Xianjie Ma

Human facial allotransplantation: a 2-year follow-up study.

BACKGROUND Progress in composite tissue allotransplantation could provide a new treatment for patients with severe facial disfigurements. We did a partial facial allotransplantation in 2006, and report here the 2 year follow-up of the patient. METHODS The recipient, a 30-year-old man from China, had his face severely injured by a bear in October, 2004. Allograft composite tissue transplantation was done in April, 2006, after careful systemic preparation. The surgery included anastomosis of the right mandibular artery and anterior facial vein, whole repair of total nose, upper lip, parotid gland, front wall of the maxillary sinus, part of the infraorbital wall, and zygomatic bone. Facial nerve anastomosis was done during the surgery. Quadruple immunomodulatory therapy was used, containing tacrolimus, mycophenolate mofetil, corticosteroids, and humanised IL-2 receptor monoclonal antibody. Follow-up included T lymphocyte subgroups in peripheral blood, pathological and immunohistochemical examinations, functional progress, and psychological support. FINDINGS Composite tissue flap survived well. There were three acute rejection episodes at 3, 5, and 17 months after transplantation, but these were controlled by adjustment of the tacrolimus dose or the application of methylprednisolone pulse therapy. Hepatic and renal functions were normal, and there was no infection. The patient developed hyperglycaemia on day 3 after transplantation, which was controlled by medication. INTERPRETATION Facial transplantation could be successful in the short term, but the procedure was not without complications. However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement.

An anatomical study with clinical application of one branch of the supraclavicular artery.

The supraclavicular flap is an important method for the reconstruction of the neck. In this study, the authors attempted to clarify the mechanism of blood flow into the supraclavicular flap based on the thoracic branch of the supraclavicular artery. Additionally, the authors discuss the clinical application of such anatomy. Thirty fresh cadavers and 13 preserved cadavers were dissected to observe the anatomic features of the pectorally extended supraclavicular flap. Additionally, 46 clinical cases were treated with such a flap. We identified two branches of the supraclavicular artery. A deltoid branch that extended to the acromial region and a thoracic branch that traveled to the anterior thoracic region. Using these data, all such flaps operated by us have to date, survived with satisfactory results. The pectorally extended supraclavicular flap could be used to repair defects on the ipsilateral or contralateral face, neck, and anterior thorax. Clin. Anat. 22:215–220, 2009.

Bone marrow mesenchymal stem cells increase skin regeneration efficiency in skin and soft tissue expansion

Background: Skin and soft tissue expansion has limitations such as long hospitalization time and flap retraction after expansion. Our previous study suggested that bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion. In this study, the authors explored the feasibility of applying the bone marrow mesenchymal stem cells (BMMSCs) to the treatment of skin and soft tissue expansion and increasing the skin regeneration efficiency. Methods: Sixty silicone expanders were implanted in the backs of 15 pigs, and allogeneic BMMSCs were transplanted to skin shallow fascia layer (local transplantation, Group A) or via ear vein (systemic transplantation, Group B). Group C was the Sham operation control; and then the expanders were injected with normal saline (N.S.). Skin was obtained at different time points (days 0, 14, 21, 28, 35, and 42). The organizational structure changes of the target skin were observed in the expansion process. The distribution, differentiation, and paracrine function of labeled BMMSCs were detected. Results: Comparing with Group B (25.00 ± 1.98 cm2) or Group C (24.00 ± 1.10 cm2, no transplantation), the expanded skin area of Group A (28.82 ± 1.43 cm2) increased, with the morphology of epidermis thickened, and dermis thinned. The BMMSCs differentiated into vascular endothelial cells and dermal fibroblasts. The quantity of newborn cells was proportional to the number of transplanted cells. The gene expression of VEGF, bFGF, EGF, and SDF in Group A was higher than those in Group B or C. The most obvious changes were on day 35. Conclusions: The local transplanted BMMSCs could increase the skin regeneration efficiency in skin and soft tissue expansion and reduce skin shrinkage effectively after removing the expander. Growth factors, VEGF, bFGF, EGF, and SDF, are favorable to this process.

Bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion†‡

Skin and soft tissue expansion stimulates the proliferation of skin epidermal basal cells and increase the dermal collagen deposition and angiogenesis. To explore the contribution of bone marrow‐derived stem cells (BMSCs) to the generation of “new” skin during the expansion, we used a chimeric mouse model in which the donor C57BL mice were engrafted with the bone marrow of enhanced green fluorescent protein (EGFP) transgenic mice. BMSCs were collected from the tibia and femur of EGFP+ transgenic mice, and then injected into normal C57BL mice via the tail vein (chimeric mice). Skin was obtained at different times (days 0, 7, 14, 21, 28, and 35). Skin stromal‐derived factor‐1 (SDF‐1) expression was evaluated. The number, distribution, and phenotype changes of EGFP+ cells in the skin were also evaluated by means of fluorescent microscopy. EGFP+ cells were present stably in the normal skin. The number of EGFP+ cells of the Group A mice changed with the tension, and reached the peak on day 21(17.1 ± 6.7%), as compared with either Group B (5.5 ± 1.0%) or Group C (5.1 ± 0.9%). The SDF‐1 expression in the expanded skin was significant increased (≈11‐fold, P < 0.01) compared to non‐expanded skin on day 21. Immunofluorescence showed EGFP+ cells were converted into vascular endothelial cells, epidermal cells, and spindle‐shaped dermal fibroblasts. Strain can promote the expression of SDF‐1 and facilitate the differentiation and proliferation of BMSCs in the expanded skin. J. Cell. Physiol. 226: 2834–2840, 2011.

Effect of camptothecin on collagen synthesis in fibroblasts from patients with keloid.

Keloids are distinguished by substantial deposition of collagen in the dermis, resulting in an imbalanced production and aggregation of extra cellular matrix. This study was undertaken to evaluate the effects of the topoisomerase I inhibitor camptothecin (CPT) on collagen synthesis in the activated dermal fibroblasts from healthy donors and patients with keloid. The fibroblasts were cultured in the presence or absence of CPT. Cellular toxicity assay was determined by MTT analysis. The expression of type I collagen and type III collagen was studied both at the transcriptional and post-transcriptional levels, using conventional quantitative real-time reverse transcription PCR and Western blotting. Results showed that there was predominantly a clear and dose-dependent decrease in the synthesis of collagen 1, not collagen 3, in keloid fibroblasts without significantly cellular toxicity. The CPT had an activity on the regulation of the ratio of type I/III collagen in the metabolism of keloid fibroblasts by inhibiting the secretion of type I collagen. The data suggest that the inhibitory effect of CPT, a topoisomerase I inhibitor, on collagen synthesis may be an effective treatment for limiting fibrosis in keloid patients.

The application of axial superficial temporal artery island flap for repairing the defect secondary to the removal of the lower eyelid basal cell carcinoma.

Our aim was to investigate the repair of the defect that follows excision of a basal cell carcinoma (BCC) of the lower eyelid. Skin projections of the superficial temporal artery and its frontal branches were marked using Doppler ultrasonography. The lesion was excised with 0.5-1.5cm margins. Frozen sections were taken to clarify the diagnosis. The frontal flap was designed according to the preoperative labelling, and was 0.5cm larger than the defect. The pedicle was 1.0-1.5cm longer than the distance between the pedicle and the defect, and the width of the pedicle was 3cm. If the lesion affected the full thickness of the lower eyelid, a conjunctival flap was sutured with the flap. A skin graft was applied when the defect was large. Such defects have been repaired successfully in 10 patients. There was no secondary defect or ectropion postoperatively. The superficial temporal artery frontal branch island flap is a satisfactory method for the repair of a defect secondary to a BCC of the lower eyelid.

Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

PurposeCervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. MethodsPostburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. ResultsCervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. ConclusionWith reliable blood supply based on the dissection of cadavers, axial flap based on the TBSA is a good option for reconstructing severe cervical scar contracture.

