中华烧伤与创面修复杂志

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Postburn facial scar contracture, which can cause disfigurement and functional impairment, is a major therapeutic challenge. Except for some scars with severe functional impairments such as ectropion of lid, obstruction of nostril, microstomia, and so on, other kinds of facial scars are recommended to be reconstructed after they become sufficiently softened. The selection of specific methods depends on the characteristics of the facial scar. The methods includ direct closure after resection, full or split-thickness skin transplantation, pedicled flap, distant flap, and free flap transfer, and tissue expansion. For the resurfacing of subtotal or total face deformity, composite facial tissue allotransplantation and prefabricated flap combined with tissue expansion and autologous fat injection are increasingly used to improve the facial aesthetic and functional outcome.

To improve the effect of reconstruction of scar contracture deformity on face and neck

Tan Qian, Yan Xin

2016, 32(8): 456-457. doi: 10.3760/cma.j.issn.1009-2587.2016.08.003

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This article briefly summarizes the methods for repair of scar contracture deformity on face and neck in recent years, including new technologies in this field. We can choose non-surgical treatment or surgical treatment to achieve the purpose of repair and reconstruction of scar contracture deformity on face and neck after considering the factors of function and appearance.

Reconstruction of postburn facial scar contracture deformity with expanded flap containing cervical cutaneous branch of transverse cervical artery

Xu Peng, Wang Shuqin, Yan Xin, Lin Yue, Ge Huaqiang, Tan Qian

2016, 32(8): 458-462. doi: 10.3760/cma.j.issn.1009-2587.2016.08.004

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Objective To observe the effect of expanded flap containing cervical cutaneous branch of transverse cervical artery (TCA) on reconstruction of postburn facial scar contracture deformity. Methods Six patients with postburn facial scar contracture deformity, hospitalized from September 2011 to January 2016, with the scar area ranging from 12 cm×10 cm to 20 cm×15 cm, were reconstructed with expanded flap containing cervical cutaneous branch of TCA. One expander of 300 mL or 350 mL implanted in anterior pectoral area was injected for excessive expanding; one patient was conducted with expansion in both sides of the anterior pectoral area. The volume of expansion varied from 1 260 to 2 010 mL after 6 to 15 months. Two flaps were delayed for their poor blood supply. After expansion, the flaps with the area ranging from 20 cm×7 cm to 25 cm×9 cm were transferred with no tension to cover the wounds after scar excision. The donor site was closed directly. Three to four weeks later, the vascular pedicle was dissected combined with local reconstruct surgery. Results All the flaps survived, with two wounds suffered delayed healing. During the follow-up for 4 to 15 months, the flaps were thin and soft with good sensation and color close to the facial skin. Conclusions Expanded flap containing cervical cutaneous branch of TCA is a good choice for reconstruction of postburn facial scar contracture deformity because of its good texture and color, thin thickness, as well as it can provide large avaliable area while causing less injury to the donor site.

Classification of massive postburn scars on neck and the reconstruction strategy using pre-expanded perforator flaps from the back

