Objective:To investigate the effects of cerium oxide nanoenzyme-gelatin methacrylate anhydride (GelMA) hydrogel (hereinafter referred to as composite hydrogel) in the repair of infected full-thickness skin defect wounds in mice.Methods:This study was an experimental study. Cerium oxide nanoenzyme with a particle size of (116±9) nm was prepared by hydrothermal method, and GelMA hydrogel with porous network structure and good gelling performance was also prepared. The 25 μg/mL cerium oxide nanoenzyme which could significantly promote the proliferation of human skin fibroblasts and had high superoxide dismutase activity was screened out. It was added to GelMA hydrogel to prepare composite hydrogel. The percentage of cerium oxide nanoenzyme released from the composite hydrogel was calculated after immersing it in phosphate buffer solution (PBS) for 3 and 7 d. The red blood cell suspension of mice was divided into PBS group, Triton X-100 group, cerium oxide nanoenzyme group, GelMA hydrogel group, and composite hydrogel group, which were treated with corresponding solution. The hemolysis of red blood cells was detected by microplate reader after 1 h of treatment. The bacterial concentrations of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli were determined after being cultured with PBS, cerium oxide nanoenzyme, GelMA hydrogel, and composite hydrogel for 2 h. The sample size in all above experiments was 3. Twenty-four 8-week-old male BALB/c mice were taken, and a full-thickness skin defect wound was prepared in the symmetrical position on the back and infected with MRSA. The mice were divided into control group without any drug intervention, and cerium oxide nanoenzyme group, GelMA hydrogel group, and composite hydrogel group applied with corresponding solution, with 6 mice in each group. The wound healing was observed on 3, 7, and 14 d after injury, and the remaining wound areas on 3 and 7 d after injury were measured (the sample size was 5). The concentration of MRSA in the wound exudation of mice on 3 d after injury was measured (the sample size was 3), and the blood flow perfusion in the wound of mice on 5 d after injury was observed using a laser speckle flow imaging system (the sample size was 6). On 14 d after injury, the wound tissue of mice was collected for hematoxylin-eosin staining to observe the newly formed epithelium and for Masson staining to observe the collagen situation (the sample size was both 3). Results:After immersion for 3 and 7 d, the release percentages of cerium oxide nanoenzyme in the composite hydrogel were about 39% and 75%, respectively. After 1 h of treatment, compared with that in Triton X-100 group, the hemolysis of red blood cells in PBS group, GelMA hydrogel group, cerium oxide nanoenzyme group, and composite hydrogel group was significantly decreased ( P<0.05). Compared with that cultured with PBS, the concentrations of MRSA and Escherichia coli cultured with cerium oxide nanoenzyme, GelMA hydrogel, and composite hydrogel for 2 h were significantly decreased ( P<0.05). The wounds of mice in the four groups were gradually healed from 3 to 14 d after injury, and the wounds of mice in composite hydrogel group were all healed on 14 d after injury. On 3 and 7 d after injury, the remaining wound areas of mice in composite hydrogel group were (29±3) and (13±5) mm 2, respectively, which were significantly smaller than (56±12) and (46±10) mm 2 in control group and (51±7) and (38±8) mm 2 in cerium oxide nanoenzyme group (with P values all <0.05), but was similar to (41±5) and (24±9) mm 2 in GelMA hydrogel group (with P values both >0.05). On 3 d after injury, the concentration of MRSA on the wound of mice in composite hydrogel group was significantly lower than that in control group, cerium oxide nanoenzyme group, and GelMA hydrogel group, respectively (with P values all <0.05). On 5 d after injury, the volume of blood perfusion in the wound of mice in composite hydrogel group was significantly higher than that in control group, cerium oxide nanoenzyme group, and GelMA hydrogel group, respectively ( P<0.05). On 14 d after injury, the wound of mice in composite hydrogel group basically completed epithelization, and the epithelization was significantly better than that in the other three groups. Compared with that in the other three groups, the content of collagen in the wound of mice in composite hydrogel group was significantly increased, and the arrangement was also more orderly. Conclusions:The composite hydrogel has good biocompatibility and antibacterial effect in vivo and in vitro. It can continuously sustained release cerium oxide nanoenzyme, improve wound blood perfusion in the early stage, and promote wound re-epithelialization and collagen synthesis, therefore promoting the healing of infected full-thickness skin defect wounds in mice.

