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Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars:a multicenter retrospective study

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Burns & Trauma 2023年第1期11卷 550-559页

作者： peiru min Shunuo Zhang Dorsa Gholamali Sinaki Ping Yao Fuhua Hu Xin Wang Danya Zhou Jun Chai Yixin Zhang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine639 ZhiZaoJu RoadHuangpu DistrictShanghai200011China Department of Plastic Surgery Hangzhou Plastic Surgery Hospital168 Shangtang RoadXiacheng DistrictHangzhou310000ZhejiangChina Department of Plastic and Reconstructive Surgery Ningbo Sixth Hospital1059 East Zhongshan RoadYinzhou DistrictNingbo315040ZhejiangChina Department of Burns and Plastic Surgery Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine197 RuiJinEr RoadHuangpu DistrictShanghai200020China

Background:An ideal tension-relieving suture should be efficient for>3 months to retrieve normal tensile *** preexisting suturing techniques provided tension elimination followed by relapse and scar proliferation due to absorption and cut-through of the *** study introduces a simple but effective suture technique developed by a senior author(ZYX)to solve this ***:A total of 120 patients with pathological scar(PS)had intervention treatment with the proposed suturing strategy at three centers from January 2018 to January 2021.A slowly absorbable 2-0 barbed suturewas used for subcutaneous tension relieving with a set-back from the wound edge and a horizontal interval between proposed inserting points of 1 *** Patient and Observer Scar Assessment Scale(POSAS),scar width,perfusion and eversion of the wound edge were evaluated at 3-,6-and 12-month *** time needed to place the tension-relieving suture was recorded and relapse was monitored for 18 months ***:In total,76 trunks,32 extremities and 12 cervical PS were included,with an average subcutaneous tension-relieving suture time of 5 *** Patient and Observer Scar Assessment Scale(POSAS)score decreased from 84.70±7.06 preoperatively to 28.83±3.09,26.14±1.92 and 24.71±2.00 at 3,6 and 12 months postoperatively,respectively(p<0.0001).The scar widths were 0.17±0.08,0.25±0.09 and 0.33±0.10 cm,respectively,with perfusion significantly decreased from 213.64±14.97 to 112.23±8.18 at 6 months(p<0.0001).The wound edge flattened out during the first 3 months in most cases with only two scar ***:Zhang’s suture technique provides a rapid and long-lasting tension-relieving effect with ideal scar appearances and lower relapse rates in the surgical management of PS.

关键词： Pathological scar Tension-relieving Suture technique Tension

Vascularized lymph node flaps can survive on venous blood without an arterial inflow:an experimental model describing the dynamics of venous flow using indocyanine green angiography(With video)

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Burns & Trauma 2023年第1期11卷 470-478页

作者： Ke Li Fabio Nicoli Chunxiao Cui Yan Wo Ning Fei Liu Shaoqing Feng Wenjing Xi peiru min Yixin Zhang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai JiaoTong University School of MedicineShanghai 200000China Translational and Clinical Research Institute Newcastle UniversityNewcastle upon Tyne NE11ADUK Department of Plastic and Reconstructive Surgery University of Rome“Tor Vergata”999016Italy Department of Plastic and Reconstructive Surgery Northumbria NHS TrustNewcastle upon Tyne NE11ADUK Department of Facial Plastic and Reconstructive Surgery ENT InstituteEye and ENT HospitalFudan UniversityShanghai 200000China Department of Anatomy and Physiology School of MedicineShanghai Jiao Tong UniversityShanghai 200000P.R.China

Background:Several surgeons have described studies of free-tissue transfers using veins instead of *** innovative microsurgical techniques can offer several advantages,such as an easier dissection during flap harvesting,and represent an alternative during an accidental surgical mistake or development of new surgical *** purpose of this study was to describe and explore different constructs of vascularized lymph node transfer(VLNT)only based on venous blood flow in a mouse model,evaluate their blood flow microcirculation through indocyanine green(ICG)angiography and investigate the lymphatic drainage function and the lymph nodes’***:Five types of venous lymph node flaps(LNF)were created and investigated:Types IA,IB,IC,IIA and IIB were developed by ICG intraoperatively(with videos in the article).Seven weeks later,by applying methylene blue,the recanalization of the lymphatic vessels between the LNF and the recipient site was *** nodes were collected at the same time and their structures were analyzed by hematoxylin and eosin staining ***:All of the venous LNFs developed except Type *** weeks later,methylene blue flowed into Types IA,IB,IIA and IIB from recipient *** comparing with arteriovenous lymph node,the medullary sinus was diffusely distributed in venous lymph *** proportion of cells was significantly reduced(p<0.05).The artery diameters were significantly smaller(p<0.05).The veins diameters and lymphatic vessels output in Types IA,IB,IIA and IIB were more dilated(p<0.05).Conclusions:This research demonstrated that Type IA,IB,IIA and IIB venous LNFs can retrogradely receive venous blood supply;they can survive,produce a lymphatic recanalization and integrate with the surrounding tissue,despite lymph node structural *** results will improve the understanding of the survival mechanism of venous LNFs and will help researchers to design new studies or lymphatic models and eventua

