Chinese Journal of Plastic and Reconstructive Surgery最新文献

Background

Scar contractions caused by trauma or burns can cause secondary physical dysfunction and disfigurement. Many minimally invasive methods for scar contraction have shown limited applicability and efficacy. This study investigated the feasibility and efficacy of intralesional collagenase injections for scar contraction treatment.

Methods

Patients with contracted scars who had limited joint movement and physical disfiguration for >1 year were enrolled in this single-blind, randomized clinical trial from July 2017 to February 2018 ​at Shanghai Ninth People’s Hospital. Collagenase was injected into the firm-contracted scar (15 U/cm²) three times at 4-week intervals in the multiple treatment group and once in the single treatment group, and a placebo injection was performed in the control group. Scar length and skin texture were documented at the 4- and 12-week follow-ups. The safety of the collagenase treatment was also evaluated.

Results

The contracted scar was significantly elongated after both single and multiple collagenase treatments. The results showed that, compared to a one-time treatment, repeated injections were more effective at 12 weeks, with an average improvement of 26.83 (15.79%). At 12 weeks, 78.9% of the patients in the multiple group and 52.9% in the single group achieved significant improvement at 12 weeks. No severe adverse events were observed.

Conclusion

Intralesional collagenase injection showed promising results in improving scar contraction and provides an alternative treatment for patients.

Trial registration

ChiCTR, ChiCTR-IIR-16009910. Registered November 18, 2016. Prospective registration, https://www.chictr.org.cn/showproj.html?proj=16853.

Background

Melasma is an acquired pigmentation condition characterized by its refractory nature and a high risk of recurrence. Treatment of melasma is challenging owing to its unclear etiology, stubborn resistance to treatment, and frequent relapses. Therefore, this study aimed to compare the efficacy, effectiveness, and safety of monotherapy and combination therapy (combination of laser and tranexamic acid (TXA)) for the treatment of melasma using a network meta-analysis.

Method

The PRISMA guidelines were used in this meta-analysis, with a literature search conducted in reputable sources, such as Cochrane, Science Direct, PubMed, and Google Scholar.

Results

From the initial search, 1 504 relevant studies were identified. After careful analysis, three studies were included in the meta-analysis. The results showed no significant differences in the Melasma Area and Severity Index (MASI) score between monotherapy (control group) and a combination therapy of laser and TXA. The mean difference in MASI score was 1.87 (95% confidence interval (CI), −0.78–4.52; P=0.17), indicating no significant difference between the two treatment approaches. Side effects were more common in the combination treatment group than in the control group. The odds ratio for experiencing side effects was 8.85 (95% CI, 1.57–50.01; P=0.01).

Conclusion

Both the monotherapy and combination therapy groups showed therapeutic improvement; however, the combination therapy group showed a higher incidence of side effects.

Background

Acne vulgaris (AV) is a common inflammatory skin disease. Although various mechanisms have been indicated in the etiopathogenesis of AV, the exact pathophysiology remains unknown. Various lasers have been used to treat AV; however, the serum level changes of inflammatory cytokines after laser therapy have not been elucidated. We aimed to investigate the relationship between inflammatory changes and remission on the opposite side in patients with moderate to severe AV after treating half of the face with 595- and 1 064-nm dual-wavelength laser.

Methods

In total, 18 patients (9 male and 9 female) between 16 and 35 years of age with moderate to severe AV were evaluated in the study. Disease severity was classified according to the Pillsbury grading system of acne. Patients were randomized to receive a series of two treatment sessions at intervals of 2 weeks and followed up at 2 weeks after the final treatment. A 3 ​mL blood sample was drawn from every subject each time, and serum levels of inflammatory cytokines such as interleukin (IL)-6, IL-8, and IL-22 were determined using enzyme-linked immunosorbent assay at baseline and 2 weeks after each treatment. Improvement was determined by a blinded assessment of photographs taken before and after the final evaluation.

Results

Inflammation was significantly reduced on both the treated and untreated sides, and symptoms of AV lesions were alleviated. All patients showed a significant increase in serum IL-22 levels after the first laser therapy, with no significant difference in serum IL-6 and IL-8 levels. After the second laser therapy, serum IL-6, IL-8, and IL-22 levels were significantly decreased. No significant side effects such as bruising, edema, hyperpigmentation, hypopigmentation, or scarring were reported.

Conclusion

Half-face treatment with 595- and 1 064-nm dual-wavelength laser for moderate and severe AV showed a significant effect of full-face remission, which was associated with a gradual decrease in IL-6, IL-8, and IL-22 levels after half-face topical treatment. This suggests that reducing inflammatory cytokine levels in the serum can relieve inflammation in non-therapeutic sites. This laser treatment is effective, economical, and painless.

Once a popular injectable filler, polyacrylamide hydrogel (PAAG) has been banned in China since 2006 due to its unclear safety and long-term complications. However, it is still being used worldwide because of its huge commercial profit, leading to emerging complications and an urgent need for standardized clinical management. This review aimed to assess the properties, safety, and complications of PAAG and treatment strategies for its removal.

