鼻内镜下应用脱细胞真皮基质及鼻底黏膜瓣修补鼻中隔穿孔

目的 探讨鼻内镜下应用人异体脱细胞真皮基质联合带蒂的鼻底黏膜瓣修补鼻中隔穿孔的可行性和疗效.方法 2006年2月至2010年10月共12例鼻中隔穿孔患者,临床主要表现为鼻塞及穿孔周边结痂.12例中8例为医源性.12例患者鼻中隔穿孔均位于鼻中隔前中部,穿孔直径约1.0～2.3 cm.鼻内镜下在穿孔前缘下部纵向切开残存鼻中隔黏骨膜至鼻底,并沿鼻底横行外延至鼻腔外侧壁.在穿孔后缘后方约1.5 cm处切开鼻中隔黏骨膜至鼻底,并沿鼻底横行外延至鼻腔外侧壁.切开下鼻道处的鼻腔外侧壁黏骨膜,将上述二切口连通.沿上述切口剥离,形成蒂在鼻中隔的鼻底黏骨膜瓣,向前上旋转覆盖穿孔,与穿孔前方和上方边缘黏骨膜间断对位缝合.将脱细胞真皮基质补片贴附于右侧鼻腔穿孔处,基底膜面朝向鼻腔侧,与穿孔边缘黏骨膜间断对位缝合.结果 术后1周见脱细胞真皮基质补片及黏膜瓣与穿孔创缘愈合好,补片未见排斥反应和挛缩.鼻中隔黏膜在4周后基本上皮化.随访3个月至4年,11例修补成功,1例失败.未见手术并发症.结论 联合应用人异体脱细胞真皮基质和带蒂的鼻底黏骨膜瓣修补鼻中隔穿孔,手术方法简便,手术成功率高,是一种修补鼻中隔穿孔的有效方法.

Abstract：

Objective To introduce the method and evaluate the efficacy of endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap. Methods Twelve patients with perforation of nasal septum were encountered since February 2006 to October 2010. The most common symptoms and sings were nasal obstruction and crusting at the margin of the perforation. Eight of 12 patients were iatrogenic following surgery. The perforation typically located at anterior medial part of the nasal septum, with their sizes ranged approximately 1. 0 -2. 3 cm in diameter. The incision was made at the anterior edge of the perforation from the left nasal cavity and continued to the nasal floor horizontally. It ended at the lateral nasal cavity. Then, another incision was made parallel to the first one, which was 1.5 cm from the posterior of the perforation. The two incisions was connected. The mucoperichondrium was stripped along with the incisions and the pedicle of mucoperichondrial flap kept on the nasal septum. Then,the flap was turned up to cover the perforation and fixed with apposition suture. Put the acellular dermal matrix graft on the perforation from the right nasal cavity and fixed it with apposition suture. Results The healing of the acellular dermal matrix and mucoperichondrium was good in the first week postoperatively and there was no rejective reaction and contracture. The epithelization of the nasal septal perforation finished 4 weeks after surgery. Follow-up ranged from 3 months to 4 years. Eleven patients had successful outcomes with complete closure of their perforations. One patient failed the operation. All of them had no complications. Conclusions Using acellular dermal matrix graft and mucoperichondrial flap to repair the septal perforation is a simple method and the success rate is high. Therefore, it is an effective way to repair the perforation of nasal septum.     

Altered cutaneous innervation in psoriatic skin as revealed by PGP 9.5 immunohistochemistry

Summary There is conflicting evidence in the literature as to whether cutaneous nerves are altered in psoriasis or not. In this study, antibodies to protein gene product (PGP) 9.5 were used to visualize cutaneous nerves in biopsies from involved and uninvolved skin of nine patients with psoriasis and from normal skin of eight healthy controls. A profound reduction in the epidermal nerve fibre density was observed in the involved psoriatic skin. These intraepidermal nerve fibres were also mostly short and found in the basal layer. Only a few nerve fibres were found in the suprabasal layer and they were non-varicose, long fibres going straight up without branching. In the uninvolved skin of psoriatic patients, the distribution and number of the intraepidermal nerve fibres was similar to that observed in normal skin. In the dermis, the distribution and the number of the nerve fibres showed no differences between involved psoriatic skin, uninvolved psoriatic skin, and normal skin. The results support previous studies in which alterations of cutaneous nerves in psoriasis have been described.     

Dermis isolated adult stem cells for cartilage tissue engineering

Adult stem cells from the dermal layer of skin are an attractive alternative to primary cells for meniscus engineering, as they may be easily obtained and used autologously. Recently, chondroinducible dermis cells from caprine skin have shown promising characteristics for cartilage tissue engineering. In this study, their multilineage differentiation capacity is determined, and methods of expanding and tissue engineering these cells are investigated. It was found that these cells could differentiate along adipogenic, osteogenic, and chondrogenic lineages, allowing them to be termed dermis isolated adult stem cells (DIAS cells). Focusing on cartilage tissue engineering, it was found that passaging these cells in chondrogenic medium and forming them into self-assembled tissue engineered constructs caused upregulation of collagen type II and COMP gene expression. Further investigation showed that applying transforming growth factor β1 (TGF-β1) or bone morphogenetic protein 2 (BMP-2) to DIAS constructs caused increased sulfated glycosaminoglycan content. Additionally, TGF-β1 treatment caused significant increases in compressive properties and construct contraction. In contrast, BMP-2 treatment resulted in the largest constructs, but did not increase compressive properties. These results show that DIAS cells can be easily manipulated for cartilage tissue engineering strategies, and may also be a useful cell source for other mesenchymal tissues.     