关键词： Vein circulation Venous Lymph node Flap Vascularized lymph node flap Lymphedema Indocyanine green

CD26 upregulates proliferation and invasion in keloid fibroblasts through an IGF-1-induced PI3K/AKT/mTOR pathway

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Burns & Trauma 2020年第1期8卷 41-54页

作者： Yu Xin peiru min Heng Xu Zheng Zhang Yan Zhang Yixin Zhang Department of Plastic and Reconstructive Surgery Shanghai 9th People’s HospitalShanghai Jiao Tong University School of Medicine639 Zhi Zao Ju RoadShanghai200011China

Background:Keloid is a fibrotic dermal disease characterized by an abnormal increase in fibroblast proliferation and *** pathological behaviours may be related to the heterogeneity of keloid fibroblasts(KFs);however,because of a lack of effective biomarkers for KFs it is difficult to study the underlying *** previous studies revealed that the expansion of CD26+KFs was responsible for increased keloid proliferation and invasion capabilities;the intrinsic relationship and mechanism between CD26 and keloid is therefore worthy of further *** aim of this studywas to explore molecular mechanisms in the process of CD26 upregulated KFs proliferation and invasion abilities,and provide more evidence for CD26 as an effective biomarker of keloid and a new clinical therapeutic ***:Flow cytometry was performed to isolate CD26+/CD26−fibroblasts from KFs and normal *** generate stably silenced KFs for CD26 and insulin-like growth factor-1 receptor(IGF-1R),lentiviral particles encoding shRNA targeting CD26 and IGF-1R were used for *** proliferations were analysed by cell counting kit-8 assay and 5-ethynyl-2-deoxyuridine(EdU)incorporation *** assay and transwell assay were used to assess cell migration and invasion *** further quantify the regulatory role of CD26 expression in the relevant signalling pathway,RT-qPCR,western blot,ELISA,PI3K activity assay and immunofluorescence were ***:Aberrant expression of CD26 in KFs was proven to be associated with increased proliferation and invasion of ***,the role of the IGF-1/IGF-1 receptor axis was also studied in CD26 and was found to upregulate KF proliferation and *** PI3K/protein kinase B(AKT)/mammalian target of rapamycin(mTOR)pathway was shown to affect CD26-regulated KF proliferation and invasion by increasing phosphorylation levels of S6 kinase and 4E-binding ***:CD26 can be the effective biomark

关键词： CD26 IGF-1 Invasion Keloids PI3K/AKT/mTOR signalling pathway Proliferation Fibroblast

Pre-expanded bipedicled visor flap:an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males

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Burns & Trauma 2020年第4期8卷 359-367页

作者： peiru min Jie Li Beniamino Brunetti Zheming Pu Weijie Su Wenjing Xi Zheng Zhang Rosa Salzillo Shaoqing Feng Yixin Zhang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina Department of Plastic and Reconstructive Surgery Campus Bio-Medico University of RomeRomeItaly

Background:Reconstruction of upper and lower lip subunits is a complicated and elusive *** patients affected by defects involving upper and lower lip subunits,a technique able to reconstruct both aesthetic units with matched colour,sufficient contours and similar texture would be *** this study,we present our experience with upper and lower lip reconstruction using the pre-expanded bipedicled visor ***:From January 2014 to January 2017,12 male patients presenting with defects of the upper and lower lip subunits were treated using this surgical *** a period of expansion of the scalp flap of over 6 months,the bipedicled visor flap was raised from both the parietal regions and rotated to resurface the *** and section of the pedicle were then ***:Twelve male patients with postburn scars aged 22 to 48 years(mean:34 years)were successfully treated with no major *** donor site was closed primarily in all *** flap debulking and minor revisions were performed under local anaesthesia between 6 and 12 months ***:The pre-expanded bipedicled visor flap provides an effective and reliable option for upper and lower lip reconstruction with excellent colour and *** is feasible to achieve these results simultaneously from a single donor site by using a pre-expanded bipedicled visor flap.

