Objective:To present a new method of vermilion tubercle reconstruction in secondary cleft lip repair.Methods:39 secondary cleft lip repair patients underwent the operation of vermilion tubercle reconstruction with a vermilion flap transferred vertically. The procedures of the reconstruction mainly included three processes, restoring the vermilion tubercle tissue in the cleft area, widening the vermilion with the vermilion flap, and augmenting the volume of the tubercle with the muscle tissue underlying that vermilion flap. The width of the vermilion and the projection of the vermilion tubercle were measured before and after operation, and then two sets of data were analyzed with paired-samples t test. A patient satisfaction survey was performed postoperatively to evaluate the effect of the reconstruction.Results:The reconstructions of vermilion tubercle were successful in all patients and no complications occurred. The most of new vermilion tubercles located in midline and appeared plump. Follow-up had been completed in 28 patients and the average follow-up period was (9.71±5.02) months. The effective vermilion width increase was from (5.32±0.91) mm, (3.98±0.89) mm, (4.30±0.86) mm before operation to (6.35±0.87) mm, (7.75±1.03) mm, (7.48±0.97) mm after operation in the midline of lip, the peak of cleft side and the midline of short arm, respectively. The postoperative width of vermilion in the cleft side was widened significantly. The projection of the tubercle was increased significantly from (0.38±0.46) mm to (0.83±0.51) mm. 96.4% (27) patients achieved satisfied results of vermilion tubercle reconstruction after operation.Conclusions:The vermilion flap transferred vertically has been found to be an effective method of vermilion tubercle reconstruction in the secondary repair of cleft lip.

Objective Secondary deformities are common in people born with unilateral cleft lip and palate.In recent years,more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy.The authors present a new method of orbicularis oris repair in secondary cleft lip repair.Methods From July 2009 to December 2011,24 patients underwent this procedure in the authors' department.Muscle reconstruction was divided into three units that dealed with the nasal base,white lip and red lip.Common anatomic pathologies including the displacement of upper lip,flared ala,blunted ala-facial groove,depressed nasal floor,lateral bulge,lack of philtrum column,free border deficiency and unapparent vermilion tubercle were corrected in a single operation.Results The average follow-up period was 16.79±6.23 months.No major complications occurred.All the patients were satisfied with their nasolabial appearance.Conclusions "Three-unit" muscle repair has found to be effective and practical in secondary repair.Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure.

Objective To discuss the feasibility and clinical effect of the nasal base reduction with internal nasal incisions and tightening nasolabial bundles of orbicularis oris.Methods From January 2014 to June 2015, 16 patients of broad nasal base were treated with nasal base reduction. During operations, we employed the internal nasal incisions and released the pyriform ligaments, then tightened nasolabial bundles of orbicularis oris. All of patients were followed up to observe the long-term effect. The interalar to intercanthal ratio was measured in pre-operation and post-operation, then two sets of data were analyzed with t test.Results 6-18months follow-up had been completed in 16 patients. No severe complication was observed. 93.8% patients achieved satisifed results with reductive nasal base width and natural appearance at 6 months after operation.Conclusion The nasal base reduction with internal nasal incision and tightening nasolabial bundles of orbicularis oris is a reliable and effective surgical manipulation.

Objective To evaluate the therapeutic effect of autologous fat grafting in secondary cleft lip.Methods Grafting of autologous fat granules was applied to correct lip under-capacity.The technique was used in 40 patients with secondary cleft lip from June 2011 to December 2015.The ratios between the point of upper lip peak to vermilion height and to white lip height on the affected side were measured by Photoshop CS6.Results Satisfactory results were achieved with all 40 patients;the lip contour and morphology improved.The preoperative ratio was 0.417±0.190 and the postoperative ratio was 0.499±0.197, which increased average 26.02%, with statistically significant (P<0.05).Conclusions Autologous fat grafting to correct lip under-capacity with secondary cleft lip is a safe, effective and micro-invasive method which can be sustained over a lengthy period.

