Objective:To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn.Methods:The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm 2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm 2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm 2 in the hard and thin scar area, and 30-40 FUs /cm 2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M ( Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results:A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm 2, with an average of 63.3 cm 2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) ( W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm 2/33.3 FUs/cm 2) to 89.7% (26.1 FUs/cm 2/29.1 FUs/cm 2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion:The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

The formation of pathological scar has an impact on patients’ normal life and mental health, which is also a thorny problem in plastic surgery. In recent years, the influence mechanism of mechanical tension and signal transduction on wound healing has attracted extensive attention and provides a new idea for the prevention and treatment of pathological scar. This paper reviews the research progress of the influence mechanism of mechanical stretch on wound healing in different stages. In the inflammatory stage, hyperplasia stage and tissue remodeling stage of wound healing, mechanical stretch tension causes biological reactions such as chronic inflammation, fibrosis, angiogenesis, and extracellular matrix remodeling through complex signal transduction and feedback mechanisms, which has an impact on wound healing and scar formation. Mechanical stretch therapy for wound healing and scar formation has also achieved certain result in clinical and basic study.

The contracted nose is a unique entity that follows rhinoplasty in the Asian patient, which is mainly related to infection, graft implant, multiple invasive nasal repair operations, patients’ own inflammatory reaction and basic conditions, and is a complication that seriously affects the nasal aesthetics and functional characteristics of patients. Comprehensive understanding of the causes, mechanisms and repair method of contracture nose is helpful for its prevention and treatment. In view of the causes and mechanisms of capsular contracture, this paper reviews the research progress in improving the aesthetic and functional characteristics of patients from the three levels of nasal mucosa, cartilage scaffold and skin, as well as the adjuvant treatment of skin contracture release.

Objective:To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn.Methods:The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm 2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm 2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm 2 in the hard and thin scar area, and 30-40 FUs /cm 2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M ( Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results:A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm 2, with an average of 63.3 cm 2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) ( W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm 2/33.3 FUs/cm 2) to 89.7% (26.1 FUs/cm 2/29.1 FUs/cm 2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion:The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

The formation of pathological scar has an impact on patients’ normal life and mental health, which is also a thorny problem in plastic surgery. In recent years, the influence mechanism of mechanical tension and signal transduction on wound healing has attracted extensive attention and provides a new idea for the prevention and treatment of pathological scar. This paper reviews the research progress of the influence mechanism of mechanical stretch on wound healing in different stages. In the inflammatory stage, hyperplasia stage and tissue remodeling stage of wound healing, mechanical stretch tension causes biological reactions such as chronic inflammation, fibrosis, angiogenesis, and extracellular matrix remodeling through complex signal transduction and feedback mechanisms, which has an impact on wound healing and scar formation. Mechanical stretch therapy for wound healing and scar formation has also achieved certain result in clinical and basic study.

The contracted nose is a unique entity that follows rhinoplasty in the Asian patient, which is mainly related to infection, graft implant, multiple invasive nasal repair operations, patients’ own inflammatory reaction and basic conditions, and is a complication that seriously affects the nasal aesthetics and functional characteristics of patients. Comprehensive understanding of the causes, mechanisms and repair method of contracture nose is helpful for its prevention and treatment. In view of the causes and mechanisms of capsular contracture, this paper reviews the research progress in improving the aesthetic and functional characteristics of patients from the three levels of nasal mucosa, cartilage scaffold and skin, as well as the adjuvant treatment of skin contracture release.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Binder syndrome, also known as maxillonasal dysplasia, is an uncommon developmental anomaly. The etiology and pathogenesis of Binder syndrome are still poorly understood, and there is a lack of normative consensus on its treatment strategies. This review retrospectively analyzed relevant studies on the etiology and treatment of Binder syndrome. The main points are summarized as follows: (1) Taken together, the etiology of Binder syndrome can be classified as genetic and non-genetic, whose crucial factor is the inactivation of vitamin K-dependent protein. (2) The management consists of orthodontic treatment, rhinoplasty, and orthognathic surgery. Orthodontic treatment can be performed at any time, while rhinoplasty and orthognathic surgery should be deferred until midfacial growth is almost complete. Therefore, the ideal timing of rhinoplasty is after 14 years old, and for orthognathic surgery, it is after 16-18 years old. Autologous costal cartilage is preferred for rhinoplasty and alloplastic materials are alternatives when donor availability is limited. Maxillary osteotomies should be reserved only for severe patients with Angle Class Ⅲ malocclusion.

