Jiasheng Dong

Growth factor therapy in patients with partial‐thickness burns: a systematic review and meta‐analysis

Growth factor (GF) therapy has shown promise in treating a variety of refractory wounds. However, evidence supporting its routine use in burn injury remains uncertain. We performed this systematic review and meta‐analysis assessing randomised controlled trials (RCTs) to investigate efficacy and safety of GFs in the management of partial‐thickness burns. Electronic searches were conducted in PubMed and the Cochrane databases. Endpoint results analysed included wound healing and scar formation. Thirteen studies comprising a total of 1924 participants with 2130 wounds (1131 GF receiving patients versus 999 controls) were identified and included, evaluating the effect of fibroblast growth factor (FGF), epidermal growth factor (EGF) and granulocyte macrophage‐colony stimulating factor (GM‐CSF) on partial‐thickness burns. Topical application of these agents significantly reduced healing time by 5·02 (95% confidence interval, 2·62 to 7·42), 3·12 (95% CI, 1·11 to 5·13) and 5·1 (95% CI, 4·02 to 6·18) days, respectively, compared with standard wound care alone. In addition, scar improvement following therapy with FGF and EGF was evident in terms of pigmentation, pliability, height and vascularity. No significant increase in adverse events was observed in patients receiving GFs. These results suggested that GF therapy could be an effective and safe add‐on to standard wound care for partial‐thickness burns. High‐quality, adequately powered trials are needed to further confirm the conclusion.

Prolonging the duration of masseter muscle reduction by adjusting the masticatory movements after the treatment of masseter muscle hypertrophy with botulinum toxin type a injection.

BACKGROUND Botulinum toxin type A (BTX-A) is widely used for the clinical treatment of masseteric hypertrophy. Until now, few reports have discussed how to prolong the duration of its effectiveness. OBJECTIVE This study evaluated that purposely adjusting the masticatory movements is possible of postponing the masseter muscle rehypertrophy. METHODS Ninety-eight patients were randomly and equally divided into 2 groups, and 35 U BTX-A per side was injected into the masseters. The thickness and volume of the masticatory muscles were measured by ultrasound and computerized tomography, respectively. Patients in Group 1 were instructed to strengthen their masticatory effort during the denervated atrophic stage of the masseter (the interval was evaluated by real-time ultrasound monitoring), whereas patients in Group 2 were not given this instruction. When the masseter muscle began to recover, patients in both groups were instructed to reduce their chewing. RESULTS The duration of the masseter muscle rehypertrophy was significantly prolonged in Group 1 patients. The thickness and the volume of the other masticatory muscles were significantly increased in Group 1 but were either slightly decreased or insignificantly different in Group 2. CONCLUSION Purposely strengthening masticatory muscle movement during the denervated atrophic stage of the masseter can prolong the duration of masseter rehypertrophy.

A Selective Cell Population From Dermis Strengthens Bone Regeneration.

Finding appropriate seed cells for bone tissue engineering remains a significant challenge. Considering that skin is the largest organ, we hypothesized that human bone morphogenetic protein receptor type IB (BmprIB)+ dermal cells could have enhanced osteogenic capacity in the healing of critical‐sized calvarial defects in an immunodeficient mouse model. In this study, immunohistochemical staining revealed that BmprIB was expressed throughout reticular dermal cells; the positive expression rate of BmprIB was 3.5% ± 0.4% in freshly separated dermal cells, by flow cytometry. Furthermore, in vitro osteogenic capacity of BmprIB+ cells was confirmed by osteogenic‐related staining and marker gene expression compared with unsorted dermal cells. In vivo osteogenic capacity was demonstrated by implantation of human BmprIB+ cell/coral constructs in the treatment of 4‐mm diameter calvarial defects in an immunodeficient mouse model compared with implantation of unsorted cell/coral constructs and coral scaffold alone. These results indicate that the selective cell population BmprIB from human dermis is a promising osteogenic progenitor cell that can be a large‐quantity and high‐quality cell source for bone tissue engineering and regeneration. Stem Cells Translational Medicine 2017;6:306–315

Remote limb ischemic post-conditioning attenuates ischemia-reperfusion injury in rat skin flapby limiting oxidative stress

PURPOSEnTo investigate the effect of remote ischemic post-conditioning (RIPoC) against ischemia-reperfusion (I/R) injury on flaps of rats.nnnMETHODSnSprague-Dawley rats were randomized into the Sham, Control, RIPoC1 and RIPoC2 groups. All the animals were submitted to a 5×4 cm superficial inferior epigastric artery flap. Eight hours of flap ischemia was induced and two protocols of limb RIPoC were applied. Tissue MDA level and SOD activity in 24-h reperfusion were assessed. Flap survival was assessed 7 days postoperatively.nnnRESULTSnCompared to the Control group, the RIPoC1 group showed statistically decreased MDA level at 6-, 12-, and 24-h reperfusion (P = 0.01, P < 0.01 and P < 0.01, respectively), and statistically increased SOD activity at 12- and 24-h reperfusion (P < 0.05 and P < 0.01, respectively). Flap survival rate on the 7th day was significantly higher in the RIPoC1 group than the control group (47.9 ± 6.4 vs . 29.4 ± 7.1 %, P < 0.01).nnnCONCLUSIONnThree cycles of 5-min Limb remote ischemic post-conditioning rather than a single cycle of 15-min limb RIPoC has protective effect on flaps against ischemia-reperfusion injury by attenuating oxidative stress.