OBJECTIVE:This study aimed to explore the influence of traditional Chinese medicines: Salvia miltiorrhiza on the survival of auto-transplantation of adipose tissue in a rabbit model.METHODS:Minced adipose tissue harvested from the scapular region was transplanted into the dorsum of the ears of New Zealand rabbits. The experimental groups were intra-peritoneally injected with S. miltiorrhiza for a total 4 weeks. The rabbits in control group were intra-peritoneally injected with normal saline. Plasma VEGF levels were assayed at week 1, 2, 4, 6, and 8 after fat tissue auto-transplantation in the dorsum of rabbit ears. Graft samples were collected and measured at week 2, 4, and 12. Survival rates were calculated, and histologic morphology was evaluated. The expression of CD31 was detected by means of immune-histochemical staining to observe neo-vascularization of the auto-transplanted fat tissue. Perilipin was detected by means of immune-histochemical staining to observe the survival of fat cells.RESULTS:At 12 weeks, the survival rates in the experimental group were statistically greater than that in the control group, respectively (p < 0.05). Plasma levels of VEGF in the experimental group at different time points were significantly higher than that in the control group (p < 0.05). Histologically, grafts in the experimental group showed better survival of adipocytes and neo-vascularization. By perilipin immuno-histochemical staining, the experimental group demonstrated better adipocyte survival.CONCLUSIONS:In the rabbit model, S. miltiorrhiza can promote the neo-vascularization of adipose tissue grafts and significantly improves the survival rate of auto-transplanted adipose tissue.NO LEVEL ASSIGNED:This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

目的 观察中药丹参、黄芪注射液对自体脂肪移植成活率的影响,为后续实验及临床应用提供依据.方法 建立新西兰白兔自体脂肪移植动物模型,实验组分别予以腹腔注射丹参、黄芪注射液,于不同时间点采血、取材,测定血清VEGF表达水平和脂肪存活率,HE染色观察组织细胞形态,血小板-内皮细胞黏附分子CD31、周脂素免疫组化染色观察毛细血管密度及细胞活性.结果 自体脂肪移植术后第12周,实验组脂肪存活率显著高于对照组;各时间点实验组血清VEGF表达水平均显著高于对照组;HE、CD31、周脂素染色示,实验组在细胞形态、新生毛细血管密度及细胞活性方面均明显优于对照组.结论 配合应用丹参、黄芪注射液,能够显著提高新西兰白兔自体脂肪移植的存活率.

BACKGROUND:Autologous free-fat transplantation is limited by fat absorption and fibrosis due to fat necrosis. In this study, we explored the feasibility of using bone mesenchymal stem cells (BMSCs) transfected by vascular endothelial growth factor (VEGF) 165 gene to improve the survival of transplanted fat tissues in a rat model. METHODS:Bone mesenchymal stem cells with (group A) and without (group B) VEGF165 gene transfection were each mixed with free transplanted fat tissue; then, they were injected subcutaneously at sites on the backs of 36 Sprague-Dawley rats. A control group (group C) was established by using low-glucose Dulbecco modified Eagle medium. The transplants from groups A, B, and C were gathered respectively at 30, 90, and 180 days after transplantation. Transplanted tissue volume and histology were evaluated, and revascularization was quantified by counting the number of capillaries. RESULTS:The survival rate of the A group was significantly higher than that of the B group (P < 0.05), which was significantly higher than that of the C group (P < 0.05). Histologic analysis revealed that both groups A and B had significantly less fat necrosis and fibrosis (P < 0.05). Group A had significantly higher capillary density than the other 2 groups (P < 0.05), and its chloromethyl-1-1'-dioctadecyl-3,3,3', 3'-tetramethylindocarbocyanineperchlorate-labeled BMSCs were also von Willebrand factor positive. CONCLUSIONS:When transfected by the VEGF165 gene, the BMSCs of a rat can better promote the regeneration of capillaries, which can improve the survival rate of transplanted free-fat tissue. This experiment combined correlative theory and techniques of stem cell research, genetic technology, and autologous free-fat transplantation. It may provide a new way to improve the survival of tissue undergoing autologous free-fat transplantation.

目的 探讨重叠褥式缝合在口轮匝肌功能复位的基础上重建患侧人中嵴的方法.方法 对单侧完全性唇裂患者施行唇裂术后鼻唇畸形整复术,同时采用重叠褥式缝合法重建人中嵴.自2010年6月至2011年6月,共治疗23例患者.结果 所有患者均Ⅰ期愈合,随访3～11个月,平均5.6个月.其中19例非常满意,2例效果一般,2例效果欠佳.结论 通过重叠褥式缝合法可增高人中嵴处的肌肉厚度,加深人中凹,使部分患者人中嵴的外观接近正常.人中嵴的静态美与动态美都有明显的改善.