Objective:To investigate the changes of the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis (TSDO).Methods:A retrospective analysis was performed on skull CT data of cleft lip and palate patients who underwent TSDO to correct midfacial hypoplasia between 2005 and 2019 in Peking University Third Hospital. The Mimics 20.0 software was used for three-dimensional(3D) model reconstruction to observe the morphological changes of the zygoma, circumzygomatic sutures, and zygomatic arch at the end of the traction period after TSDO. Measurements were taken and analyzed for the distances from mp point to 3D reference planes, zygoma height, zygoma width 1, zygoma width 2, zygoma thickness, zygoma volume, zygomaticomaxillary suture width, zygomaticotemporal suture width, zygomaticofrontal suture width, zygomatic arch length, and distances from zygomatic arch landmarks (tp point, zy point, and ju point) to the 3D reference planes. All data were divided into cleft and non-cleft sides. GraphPad Prism 9.4.1 software was used to analyze the changes before and after TSDO. Measurement data of normal distribution was expressed by ± s and the comparison between groups before and after traction was analyzed by paired t-test. Measurement data of non-normal distribution was expressed by M(IQR) and the comparison between groups before and after traction was analyzed by paired Wilcoxon test. If P<0.05, the difference was statistically significant. Results:A total of 27 patients were included in the study, including 23 males and 4 females, with a mean age of (11.19±2.35) years (5-15 years). Of these patients, 10 had bilateral cleft lip and palate, and 17 had unilateral cleft lip and palate (9 on the left side and 8 on the right side). The average traction period was (40.26±11.43) days. The midfacial depression of the patients was corrected after TSDO, and the zygoma grew forward, downward, and horizontally. The circumzygomatic sutures shifted forward. The zygomatic arch showed forward and downward growth. The measurements of zygoma showed that the mp point moved forward by (7.82±3.95) mm on the cleft side and 4.26(5.72) mm on the non-cleft side with statistical differences ( P<0.05). The mp point moved slightly downward, and outward after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). After TSDO, the zygoma height, width, and volume were all increased compared to preoperative levels, and these differences were statistically significant ( P<0.05). The width of the lower part of the zygomatic bone showed the most significant change, increasing by 4.33(5.17) mm on the cleft side and (3.42±2.67) mm on the non-cleft side and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the thickness of the zygoma after TSDO compared to before surgery ( P>0.05). The widths of circumzygomatic sutures were all increased after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). The width of zygomaticofrontal suture showed the greatest increase and the width of zygomaticomaxillary suture showed the smallest increase. The length of the zygomatic arch increased after TSDO compared to before surgery, with an increase of (4.78±2.71) mm on the cleft side and (2.03±1.48) mm on the non-cleft side, and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the position of the tp point after TSDO compared to before surgery ( P>0.05), while the position of the zy point and the ju point moved significantly forward and downward, and these differences were statistically significant ( P<0.05). In the horizontal direction, there was no statistically significant difference in the position of the zy point and ju point after TSDO compared to before surgery ( P>0.05). Conclusion:After TSDO, the zygoma shows three-dimensional growth with significant increases in height, width, and volume. The position of zygoma moves forward, downward, and outward. The circumzygomatic sutures widen due to the distraction force, and the zygomatic arch grows forward and downward, with an increase in length.

The treatment of chronic wounds has been one of the most challenging problems in the medical field due to their complex pathogenesis and long course. In recent years, the research of adipose-derived stem cells (ADSCs) therapy in the treatment of chronic wounds has been greatly developed. The application of stem cells has been innovated with the further investigation of cell behavior and signaling pathways, and the advancement of derivative extraction technology. In this article, the effects of ADSCs and their derivatives on chronic wounds are discussed in terms of the mechanisms of normal and chronic wound healing, and the related studies are reviewed.