Objective To evaluate the operative methods and therapeutic effects of nasal septum cartilage-sil ica gel complex for two-stage repair of nasal deformities of unilateral cleft l ip. Methods From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft l ip were treated with transplanting nasal septum cartilage-sil ica gelcomplex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft l ip, including 21 cases of complete cleft l ip and 17 cases of incomplete cleft l ip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years (mean 5.5 years). According to nasal deformity, the nasal septum cartilage of 1.8 cm × 1.2 cm was cut, and transplanted into the nose point phantom surface forming “the shield” to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. Results Primary heal ing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no compl ication. The figure of nose was sl inky, the height of apex of nose and the shape of nose was natural,the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [(the results were satisfactory in 30 cases (78.9%), general in 8 cases (21.1%)]. The nose department overall esthetics shape was improved in all the patients, no compl ications of the phantom sl iding, shifting and exposure, hemorrhage and infection occurred. Conclusion The nasal septum cartilagesil ica gel complex to repair the nasal deformities of unilateral cleft l ip is an ideal operation style.
Objective To observe the cl inical outcome of treating blepharophimosis-ptosis-epicanthus inversus syndrom (BPES) by means of primary and complex recection of levator palpebrae superioris musculus. Methods From May 2001 to May 2007, 12 patients with BPES were treated, including 6 males and 6 females aged 4-15 years old (average 7 years old).All patiens marked signs of BPES— typical ptosis of the upper eyel ids, epicanthus inversus, palpebral fissure, and increased distance between inner canthus.The eye fissure width was (2.8 ± 1.8) mm, the eye fissure length was (19.8 ± 4.7) mm, and the inner canthic diameter was (41.6 ± 6.5) mm.The muscular strength of levator palpebrae superioris was deficient in 4 cases, the muscular strength of levator palpebrae superioris was (2.0 ± 0.6) mm in 8 cases.All patients were associated with visual function congenital defects of varying degrees.The surgical technique included shortening of the internal canthal l igaments, recection of the tarsus and levator muscle, and skin plasty. Results All the incisions healed by first intension.Twelve patients were followed up for 12-48 months (average 30 months).Amel ioration of ptosis and epicanthus was achieved.At 18 months after operation, the eye fissure width of 10 petients was (9.0 ± 2.1) mm, the eye fissure length was (26.5 ± 3.5) mm, and inner canthic diameter was (30.2 ± 2.7) mm, the muscular strength of levator palpebrae superioris increased to (5.6 ± 1.9) mm, showing significant difference when compared with preoperation (P lt; 0.05). Conclusion The primary and complex recection of levator palpebrae superioris musculus can provide relating good cosmetic and functional results for the correction of BPES. Patients with BPES should receive surgery as early as possible.
ObjectiveTo investigate the effect of adipose-derived stem cells (ADSCs) combined with chitosan on the immediate retraction rate of rabbit expanded skin. MethodsADSCs were isolated from rabbit fresh fat under sterile conditions and cultured to the 3rd generation by methods of enzymatic digestion; the specific surface markers and the differentiation into epidermal cells and cartilage cells were identified. Forty New Zealand white rabbits (aged, 2-3 months) were randomly divided into 4 groups (n=10): control group (group A), ADSCs group (group B), chitosan group (group C), and ADSCs+chitosan group (group D). ADSCs cell suspension with the concentration of 5×106 cells/mL was prepared. The skin expansion model was made by embedding 30 mL dilator into the back of rabbit. Chitosan (2%, 5 mL) was coated on the surface of the dilator in groups C and D, and ADSCs cell suspension (1 mL) was injected into the skin in groups B and D. Conventional tissue expansion was performed to expected capacity at 4 weeks, and maintained for 1 week. The expanded skin was harvested to measure the immediate retraction rate, and the thickness of skin, epidermis, and fibrous capsule with HE staining. Masson staining was used to observe the characteristics of collagen in the fibrous capsule, and immunohistochemical staining for CD31 to determine the microvessel density (MVD). ResultsADSCs were successfully isolated, and had multiple differentiation ability. All the animals survived to the end of the experiment. The immediate retraction rate of group D was significantly lower than that of the other groups (P<0.05), groups B and C were significantly lower than group A (P<0.05), and group B was significantly lower than group C (P<0.05). The histological staining revealed that there were more mature fibroblasts and coarse collagen fibers with regular arrangement in groups A and B; there were more naive fibroblasts and tiny and sparse collagen fibers in groups C and D. The thickness of skin and epidermis, and MVD of groups B and D were significantly larger than those of groups A and C (P<0.05); the thickness of fibrous capsule of groups C and D was significantly less than that of groups A and B (P<0.05); but no significant difference was found in the above indexes between other groups (P>0.05). ConclusionADSCs can promote angiogenesis and regeneration of the expanded skin, have no effect on the fibrous capsule. Chitosan can inhibit the proliferation of fibrous capsule, so a combination of ADSCs and chitosan can inhibit the immediate retraction of the expanded skin.
Objective To investigate the surgical methods and outcome of reshaping the nose by using autologous cartilage grafting-silicone gel complex combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip. Methods Between May 2006 and July 2008, 36 patients with ugly nose shape received open nasal plasty by thinningthe superfluous tissue and trimming the lower lateral cartilages combined with implant of auto-cartilage and silicone gel complex. There were 3 males and 33 females with an average age of 23 years (range, 18-36 years), including 20 cases of hypertrophy and obtuse round of nasal tip, 10 cases of flat of nasal tip, 2 cases of sl ight nostril exposure, and 4 cases of small whole nose with hypertrophy of nasal tip. Among them, 8 cases received 2-time operations. Results All incisions achieved heal ing by first intention. No deformation and compl ication occurred at donor sites of cartilage. The appearance, contour, color, and touch sensation of the nose were satisfactory and no complications of prosthesis exposure and skin redness of the nasal tip occurred. At 3-5 months after operation, the appearance of the nasal tip was satisfactory when part of the soft tissue was absorbed. Thirty-two patients were followed up 3-12 months (6 months on average), who were satisfied with the appearance of nose with good correct rate. Conclusion Nasal plasty by using auto-cartilage grafting and silicone implant combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip is an effective method especially for round or bulbous nasal ti p.