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Clinical outcomes for Conduits and Scaffolds in peripheral nerve repair

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World Journal of Clinical Cases 2015年第2期3卷 141-147页

作者： David J Gerth Jun Tashiro Seth R Thaller Division of Plastic Aestheticand Reconstructive SurgeryDe Witt-Daughtry Family Department of SurgeryLeonard M. Miller School of MedicineUniversity of Miami

The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, *** include limited availability of donor tissue,sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies,researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive *** of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes.

关键词： Plastic surgery reconstructive surgical procedures Nerve tissue Conduit Scaffold

Substance use and inhalation injury in adult burn patients:retrospective study of the impact on outcomes

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Burns & Trauma 2019年第1期7卷 132-138页

作者： Kevin M.Klifto Luis Quiroga C.Scott Hultman department of Plastic and reconstructive surgery Johns Hopkins Burn CenterThe Johns Hopkins Hospital4940 Eastern AvenueBaltimore 21224USA

Background:Substance use,alcohol use,and smoking use have all been associated with burn *** studies have investigated associations with substances,alcohol,smoking,inhalational only burns,and patient *** purpose of the study was to identify risk factors for pulmonary failure in patients suffering inhalation injury,focusing on the impact of substance,alcohol,and cigarette ***:This is a single-center retrospective analysis of 115 patients admitted to the Johns Hopkins Bayview Burn Center with inhalational injury from January 1,2010,through September 30,*** were excluded if they were under the age of 18 years or had burn involvement of the skin>5%.Primary outcome variables measured were if patients were intubated,length of total time intubated,substance use,alcohol use,and smoking *** outcome variables measured were types of substances used(amphetamines,barbiturates,benzodiazepines,cannabinoids,cocaine,methadone,codeine/morphine),total number of substances used,intensive care unit(ICU)length of stay(LOS),hospital LOS,secondary complications,and patient *** was performed with Fisher’s exact test and the Mann-Whitney U test.A sub-group analysis for each substance,alcohol,smoking,and control subgroup was compared to its respective sub-group without substance,alcohol,smoking,and control within the no intubation and intubation group.A sub-group analysis of substance use,alcohol use,smoking use,and control was further analyzed with binomial logistic regression within the intubation ***:Following inhalation injury,50/115(43%)patients required ***-two of the 50(84%)patients intubated had substance use(p<0.001).Thirty-one of the 50(62%)patients intubated had history of smoking(p=0.038).Among the specific substances used,26/50(52%)patients intubated were using benzodiazepines(p<0.001)and 7/50(14%)patients were using cocaine(p=0.022).The lengths of intubation,ICU LOS,and hospital LOS with no substanc

关键词： Intubation Smoking Burn Risk factors Cocaine Benzodiazepines Morphine Inhalation

Indocyanine green lymphangiography-guided liposuction in breast cancer-related lymphedema treatment-patient selection and technique

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Plastic and Aesthetic Research 2020年第2期7卷 30-36页

作者： Hin-Lun Liu Melody Man-Kuen Wong Joseph Hon-Ping Chung Division of Plastic and reconstructive surgery Department of SurgeryThe University of Hong KongQueen Mary HospitalHong Kong SARChina

Aim:The rationale of using liposuction to treat lymphedema is that the chronic inflammatory process of lymphedema results in fat *** authors describe the technique of indocyanine green lymphangiography-guided liposuction,its rationale,and our patient selection criteria for better clinical ***:Thirty-two patients underwent liposuction for breast cancer-related *** green lymphangiography was performed prior to *** patients without linear and splash patterns in indocyanine green lymphangiography,circumferential liposuction was performed *** patients who had linear or splash patterns,liposuction was not performed at regions with remaining functional lymphatic *** were assessed using circumferential reduction ***:At a mean follow-up of 24.5±6.5 months,all(100%)patients had a reduction in limb circumferences after *** mean circumference reduction rate was 67.6%±27.9%.Conclusion:Liposuction is a valuable treatment for breast cancer-related *** believe patients with fat predominant lymphedema are the best candidates for liposuction.