Objective The objective of the study was to explore a simple and reliable method to decrease tension of the nasal floor and guarantee its closure during the repair of wide unilateral complete cleft lip. Methods Using 2 mucosal flaps at the upper lip margin, the tension was decreased efficiently on closure of the nasal floor. Results From 2008 to 2010, 45 patients of wide unilateral complete cleft lip received the surgery at 3 to 7 months of age. A follow-up of 3 to 6 months revealed satisfactory restoration of the nasal floor and nasal sill, as well as the inconspicuous scar. Conclusions The technique serves to close the nasal floor with ease and safety, which aids the repair of wide unilateral complete cleft lip.

Complications of polyacrylamide hydrogel injection for augmentation mammaplasty have captured the attention of both medical experts and the general public in China. Increasing numbers of patients are seeking to have the polyacrylamide gel removed from their breasts regardless of whether they suffer from symptoms. Blunt aspiration, which is widely performed but removes only free hydrogel, leaves residual hydrogel in the breast. We report and discuss our ideas and techniques for the treatment of polyacrylamide hydrogel-injected breasts.

[Abstract] Objective To explore the feasibility of repairing the bony defect in cleft palate using autologous bone marrow stromal cells with coral in a lamb model.Methods Isolated bone marrow stromal cells were expanded and osteogenically induced in vitro.Coral and osteogenically induced BMSCs in passage three were applied to repair the bone defects in the complete cleft palate,and others served as controls using coral alone to repair the defects.The engineered bone was evaluated by 3D-CT scan on the postoperative week 2,12,24 and 32,and gross and histological examination and Micro-CT measurement on the postoperative week 24 and 32 respectively.Results 3D-CT scan,gross and histological examination showed the cell-coral composite was substituted by new bone in experimental groups and the bony defects were mainly healed,whereas evident degradation was seen in control group,with the cleft not repaired.It was shown that an average of (88.52 ± 10.95)％ and (90.52 ±8.12)％ of each defect volume had been repaired in experimental group on the postoperative week 24 and 32 respectively; while on the control side,only limited bone formed at the periphery of the defect (P ＜ 0.05).Micro-CT measurement demonstrated well the bony-union in experimental group,with the same bone mineral density as normal bone (P ＞0.05).Conclusion The bony defect in cleft palate in a lamb model can be repaired with the tissue-engineered bone generated by autogenous ostegenic BMSCs and coral scaffold.

Objective To explore the influence of bone marrow stem cells(BMSCs) transfected by VEGF165 on the survival rate of transplanted fat tissue.Methods BMSCs with(transfected group) and without VEGF165 gene transfection(non-transfected group) were respectively mixed with free transplanted fat tissue.Then they were injected subcutaneously at SD rats′ back.Blank control group was established using DMEM.The percent of survival volume and regenerative capillary density were detected.Results The expression of VEGF mRNA and protein in transfected cells were positive.The percent of survival volume and capillary density of transfected group were significantly higher than non-transfected group.And they were also significantly higher than blank control group.Conclusion The BMSCs transfected by VEGF165 gene can promote the regeneration of capillaries and improve the survival rate of free fat transplantation.

Objective To explore the technique of double intersecting dermal flap in the treatment of severe inverted nipple.Methods Thirty-nine severe inverted nipples were included in the study.The double intersecting dermal flap was designed in four directions.The flap was pulled out through the tunnel under the nipple to the opposite side and sutured at the areolar dermis of the base of the opposite flap.The cross-fixation was accomplished to support the nipple tissue.Results All nipples manifested satisfactory aesthetic projection with no recurrence.No complications were observed such as: infection,hematoma,permanent numbness and necrosis.Conclusion In the treatment of Grade Ⅲ inverted nipple,the technique of the nipple suspension using the double intersecting dermal flap could provide a strong suspension system with areolar fulcrums in less recurrence rate.

Objective To explore a simple and reliable method to decrease tension of the nasal floor and guarantee closure of the nasal floor in the treatment of unilateral complete cleft lip.Methods Two mucosal flaps were made at the lip margin to close the nasal floor with little tension,and vestibular oronasal fistula as well.Results Total 37 patients showed healing by first intention at the incision site without obvious scar,good closure at the nasal floor,and fullness of nasal sill and floor.Conclusion Mucosal flaps at lip margin can repair nasal floor defect effectively in unilateral complete cleft lip.

