ObjectiveTo evaluate the efficacy and safety of photodynamic treatment for port wine stains compared with gold standard pulsed dye laser.MethodsA literature search was performed in PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, CQVIP, and Wanfang to identify the clinical randomized controlled studies on photodynamic therapy, pulsed dye laser, and port wine stains, which were published from the establishment of the databases to April 3rd, 2021, and the outcome measurements included effective rate and incidence of adverse reactions. Data were extracted and meta-analysis was performed with RevMan5.3 software, and the quality of evidence was evaluated according to GRADE standards.ResultsThree randomized controlled studies were included, with a total of 268 cases of port wine stains. Meta-analysis results showed that there was no statistically significant difference in the efficacy [relative risk (RR) =1.08, 95% confidence interval (CI) (0.89, 1.32), P=0.42] or the incidence of pigmentation [RR=1.03, 95%CI (0.65, 1.65), P=0.89] between photodynamic therapy and pulsed dye laser in the treatment of port wine stains.ConclusionsThe effectiveness and the occurrence of pigmentation of photodynamic therapy on port wine stains are not significantly different from those of pulsed dye laser. Photodynamic therapy is an effective and safe method for the treatment of port wine stains. Due to the limited literature included, large-scale prospective clinical trials are still needed to verify the conclusion.
ObjectiveTo discuss a reliable and aesthetic surgery method for the reconstruction of large defects on the top of nose after giant nevi resection.
MethodsBetween January 2011 and June 2015, 46 cases of nasal tip defects caused by giant nevi resection were treated. Of 46 cases, 22 were male and 24 were female, aged 15-59 years (median, 28 years). The right ala nasi was involved in 28 cases, the apex nasi in 8 cases, and the left ala nasi in 10 cases. The diameters of nevi were from 8 to 12 mm (mean, 9.75 mm); no alar cartilage was invaded. Hair growth was seen in 14 cases. The duration of nasal nevi was from 3 years to 49 years (mean, 9.8 years). There were 9 recurrent patients who received laser therapy before surgery. The defects sizes after excision were from 10 mm×10 mm to 14 mm×14 mm. The bilobed flaps were used for one-stage reconstruction, which sizes were from 11 mm×10 mm to 15 mm×14 mm and from 10 mm×10 mm to 15 mm×14 mm.
ResultsAll the incisions healed by first intention, and the flaps survived. No complication of intracranial hemorrhage or subdural hemorrhage occurred. The patients were followed up 6 months to 5 years (mean, 18 months). The appearance of nasal tip and nasolabial fold was satisfactory, and no recurrence was found during follow-up.
ConclusionOne-stage bilobed flap reconstruction for nasal tip defects after giant nevus resection is one of the effective, safe, and aesthetic surgery methods.
Objective
To investigate the feasibility of human amniotic membrane-living skin equivalent (AM-LSE) in repairing the skin defect.
Methods
A 5-year-old boy with giant nevus at neck, shoulder, and back was admitted in July 2016. Normal skin tissue of the patient was harvested and keratinocytes and dermal fibroblasts were separated and expanded in vitro. Human AM was donated from a normal delivery and de-epithelialized for constructing an LSE as a matrix. Keratinocytes were seeded on the epithelial side of the AM which was previously seeded with fibroblasts on the stromal side and then the complex was lifted for air-liquid surface cultivation for 10 days and observed under naked eyes and sampled for histological study. The nevus was excised to deep fascia and the skin defect in size of 20 cm×15 cm was covered with artificial skin of collagen sponge for 2 weeks to enhance granulation tissue formation, and then the AM-LSE grafts of stamp size were grafted on. The dressing was changed until the wound healed.
Results
After 10 days of air-liquid surface cultivation, the AM-LSE developed a multilayered and differentiated epidermis with the fibroblasts-populated amnion as the dermal matrix. The LSE stamps survived and expanded to cover the whole wound. The grafted area showed normal skin color and soft contexture at 6 months after operation, and histological study showed well developed epidermis with compactly aligned basal cells, stratified and well differentiated squamous, granular layers and stratum corneum and well vascularized dermal compartment without inflammatory cells infiltration.
Conclusion
The cultivated AM-LSE with autologous cells can repair skin defect and survive for a long term without rejection.
Objective To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus. Methods Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years(mean, 8 years). The size of giant nevus was 20 cm × 12 cm to 60 cm × 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate spl it thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively. Results The wound size was (2 110.74 ± 725.69) cm2 after resection of giant nevus, and was (1 624.94 ± 560.57) cm2 after thorax wire fastening, showing significant difference (t=9.006, P=0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar prol iferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation. Conclusion It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off .