Columella Lengthening by a Vascularized Preauricular Flap

BackgroundA short columella can result in significant cosmetic and functional deformities. Various techniques such as local flap transfer and composite grafts have been reported for columellar lengthening, but the overall results remain unsatisfactory. Transferring a local flap cannot provide new tissue for the columella, which limits its application. Composite grafting can provide new tissue volume, and the composite tissue from the preauricular region has an excellent color and texture match. However, the lack of a stable blood supply for the composite graft restricts its clinical application due to problems such as viability, dimensions, and atrophy. To overcome these limitations, the authors harvested a vascularized preauricular flap for columella lengthening.MethodsBased on the superficial temporal vessels, the vascularized preauricular flap was harvested as a free flap and transferred to the columella region. The recipient vessels were angular vessels or facial vessels, and microsurgical anastomosis was performed between recipient vessels and the pedicle. The lateral femoral circumflex vessels were used as vascular grafts when the pedicle was not long enough.ResultsEight patients who had short columellas were reconstructed with vascularized preauricular flaps. Six flaps were harvested in a reverse fashion, and the remaining two flaps were harvested in an anterograde direction. All the flaps survived well and showed a good color and texture match without hypertrophic scars. An average of 13.3xa0mm improvement in length was obtained for the eight patients. Two patients underwent a secondary debulking procedure to thin the flap.ConclusionThe free vascularized preauricular flap procedure is a reliable method for columellar lengthening and has wide clinical application.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Bone morphogenetic protein receptor IB as a marker for enrichment of osteogenic precursor-like cells in human dermis

The scarcity of bone marrow mesenchymal stromal cells (BMSCs) prompts the search for alternative sources for cell-based bone defects repair. Human dermal fibroblasts (FBs) have been shown to have a high proliferative potential and the capacity to differentiate into an osteogenic phenotype. The easy and repeated harvest in large quantities makes this cell source a potential candidate for bone tissue engineering. The aim of our study was to compare directly the immune phenotype, proliferative capacity and osteogenic differentiation potential of FBs with that of “gold standard” BMSCs or adipose-derived mesenchymal stromal cells (ADSCs), another alternative osteoprogenitor cell source. Flow cytometry demonstrated that FBs, ADSCs and BMSCs shared common cell surface marker protein expression profiles when using a panel of surface antigens. FBs had the highest proliferative potential, but lowest osteogenic differentiation potential in vitro, compared with ADSCs or BMSCs. More importantly, BMPR-IB+-sorted FBs subpopulation had a higher osteogenic differentiation potential than BMPR-IB−-sorted FBs subpopulation. Our results indicated that the heterogeneous FBs were not an appropriate cell source for bone tissue engineering. Immunoselection by BMPR-IB can generate highly purified osteogenic precursor-like cells in the human dermis.

A low initial botulinum toxin A treatment response does not predict poor long-term outcomes in patients with axillary bromhidrosis

Abstract Purpose: For patients with axillary bromhidrosis, it is not clear that whether a low response to initial botulinum toxin A (BTX-A) treatment is related to poor long-term outcomes. Patients and methods: From August 2011 to March 2016, 31 patients with primary axillary bromhidrosis were recruited. They had the duration of efficacy for less than 4 weeks (median, 3 weeks; range, 1–3 weeks) after the first BTX-A injection (50u2009U per underarm) and were considered to have a low response to BTX-A treatment. The second injection with the same dose was immediately administered once the symptoms recurred. Subsequent sessions were performed with a double dose. Results: The duration of efficacy rose significantly to 10 weeks (range, 1–24 weeks) after the second injection (pu2009<u2009.01). Twenty-five patients received the third injection. The resultant duration further increased to 16 weeks (range, 12–26 weeks). No patients reported adverse effects during our follow-up period. Conclusions: For patients with primary axillary bromhidrosis, a low initial BTX-A treatment response does not predict poor long-term outcomes. Immediate reinjection with the same dose and subsequent sessions with a double dose is a safe strategy and can increase the duration of BTX-A therapy.

What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

Background We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap. Methods A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively. Results Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%). Conclusions It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap.

Ectopic implantation of an avulsed scalp with a tissue expander on a forearm for combined total scalp avulsion and spine injuries: a case report

Total scalp avulsion with severe cervical spine injury is a contraindication for emergency replantation of the scalp to its anatomical site. We describe a case involving the ectopic implantation of an avulsed scalp on the forearm. A 41‐year‐old woman presented with severe total scalp avulsion and tears in the intervertebral discs at the C4/5 and C5/6 levels. The avulsed scalp was ectopically implanted on the left forearm with a tissue expander to provide support. Two‐stage replantation of the scalp at its anatomical site was performed 19 and 40 days later. Replantation was successful, and the avulsed tissue exhibited excellent viability. In conclusion, this case shows that the ectopic implantation of the avulsed scalp on the forearm may be an option for total scalp avulsion with cervical spine injury.

Effectiveness of botulinum toxin A injection for the treatment of secondary axillary bromhidrosis

Surgical removal of apocrine glands is a valid treatment option for axillary bromhidrosis. However, malodor may recur after the operation. The value of botulinum toxin A (BTX-A) injection in the treatment of secondary axillary bromhidrosis was investigated in the present study. From July of 2012 to May of 2016, 53 patients with secondary axillary bromhidrosis were enrolled in our clinic. Various BTX-A injection strategies were applied depending on different types of previous surgery. None of the patients reported adverse side effects after the procedure. The duration of efficacy ranged from 1 to 12 months, with the median value of 6 months. At the end of follow-up, 48 patients ranked the satisfaction with BTX-A treatment as very good or good. For patients with secondary axillary bromhidrosis following various surgical modalities, the BTX-A treatment strategy we propose can achieve a lengthy duration of efficacy with a low risk of side effects and should be considered a good and reliable option.