BACKGROUND: Cutaneous wound healing represents a common fundamental phenomenon requiring the participation of cells of distinct types and a major concern for the public. Evidence has confirmed that photobiomodulation (PBM) using near-infrared (NIR) can promote wound healing, but the cells involved and the precise molecular mechanisms remain elusive. METHODS: Full-thickness skin defects with a diameter of 1.0 cm were made on the back of rats and randomly divided into the control group, 10 J, 15 J, and 30 J groups. The wound healing rate at days 4, 8, and 12 postoperatively was measured. HE and Masson staining was conducted to reveal the histological characteristics. Immunofluorescence staining was performed to label the epidermal stem cells (ESCs) and hair follicle stem cells (HFSCs). Western blot was performed to detect the expressions of proteins associated with ESCs and HFSCs. Cutaneous wound tissues were collected for RNA sequencing. Gene ontology and the Kyoto Encyclopedia of Genes and Genomes analysis was performed, and the hub genes were identified using CytoHubba and validated by qRT-PCR. RESULTS: PBM can promote reepithelialization, extracellular matrix deposition, and wound healing, increase the number of KRT14+/PCNA+ ESCs and KRT15+/PCNA+ HFSCs, and upregulate the protein expression of P63, Krt14, and PCNA. Three hundred and sixty-six differentially expressed genes (DEGs) and 7 hub genes including Sox9, Krt5, Epcam, Cdh1, Cdh3, Dsp, and Pkp3 were identified. These DEGs are enriched in skin development, cell junction, and cadherin binding involved in cell–cell adhesion etc., while these hub genes are related to skin derived stem cells and cell adhesion. CONCLUSION PBM accelerates wound healing by enhancing reepithelialization through promoting ESCs and HFSCs proliferation and elevating the expression of genes associated with stem cells and cell adhesion. This may provide a valuable alternative strategy to promote wound healing and reepithelialization by modulating the proliferation of skin derived stem cells and regulating genes related to cell adhesion.

OBJECTIVE: To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice. METHODS: The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed. RESULTS: This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications. CONCLUSION Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Animals ; Abdominal Wall/surgery* ; Vascularized Composite Allotransplantation/methods* ; Transplantation, Homologous ; Skin Transplantation/methods* ; Hematopoietic Stem Cell Transplantation