关键词： Lymphedema breast cancer-related lymphedema liposuction indocyanine green lymphangiography

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

Efficacy and safety of a dual-scan protocol for carbon dioxide laser in the treatment of split-thickness skin graft contraction in a red Duroc pig model

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Burns & Trauma 2021年第1期9卷 1-11页

作者： Jie Li Sally Kiu-Huen Ng Wenjing Xi Zheng Zhang Xiaodian Wang Hua Li Weijie Su Jingyan Wang Yixin Zhang department of Plastic and reconstructive surgery Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China department of Plastic surgery Austin HealthMelbourne 3084Australia Victorian Adult Burns Service Alfred HealthMelbourne 3181Australia department of Plastic and reconstructive surgery Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghai 200092China

Background:Fractional CO_(2) laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the ***,the optimal treatment protocol remains *** study applied a dual-scan protocol to achieve both releasing and ablation of contracted skin *** comprehensively describe this treatment method and compare the efficacy and safety between this dual-scan method and the conventional mono-scan ***:A hypercontracted scar model after split-thickness skin grafting in red Duroc pigs was *** scars meeting the inclusion criteria were randomly divided into four groups:high fluence–low density(HF–LD),low fluence–high density(LF–HD),combined group and control *** energy per unit areawas similar in the HF–LD and LF–HD *** laser interventions were performed at a 6-week *** efficacy of the treatment was evaluated by objective measures of scar area,release rate,elasticity,thickness and flatness,while the safetywas evaluated based on adverse reactions and melanin *** structurewas observed *** animals were followed up for a maximum of 126 days after ***:A total of 28 contracted scars were included,7 in each *** 18 weeks postoperatively,the HF–LD and the combined groups showed significantly increased scar release rate(p=0.000)and elasticity(p=0.036)and decreased type I/III collagen ratio(p=0.002)compared with the control and LF–HD *** terms of flatness,the combined group was significantly better than the HF–LD group for elevations<1mm(p=0.019).No significant skin side effects,pigmentation or scar thickness changes were observed at 18 ***:Dual-scan protocol could achieve superficial ablation and deep release of contracted split-thickness skin graft in a single treatment,with similar contraction release and texture improvement compared to a single deep *** main advantage is to

关键词： Skin graft contraction Scar Laser treatment Fractional carbon dioxide laser

Osteolectin+stromal cells:Mechanical stimulation improves bone regeneration and supports bacterial clearance after fracture

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Signal Transduction and Targeted Therapy 2021年第8期6卷 2257-2258页

作者： Sabrina Ehnert Tina Histing Andreas K.Nussler department of Trauma and reconstructive surgery Eberhard Karls University Tubingen Siegfried Weller Research InstituteBG Trauma Center TubingenTubingenGermany

In a study recently published in Nature,Shen and colleagues characterized a peri-arteriolar niche in the bone marrow with highly proliferative,short-lived,leptin receptor-and osteolectin(Oln)positive stromal cells,which improved bone regeneration and supported bacterial clearance after *** proving that maintenance of these cells critically required mechanical stimulation,which in turn was affected by age,1 the authors identified possible therapeutic targets for bone healing and regeneration.

关键词： stimulation healing clearance

Scar-centered dilation in the treatment of large keloids

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World Journal of Clinical Cases 2022年第18期10卷 6032-6038页

作者： Min Wu Jie-Yu Gu Ran Duan Bo-Xuan Wei Feng Xie department of Plastic and reconstructive surgery Shanghai Ninth People’s HospitalShanghai JiaoTong University School of MedicineShanghai 200011China