Zan Tao, Gao Yashan, Li Haizhou, Gu Bin, Xie Feng, Zhu Hainan, Li Qingfeng

2016, 32(8): 463-468. doi: 10.3760/cma.j.issn.1009-2587.2016.08.005

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Objective To explore the classification of massive postburn scars on neck and the reconstruction strategy using pre-expanded perforator flaps from the back. Methods Thirty-seven patients with massive postburn scars on neck were admitted from January 2010 to December 2014 and treated by our treatment group. The massive postburn scars on neck were categorized into three types according to their size and location. Based on the principles of reconstructive ladder, matching in color and texture between donor site skin and neck skin, large size and thinner thickness of tissue of donor site skin, donor-recipient sites balance, and dominant supplying vessel, we proposed the following treatment strategy for choosing perforator flaps from the back. (1) In view of central cervical scar involving the central area (mainly in this area) and one side of peripheral zone, the free circumflex scapular artery perforator flap was chosen. (2) In view of peripheral cervical scar involving the central area and one side of peripheral zone (mainly in this area), the pedicled superficial cervical artery perforator flap was the first choice. In case the pedicled superficial cervical artery perforator flap was unavailable because of the absence of superficial cervical artery perforator or scarring within its vascular territory, the pedicled occipital artery perforator flap, pedicled dorsal scapular artery perforator flap, and free circumflex scapular artery perforator flap were chosen as alternative options considering specific condition. (3) In view of total cervical scar involving the central area and both sides of peripheral zone, the circumflex scapular artery perforator supercharged pedicled superficial cervical artery perforator flap was chosen. Tissue expansion was performed in the first stage for all the patients. In the second stage, after excision of the cervical scars, the flaps were transferred to cover the wounds. Results Among the 37 patients, 7 were with central cervical scar, 12 with total cervical scar, and 18 with peripheral cervical scar. Among patients with peripheral cervical scar, the pedicled superficial cervical artery perforator flaps were used in 11 cases, pedicled occipital artery perforator flaps in 2 cases, pedicled dorsal scapular artery perforator flap in 1 case, and free circumflex scapular artery perforator flaps in 4 cases. Tip necrosis occurred in 3 flaps of patients after surgery, which were healed by dressing change. The other flaps of patients grew well after surgery. Patients were followed up for 1 to 6 years, and all patients were able to extend neck beyond 110° with no sense of restricted neck flexion or rotation. No contracture of flap was observed. Thirty-five patients were satisfied with their appearance after surgery. Conclusions Pre-expanded perforator flaps from the back are useful flaps for reconstruction of massive postburn scar on neck. Free circumflex scapular artery perforator flap is recommended for reconstruction of central cervical scar. Pedicled superficial cervical artery perforator flap is the first option for reconstruction of peripheral cervical scar, while the pedicled occipital artery perforator flap, pedicled dorsal scapular artery perforator flap and free circumflex scapular artery perforator flap are alternative options. For total cervical scar, the circumflex scapular artery perforator supercharged pedicled superficial cervical artery perforator flap is recommended.

Aesthetic reconstruction strategy for postburn facial scar and its clinical effect

Ma Xianjie, Li Weiyang, Liu Chaohua, Li Yang

2016, 32(8): 469-473. doi: 10.3760/cma.j.issn.1009-2587.2016.08.006

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Objective To explore the aesthetic reconstruction strategy for postburn facial scar and its clinical effect. Methods Three hundred and forty-two patients with postburn facial scars were hospitalized from January 2000 to December 2015. Local expanded flap or deltopectoral expanded flap was used for reconstruction according to the location and size of the facial scar. The forehead expanded flap could be chosen for the scar in dorsum nasi or inferior eyelid. The local expanded flap was chosen when the scar width was smaller than 5 cm in cheek, chin, and marginal mandible region. The expanded deltopectoral flap was chosen when the scar width was larger than 5 cm in cheek, chin, and marginal mandible region or the scar contracture was too serious to cause displacement of lips, nose, or eyelid, and the wound width was larger than 5 cm after release. The facial scars of 82 patients, with size ranged from 6.0 cm×2.5 cm to 15.0 cm×10.0 cm, were reconstructed with expanded local flaps. The facial scars of 260 patients, with size ranged from 8.0 cm×7.0 cm to 38.0 cm×13.0 cm, were reconstructed with expanded deltopectoral flaps. After expansion of 2 to 6 months, the facial scars were excised and completely released first of all. The transfer way of local flap and size of deltopectoral flap with pedicle were designed according to the size and shape of the wound. Three weeks after transfer of deltopectoral flap, flap delay procedure was conducted. One week later, the pedicle was severed from the flap to reconstruct the remaining scar. Anti-scar medicine, laser therapy, and elasticized fabric were used postoperatively on the scars in both donor and recipient sites. Results During the postoperative follow-up for 3 to 12 months, the flaps of 40 out of 82 cases reconstructed with expanded local flaps were in good color and texture. Before 2008, mild scar hyperplasia was observed in the incision of 19 patients; with application of laser after 2008, the number of patients with scar hyperplasia was decreased. During the postoperative follow-up for 3 to 12 months, the flaps of 90 out of 260 cases reconstructed with expanded deltopectoral flaps were in good color and texture. The expander was exposed from the incision in 15 patients, while it did not affect the later treatment. Nine unilateral flaps showed poor blood circulation at the distal end, and they were healed after dressing change. In the early phase, necrosis was observed in one flap after transfer, and it was healed after transplantation of free skin graft. Scar hyperplasia was observed in the chest donor site of one patient, and it was improved after laser therapy. Conclusions Postburn facial scar could be reconstructed with local or deltopectoral flaps, following the principle of similarity. The expansion could increase the size of the flaps, reduce the thickness of the flaps, and lower the donor site damage.