关键词： Postburn Pre-expanded Visor flap Lip defect Reconstruction

Control of fibrosis and hypertrophic scar formation via glycolysis regulation with IR780

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Burns & Trauma 2022年第1期10卷 452-464页

作者： Xinxian Meng Zhixi Yu Wanyu Xu Jun Chai Shuo Fang peiru min Yunsheng Chen Yixin Zhang Zheng Zhang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalSchool of MedicineShanghai Jiao Tong University639 Zhizaoju RdShanghai 200011China Department of Plastic and Reconstructive Surgery The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal hospitalGusu schoolNanjing Medical UniversitySuzhou 215008JiangsuChina Department of Plastic and Reconstruction First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Department of Burns and Plastic Surgery Shanghai Institute of Burns ResearchRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200025China

Background:Hypertrophic scars(HS)represent one of the most common clinical challenges due to unsatisfactory therapeutic *** formation is associated with the abnormal activation of fibroblasts and their excessive fibrotic *** dysregulation has been shown to participate in the incidence and progression of various fibrotic diseases and shows potential as a means of controlling HS *** work aimed to discuss the impact of augmented glycolysis on HS and to propose a method for controlling HS formation through glycolysis ***:Here,augmented glycolysis was confirmed together with enhanced fibrotic activity in both HS fibroblasts(HFs)and HS tissues,and the suppression of glycolysis also attenuated fibroblast *** also introduced IR780,a heptamethine cyanine dye,to regulate glycolysis for the control of HS ***:In vitro,cell studies indicated that IR780 significantly down-regulated glycolysis and suppressed the fibrotic activity of *** vivo,the intralesional injection of IR780 into rabbit HS models led to the downregulation of glycolysis and the control of HS ***,IR780 accumulated preferentially in activated fibroblasts in both in vitro and in vivo studies,and thus specifically downregulated glycolysis and efficiently controlled fibrosis by targeting activated ***:This work identified a strategy for controlling fibrosis and HS formation from the perspective of glycolysis regulation with IR780 targeting of activated fibroblasts.

关键词： Hypertrophic scar Glycolysis Fibrosis IR780 Activated fibroblast

红外热成像技术与彩色多普勒超声在股前外侧穿支皮瓣术前穿支血管探测中的比较

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中华显微外科杂志 2021年第4期44卷 388-391页

作者：徐宏征张书诺章一新肖文天闵沛如北京市垂杨柳医院普通外科北京100022 上海交通大学医学院附属第九人民医院整形和重建外科上海200011

目的探讨及对比红外热成像技术(IRT)与彩色多普勒超声(CDU)在股前外侧穿支皮瓣(ALTPF)术前穿支血管探测中的应用效果。方法自2017年9月至2019年9月,接受ALTPF手术行修复重建的患者共25例,其中男16例,女9例;年龄12~53岁,平均38.7岁;所有... 详细信息

目的探讨及对比红外热成像技术(IRT)与彩色多普勒超声(CDU)在股前外侧穿支皮瓣(ALTPF)术前穿支血管探测中的应用效果。方法自2017年9月至2019年9月,接受ALTPF手术行修复重建的患者共25例,其中男16例,女9例;年龄12~53岁,平均38.7岁;所有患者均切取带蒂或者游离的ALTPF,大小5.0 cm×8.0 cm~7.5 cm×30.0 cm,其中游离皮瓣21例,局部带蒂转移皮瓣4例。所有患者术前均常规行IRT以及CDU检查进行供区穿支血管定位。使用卡方检验比较术前探测与术中实际情况,统计一致性。结果本组25例中,术前CDU共检测出53条穿支血管,IRT共检测到51个"热点",其中50个"热点"与CDU的结果相对应,κ指数为0.712(P<0.05),代表高度一致性,敏感性为94.3%,特异性为85.7%,两者之间定位的偏移与皮下组织厚度呈正相关。结论利用IRT在ALTPF术前探测穿支血管与CDU相比具有高度的一致性,兼具便携、经济、无创、操作简便的特点,同时在皮下组织较薄的人群中具有更高的精准度,是术前穿支血管导航的重要组成部分。

