Wei-Qiang Tan

Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

BackgroundLower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid.MethodsThis study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect.ResultsNo problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible.ConclusionsThe application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.

Effect of chitosan nanospheres loaded with VEGF on adipose tissue transplantation: a preliminary report.

Neovascularization plays an important role in adipose tissue transplantation, because survival of implanted cells strongly relies on sufficient oxygen and nutrient supply. Vascular endothelial growth factor (VEGF) is known as the master regulator of angiogenesis. It is capable of starting the complex cascade of events leading to endothelial cell activation, assembly of new vascular structures, mural cell recruitment, and vessel stabilization. However, consensus is lacking regarding safe and efficient methods for applying VEGF in free fat transplantation in the clinical setting. We investigated whether chitosan nanospheres, a biocompatible high-molecular-weight material, safely improve the efficiency of VEGF application in free fat transplantation. Immunologically compromised nude mice were used as adipose tissue transplantation receptors. Nanospheres loaded with VEGF were mixed with adipocytes and injected subcutaneously to the dorsa of mice. Grafts were harvested at weeks 3, 6, and 12. We found that treated-graft weight and vascularization were significantly higher than controls in a time-dependent manner. We demonstrated that chitosan nanospheres loaded with VEGF significantly promote the fat graft neovascularization and improve adipocyte survival.

Angiotensin-converting enzyme inhibitor reduces scar formation by inhibiting both canonical and noncanonical TGF-β1 pathways

Angiotensin-converting enzyme inhibitors (ACEIs) can improve the fibrotic processes in many internal organs. Recent studies have shown a relationship between ACEI with cutaneous scar formation, although it has not been confirmed, and the underlying mechanism is unclear. In this study, we cultured mouse NIH 3T3 fibroblasts with different concentrations of ACEI. We measured cell proliferation with a Cell Counting Kit-8 and collagen expression with a Sirius Red Collagen Detection Kit. Flow cytometry and western blotting were used to detect transforming growth factor β1 (TGF-β1) signaling. We also confirmed the potential antifibrotic activity of ACEI in a rat scar model. ACEI reduced fibroblast proliferation, suppressed collagen and TGF-β1 expression, and downregulated the phosphorylation of SMAD2/3 and TAK1, both in vitro and in vivo. A microscopic examination showed that rat scars treated with ramipril or losartan were not only narrower than in the controls, but also displayed enhanced re-epithelialization and neovascularization, and the formation of organized granulation tissue. These data indicate that ACEI inhibits scar formation by suppressing both TGF-β1/SMAD2/3 and TGF-β1/TAK1 pathways, and may have clinical utility in the future.

The Effectiveness of Topical Anti-scarring Agents and a Novel Combined Process on Cutaneous Scar Management.

Cutaneous scars (particularly hypertrophic and keloid scars), not only can cause adverse cosmetic problems, but also can be associated with emotional distress such as anxiety and depression. Comparing with other surgical treatments, patients who do not opt for or cannot opt for invasion therapies are more eligible for using the topical anti-scarring agents. In this mini-review, we have researched for and collected the data between October 2005 and October 2015, in PubMed and Web of Science, and identified those agents including silicone-based products, imiquimod, corticosteroids, 5-fluorouracil, bleomycin, mitomycin, and plant extracts such as onion extract, asiaticoside, aloe vera, vitamin E, and so on. Besides, we have listed these popular products in commercial market with their useful information. We have also described the combined process according to our clinical experience. However, to establish the more effective treatment among different types of topical agents or their combined process, large, well-designed head-to-head comparisons between individual and combined preparations in relevant patient populations are urgently needed.

Effect of Calcium Alginate Microsphere Loaded With Vascular Endothelial Growth Factor on Adipose Tissue Transplantation.