Clinical effects of different modes of ultra pulse carbon dioxide fractional laser used in combination on the treatment of hypertrophic scar on face and neck

Lei Ying, Li Shifeng, Yu Yiling, Tan Jun

2016, 32(8): 474-478. doi: 10.3760/cma.j.issn.1009-2587.2016.08.007

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Objective To explore the clinical effects of ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode on the treatment of patients with hypertrophic scars on face and neck. Methods One hundred and fifty-eight patients with hypertrophic scars on face and neck who met the inclusion criteria were admitted to Hunan Provincial People′s Hospital from January 2012 to January 2015. Firstly, the scar areas were cleaned and given compound lidocaine cream for surface anesthesia. Then the scar areas were treated with ultra pulse mode of ultra pulse carbon dioxide fractional laser, with energy from 150 to 175 mJ, frequency of 40 Hz, hole to hole distance of 4 mm or 5 mm, and the treatment time of each hole of 2 s or 3 s. For mild scar, Deep FX mode was added for treatment with energy from 30 to 50 mJ, frequency of 300 Hz, and density of 5%; for moderate and severe scar, Scaar FX mode was additionally used for therapy, with energy from 80 to 150 mJ, frequency of 300 Hz, and density of 3%. The above-mentioned treatments were performed per three months, totally for 3 times, 10-15 min per treatment. After each treatment, wounds were moisturized and given sun protection. Before the first treatment and 6 months after treatment of 3 times, the curative effect was assessed by Vancouver Scar Scale (VSS) and University of North Carolina Scar Scale. Six months after treatment of 3 times, satisfaction degree of patient and loss of working time were recorded. The adverse effects of whole treatment course were recorded. Data were processed with t test. Results (1) Six months after treatment of 3 times, VSS score of patients was (3.1±1.0) points, which was significantly lower than that before the first treatment [(9.4±1.8) points, t=53.096, P<0.05]; University of North Carolina Scar Scale score of patients was (1.6±0.7) points, which was significantly lower than that before the first treatment[(8.0±1.4) points, t=63.730, P<0.05]. (2) Six months after treatment of 3 times, 150 patients were very satisfied with the curative effect, 6 patients were satisfied, and 2 patients were relatively satisfied. The loss of working time of patients was 10-15 (10.5±0.3) d. (3) During the treatment, mild erythema appeared in 5 patients which disappeared without treatment; pigmentation appeared in 6 patients 2 weeks after the first treatment, and pruritus and rash appeared in 2 patients 3 days after the first treatment, which were all improved with pharmaceutical therapy. Conclusions Ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode has definitely clinical effect on patients with hypertrophic scars on face and neck with few adverse effects, which is worth to popularize and apply for clinic.

Application of percutaneous transluminal angioplasty in the surgical treatment of patients with diabetic feet

Gao Ya, Cui Zhengjun, Shi Xun, Guo Pengfei, Meng Qingnan, Yang Gaoyuan, Yang Rongqiang

