017 to November 2021. All the patients underwent composite labia minora and clitoral hood reduction using a simple three-step excision. In the first step, a longitudinal shuttle incision was designed to remove the redundant lateral prepuce of the clitoris; In the second step, the hypertrophic part of labia minora was removed by wedge resection; The third step was to trim the triangular flap formed by the excess skin at the junction of the labia minora and the clitoral hood, and then complete the incision suture. Patients were asked to return for examinations on days 1, 7, and 10 postoperatively. After that, the patients were followed up in the outpatient department or online, and the satisfaction questionnaires were conducted. The contents included appearance improvement, preoperative symptom improvement, postoperative discomfort symptoms, sexual life quality, partner’s evaluation of surgical effect, and patient’s evaluation of surgical impact.Results:A total of 295 patients were enrolled, with an average age of 29 years, ranged from 9 to 52 years old. Patients were divided into 4 categories according to the surgeries they received, including 21 patients (7.1%) with unilateral labia + unilateral prepuce hypertrophy, 12 patients (4.1%) with unilateral labia + bilateral prepuce hypertrophy, 50 patients (16.9%) with bilateral labia + unilateral prepuce and 212 patients (71.9%) with bilateral labia + bilateral prepuce hypertrophy. The incidence of complications was 3.4%(10/295), hematoma occurred in 8 cases, scar hyperplasia with obvious pain in 1 case, and blood supply disorder in 1 case. After the complementary treatments, all patients recovered well from surgeries. 219 questionnaires were obtained three months after surgeries, and 76 cases were lost to follow-up. The overall satisfaction rate of patients was 94.5%(207/219).Conclusions:The preoperative design of three-step resection is simple, which can safely and effectively carry out composite labia minora and clitoral hood reduction, with less complications, concealed incision, slight scar, and high satisfaction.

Localized scleroderma (LoS) is a chronic autoimmune skin disorder characterized by fibrosis and hardening of the skin and subcutaneous tissues, potentially affecting deeper tissues and other organs. Currently, China lacks evidence-based guidelines for the diagnosis and management of LoS, which poses a challenge to disease recognition and leads to significant variation in treatment strategies across medical centers. To address this problem, we plan to establish a nationwide, multidisciplinary expert team through the Chinese Society of Plastic Surgery to initiate the development of the Chinese Guideline for the Diagnosis and Management of Localized Scleroderma. The guideline aims to standardize the diagnosis and treatment procedures for LoS, improve clinical diagnostic and therapeutic capabilities, and enhance patient outcomes through early identification and intervention. The guideline will adhere to international standards, with recommendations formed through evidence evaluation and multiple rounds of expert discussions. Although evidence-based data on LoS specific to the Chinese population is currently limited, and no unified gold standard for disease assessment exists, the clinical expertise of multidisciplinary specialists will play a pivotal role in the guideline's formulation. We anticipate that this guideline will provide LoS patients with higher-quality medical care and enhance patient awareness and engagement, which may ultimately help reduce social and healthcare burden. This proposal outlines the background, methodology, and anticipated value of the guideline, with the hope of providing guidance for its rigorous development and successful publication.