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ABSTRACT: To evaluate the effect of bone marrow-derived mesenchymal stem cells (BM-MSCs) transplantation on tissue expansion.
Tissue expansion provides a better solution to large defect reconstruction with perfectly matched skin and without deformity at the donor site. How to promote tissue expansion and reduce complications has been a focus in this field. BM-MSCs have been found to exhibit tissue regeneration-promoting ability, but their effect on skin growth during tissue expansion has remained unclear.
BM-MSCs transplantation was performed on a rat tissue expansion model. Inflation volume, expansion time, and area were examined to determine the effect on tissue expansion. Factors related to skin regeneration were examined to evaluate BM-MSCs' role in skin regeneration during expansion. The mechanism was explored by in vivo and in vitro experiments.
Higher inflation volume, larger expansion area, and shorter expansion time could be achieved by BM-MSCs transplantation (all P < 0.05). The skin regeneration during expansion was enhanced by BM-MSCs treatment, as evidenced by a thicker epidermis and further evidenced by increased cell proliferation, collagen synthesis, and angiogenesis. Cell tracking showed that the transplanted BM-MSCs appeared in skin structures, suggesting a direct contribution to skin regeneration. The paracrine secretion effect of BM-MSCs was also examined. The roles of epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were studied, and EGF was found to play an important role in the skin regeneration-promoting effect of BM-MSCs.
This study shows that BM-MSCs transplantation can shorten the tissue expansion process by enhancing skin regeneration.
Annals of surgery 01/2011; 253(1):202-9. · 7.90 Impact Factor
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Dermatologic Surgery 08/2010; 36(8):1314-8. · 1.80 Impact Factor
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ABSTRACT: This study was conducted to investigate whether there is a consistent cutaneous branch by anatomic research of the supratrochlear artery. Ten fresh adult cadavers were selected. Anastomosis between the supratrochlear artery and supraorbital artery was observed. The mean distance from the supraorbital rim to the supratrochlear artery was 1.18 +/- 0.36 cm. A consistent cutaneous branch of the supratrochlear artery increased in a position 1.35 +/- 0.34 cm lateral to the midline that anastomosed abundantly with the cutaneous branch, the muscular branch of the opposite side, the ipsilateral muscular branch, and bilateral supraorbital arteries. An ultrathin forehead skin flap with the cutaneous branch as the blood vessel was designed and used for nasal reconstruction in 15 cases. Postoperatively, all flaps survived successfully with satisfactory surgical results. The advantages of the flap are its thin feature and preservation of the entirety of the frontalis muscle.
Annals of plastic surgery 08/2010; 65(2):183-7. · 1.29 Impact Factor
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ABSTRACT: Forehead skin is often insufficient to use for nasal reconstruction because of a low hairline. In addition, skin graft used to repair donor-site defects results in obvious mismatched patches, whereas healing by secondary intention of donor-site defects causes conspicuous scars. To make up for the shortage of forehead skin used for nasal reconstruction and primary donor-site defect closure, the authors challenged the conventional idea of late shrinkage of expanded forehead flaps for nasal construction, and suggest a technique combining extended forehead skin expansion with single-stage nasal subunit plasty.
This technique was applied to 43 patients for nasal reconstruction over a 9-year period. The technique consists of three stages: extended forehead skin expansion, single-stage nasal contouring and subunit plasty, and pedicle restoration. All cases were followed for at least 12 months. Outcomes were evaluated in terms of aesthetics, function, and donor-site aesthetics.
No secondary shrinkage occurred in any of the cases. Eighty-one percent of the patients assessed themselves as satisfactory for aesthetics, 70 percent assessed themselves as satisfactory for function, and 77 percent assessed themselves as satisfactory for donor-site aesthetics. The complications included minor brow elevation (five cases), L-strut distortion (four cases), stuffiness of the nostrils (four cases), flap hyperpigmentation (one case), flap skin paleness (one case), and alar graft extrusion (one case).
The combination of extended forehead skin expansion with single-stage nasal subunit plasty overcomes the defect of late shrinkage of an expanded flap for nasal reconstruction and achieved satisfactory results in aesthetics (nose and donor site) and function.