2016, 32(8): 479-483. doi: 10.3760/cma.j.issn.1009-2587.2016.08.008

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Objective To explore the application of percutaneous transluminal angioplasty (PTA) in the surgical treatment of patients with diabetic feet. Methods The clinical data of 83 patients with diabetic feet, 95 limbs (95 wounds) in total, hospitalized in our unit from September 2011 to September 2014, conforming to the study criteria, were retrospectively analyzed. Patients were divided into conventional treatment group (CT, n=43, 51 wounds) and PTA group (n=40, 44 wounds) according to whether receiving PTA treatment or not. Patients in two groups received conventional debridement after admission, and patients in PTA group received another PTA treatment before debridement. Granulation growing well rates of wounds of patients in two groups were calculated on post debridement day (PDD) 3, 6, 9, and 12. Two stage preoperative preparation time of wounds of patients in two groups was recorded. Status of free skin graft survival of wounds and wound healing of patients in two groups were recorded according to the grade of Wagner. Values of ankle-brachial index (ABI) and ulcer recurrence of patients in two groups checked every month during follow-up time of half a year were recorded. Data were processed with chi-square test and t test. Results Granulation growing well rate of wounds of patients in group CT rose slowly after treatment, which was less than 40% on PDD 12. Granulation growing well rate of wounds of patients in PTA group rose significantly on PDD 9 and all the granulation grew well on PDD 12. On PDD 9 and 12, Granulation growing well rates of wounds of patients in PTA group were significantly higher than those in group CT (with χ² values respectively 30.008 and 47.810, P values below 0.01). Two stage preoperative preparation time of wounds of patients in group CT [(24±10) d] was obviously longer than that in PTA group [(15±3) d, t=5.709, P<0.01]. The ratios of survived free skin graft and healed suture in Wagner 2, 3, and 4 wounds of patients in PTA group were significantly higher than those in corresponding Wagner of group CT (with χ² values from 6.741 to 24.498, P values below 0.01). During follow-up time of half a year, values of ABI of patients in PTA group every month were significantly higher than those in group CT (with t values from 5.411 to 9.583, P values below 0.01). During follow-up time of half a year, there was no ulcer recurrence in group CT in the first four months, but ulcer recurrence was observed in one patient in the fifth month and in two patients in the sixth month. While no ulcer recurrence was found in PTA group during follow-up time of half a year. Conclusions PTA has certain effect and clinical value for the treatment of diabetic foot.

Classification and corrective methods of obviously asymmetric palpebral fissure of single-fold eyelid

Zhao Feng, Fu Yanjie, Yang Xiaoliang, Wu Jiani, Li Huibin

2016, 32(8): 484-488. doi: 10.3760/cma.j.issn.1009-2587.2016.08.009

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Objective To discuss the classification of obviously asymmetric palpebral fissure of single-fold eyelid and their corrective methods performed with double-fold eyelid blepharoplasty simultaneously. Methods Forty patients with obviously asymmetric palpebral fissure of single-fold eyelid of two eyes were admitted to Linyi People′s Hospital in Shandong province from January 2010 to September 2014, asking for double-fold eyelid blepharoplasty. The preoperative difference of palpebral fissure width between two eyes reached 1.0-2.0 (1.44±0.23) mm. Obviously asymmetric palpebral fissures of single-fold eyelid were divided into three types according to the characteristics of eyelids of two eyes and were corrected by following methods performed with double-fold eyelid blepharoplasty with total incision simultaneously. (1) Twenty-four patients only with different sagging skin of upper eyelids were corrected by resecting sagging skin of eyelids′ margins, and the width of the widest position of resected eyelids′ skin was twice as wide as that of the sagging skin of eyelids′ margins (the same below). (2) Among 6 patients only with different palpebral fissure width, 4 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by the method of resecting surplus skin, and the width of the widest position of resected eyelids′ skin with narrower palpebral fissure was 1 mm wider than the difference of palpebral fissure width between two eyes (the same below). The other 2 patients whose difference of palpebral fissure width between two eyes was bigger than 1.4 mm were corrected by the method of resecting surplus skin and shortening aponeurosis of levator muscle of upper eyelid. The width of shortened aponeurosis of levator muscle of eyelids with narrower palpebral fissure was 1 mm wider than difference of palpebral fissure width between two eyes (the same below). (3) Among 10 patients with mixing symptoms of sagging upper eyelids skin and difference of palpebral fissure width bigger than 1.0 mm after smoothing sagging upper eyelids′ skin, 7 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by resecting sagging skin and the method of resecting surplus skin. The other 3 patients whose difference of palpebral fissure width was bigger than 1.4 mm were corrected by resecting sagging skin, shortening aponeurosis of levator muscle of upper eyelids and resecting surplus skin. Palpebral fissure widths of patients were measured during follow-up. Difference of palpebral fissure width between two eyes was calculated and the last difference was recorded. Data were processed with paired sample t test. Results Nine patients who showed incomplete closure of palpebral fissure on the sides of resected eyelids skin or shortened aponeurosis of levator muscle of upper eyelids after operations were treated with erythromycin eye ointment drop in eyes and recovered one week to one month after operations, with no complication of conjunctivitis or keratitis. Double-fold eyelids of all patients who were followed up for 8 to 12 months showed natural shape, smooth lines. No patient showed obvious asymmetry of palpebral fissure between two eyes, and no recurrence of asymmetric palpebral fissure was observed. Difference of palpebral fissure width was 0.1-0.5 (0.19±0.09) mm in the last follow-up, which was obviously smaller than that before operation (t=39.202, P<0.001). Conclusions Obviously asymmetric palpebral fissure of single-fold eyelid can be corrected during the operation of double-fold eyelid blepharoplasty. Patients only with different sagging skin of upper eyelids can be corrected by resecting sagging skin of eyelids′ margins. Patients only with different palpebral fissure width between two eyes can be corrected by the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids. Patients with different sagging skin of upper eyelids and different palpebral fissure width can be corrected by resecting sagging skin of eyelids′ margins and the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids.

