Objective To explore the underlying mechanism of β2 adrenergic receptor(ADRB2)in fibrogenesis during wound healing.Methods Non-specific ADRB2 gene knockdown adeno-associated virus(AAV-ADRB2 group,6 mice)and control virus(AAV-NC group,6 mice)was injected randomly into the back skin of 12 mice for 21 days,a full-thickness skin defected wound healing murine model was established.Wound healing rates were recorded at the 1st,3rd,5th,and 7th day after operation.Histological examinations by H-E staining,Masson staining,and immunohistochemistry were conducted to observe wounded skin tissue structure,fibrosis,and α-SMA protein expression;quantitative PCR was employed to analyze ADRB2 and matrix metalloproteinase(MMP)mRNA levels;Western blotting was utilized to assess the protein expression levels of COL1A1,COL3A1,TGF-β1,and Smad3.Results On postoperative day 5 and 7,the wound healing rate of the AAV-ADRB2 group significantly decreased(P＜0.05),accompanied by a series pathological changes,including thickened epidermis,exaggerated inflammation,reduced fibroblast count,and inhibited collagen deposition;the α-SMA expression showed a significant decrease(P＜0.05),and the ratio of COL1A1 to COL3A1 decreased(P＜0.05);ADRB2 mRNA levels significantly decreased(P＜0.01),while MMP-1 and MMP-8 mRNA levels increased(P＜0.01);the protein levels of TGF-β1 and Smad3 exhibited a significant decrease(P＜0.05).Conclusions ADRB2 knockdown reduced fibrosis during wound healing and degenerated connective tissue content around the wound bed by inhibiting the TGF-β1/Smad3 signaling pathway,which leads to an increase in MMP mRNA levels and a decrease in the ratio of type Ⅰ to type Ⅲ collagen.

Objective To verify the role of aldehyde dehydrogenase 2(ALDH2)in wound healing and to explore the underlying mechanisms.Methods A murine excisional wound model was developed and mice were randomly assigned to control group and Alda-1(ALDH2 agonist)group.Wound healing rate and activity of ALDH2 were measured.Masson staining was used to observe the collagen fiber content,and immunohistochemistry was used to detect the expression of ALDH2 and α-smooth muscle actin(α-SMA).The expression of collagen typeⅠandⅢ(Col-Ⅰ,Col-Ⅲ),and the number of F4/80,inducible nitric oxide synthase(iNOS)and CD206 positive(F4/80+,iNOS+,CD206+)cells were analyzed using immunofluorescences.Furthermore,interleukin(IL)-4-stimulated RAW264.7 cells were treated with Alda-1 or CVT-10216(an ALDH2 inhibitor)in vitro.The proportion of F4/80+CD206+cells were analyzed using flow cytometry.Anti-inflammatory and pro-inflammatory cytokines were examined using ELISA.The expression of protein associated with the AKT/mTOR pathway were detected via western blotting.Results Compared with control group,the wound healing rate of mice in the Alda-1 group was significantly improved,and the expression of Col-Ⅰ,Col-Ⅲ,and α-SMA in the wound surface increased.Although the number of F4/80+cells in wounds did not significantly differ,there was a decrease in iNOS+cells and an increase in CD206+cells.In vitro,compared to IL-4 group,IL-4+Alda-1 group exhibited an increased proportion of F4/80+CD206+macrophages and higher levels of anti-inflammatory factors,alongside a reduction in levels of pro-inflammatory factors.Conversely,IL-4+CVT-10216 group demonstrated a decreased proportion of F4/80+CD206+macrophages,lower levels of anti-inflammatory factors with a concomitant increase in pro-inflammatory factors.Additionally,the protein expressions of p-AKT and p-mTOR were significantly elevated in IL-4+Alda-1 group and diminished in IL-4+CVT-10216 group.Conclusion ALDH2 induces M2 macrophage polarization via AKT/mTOR pathway to promote wound healing in mice.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To investigate the surgical treatment of the tumors at cervicothoracic junction.Methods:A retrospective analyses was performed for 63 patients with tumors at the cervicothoracic junction receiving surgery from Mar 2008 to May 2020 in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical data about manifestation, surgical approach, resection degree and pathological types were collected. There were 43 cases of asymptomatic patients and 20 cases of patients with ≥1 clinical manifestations. Twenty two patients receiving radical resection with video-assisted thoracoscopic surgery. Anterior approach was the most popular treatment in open surgery (24 cases, 38.1%), and 8 cases of anterolateral approach(6 cases of Hemiclamshell incisions, 2 cases of trap-door incisions), 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular combined posterolateral approach.Results:Pathological examination suggested 61 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most common pathological type (27 cases, 42.9%), the second common pathological type was tumor originated from fibrous tissues (6 cases, 9.5%). The 3-year overall survival rate of those 63 patients was 88.9%, while the 5-year overall survival rate was 84.1%.Conclusion:Tumors involving the cervicothoracic junction are characterized as special location, complicated anatomy and various histopathological subtypes. Individualized approach and surgery improve safety and normalization of tumors at cervicothoracic junction treatment.