关键词：股前外侧穿支皮瓣红外热成像技术穿支血管探测彩色多普勒超声

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颈部烧伤后瘢痕挛缩畸形的手术策略

中华烧伤杂志 2015年第4期31卷 280-284页

作者：冯少清苏薇洁喜雯婧闵沛如濮哲铭张艳章一新上海交通大学医学院附属第九人民医院整复外科 200011

目的探讨颈部烧伤后瘢痕挛缩畸形的手术策略。方法2013年7月-2014年7月，笔者单位收治65例颈部烧伤后瘢痕挛缩患者。按颈部下唇唇红缘一颌上区、颌下区、颈前区3个解剖学亚单位的不同要求，对颈部挛缩瘢痕进行相应松解，后行颈阔肌松解... 详细信息

目的探讨颈部烧伤后瘢痕挛缩畸形的手术策略。方法2013年7月-2014年7月，笔者单位收治65例颈部烧伤后瘢痕挛缩患者。按颈部下唇唇红缘一颌上区、颌下区、颈前区3个解剖学亚单位的不同要求，对颈部挛缩瘢痕进行相应松解，后行颈阔肌松解术，部分颏部发育短小患者行水平截骨颏成形术。依据覆盖颈部创面的皮肤组织与创周皮肤组织的色泽、质地、厚度等尽可能接近的相似性原则，除学龄前患儿行皮片移植外，根据患者情况分别采用局部皮瓣、邻位皮瓣或游离皮瓣修复创面。结果所有患者均行瘢痕松解及颈阔肌松解术；9例患者行水平截骨颏成形术；32例患者采用局部扩张皮瓣，7例患者采用邻位皮瓣，11例患者采用游离皮瓣，15例患者采用皮片。术后所有皮片、皮瓣均成活，所有患者术后颈部活动良好，重建后的颏颈角角度为90—120°。随访6～24个月，6例植皮患者出现一定程度的皮片挛缩，采用皮瓣修复的患者均未见挛缩现象。结论颈部瘢痕挛缩畸形的治疗以颏颈角重建为重点，依据亚单位原则松解挛缩瘢痕，依据相似性原则修复创面，优先采用皮瓣移植术，次选植皮术，可取得较佳修复效果。

关键词：烧伤颈外科皮瓣瘢痕挛缩

颞浅双蒂预扩张头皮瓣在严重烧伤后下面部轮廓重建中的应用

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组织工程与重建外科杂志 2019年第1期15卷 20-24页

作者：闵沛如章一新上海交通大学医学院附属第九人民医院整复外科上海市200011

目的探讨颞浅双蒂预扩张头皮瓣在严重烧伤后下面部轮廓重建中的应用效果。方法 2014年1月至2017年1月,应用颞浅双蒂预扩张皮瓣修复10例男性患者烧伤后上、下唇瘢痕。一期于头皮下放置扩张器,经6～8个月扩张后,行二期手术,缺损覆盖按亚... 详细信息

目的探讨颞浅双蒂预扩张头皮瓣在严重烧伤后下面部轮廓重建中的应用效果。方法 2014年1月至2017年1月,应用颞浅双蒂预扩张皮瓣修复10例男性患者烧伤后上、下唇瘢痕。一期于头皮下放置扩张器,经6～8个月扩张后,行二期手术,缺损覆盖按亚单位原则进行。结果扩张皮瓣全部成活并覆盖上、下唇区域,未发生术后并发症。随访6～12个月,皮瓣质地柔软,不臃肿,肤色与正常唇周皮肤相近,瘢痕隐蔽,张口及表情功能良好。结论颞浅双蒂预扩张头皮瓣是修复男性患者上下唇全层皮肤组织缺损的较好方法。

关键词：颞浅双蒂预扩张头皮瓣烧伤后瘢痕上下唇缺损

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组合皮瓣的临床应用及进展

组织工程与重建外科杂志 2011年第3期7卷 175-179页

作者：闵沛如章一新上海交通大学医学院附属第九人民医院整复外科上海市200011

多组织瓣可以依据血供来源分为复合皮瓣、联体皮瓣和组合皮瓣。组合皮瓣被广泛应用于口腔、头面部及四肢部位的组织缺损修复,对包含软组织缺损的巨大复合组织缺损疗效确切。应用组合皮瓣减少了手术对供区外观和功能的损伤,避免死腔形成... 详细信息

多组织瓣可以依据血供来源分为复合皮瓣、联体皮瓣和组合皮瓣。组合皮瓣被广泛应用于口腔、头面部及四肢部位的组织缺损修复,对包含软组织缺损的巨大复合组织缺损疗效确切。应用组合皮瓣减少了手术对供区外观和功能的损伤,避免死腔形成。本文就组合皮瓣的定义及分类、近5年内国内外组合皮瓣的应用,以及各类组合皮瓣的临床优点和局限性进行综述。

关键词：组合皮瓣皮瓣分类血供