Panxi Yu

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Background Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative‐pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews. Methods English‐language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained. Results Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication‐threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32). Conclusion NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.

Phage Display, Peptide Production and Biological Assessment of Key Sequence of TGF-β1

To isolate key sequences of transforming growth factor-beta 1 (TGF-β1) from the phage display 12-mer peptide library, synthesize the bioactive peptides, and evaluate their biological effects on fibroblasts. Using monoclonal anti-human TGF-β1 antibody as the target, a phage display 12-mer peptide library was screened to isolate target sequences. The key sequences of TGF-β1 were chosen through alignment analysis. Based on these sequences, bioactive peptides were produced. After being purified, structurally modified and fluorescence labeled, the peptides were added to the cultured fibroblasts. The effects of the biosynthesized peptides on fibroblasts were evaluated. Ten specific sequences similar to that of TGF-β1 were isolated from a phage display 12-mer peptide library. Seven key sequences were chosen to generate bioactive peptides of TGF-β1. Only one model peptide could bind to fibroblast and promote its proliferation. The result of quantitative real-time PCR analysis and Western blot analysis indicated the model peptide could promote both the mRNA expression and protein expression of TGF-β RII in fibroblasts. The key sequences of TGF-β1 can be screened from a phage display 12-mer peptide library. One of the bioactive peptides generated from the sequences can bind to and play biological effect on fibroblasts. The results are expected to help promoting wound healing.

Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review

BackgroundPlatelet-rich fibrin (PRF) has been applied in the clinical field for more than a decade, but largely in oral surgery and implant dentistry. Its utilization in plastic and reconstructive surgery is limited and lacking a comprehensive review. Hence, this article focuses on the various clinical applications of PRF pertaining to the plastic and reconstructive field through a systematic review.MethodsIn this review, articles describing the clinical application of PRF in plastic and reconstructive surgery were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the utilization of PRF. The effects and complications of PRF were analyzed and concluded.ResultsAmong the 634 articles searched, 7 articles describing 151 cases are eligible. PRF was applied on 116 (76.8%) wounds to facilitate tissue healing, and the complete wound closure rate was 91.4% (106/116). Otherwise, PRF was applied in 10 (6.6%) cases of zygomaticomaxillary fracture to reconstruct orbital floor defects and in 25 (16.6%) cases of facial autologous fat grafts to increase the fat retention rate successfully. There is no report of PRF-related complications.ConclusionsPRF could facilitate wound healing, including the healing of soft tissues and bony tissues, and facilitate fat survival rate. Further studies are needed to test the mechanism of PRF and expand its scope of application in plastic and reconstructive surgery.Level of Evidence IIIThis 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.

Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction

BackgroundMandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction.MethodsFrom May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed.ResultsTwenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision.ConclusionsWhen performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent.Level of Evidence IVThis 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.

Effect of Dermabrasion and ReCell® on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes

Objective To explore the effects of dermabrasion combined with ReCell® on large superficial facial scars caused by burn, trauma and acnes.Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell®. According to the etiology, patients were classified into post-burning group (n=5), post-traumatic group (n=7) and post-acne group (n=7). Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score (PSS), Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group (19.6±4.0 days), post-traumatic group (15.8±2.6 days), and post-acne group (11.4±3.1 days) varied remarkably (F=7.701, P=0.007). The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups (P<0.05), where the most significant improvement was shown in the post-acne group (P<0.05). The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group (all P<0.05), where the more significant improvement was also shown in the post-acne group (P<0.05).Conclusions The combined treatment of dermabrasion and ReCell® has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.