Xiao Long

Anterolateral thigh flap-based reconstruction for oncologic vulvar defects.

Background: Vulvar defects after tumor extirpation always require immediate reconstruction. Transferring a skin flap from a distant region may be required for large defects. Although the anterolateral thigh flap has gained popularity in other types of oncoplastic surgery, it has rarely been reported for vulvar reconstruction. The aims of this retrospective study were to evaluate the outcome of anterolateral thigh flap–based vulvar reconstruction and to develop an operative strategy. Methods: Eleven patients with vulvar carcinoma underwent resection and immediate reconstruction with the anterolateral thigh flap between 2005 and 2009. Based on defect type and local soft-tissue quality, four types of anterolateral thigh flap–based reconstructions were performed: unilateral anterolateral thigh flap, ipsilateral anterolateral thigh flap combined with contralateral advancement flap or local flap, fenestrated anterolateral thigh flap, and split anterolateral thigh flap. Postoperative complications were recorded and clinical outcomes were evaluated. Results: Partial flap necrosis occurred in one patient with a fenestrated anterolateral thigh flap for bilateral reconstruction. One wound dehiscence occurred in the contralateral local flap. Two patients had prolonged serous drainage. Mean follow-up was 8 months. One patient developed stricture of the urethral meatus and another had regional metastasis. Conclusion: With careful design, the anterolateral thigh flap may provide reliable and durable soft-tissue coverage for various vulvar defects with good outcomes and minimal donor-site morbidity.

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

Objective: Clinical application of autologous fat grafting (AFG) is quickly expanding. Despite the widely acceptance, long-term survival rate (SR) of AFG remains a question not yet solved. Meanwhile, although rare, severe complications related to AFG including vision loss, stroke even death could be seen in the literature. Data Sources: A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Articles were screened using predetermined inclusion and exclusion criteria. Study Selection: Data collected included patient characteristics, surgical technique, donor site, recipient site, graft amount, and quantified measurement methods. Patient cohorts were pooled, and SR was calculated. All the severe complications were also summarized according to the different clinical characteristics. Results: Of 550 articles, 16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods. Totally, 596 patients were included. SR varied from 34% to 82% in breast and 30–83% in the facial area. Nude mice were applied to investigate human fat grafting SR (38.3–52.5% after 15 weeks). Rabbits were commonly used to study animal AFG SR (14.00–14.56% after 1-year). Totally, 21 severe complications were reported, including death (2), stroke (10), vision loss (11, 8 of which accompanied with stroke), sepsis (3), multiple abscess (1) and giant fat necrotic cyst (2). Ten of these complications happened within 10 years. Conclusions: There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite. Body mass index change between pre- and postoperation may be the bias factor in evaluating fat SR. Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

MiR-26a inhibits proliferation and migration of HaCaT keratinocytes through regulating PTEN expression

MicroRNAs (miRNAs) have been shown to be associated with differentiation, migration and apoptosis in keratinocyte. Although it has been reported that microRNA-26a (miR-26a) plays important roles in tumor cells, its biological functions in keratinocytes are still not well elucidated. In this study, we confirmed expression of miR-26a in human keratinocytes using RT-PCR and further studied the role of miR-26a in cell proliferation and cell migration. Ectopic expression of MiR-26a mimic or inhibitor increased or decreased miR-26a expression respectively in HaCaT cells. Proliferation of HaCaT keratinocyte can be suppressed or promoted by overexpression or down-expression of miR-26a. In scratch wound-healing assay and Boyden chamber cell migration assay, upregulating miR-26a expression blocked cell migration, while downregulating miR-26a expression enhanced the migration. Using quantitative RT-PCR (qRT-PCR) and western blot, we further discovered that both mRNA and protein level of phosphatase and tensin homolog deleted from chromosome 10(PTEN) were regulated by miR-26a in HaCaT cells. Meanwhile the level of active form of AKT was also regulated by the miR-26a. In rescue experiment, knockdown of PTEN in the miR-26a mimic transduced cells recovered the migration ability of HaCaT cells. Together these results suggest that miR-26a modulates the proliferation and migration of keratinocytes via regulating PTEN/AKT signaling pathway.

Complication Rate of Autologous Cartilage Microtia Reconstruction: A Systematic Review

Background: Autologous cartilage has been widely accepted as the frame material of ear reconstruction for patients with microtia. Although rare, there are multiple complications related with the surgical reconstruction techniques. The authors performed a systematic review of the English literature of microtia reconstruction to determine significant surgical factors that are predictors of postoperative complications. Methods: A PubMed search using the terms “ear reconstruction” and “microtia” was conducted. Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, surgical techniques, the incidence of all kinds of complications, and the specific postoperative morbidity. Patient cohorts were pooled, and the incidence of complications was calculated. Significant predictors such as the use of tissue expander, simultaneously mid-ear reconstruction, with/without skin graft, and different fascia coverage were analyzed by chi-square test. Result: Of 320 articles found, 60 met the inclusion criteria. Totally 9415 patients with microtia were analyzed in this review with 1525 cases with complications. The overall complication incidence is 16.2% in average with a range of 0–72.9%. There was no significant difference when comparing the overall complication rate between with/without preexpansion 2-stage and multiple-stage techniques or with/without mid-ear reconstruction simultaneously. Conclusion: Although there is little agreement in literature regarding risk factors for complications, the authors were able to demonstrate several significant predictors by systematically analyzing 60 articles. Improved knowledge of the incidence of different complications related with various surgical methods can help surgeons provide improved preoperative counseling and take measures to minimize the risk.