Reconstruction of Facial-Cervical Scars With Pedicled Expanded Deltopectoral Flap

Abstract The facial-cervical scars bring the suffering to the patients both physically and mentally. Choosing a proper donor soft tissue is always one of the critical issues, especially to Asian patients. Among the common used donor sites, the deltopectoral site was conceived as the most suitable donor tissue for the reconstruction in face and neck for its adjacent site and match in color and texture. There were 220 patients with facial-cervical scars reconstructed by the pedicled expanded deltopectoral flap between 2007 through 2015 in the authors’ hospital. There are 4 stages, including tissue expansion, flap pedicled transfer, pedicle delaying, and pedicle division, for the reconstruction of the facial-cervical scars using the pedicled expanded deltopectoral flap. Good skin compliance, normal contours, and emotional expression were noted in all the patients after the reconstruction. However, there were complications including expander exposure, stretch marks, flap tip necrosis, and mild postoperative hypertrophic scars. The unpleasant skin wound or color caused by the complications was repaired by further treatments such as skin grafting and laser. In conclusion, the pedicled expanded deltopectoral flap is a reliable and excellent option for the reconstruction of the facial-cervical scars.

Usnic acid inhibits hypertrophic scarring in a rabbit ear model by suppressing scar tissue angiogenesis

Hypertrophic scarring is a common condition in the Chinese population; however, there are currently no satisfactory drugs to treat the disorder. Previous studies showed that angiogenesis plays an important role in the early phase of hypertrophic scarring and inhibition of angiogenesis has been reported as an effective strategy for anti-hypertrophic scar therapy. A recent study showed that usnic acid (UA), an active compound found mainly in lichens, inhibited tumor angiogenesis both in vivo and in vitro. To investigate the therapeutic effects of UA on hypertrophic scarring and to explore the possible mechanism involved, a rabbit ear hypertrophic scar model was established. Scars were treated once a week for four weeks with UA, DMSO or triamcinolone acetonide acetate. Histological evaluation of hematoxylin and eosin staining indicated that UA significantly inhibited hypertrophic scar formation, with obvious reductions in scar height and coloration. The scar elevation index (SEI) was also evidently reduced. Massons trichrome staining showed that UA significantly ameliorated accumulation of collagen tissue. Immunohistochemical analysis of CD31 expression showed that UA significantly inhibited scar angiogenesis. In vitro, UA inhibited endothelial cell migration and tube formation as well as the proliferation of both human umbilical vein endothelial cells and scar fibroblast cells. These results provide the first evidence of the therapeutic effectiveness of UA in hypertrophic scar formation in an animal model via a mechanism that involves suppression of scar angiogenesis.

Reconstruction of Large Postburn Facial-Scalp Scars by Expanded Pedicled Deltopectoral Flap and Random Scalp Flap: Technique Improvements to Enlarge the Reconstructive Territory

Abstract The scars of face and scalp caused by burning often show as 1 large facial-scalp scar. The deltopectoral flap was recognized as one of the first choices for the facial scar reconstruction. However, this flap cannot cross the level of zygomatic arch traditionally when it was transferred with pedicle. When the flap reconstructed the facial-scalp scars with expanded random scalp flap, another flap was often needed to reconstruct the remaining temple and forehead scars. The authors reviewed 24 patients of large facial-scalp scars reconstructed by expanded pedicled deltopectoral flap and scalp flap with several technique improvements. The seaming scar between the deltopectoral flap and scalp flap in the temple region formed the new hairline. The technique improvements included ligation of the perforating branches of the transverse cervical artery and thoracoacromial artery when dissecting the pocket, the partial bolster compressive dressing to the distal part of the flap and dividing the pedicle partly as a delaying procedure before dividing the pedicle completely. Good skin compliance, normal contours, and emotional expression were noted. There were complications including expander exposure in 3 patients, stretch marks in 5 patients, flap tip necrosis in 2 patients, and mild postoperative hypertrophic scars in 3 patients. In conclusion, the expanded pedicled deltopectoral flap can enlarge the reconstructive territory in face successfully with the technique improvements. The combination of the expanded pedicled deltopectoral flap and scalp flap is a reliable and excellent reconstructive option for large postburn facial-scalp scars.