Abnormality in bone metabolism after burn

Gong Xiang, Xie Weiguo

2016, 32(8): 502-504. doi: 10.3760/cma.j.issn.1009-2587.2016.08.015

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Burn causes bone metabolic abnormality in most cases, including the changes in osteoblasts and osteoclasts, bone mass loss, and bone absorption, which results in decreased bone mineral density. These changes are sustainable for many years after burn and even cause growth retardation in burned children. The mechanisms of bone metabolic abnormality after burn include the increasing glucocorticoids due to stress response, a variety of cytokines and inflammatory medium due to inflammatory response, vitamin D deficiency, hypoparathyroidism, and bone loss due to long-term lying in bed. This article reviews the pathogenesis and regularity of bone metabolic abnormality after burn, the relationship between bone metabolic abnormality and burn area/depth, and the treatment of bone metabolic abnormality, etc. and discusses the research directions in the future.

Advances in the research of application of hydrogels in three-dimensional bioprinting

Yang Jing, Zhao Yang, Li Haihang, Zhu Shihui

2016, 32(8): 505-507. doi: 10.3760/cma.j.issn.1009-2587.2016.08.016

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Hydrogels are three-dimensional networks made of hydrophilic polymer crosslinked through covalent bonds or physical intermolecular attractions, which can contain growth media and growth factors to support cell growth. In bioprinting, hydrogels are used to provide accurate control over cellular microenvironment and to dramatically reduce experimental repetition times, meanwhile we can obtain three-dimensional cell images of high quality. Hydrogels in three-dimensional bioprinting have received a considerable interest due to their structural similarities to the natural extracellular matrix and polyporous frameworks which can support the cellular proliferation and survival. Meanwhile, they are accompanied by many challenges.

Advances in the research of acute kidney injury post burn

Guo Songxue, Zhou Hanlei, You Chuangang, Han Chunmao

2016, 32(8): 508-511. doi: 10.3760/cma.j.issn.1009-2587.2016.08.017

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Acute kidney injury (AKI), one of the common and important complications post burn, shows a high incidence and mortality in severely burned patients. The common etiologic factors involved in the development of AKI post burn include hypovolaemia, denatured proteins, nephrotoxic agents, etc., while the molecular mechanisms include oxidative stress injury, systematic or local inflammation, apoptosis, and so on. Furthermore, quite a few signaling pathways participate in the regulation of the occurrence and development of AKI post burn. Existed researches on the treatment of AKI post burn focus on the fluid replacement, renal replacement therapy, anti-infection, and specific agents interfering pathophysiologic or molecular mechanisms of AKI. In this review, we summarize the new advances in the research of the occurrence, development, and diagnosis and treatment of AKI post burn.

2016 Vol. 32, No. 8

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