[Surgical treatment of eyelid divided nevus].

OBJECTIVE: To investigate the surgical techniques and therapeutic effect of eyelid divided nevus. METHODS: From January 2000 to January 2014, 27 cases with 27 eyelid divided nevi were treated by staged excision (2 cases), or full-thickness skin graft (20 cases) or frontal and facial expanded flaps (3 cases), or combined expanded flaps with skin grafts (2 cases) for large lesions. One case with skin graft underwent secondary treatment with expanded flap due to obvious scar. RESULTS: Except for one case with residue lesion (0. 5 cm x 0. 5 cm), all the other cases underwent successful treatment with primary healing. All the patients were followed up for 3-48 months (average, 7. 4 months). Except for one case with secondary expanded flap treatment, all the other patients were satisfied with aesthetic and functional results. No occurrence happened. CONCLUSIONS: Staged excision and full-thickness skin grafts are simple and effective method for eyelid divided nevus. For large lesions, expanded flap, or combined with skin graft should be considered.

Expanded forehead flaps for reconstruction of different faciocervical units: selection of flap types based on 143 cases.

BACKGROUND: Forehead flaps have been used in the reconstruction of one particular faciocervical region, such as the nose and periorbital unit. The aims of the present study were to determine whether all the unit/multiunits of the face and neck could be aesthetically reconstructed by using expanded forehead flaps and to propose a strategy for flap selection for the reconstruction of different faciocervical units. METHODS: The authors systematically reviewed the application of expanded forehead flaps for cervicofacial rehabilitation in their center from 2000 to 2013. RESULTS: Four types of expanded forehead flaps were used for the faciocervical reconstruction of 143 patients. Type I was a pre-expanded local flap used for repairing defects of the partial forehead unit, subunits of the periorbital unit, or partial involvement of the two adjacent units. Type II was an expanded paramedian forehead flap used for resurfacing the nose, orbital unit, upper cheek unit, and partial involvement of these adjacent units. Type III was a bilateral pedicled expanded forehead flap for the reconstruction of the lower face and anterior neck. Type IV was a unilateral pedicled expanded forehead flap, based on the superficial temporal vessels, used to reconstruct the ipsilateral part of the middle face. CONCLUSIONS: The four types of expanded forehead flap can be used for the reconstruction of different faciocervical units. Based on the location and size of the defect or lesion, the selection of these flaps can be planned preoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A review of prophylactic antibiotics use in plastic surgery in China and a systematic review.

The purpose of this study was to investigate the use of antibiotic prophylaxis for plastic surgical procedures at our hospital, and to perform a systematic literature review of randomized controlled trials evaluating the use of prophylactic antibiotics in plastic surgery. The records of patients who received plastic surgical procedures with Class I surgical incisions between 2009 and 2010 were retrospectively reviewed. A systematic literature review was conducted for studies examining the use of prophylactic antibiotics for Class I surgical wounds. A total of 13,997 cases with Class I surgical incisions were included. Prophylactic antibiotics were given in 13,865 cases (99.1%). The antibiotics used were primarily cefuroxime, clindamycin, metronidazole, cefoxitin sodium, and gentamicin. The average duration of administration was 4.84 ± 3.07 (range, 1-51) days. Antibiotics were administered postoperatively in >99% of cases while preoperative antibiotic administration was only given in 32 cases (0.23%). Wound infections occurred in 21 cases for an overall infection rate of 0.15%. Fourteen studies met the inclusion criteria of the systematic review. There was marked variation in the timing of antibiotic administration with antibiotics given pre-, peri-, and postoperatively. Of studies that compared the use of prophylactic antibiotics with placebo, a reduction in wound infections was noted in 4 trials and no difference was noted in 6 trials. No significant difference in infection rates was shown between the prophylactic and postoperative arms. In conclusion, prophylactic antibiotics are overused in plastic surgical procedures. Evidence-based guidelines for the use of prophylactic antibiotics in plastic surgical procedures are needed.

EGF enhances ADSCs secretion via ERK and JNK pathways.

The objective of this work was to study the effect of epidermal growth factor (EGF) induced secretions of angiogenesis factors in adipose-derived stem cells (ADSCs) and the involvement of mitogen-activated protein kinases (MAPK). ADSCs were cultured and ELISA assays were performed to quantify the vascular endothelial growth factor, the hepatocyte growth factor, and the stromal derived factor-1 in ADSC-conditioned medium before and after EGF treatments and after pharmacological inhibition of MAPKs with PD98059, SB203580, and SP600125. The tube formation assay was used to test the effects of EGF treated and inhibitor treated ADSCs on the human umbilical vein endothelial cells (HUVECs) tube formation. Liposuction was applied and ADSCs were cultured successfully. The ADSCs released a variety of angiogenic factors, with the EGF treatments enhancing secretions and promoting the HUVEC tube formation. The MAPK inhibitors PD98059 and SP600125 increased the paracrine to promote tubular formation, while the SB203580 played an opposite role. In conclusion, (1) the in vitro cultured ADSCs secrete various angiogenic factors and the EGF amplifies the secretion and can enhance the ADSCs on the HUVEC tube formation. (2) ERK1/2 and JNK pathway may be involved in the enhanced secretion capacity of ADSCs while the p38 pathway may exert an opposite effect.

Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application.

Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distribution patterns of the angular artery were recorded. Based on the anatomical study findings, the angular vessels were proposed as a vascular source for the island nasal chondromucosal flap. Observations with regard to the varying origins of the angular artery were categorized into four types. The course of the angular artery along the nasojugal fold was constant. The angular artery branched off into the upper two-thirds of the lateral nasal region and anastomosed with the other vascular branches on the nasal dorsum. Clinically, reconstruction of a full-thickness defect of the lower eyelid was successfully performed by using this composite flap based on the angular vessels and an adjacent orbicularis oculi myocutaneous flap. Satisfactory esthetic outcomes were obtained for the donor and recipient sites. The angular artery is a good vascular source for an island nasal chondromucosal flap. The flap may be created safely and successfully in clinic. Island nasal chondromucosal flaps and nasolabial groove skin flaps based on the angular vessels may be designed simultaneously for use on full-thickness defects of the eyelid.

Frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children.

BACKGROUND: We aimed to report our successful use of frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children. METHODS: This retrospective study included 61 early age children (41 boys, 20 girls) with an average age of 6 years (range, 3-10 years) with congenital blepharoptosis who received surgery during the period from March 2007 to January 2011. There were 39 cases of unilateral blepharoptosis and 22 cases of bilateral blepharoptosis, thus a total of 83 eyes were affected. If patient had bilateral blepharoptosis, both eyes were operated on in the same surgery. Patients were followed for 3 months to 5 years. The procedure was performed without complications in all cases. RESULTS: The postoperative healing grade was good in 81 eyes (97.6%); the correction of blepharoptosis was satisfactory, the double eyelid folds were natural and aesthetic, the eyelid position and the curvature were ideal, and the eyes were bilaterally symmetrical. The postoperative healing grade was fair in 2 eyes (2.4%); blepharoptosis was improved compared with that before surgery. At discharge, lagophthalmos was noted in 10 eyes of which 4 cases resolved by the last follow-up. The remaining 6 cases were mild. Eleven eyes received reoperation for residual ptosis after the first surgery. The curvature of the palpebral margin was not natural in 4 eyes. These unnatural curvature possibly was caused by an excessively low lateral fixation point or postoperative avulsion. CONCLUSION: Frontalis muscle flap suspension under general anesthesia for the correction of congenital blepharoptosis in early age children can achieve good surgical results.

[En block frontal-temple silicone for humping the forehead and temple].

OBJECTIVE: To explore the reliability of humping the forehead and temple by en block frontal temporal silicone . METHODS: Make wax mold by piling up wax slices layer by layer according to the rang of depressing of the forehead and temple, the section being humped and the hight need to be projected. Order the silicone block according to the dimension of the wax mold. Make the implant from the silicon block. Under local anaesthesia dissection under the superficial temporal fascia and galea through forehead and two temporal incisions. Implant the silicon through the middle incision. RESULTS: Total 18 cases in this group were followed up for 3-12 months. Wound healed primarily without infection. I case with early blood effusion cured after aspiration. l case with later clear effusion cured after aspiration ad injection of prednisone in to the capsular. The frontal temporal contours were satisfactory . No outline of the implant was seen. CONCLUSION: It is safety and satisfied to hump the forehead and temple by en block frontal temporal silicone.

[Reconstruction of the lower face and the anterior neck with a bipedicled expanded flap].

OBJECTIVE: To explain a method for lower face and anterior neck reconstruction. METHODS: Tissue expanders were implanted subcutaneously beside the defect. When the skin was properly expanded, the bipedicled expanded skin flap was created and transferred to the lower face and the anterior neck. If the defect can not be repaired by one stage, the expanded skin was re-expanded for the rest. RESULTS: 11 patients have been treated with this method since 1990. All flaps survived and all the defects have been successfully repaired with satisfactory results. CONCLUSION: The bipedicled expanded flap, which provided good blood supply, improved the survival rate of the flap and reduced the incision scar on the face, is an effective surgical procedure.

[Experimental study on enhancement of tissue expansion with papaverine cream].

OBJECTIVE: To evaluate the effect of external use of papaverine cream on enhancement of tissue expansion. METHODS: 8 mini pigs were randomly divided into 4 groups. During inflation, papaverine was given externally in group A, through a delivery system in group B, though intramuscular injection in group C. Papaverine was not given in group D. The time of inflation, the expansion rate, the surviving length of expanded flaps and the papaverine concentration in the fibrous capsule in each group were examined. Histologic and electroscope examinations of the expanded tissue were made. RESULTS: The average inflation time was 28.9 +/- 4.5 days in group A, 34.0 +/- 2.6 days in group B, 37.6 +/- 4.8 days in group C and 38.5 +/- 3.5 days in group D. There was significant difference between each group(P < 0.05). The average surviving length of expanded flaps in group A was 13.67 +/- 1.28 cm, 11.07 +/- 0.88 cm in group B, 10.79 +/- 0.49 cm in group C, and 9.49 +/- 0.77 cm in group D. There was significant difference between each group (P < 0.01). Histologic examinations of the expanded tissue suggested that there were no significant differences in thickness of epidermis, derma and fibrous capsule among the four groups. Electroscope examinations of the myofibroblast in fibrous capsule showed that there were smaller nuclei, fewer microfilaments and fewer mitochondrias and rougher endoplastic reticulume in group A than those in other groups. The concentration of papaverine in fibrous capsule of group A was 3.5 +/- 1.2 micrograms/g. Papaverine was detected neither in the skin of other groups nor in the blood of all groups. CONCLUSIONS: 1. Papaverine cream can permeate through skin and maintain high concentration and continuous effect in local tissue. 2. External use of papaverine cream can inhabit the function of myofibroblast in fibrous capsule, increase inflation rate, accelerate expansion process, and improve microcirculation of the expanded skin with a result of prolongation of surviving length of expanded flaps. 3. The technique of enhancing tissue expansion with external use of papaverine has the advantages of convenient delivery, cheapness, no more injury and infection, and no side effects etc. It is a safe, effective, simple, and reliable method for accelerating tissue expansion.