Objective:To investigate the causes and treatment of implant malposition after breast augmentation surgery.Methods:A retrospective study was conducted to investigate the patients with implant malposition after breast augmentation treated or consulted in our department from January 2000 to December 2020. A total of 95 breasts in 74 patients were treated during the period. The age of the patients was from 19-50 years, with the mean of 31.2 years. Causes of these complications were analyzed and the patients were managed in different ways according to the times after primary breast augmentation.Results:Twenty-one malposition breasts occurred within one week after primary surgery, and 17 breasts were successfully treated with manual reduction and fixation. 4 breasts were treated with operation after failed with manual reduction. The patients had good and bilateral symmetric breast morphology during the 6 months follow-up after the second operation. 25 malposition breasts were treated from one week to one month after primary surgery. Reoperation was performed through the original incision, separating the adhesive cavity to reposition the implant. Those patients were successfully treated. No re-occurrence was detected at 6 months follow-up after treatment. 49 malposition breasts were treated more than 3 months after primary surgery. Excessive capsule wrapping the shifted implant was removed to recreate a fresh wound while the adhesive cavity was separated to reset the implant. Bandage fixation was necessary. 7 implants were exchanged. 2 breasts were over corrected and re-operated successfully.Conclusions:The causes of implant malposition at different time after breast augmentation are various. Different methods can be used for effective treatment.

Objective:Nipple inversion is relatively common, occurring in up to 10% of females, various techniques have been described for correction of inverted nipples. However, data are limited on the associated complications. The presented study aimed to assess the management of nipple necrosis after inverted nipple repair.Methods:A retrospective chart review was performed on 25 cases of nipple necrosis after correction of nipple inversion between January 2018 and June 2020. All patients were female. Age ranged from 10 to 37 years with the average of 24.4 years. 13 cases were partial nipple necrosis with retract recurrence, and 12 cases were complete nipple necrosis.Results:The follow-up period was 6 months. All cases achieved primary healing. No infection or nipple necrosis occurred. All patients had satisfactory appearance.Conclusions:Appropriate intervention time, accurate preoperative evaluation and well-performed operation are important factors for the management of nipple necrosis after inverted nipple repair.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

In the special period of COVID-19’s epidemic situation, plastic surgeons are subordinate first and foremost to the national situation and assume the duties that doctors have to cope with in the fight against the epidemic. At the same time, conditions have been created for the provision of professional services to patients who have to undergo emergency plastic treatment, while ensuring the safety of the epidemic. The forum has two components: (1) Presentation of the experience of representative medical institutions in the emergency plastic treatment in a safe manner to prevent epidemics and the safety measures for plastic work in the normal environment of epidemic prevention. (2) A reflection by the plastic surgeons on the professional characteristics and problems at this extraordinary time, and a discussion of the factors affecting the future of plastic surgery industry.

Melanoma is a highly invasive and lethal skin malignant tumor derived from melanocytes. It has the characteristics of high early metastasis and high mortality. In recent years, with the in-depth study of the pathogenesis of melanoma, it has been found that epigenetic modification, especially DNA methylation, is considered to be a universal intrinsic feature of melanoma development and evolution. This article reviews the research progress of abnormal DNA methylation genes in melanoma in detail, and summarizes the biomarker effect of DNA methylation genes, suggesting that the detection of abnormal DNA methylation genes in melanoma patients is hopeful as an early screening index and diagnostic marker for melanoma patients.