Objective To investigate the operative method and clinical results of repeating after augmentation mammaplasty with injecting hydrophilic polyacrylamide gel.Methods The reason of the repeating effusion was analyzed.The injected hydrophilic polyacrylamide gel was taken out and the fibrous capsule around the injection substance was removed.Results All patients were satisfied with the results.There were no recurrence of effusion after 18 months follow up.Conclusion In the treatment of repeating effusion after injecting augmentation mammaplasty,surgical resection is the first choice.For those patients with evident capsule formation,we prefer to remove the capsule during operation.

Objective To evaluate the surgical technique and procedures of transumbilieal breast augmentation with an inverse U-shape incision and insertion of saline-filled breast implants. Methods With specialized instruments, the subcutaneous tunnel was undermined to the inframammary crease after inverse U incision made along the umbilical border. The subpectoral space was dissected with a dissector after the advancement of obturator across the inframammary crease. The expander was inserted into the subpectoral pocket to be filled to obtain the high degree of symmetry of the breasts. Finally, the previous-ly prepared implants were inserted after the expander deflated and removed. Results All patients gained satisfactory results with no complications, such as hematoma, infection, implant deflation and Baker Ⅲ or Ⅳ capsular contracture. Conclusions Breast augmentation could be performed through umbilical inci-sion with the usage of saline-filled breast implant. This is an alternative of incisions in breast augmenta-tion.

BACKGROUND:Traditionally, breast implant extraction and capsulectomy have been performed using a transareolar approach. However, this approach is not acceptable to Chinese patients because of the additional scar formation. The authors present their experience with capsulectomy using transaxillary endoscopic assistance without the need for an additional incision.METHODS:The former transaxillary incisional scar for augmentation mammoplasty is used. Blunt dissection is performed to the outer surface of the fibrous capsule. A 30 degrees , 10-mm endoscope is placed through the axillary incision to dissect the outer surface of the capsule. After this is finished, the capsule is cauterized open, and extraction is completed. Transaxillary capsulectomy is performed under endoscopic control.RESULTS:From 2003 to 2005, a total of 30 breasts involving 15 patients were treated. The follow-up period was 4 to 6 months, with favorable results. No scar was left on the breast, and no additional scar was made. No liquid accumulation was identified.CONCLUSIONS:Endoscopic transaxillary capsulectomy can be completed through the axillary incision. The technique successfully removed the fibrous capsule, eliminated the needed for an incision on the breast, and created an incision far from the breast for completion of the procedure.

Objective To explore the feasibility of repairing the bony defect in cleft palate using autologous bone marrow stromal cells with coral in a lamb model.Methods Isolated bone marrow stromal cells were expanded and osteogenic induced in vitro.Coral and osteogenic induced BMSCs in the third generation were applied to repair the bone defects in complete cleft palate,the control group was given coral alone.The results were evaluated by 3D-CT scan and gross observation in 16 weeks postoperatively.Results 3D-CT scan showed the cell-coral composite were substituted by new bone in experimental groups whereas evident degradation were seen in control groups,with obvious cleft palate.Gross observation revealed the bony defect were mainly healed in experimental groups,with the cleft not repaired.Conclusion Osteogenic-induced BMSCs combined with coral can repair the bony defect in cleft palate in a lamb model.

Objective To establish a complete cleft palate model by selection of suitable surgical approaches. Methods Ten healthy goats at age 2 months were divided randomly into two experimental groups. All goats were operated on and two types of palate osteoectomy were performed. All animals were sacrificed at 32 weeks after operation. The morphology of soft,sclerous tissues of the cleft was measured and compared at 1 and 32 weeks postoperatively by 3D-CT. The state of the cleft in these two groups was also observed directly after cleaning the skulls. Results All goats were in good condition during the experiment. No spontaneous bone healing occurred in experimental animals. The width of the cleft palate at 32 weeks postoperatively was greater than that at 1 week postoperatively in each group,and there was no significant difference between two groups. Conclusion It is feasible to an establish experimental complete cleft palate on young goats by the two types of surgical operations for further study.

OBJECTIVETo analyze the clinical manifestations and explore suitable treatments for the complications induced by polyacrylamide hydrogel(PAHG) injection for augmentation mammoplasty.METHODSThe symptoms, physical signs and treatments of the 118 cases were analyzed and summarized.RESULTSThe complications included in nodule formation (54.2%), pain (33.9%), PAHG migration (7.6%) and acute mastitis in lactation (4.3%). Satisfactory clinical treatment results have been obtained after suitable treatments.CONCLUSIONSThe complications induced by PAHG injection for augmentation mammoplasty have increased following its widely use, the re-evaluation for this technique should be made, and more effective treatment should be considered.