Objective:To investigate the clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck.Methods:A retrospective observational study was conducted. From February 2010 to August 2020, 17 cervical scar deformity patients (9 males and 8 females, aged 8-42 years) who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients underwent skin and soft tissue expander (hereinafter referred to as expander) implantation in scapular region in stage Ⅰ procedures, and the free transplanted pre-expanded flaps were used to resurface the wounds followed by neck scar resection in the stage Ⅱ procedures. The wound size after neck scar release was 12.0 cm×6.0 cm-30.0 cm×24.0 cm, and the size of the flap ranged from 13.0 cm×7.5 cm to 31.5 cm×25.0 cm. The wounds in donor site of 15 patients were sutured directly, and the wounds in donor site of 2 patients were covered with full-thickness skin graft from abdominal area. The survival of flaps was observed after the operation of stage Ⅱ. Six months after stage Ⅱ surgery, Z plasty was performed to treat the incision scar contracture in 2 patients. For the 5 patients of overweight or bloating appearance in the 1/3 proximal flap underwent debulking procedures in 6-9 months after stage Ⅱsurgery. Before the stage Ⅰ surgery and six months after the last procedure (stage Ⅱ or stage Ⅲ), mental cervical angle (MCA) and cervical mandibular angle (CMA) were measured and the improvement of neck scar was evaluated by the angle values. The cervical motor function, skin color and texture in recipient areas, and scar in the donor sites assessed by Vancouver scar scale (VSS) were observed during follow-up. Data were statistically analyzed with paired sample t test. Results:After stage Ⅱ surgery, 15 patients' flaps survived well; venous crisis occurred in 2 flaps within 24 h after operation, and the flaps survived well after emergency exploration and thrombus removal+vascular re-anastomosis. Compared with the angle values of MCA of (126±12)° and CMA of (148±13)° of patients before the stage Ⅰ surgery, the angle values of MCA of (107±12)° and CMA of (123±11)° of patients in six months after the last procedure were significantly decreased (with t values of 10.68 and 6.54, respectively, P<0.05). After 2 years of follow-up, the patient's neck dorsiflexion, lateral bending, or other motor functions were not restricted; the color and texture of the flap in recipient site were close to those of the normal neck skin; the patient cases with VSS scores of scarring of 3, 4, 5, 6, and 7 were 1, 3, 7, 5, and 1 case, respectively. Conclusions:The free transplantation of the pre-expanded scapular flaps can provide sufficient tissue for wound coverage after the release of cervical scar contracture deformity; the expanded skin tissue is featured by thin soft tissue and good pliability, which is conducive to restore the neck appearance; the donor sites are relatively covert with less tension, therefore, the treatment is an effective method for correcting the contracture in the neck.

Objective:To evaluate the efficacy of combined fascia sheath suspension (CFS) and frontalis muscle flap suspension in the treatment of severe congenital blepharoptosis.Methods:We searched PubMed, EMbase, Cochrane Library, web of science and Chinese Hownet, Wanfang, VIP, CBM and other databases to collect randomized and non-randomized controlled trials comparing the efficacy of CFS and frontalis muscle flap suspension in the treatment of severe congenital ptosis, from the establishment of literature retrieval database to March 2020; two researchers used RevMan 5.3 software to select and exclude the literature, extract the data and evaluate the quality, set up appropriate effect index and conduct Meta-analysis.Results:Eleven studies included 661 patients, There were 312 cases in study group and 349 cases in control group. The results of Meta analysis showed that the OR of the two groups was 4.88 with 95% CI (2.69, 8.85); the OR of failure rate was 0.20, with 95% CI (0.11, 0.37); the OR of complications was 0.22, with 95% CI (0.14, 0.34). All three groups of data were statistically significant ( P<0.05). Conclusions:The available evidence shows that the combined fascia sheath suspension (CFS) is effective in the treatment of severe congenital blepharoptosis compared with frontalis muscle flap suspension, but the complications of CFS are lower and the satisfaction is higher; these findings have yet to be validated by more high-quality studies due to limitations in the quality and quantity of studies included.

Objective:To investigate the application and efficacy of cross-bridge free flap to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in recipient site from February 2008 to February 2017 was retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels which named bridge blood supply. The radial artery and cephalic vein of ipsilateral forearm were bridged for repairing defects of head, face and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or resurfaced by skin grafting. Division procedures were performed after circulation reestablished for 5 weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including 9 males and 3 females, aged 18-59 years old. The cases consisted of 4 head and facial defects, 1 hip tumor excision, 6 lower extremities and 1 dorsal foot injuries. The defect areas were ranged 18. 0cm×7. 0 cm- 23. 5 cm × 13. 0 cm, and the flaps were harvested by 20. 0 cm× 8. 0 cm- 25. 0 cm× 15. 0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by thoracic umbilical and anterolateral thigh flap. Vascular crisis occurred in 1 case, and the graft survived well after venous thrombosis removed timely. One case of partial skin graft necrosis occurred on the back donor site which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups were lasted 1 to 1. 5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. But some pigmentation and superficial scar was left on the thighs.Conclusions:For large and severe soft tissue defect where no anastomotic vessels available, the application of free flap by bridge transplantation is an alternative for good outcomes.