BACKGROUND Hypertrophic scars and keloid treatment is a major problem in plastic *** small keloids can be treated with resection followed by radiotherapy,large keloids require treatment with a tissue *** methods increase the need for auxiliary incisions,causing new scar *** To introduce a new method for the treatment of keloids with an *** Between 2018 and 2021,we performed surgeries to treat large keloids in nine patients with a two-stage *** the first stage,an intrascar incision was made in the keloid,and a customized expander was implanted under the keloid and the surrounding normal skin.A period of 3-6 mo was allowed for skin *** the second stage,after the initial incision healed,a follow-up surgery was performed to remove the expander,resect the keloid,and repair the expanded skin *** accomplish this,an incision was made along the scar boundary to avoid making a new surgical incision and creating new *** radiotherapy was then performed *** Two patients had anterior chest *** treatment,the anterior chest incision was broken repeatedly and then sutured again after *** healed smoothly without scar *** were successfully removed in 7 patients without *** This method was performed through a keloid incision and with a custom expander *** full expansion,the keloid was directly resected using a linear suture,which avoids new surgical incisions and scars and can successfully remove large-area *** treatment is effective,providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.

关键词： Expander Keloids Superficial radiotherapy Intrascar incision Treatment

Targeting facial aging with nano and regenerative technologies and procedures

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Plastic and Aesthetic Research 2020年第1期7卷 1-8页

作者： Marek Dobke Adam Hauch Division of Plastic and reconstructive surgery Department of SurgeryUniversity of California San DiegoSan DiegoCA 92103USA.

This study reviews information about the most novel ideas and modalities being incorporated into facial and neck cosmetic *** seek to identify trends and developments within these areas as well as perceptions of plastic surgeons regarding their probable significance,and discussion on how these modalities may impact future practice *** is hypothesized that nano and regenerative technologies are considered the most"hopeful".Emerging invasive and non-invasive modalities utilizing nano and regenerative concepts were *** intentionally sought to investigate approaches to beautification,including maintenance and reversal of signs of aging,utilizing methods lacking an established level of *** included promising modalities which are currently at the investigational *** board-certified plastic surgeons were surveyed regarding the clinical importance of twelve concepts and their expected impact on facial and neck *** and technological creativity in aesthetics is rapidly changing,and the efficacy of innovations and safety margins are *** and regenerative medicine-based technologies and procedures were ranked most promising for the future of *** potential applications and research were reviewed in the context of surgical and non-surgical modalities in clinical *** has been an advent of new approaches to facial and neck aesthetic surgery and tissue care,which is well-beyond just skin *** this new level of knowledge regarding variability in care responses and indications for procedures on an almost"molecular level",personalized and precise aesthetic surgery and medicine are quickly becoming a reality.

关键词： Face neck rejuvenation nano regenerative technologies

Lower extremity amputation:the emerging role of targeted muscle reinnervation(TMR)and regenerative peripheral nerve interface(RPNI)

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Plastic and Aesthetic Research 2022年第1期9卷 334-350页

作者： Yoshiko Toyoda Said Azoury Andrew Bauder L.Scott Levin Stephen Kovach Division of Plastic and reconstructive surgery University of PennsylvaniaPhiladelphiaPA 19104USA department of Plastic and reconstructive surgery Memorial Sloan Kettering Cancer CenterNew YorkNY 10065USA department of Orthopedic surgery University of PennsylvaniaPhiladelphiaPA 19104USA

Lower extremity amputation is increasingly prevalent in the United States,with growing numbers of patients suffering from diabetes and peripheral vascular *** has significant functional sequelae as more than half of patients are unable to ambulate at one year *** mobility and decreasing chronic post-amputation pain can significantly improve the quality of life for these patients and reduce the cost burden on the healthcare *** and reconstructive surgery has been at the forefront of“reconstructive amputation”,in which nerve pedicles can be surgically guided to decrease painful neuroma formation as well as provide targets for myoelectric prosthesis *** herein review post-amputation outcomes,epidemiology of chronic,post-amputation pain,and current treatments,including total muscle reinnervation and regenerative peripheral nerve interface,which are at the forefront of multidisciplinary treatment of lower extremity amputees.

关键词： Lower extremity amputation post-amputation pain neuroma targeted muscle reinnervation regenerative peripheral nerve interface