Congenital Dermal Melanocytosis on the Foot: A Case Report and Review of the Literature

Dermal melanocytosis is a common pigmented skin disease, characterized by an increased number of ectopic melanocytes in the dermis. Rare variants of dermal melanocytosis that do not belong to these four typical groups–nevus of Ota, nevus of Ito, blue nevus, and Mongolian spots–are called dermal melanocyte hamartoma, or congenital dermal melanocytosis (CDM) as it mostly appears from birth. We report a case of CDM on the foot of a young woman with a literature review of previously reported cases of CDM.     

Dermal carbonyl modification is related to the yellowish color change of photo-aged Japanese facial skin

Background

The photo-aged facial skin is characterized by various unique features such as dark spots, wrinkles, and sagging. Elderly people, particularly Asians, tend to show a yellowish skin color change with photo-aging. However, there has been no analytical study conducted on this unique skin color change of the aged facial skin.

Objective

The purpose of the present study is to examine whether the carbonyl modification in the dermal protein is involved in the yellowish color change that occurs in the photo-aged skin.

Methods

Normal skin samples excised from the face, abdomen and buttock of variously aged Japanese were separated into the epidermal and the dermal portions. These skin samples were histologically examined for carbonyl modification. Moreover, an in vitro constructed dermis model composed of a contracted collagen gel was treated with acrolein or 4-hydroxynonenal. All these samples were also studied colorimetrically.

Results

The dermal samples obtained from the photo-aged facial skin exhibited an appearance of yellowish color, whereas neither the facial epidermis nor the dermis obtained from the abdomen or buttock showed such a yellowish discoloration. The upper layer of the dermis that revealed the yellowish color showed elastosis whose elastic fibers were found to colocalize with carbonyl protein as detected by a labeled hydrazide, as well as by an immunohistochemical examination using the antibody against acrolein adduct. Experimental induction of carbonyl modification in a dermis model in vitro by a long-term treatment with acrolein or 4-hydroxynonenal was found to show the appearance of the yellowish change which was also proven by an increase in b* value of colorimetry. It was more pronounced than that induced by glycation.

Conclusion

Our present results strongly suggest that carbonyl modification of the dermal protein is involved in the production of the yellowish color change that is noted in the photo-aged facial skin.     

无菌切口皮肤缝合方式对美观的影响

目的比较真皮内连续缝合与传统缝合皮肤对无菌切口皮肤愈合的影响。方法从2003年4月到2006年4月,把120例接受无菌手术者随机分为两组。A组用无损伤缝合线真皮内连续缝合。B组用1号丝线做常规传统皮肤缝合,观察比较两组拆线时皮肤愈合情况及3个月后切口瘢痕情况。结果A组拆线无线结反应和感染情况,60例全部愈合,切口瘢呈线形痕,3个月后切口处更接近邻近皮肤色泽,美观性好,病人满意度为98.3%。B组拆线时,42例皮肤切口周围有蜈蚣样改变,12例有线结反应,1例感染,3个月后有36例有明显蜈蚣样瘢痕,切口瘢痕平均宽度为1.8 mm,美观性差,病人满意度为18%。结论真皮内连续缝合较传统缝皮有更好的愈合性、美观性及很高的满意度,是无菌手术缝合皮肤的首选方法。     

同种异体脱细胞真皮基质在膀胱阴道瘘修补术中的应用

目的评价同种异体脱细胞真皮基质(ADMA)在膀胱阴道瘘修补术中的应用价值。方法对8例复杂性膀胱阴道瘘患者进行了手术治疗,术中均采用了ADMA作为组织替代物。采用腹膜外经膀胱途径进行膀胱阴道瘘修补,术中将ADMA置入阴道、膀胱之间。结果所有病例均未发生任何手术并发症。术后阴道漏尿停止,保留尿管4周,随访6-12月,未见复发。结论在膀胱阴道瘘手术治疗中,采用ADMA替代自体组织,手术效果确切,时间短,尤其避免了以往获取自体组织所带来的创伤。     

主动脉平滑肌细胞在三维培养中产生弹性纤维的研究

目的 研究主动脉平滑肌细胞(ASMC)在仿真皮替代物的三维培养中是否能产生弹性纤维。方法 取1周龄SD大鼠胸主动脉,进行原代和传代培养,以α肌动蛋白免疫细胞化学染色鉴定平滑肌细胞。然后,将ASMC与胶原、甲壳素及糖胺多糖组合形成的凝胶混合,进行三维培养;培养1周和2周后,用Gomori醛复红染色和弹性蛋白免疫细胞化学染色,检测ASMC胶原凝胶。结果传代细胞经α肌动蛋白免疫细胞化学染色鉴定,98％以上为ASMC。培养1周和2周的ASMC胶原凝胶中,均显示有弹性纤维存在。结论 ASMC在仿真皮替代物的三维培养中能够产生弹性蛋白,并形成弹性纤维。