Eyebrow lifting is a common surgical procedure used to correct the laxity of upper eyelid skin in middle-aged women, and there are many kinds of eyebrow lifting method including supra-brow blepharoplasty, sub-brow blepharoplasty, transbrow excision blepharoplasty, supra-brow combined with infra-brow blepharoplasty, as well as endoscopic brow lift. Different surgical method are suitable for different populations, and every procedure has its own advantages and disadvantages. In recent years, with the development of eyebrow lifting method , the effects of eyebrow lifting on the correction of upper eyelid skin laxity becomes more permanent, and there is a growing trend that eyebrow lifting method combined with other periorbital procedures will be used to realize periorbital rejuvenation.

Objective:To investigate the application and efficacy of cross-bridge free flaps to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in the recipient site from February 2008 to February 2017 were retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps, or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels, named as bridge blood supply. The radial artery and cephalic vein of the ipsilateral forearm were bridged to repair defects of the head, face, and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or covered by skin grafting. Division procedures were performed after circulation reestablishment for five weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including nine males and three females, aged 18-59 years old. The cases included four head and facial defects, one hip tumor excision, six lower extremities injuries, and one dorsal foot injury. The defect areas ranged 18.0 cm × 7.0 cm-23.5 cm × 13.0 cm, and the flaps size ranged 20.0 cm × 8.0 cm-25.0 cm × 15.0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by a thoracic umbilical and an anterolateral thigh flap. The vascular crisis occurred in one case, and the graft survived well after the timely removal of the venous thrombosis. One case of partial skin graft necrosis occurred on the back donor site, which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups lasted 1 to 1.5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. Some pigmentation and superficial scar were left on the thighs.Conclusions:For large and severe soft tissue defects where no anastomotic vessels were available, the application of free flap by bridge transplantation is an alternative with good outcomes.

Eyebrow lifting is a common surgical procedure used to correct the laxity of upper eyelid skin in middle-aged women, and there are many kinds of eyebrow lifting method including supra-brow blepharoplasty, sub-brow blepharoplasty, transbrow excision blepharoplasty, supra-brow combined with infra-brow blepharoplasty, as well as endoscopic brow lift. Different surgical method are suitable for different populations, and every procedure has its own advantages and disadvantages. In recent years, with the development of eyebrow lifting methods, the effects of eyebrow lifting on the correction of upper eyelid skin laxity becomes more permanent, and there is a growing trend that eyebrow lifting method combined with other periorbital procedures will be used for periorbital rejuvenation.

Objective:To investigate the application and efficacy of cross-bridge free flap to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in recipient site from February 2008 to February 2017 was retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels which named bridge blood supply. The radial artery and cephalic vein of ipsilateral forearm were bridged for repairing defects of head, face and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or resurfaced by skin grafting. Division procedures were performed after circulation reestablished for 5 weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including 9 males and 3 females, aged 18-59 years old. The cases consisted of 4 head and facial defects, 1 hip tumor excision, 6 lower extremities and 1 dorsal foot injuries. The defect areas were ranged 18. 0cm×7. 0 cm- 23. 5 cm × 13. 0 cm, and the flaps were harvested by 20. 0 cm× 8. 0 cm- 25. 0 cm× 15. 0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by thoracic umbilical and anterolateral thigh flap. Vascular crisis occurred in 1 case, and the graft survived well after venous thrombosis removed timely. One case of partial skin graft necrosis occurred on the back donor site which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups were lasted 1 to 1. 5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. But some pigmentation and superficial scar was left on the thighs.Conclusions:For large and severe soft tissue defect where no anastomotic vessels available, the application of free flap by bridge transplantation is an alternative for good outcomes.