Plastic and reconstructive surgery 04/2010; 125(4):1119-28. · 2.74 Impact Factor
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ABSTRACT: Partial necrosis of skin flaps remains a significant problem in plastic and reconstructive surgery. In this study we attempted to evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) transplantation on improvement of skin flap survival in a rat random pattern skin flap model. Thirty Wistar rats were divided into three groups with each consisting of 10 rats. BM-MNCs and the adipose-derived stem cells (ADSCs) were transplanted into the subcutaneous tissue in the area where the flap would be dissected. The flaps were then raised two days after cells transplantation. The animals receiving the preoperative Dulbecco's Modified Eagle Medium (DMEM) treatment were used as the controls. On the 7th postoperative day, the survival areas of flaps were measured and tissues were collected for examinations. The results showed that the mean survival areas were 46.33 +/- 13.46% in the ADSCs group and 50.06 +/- 13.82% in the BM-MNCs group as the percentages of the total skin flaps, which were significantly higher than that in the control group (26.33 +/- 7.14%) (P < 0.05). Histological analysis showed increased neovascularization in the flap treated with BM-MNCs when compared with ADSCs transplantation. Survival BM-MNCs and ADSCs were detected in the flap tissues. Higher levels of the basic fibroblast growth factor (bFGF) and vascular endothelium growth factor (VEGF) were found in the BM-MNCs transplantation group (P < 0.05). The findings from this study demonstrated that preoperative treatment with BM-MNCs transplantation could promote neovascularization and improve flap survival. These effects of BM-MNCs on flap survival were comparable with ADSCs transplantation, but without necessity of in vitro cells expansion.
Microsurgery 03/2010; 30(4):275-81. · 1.61 Impact Factor
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ABSTRACT: Hypoxia is the original signal to promote angiogenesis in ischaemic tissues. However, hypoxia-induced angiogenesis usually cannot compensate for the ischaemic injury in surgery, resulting in tissue necrosis. Mimic hypoxia may be an option to improve angiogenesis for the purpose of preventing or reducing necrosis. In this study, the authors explored the feasibility of applying hypoxic mimic--deferoxamine (DFO) to the treatment of ischaemic random skin flaps.
Ischaemic random skin flap models were developed in 18 nude mice using a cutaneous marking technique. The mice were divided into a DFO-treated group and a control group. Vascular endothelial growth factor (VEGF) protein level, vessel density and flap survival rate were evaluated on the seventh postoperative day. In vitro, both VEGF mRNA expression and protein level were investigated in endothelial cells and fibroblasts under DFO, hypoxia and normoxia conditions. The (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed to study the impact of DFO-induced VEGF up-regulation on endothelial cell viability after severe hypoxia injury.
The flap survival rate, vessel density and VEGF level in the DFO group are significantly higher than in the control group. In vitro, DFO-induced increase in VEGF mRNA expression translated into 2.3- and 5.8-fold increases in VEGF protein secretion in DFO-conditioned media of endothelial cells and fibroblasts, respectively. The MTT assay showed that the cell viability both in the DFO group and in the VEGF group was significantly higher than in the control group.
VEGF praracrine and autocrine secretion in fibroblasts and in endothelial cells play an important role in DFO-induced angiogenesis, which improves ischaemic flap survival. DFO-induced VEGF autocrine secretion also protects endothelial cells from severe hypoxia injury.
Journal of Plastic Reconstructive & Aesthetic Surgery 03/2010; 63(12):2152-9. · 1.49 Impact Factor
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ABSTRACT: Flap prefabrication is started with transposition of a vascular pedicle into a donor area that lacks an axial blood supply. Adipose-derived stem cells (ASCs) have been proven beneficial for promoting neovascularization and tissue regeneration in several animal models. Here we investigated the feasibility of applying ASCs as a novel strategy to promote flap prefabrication, which involves the processes of neovascularization and regeneration. Prefabricated flaps were performed by two-stage procedure in a rat model. At stage one, the right femoral vascular pedicle was dissected and embedded underneath the abdominal flap to form a man-made axial flap. At stage two, the prefabricated abdominal flap was elevated as an island flap based on the implanted femoral vessel. Ninety rats were randomly divided into 3 groups and received allogeneic ASCs, chondrocytes and phosphate-buffered saline (PBS), respectively during the first operation. Eighteen flaps of each group were harvested for vascular endothelial growth factor-A (VEGF-A) protein assay after the first surgery. The other flaps were processed for flap viability measurements by flap survival rate and capillary density after the second surgery. Results demonstrated that the ASCs treated group had higher survival percentage and capillary density of flap as compared with either PBS group or chondrocyte group. Furthermore, the ASC group had the highest level of in vivo VEGF-A among three groups, while the chondrocyte group had the lowest. These results indicate that ASCs are capable of promoting flap prefabrication, and its therapeutic potential is correlated with the angiogenic cytokines such as VEGF-A.
The Tohoku Journal of Experimental Medicine 01/2010; 222(2):131-40. · 1.24 Impact Factor
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ABSTRACT: To compare the effect of local administration of endothelial progenitor cells (EPCs) and VECF on improving neovascularization and augmenting the survival areas in a rat model of prefabricated flap.