Port-wine stain (PWS) is a congenital capillary malformation that occurs in 0.3%–0.5% of newborns. The pulsed dye laser is the current gold standard treatment for PWS; however, its efficacy is poor. Photosensitizer photodynamic therapy (PDT) is considered a promising treatment for PWS. Here we provide a comprehensive overview of PDT.

Total avulsion of the scalp is a serious traumatic injury and an absolute surgical emergency. Despite well-stocked literature on its immediate care, there is insufficient literature regarding its long-term complications. Here, we describe the case of a patient who developed chronic pain 24 months after replantation. The patient underwent several needle rigotomy sessions associated with lipofilling to reconstruct a sliding plane between the scalp and periosteum, followed by nanofat sessions to improve skin elasticity. This autologous fat injection treatment was successful, and the patient is currently pain-free. Therefore, lipofilling followed by nanofat injection is an effective treatment for this complication.

Local flaps are widely known as the best option for partial nasal reconstructions depending on donor tissue laxity, vascularization, and defect shape and size. The nasolabial flap is used more often in the nasal sill. For larger defects, greater tissue mobilization with larger scars or free flaps is required. Historically, the Abbe flap has been used for lip reconstruction in patients with cleft lip deformities. It allows less retraction than other local flaps or skin grafts in patients with large defect sizes and great defect depths. This study reported on the application of the Abbe flap for nasal sill reconstruction on a 71-year-old female patient with nasal sill basal cell carcinoma who had undergone resection surgery with a posterior lip switch operation with satisfactory results. The application of the Abbe flap could be considered in patients with multiple previous surgeries and at risk for necrosis.

Infantile hemangiomas (IHs) are the most common benign soft-tissue tumors in infancy; about 10%–15% of them may result in various complications that require active management. The current first-line treatment for IH is oral propranolol; however, some studies recommend intralesional corticosteroid injections for small, limited, deep, or prominent tumors because of concern regarding serious systemic complications related to propranolol. This review summarizes and analyzes the current clinical studies on corticosteroid injections in IHs, discusses treatment norms, and explores future research directions.

Background

Skin aging has recently gained significant attention in both society and skin care research. Understanding the biological processes of photoaging caused by long-term skin exposure to ultraviolet radiation is critical for preventing and treating skin aging. Therefore, it is important to identify genes related to skin photoaging and shed light on their functions.

Methods

We used data from the Gene Expression Omnibus (GEO) database and conducted bioinformatics analyses to screen and extract microRNAs (miRNAs) and their downstream target genes related to skin photoaging, and to determine possible biological mechanisms of skin photoaging.

Results

A total of 34 differentially expressed miRNAs and their downstream target genes potentially related to the biological process of skin photoaging were identified. Gene Ontology enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis showed that these target genes were enriched in pathways related to human papillomavirus infection, extracellular matrix (ECM)-receptor signaling, estrogen receptor, skin development, epidermal development, epidermal cell differentiation, keratinocyte differentiation, structural components of the ECM, structural components of the skin epidermis, and others.

Conclusion

Based on the GEO database-derived findings, we determined that target genes of two miRNAs, namely miR-4667-5P-KRT79 and miR-139-5P-FOS, play an important role in skin photoaging. These observations could provide theoretical support and guidance for further research on skin aging-related biological processes.

Background

This study aimed to review treatments and evaluate the aesthetic outcomes, complications, and reoperation rates regarding surgical correction for a postoperative contracted nose.

Methods

PubMed, MEDLINE, and Embase databases were searched for studies detailing aesthetic outcomes and complications of surgical correction of a contracted nose. Surgical procedures, adjuvant treatment, outcomes, and complications were synthesized and analyzed.

Results

Nine articles encompassing 376 patients were included in the systematic review, and six articles (198 participants) were included in the meta-analysis. The most frequently used graft material was the autologous rib cartilage (61.1%). Surgical procedures were heterogeneous in these studies. The nasolabial angle reduced by 9.52° (95% confidence interval (CI): (−11.95, −7.09), P<0.000 1), and the nasal length increased significantly (standardized mean difference (SMD)=2.25, 95% CI: (1.26, 2.23), P<0.000 01). However, the evidence was insufficient to determine a significant change in the columellar-labial angle (SMD=−0.95, 95% CI: (−2.19, 0.29), P=0.13) and columellar-lobular angle (SMD=2.39, 95% CI: (−1.20, 5.97), P=0.19). Aesthetic dissatisfaction (12.5%) and infection (4.5%) were the most commonly reported complications. Reoperation was performed in 5.3% of patients.

Conclusion

Surgical correction can increase the nasal length, reduce the nasolabial angle, and have a low reoperation rate. No significant improvement in the columellar-labial or columellar-lobular angle was observed.