AbstractRevascularization in the early period after transplantation is the key to improving adipocyte survival. Vascular endothelial growth factor (VEGF) is known as the master regulator of angiogenesis. However, consensus is lacking regarding safe and efficient methods for applying VEGF in free fat transplantation in the clinical setting. We constructed calcium alginate (CA) microspheres loaded with VEGF to increase the survival of implanted adipocytes. BALB/c nude mice were used as adipose tissue transplantation receptors. Adipocytes were mixed with CA microspheres loaded with VEGF and implanted subcutaneously into the dorsum of mice. Grafts were harvested at week 3, 6, and 12 after transplantation. We found that the mass and microvascular density of grafts in the VEGF + CA group (CA microspheres loaded with VEGF) were statistically higher than that of other groups in a time-dependent manner. We demonstrated that CA microspheres loaded with VEGF can significantly promote the fat graft neovascularization, thus improving adipocyte survival.

Modified tumescent liposuction-curettage through mini incisions for the treatment of secondary axillary bromhidrosis with subcutaneous scarring.

the platysmal band at intervals of 2 mm for total release of the platysmal band. When associated with other procedures, closed platysmotomy was performed after liposuction and before lateral platysmarrhaphy. All cases had good results regarding patient satisfaction. No complications were observed. We believe that closed platysmotomy is better than medial open approaches for platysmal bands and can be associated with liposuction or lateral platysmarrhaphy to achieve better cervical contour when needed. When a submental incision is used, scars are frequently unaesthetic and frequently need revision. Medial cervical dissection can lead to irregularities, bowstrings, hematomas, and infection.1,3,4 Closed platysmotomy techniques do not employ submental incision and medial cervical dissection, thus avoiding these complications. In conclusion, the device we used for closed platysmotomy (steel braided thread) seems faster, simpler, and equally effective compared with alternative techniques. DOI: 10.1097/PRS.0b013e31826da1b0

A New Skill for Treating Unclassified Thumb Polydactyly: Ablation via a Periosteal Incision

BackgroundThumb polydactyly is a common congenital abnormality of the hand. Surgical treatment includes reduction and reconstruction. A new type of thumb polydactyly and the achieved treatment are reported.MethodsA 4-year-old boy with thumb polydactyly is reported. The duplicated two thumbs had one complete metacarpal and a separated triphalangeal phalanx. The ulna thumb was removed via periosteal incision, and a whole complex tissue sleeve was used to repair the ulna part of the joint capsule.ResultsThe postoperative aesthetic and functional results were satisfactory.ConclusionsA new type of thumb polydactyly that cannot be matched with the classification of either Wassel or Wood is described. The thumb polydactyly was treated by ablation via periosteal incision and ulna metacarpophalangeal joint capsule reconstruction. Three-dimensional computed tomography could be a good way to examine the area preoperatively.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 at www.springer.com/00266.

The modified liposuction-curettage cannula for the treatment of secondary axillary bromhidrosis with subcutaneous scarring.

1077e The Modified Liposuction-Curettage Cannula for the Treatment of Secondary Axillary Bromhidrosis with Subcutaneous Scarring Sir: W have modified the classic liposuction-curettage procedure and used it for the treatment of secondary axillary bromhidrosis with subcutaneous scarring.1 Although various cannulas have been described,2–4 not all of them were easy to use for our procedure. Even the two-hole cannula we previously used had the following disadvantages: only two opposite suction holes at the tip and thus rotating through 90 degrees was necessary to perform sufficient curettage during pinching liposuction-curettage1; and suction holes at the tip were easily pulled out of the subdermal tunnel, thus weakening the effect of negative pressure. Now we introduce the modified three-hole and four-hole liposuction-curettage cannulas as specially designed instruments for this operation (Fig. 1). The following modifications were made: optimization of the combination of length and diameter; addition of two suction holes on the lateral sides of the slope; and shortening of the longitudinal spacing between suction holes. From June of 2012 to December of 2013, this procedure was performed in 31 patients (55 axillae) with unsuccessful primary treatment. The five steps of our technique were described before1 and in Figure 2. The follow-up period ranged from 3 to 24 months (mean, 9.7 months). The effect was slightly better than before, but a significant shortened operative time by simplifying the procedures was offered (Table 1).1 The modified cannula has five characteristics and advantages. First, the pointed tip allows easier dissection of fat and dermis to eliminate sweat glands located in the deep dermis. Moreover, the slope of the cannula tip performs an aggressive curettage. Second, enlarged suction holes of the modified cannula are better because small suction holes were frequently obstructed.5 Third, a diameter of 3 mm ensures both small incisions and increasing efficiency. A length of 19 cm makes the cannula easily placed in the subdermal tunnel. Fourth, rotating through 90 degrees is no longer necessary. Fifth, the probability of carelessly pulling the holes out of the tunnel is reduced. This modified liposuction-curettage cannula is indicated for secondary axillary bromhidrosis with subcutaneous scarring, but the patient must wait at least 6 months after unsuccessful primary treatment, and the subcutaneous scar must be very soft. The points listed below should be considered:

Breast reconstruction with Alloderm Ready to Use: A meta-analysis of nine observational cohorts

BACKGROUND AlloDerm-RTU is a new member of human acellular dermal matrix (HADM) which was launched in 2012. The present meta-analysis aimed to investigate whether AlloDerm-RTU was superior compared with previous HADMs. METHODS All available databases were searched for retrospective or prospective studies regarding breast reconstruction with AlloDerm-RTU compared with other HADMs. The primary outcome was the incidence of complications among different HADMs. RESULTS Two prospective and seven retrospective studies with a total of 1406 patients were enrolled. There was no significant difference in any of the complications, including the incidence of hematoma (RR 0.78, 95%CI 0.19 to 3.19; P = 0.73), seroma (RR 0.98, 95%CI 0.43 to 2.26; P = 0.97), cellulitis (RR 0.82, 95%CI 0.32 to 2.11; P = 0.68), necrosis (RR 0.69, 95%CI 0.44 to 1.10; P = 0.12), infection (RR 0.68, 95%CI 0.37 to 1.25; P = 0.22), explantation (RR 0.61, 95%CI 0.35 to 1.06; P = 0.08), and total complications (RR 0.91, 95%CI 0.55 to 1.52; P = 0.73). Subgroup analysis showed that AlloDerm-RTU demonstrated no superiority compared with FD AlloDerm, AlloMax, or DermACELL. Sensitivity analysis indicated that the outcomes were stabilized. No publication bias existed in the present meta-analysis. CONCLUSION Four HADM products, AlloDerm-RTU, FD AlloDerm, AlloMax, and DermACELL, showed similar risks of complications. However since most of the included studies had a low level of evidence, further random trials with large numbers of patients are needed.

Effectiveness and Complications of Improved Liposuction–Curettage Through Mini-Incisions for the Treatment of Axillary Osmidrosis

Background: Liposuction–curettage (LC) is a popular and effective surgical method for the treatment of axillary bromhidrosis (AB). However, residual malodour and skin necrosis often appear after this type of surgery. We investigated the efficacy and complications of 4 methods of LC. Methods: A total of 280 patients with AB comprised the study cohort, of which 228 were followed up. We carried out 4 methods of modified tumescent LC through mini-incisions and provided a questionnaire for evaluation of surgical outcome. Evaluations were malodour elimination, scarring, reduced growth of hair, and complications. Mean follow-up was 15 months. Results: The study involved 449 axillae. In patients with LC in the final phase of improvement (programmed and well-organized LC, skin pinching to wrap up the cannula, LC to the skin around 2 surgical incisions, and cotton balls packed in gauze and an elastic set for post-operative management), excellent elimination of malodor was observed in 141 (89.81%) of 157 axillae. Only 4 (2.55%) cases encountered a small area of skin necrosis, and 28 (17.83%) had local damage to the epidermis. Conclusion: These data suggest that LC with a final phase of improvement through mini-incisions is effective for AB treatment.