Prefabricated flaps were created by ligating the right femoral vascular pedicle and implanting it underneath the abdominal flap. The in vitro cultured EPCs (Group I , n=15) and VEGF protein (Group II , n=15) were injected subcutaneously around the implanted pedicle in experimental groups. PBS was injected in control group (Group Ill , n=15). 4 weeks later, the abdominal island flap based solely on the implanted vessels was elevated and sutured back. Then flap viability and numbers of capillary were evaluated on day 7.
There was more statistically significant augmentation of flap survival [(87.26 +/- 10.13) % versus (66.13 +/- 9.9)% and (55.59 +/- 13.06)%, P < 0.001], a higher capillary density (38.67 +/- 9.52 versus 25.83 +/- 6.33 and 26.5 +/- 5.61 capillary/mm2 , P < 0.05) in EPCs group than in the other two groups.
EPCs are superior to VEGF in improving neovascularization during flap prefabrication. Local transplantation of bone marrow-derived EPCs may be a useful strategy for augmentation of the survival areas of prefabricated flaps.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 11/2009; 25(6):451-5.
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ABSTRACT: Nasal frame grafting has been widely used in nasal reconstruction; however, a stable nasal frame with satisfactory functional and aesthetic results is hard to achieve in total nasal reconstruction. In this study, we devised a technique to create an individually designed anchor-shaped nasal frame composed of an L-strut and two C-battens, and applied it in the total nasal reconstruction procedure to achieve satisfactory functional and aesthetic results.
In a 9-year period, 17 patients with total nasal defect were treated with autogenous costal grafting utilising forehead flap as the covering. The techniques of the individualised design of the anchor-shaped nasal frame were applied to fit the facial features. All cases were followed for at least 18 months, and outcomes were evaluated separately by the patients and plastic surgeons in terms of aesthetics, stability and function.
Satisfactory results were achieved in most of the cases after the operation. More than 82.4% of the patients in this series were assessed as satisfactory by both groups in the aesthetics survey; more than 76.5% in the stability survey; and more than 64.7% in the function survey. Complications included flap hyperpigmentation (one case), flap-skin paleness (one case), L-strut distortion (three cases) and stuffiness of the nostrils (one case) as well as minor brow elevation of the donor side (five cases).
The procedure of applying individually designed anchor-shaped nasal frame with forehead flap technique has obvious advantages for restoration of distinct and delicate subunits, stable nasal structure and good nasal function.
Journal of Plastic Reconstructive & Aesthetic Surgery 07/2009; 63(6):954-62. · 1.49 Impact Factor
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ABSTRACT: Resurfacing of facial massive soft tissue defect is a formidable challenge because of the unique character of the region and the limitation of well-matched donor site. In this report, we introduce a technique for using the prefabricated cervicothoracic skin flap for facial resurfacing, in an attempt to meet the principle of flap selection in face reconstructive surgery for matching the color and texture, large dimension, and thinner thickness (MLT) of the recipient.
Eleven patients with massive facial scars underwent resurfacing procedures with prefabricated cervicothoracic flaps. The vasculature of the lateral thigh fascial flap, including the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia, was used as the vascular carrier, and the pedicles of the fascial flap were anastomosed to either the superior thyroid or facial vessels in flap prefabrication. A tissue expander was placed beneath the fascial flap to enlarge the size and reduce the thickness of the flap.
The average size of the harvested fascia flap was 6.5 x 11.7 cm. After a mean interval of 21.5 weeks, the expanders were filled to a mean volume of 1,685 ml. The sizes of the prefabricated skin flaps ranged from 12 x 15 cm to 15 x 32 cm. The prefabricated skin flaps were then transferred to the recipient site as pedicled flaps for facial resurfacing. All facial soft tissue defects were successfully covered by the flaps. The donor sites were primarily closed and healed without complications. Although varied degrees of venous congestion were developed after flap transfers, the marginal necrosis only occurred in two cases. The results in follow-up showed most resurfaced faces restored natural contour and regained emotional expression.
MLT is the principle for flap selection in resurfacing of the massive facial soft tissue defect. Our experience in this series of patients demonstrated that the prefabricated cervicothoracic skin flap could be a reliable alternative tool for resurfacing of massive facial soft tissue defects. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.
Microsurgery 04/2009; 29(7):515-23. · 1.61 Impact Factor
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Medical Hypotheses 01/2009; 72(4):475-6. · 1.39 Impact Factor
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Journal of Plastic Reconstructive & Aesthetic Surgery 12/2008; 62(6):e162-3. · 1.49 Impact Factor