2ME2 increase radiation-induced apoptosis of keloid fibroblasts by targeting HIF-1α in vitro

Radiation therapy is considered to be a treatment for keloid scarring; however, radioresistance has been shown to be a serious impediment to treatment efficacy. There is therefore a need for the discovery of novel critical molecular targets whose inhibition might enhance the radiotherapeutic response. An elevated level of hypoxia inducible factor (HIF)‐1α expression after radiation therapy in keloid fibroblasts has been demonstrated in our recent experiments. Therefore, we suggested there was a possible close relationship between HIF‐1α and keloid radioresistance. The current study aimed to investigate whether target HIF‐1α may enhance the radiotherapeutic efficacy of keloids.

Incidence of lower limb lymphedema after vulvar cancer: A systematic review and meta-analysis

Background: Lower limb lymphedema (LLL) is an important concern for patients with vulvar cancer. Studies of the incidence of vulvar cancer-related lymphedema and its risk factors have substantially increased in the new millennium. Objectives: This article is a meta-analysis that aimed to systematically evaluate the incidence of LLL and its risk factors related to vulvar cancer. Data sources: Data were collected from eligible studies from PubMed, ScienceDirect, and Web of Science. Synthesis methods: Random effects models were used to calculate a pooled overall estimate of LLL incidence, and subgroup analyses were performed to assess the effects of different study designs, countries of study origin, diagnostic methods, and extent of lymph node surgery. Risk factors for lymphedema were also evaluated. Results: Twenty-seven studies met the inclusion criteria for the assessment of lymphedema incidence with a pooled estimate of 28.8% [95% confidence interval (CI) 22.1–35.5]. The estimate was 16.7% (95% CI 9.7–23.7) when data were restricted to prospective cohort studies (7 studies). The incidence of LLL was increased by approximately 5-fold in women who underwent inguinofemoral lymph node dissection compared to those who underwent sentinel lymph node biopsy. The reported risk factors included wound infection, inguinofemoral lymphadenectomy, older age, body mass index (BMI), and radiation therapy. Conclusions: Approximately 3 in 10 women who survive vulvar cancer will develop lower limb lymphedema. More studies are needed to improve the understanding of its risk factors and to develop prevention and management strategies to alleviate this distressing disorder.

Radiation Therapy in Keloids Treatment: History, Strategy, Effectiveness, and Complication

Objective: Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions. However, there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids. We here provide a comprehensive review over this issue and emphasize on the influencing factors. Data Sources: The data analyzed in this review were searched from articles included in PubMed and EMBASE databases. Study Selection: The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review. Results: The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy. Furthermore, several factors including radiation type, dose, fraction, interval, and complications were reviewed, and the results revealed that these factors were significant toward clinical outcome at various levels. Conclusions: Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible. However, the optimization of treatment strategy was based on different radiation types and should take dose, fractions, interval, and complications into consideration, which will then decrease the rate of recurrence and increase the level of satisfaction.

A Systematic Quality Evaluation of Meta-Analyses Related to Plastic Surgery.

Introduction Meta-analyses are considered to be an important source of evidence. This review aims to systematically assess the quality of meta-analyses addressing topics in plastic surgery. Methods Electronic databases were selected for systematic review. A search was performed focusing on communication addresses containing terms related to plastic surgery, and detailed inclusion criteria were used. Related data were extracted and recorded according to the items of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. To assess the quality of the meta-analyses over time, studies published before and after PRISMA were evaluated. Results A total of 116 meta-analyses were included. There was 1 study that was fully in compliance with the PRISMA items. The main flaws impacting the overall quality of the included studies were in the following areas: structured summary (48%), protocol and registration (2%), full electronic search strategy (35%), risk of bias in individual studies (41%), additional analyses (27%), risk of bias within studies (47%), additional analysis (30%), and funding (47%). Study quality was evaluated using relative risks (RR) with a 95% confidence interval (95% CI); this revealed that there were few significant improvements in adherence to the PRISMA statement after its release, especially in selection (RR, 1.80; 95% CI, 1.08–2.99), results of individual studies (RR, 2.88; 95% CI, 1.41–5.91), synthesis of results (RR, 3.08; 95% CI, 1.32–7.17), and funding (RR, 1.65; 95% CI, 1.21–2.24). Conclusions There have been measurable improvements in the quality of meta-analyses over recent years. However, several serious deficiencies remain according to the PRISMA statement. Future reviewers should pay more attention to not only reporting the main findings but also encouraging compliance with proper standards.

Algorithm of chest wall keloid treatment.

AbstractKeloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids.A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6–18 months), 362 patients participated in the assessment of POSAS with doctors.Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P < 0.001) between the before-surgery score and the after-surgery score from both doctors and patients, indicating that both doctors and patients were satisfied with the treatment effect.Our preliminary clinical result indicates that good clinical results could be achieved by choosing the proper method in this algorithm for Chinese patients with chest wall keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment.

Reconstruction of periorbital soft tissue defect with reversed superficial temporal artery island flap.

BackgroundPeriorbital soft tissue reconstruction is a challenge because of its difficulty in regaining both the form and the function. Local flap is the priority method because it could provide excellent match in skin color and texture. ObjectiveWe aim to investigate the application of pedicled reversed superficial temporal artery island flap in the reconstruction of periorbital soft tissue defect. MethodDifferent kinds of reversed superficial temporal artery island flaps were harvested from the auricular area to cover the defect in the periorbital area. ResultsTen patients who suffered congenital or acquired periorbital diseases were treated with this method. One case suffered minor venous congestion postoperatively. All the other cases achieved good aesthetic result in both the donor and the recipient sites. ConclusionReversed superficial temporary artery island flap could be safely harvested from the auricular region even in a split pattern. It could be used to cover the periorbital defect with an unconscious scar at the donor site.