Correction of the Tear Trough Deformity and Concomitant Infraorbital Hollows With Extracellular Matrix/Stromal Vascular Fraction Gel.

BACKGROUND: The tear trough deformity is a sign of eye aging. Filling is an ideal choice for the tear trough accompanied by infraorbital hollows. OBJECTIVE: To evaluate the efficacy and safety of stromal vascular fraction gel (SVF-gel) as a filler for the tear trough deformity which is combined with infraorbital hollows. MATERIALS AND METHODS: From July 2017 to June 2018, 33 patients underwent autologous fat aspiration and were followed up successfully. Stromal vascular fraction gel was used to correct patients with bilateral Barton I/II; tear trough deformity and infraorbital hollows. Improvement was evaluated by measuring skin-periosteal depth, 3D volume, global aesthetic improvement scale (GAIS), and patient self-assessment. RESULTS: Skin-periosteal depth improved significantly (p < .001). The volumetric increment of the tear trough and infraorbital regions increased 2.132 ± 0.671 mL, and the retention rate was excellent (72.87 ± 10.23%). The GAIS showed a high score (2.5 ± 0.5 points), with patient self-assessment showing satisfactory results for all 7 questions on the questionnaire. CONCLUSION: The high retention rate of SVF-gel suggests that it can provide an effective solution to tear trough deformity accompanied by infraorbital hollows.

[Repair of soft tissue defects in lower extremities by latissimus dorsi myocutaneous flap with T type of vascular pedicle].

Objective: To investigate the Application of latissimus dorsi myocutaneous flap with T type of vascular pedicle in repairing soft tissue defects at lower extremities. Methods: Between January 2003 and August 2013,16 patients with skin and soft tissue defects at lower extremities were treated with T type vascular pedicled latissimus dorsi myocutaneous flap through bridge transplantation. There were 13 male and 3 female patients with an average age of 36.2 years(range,17-54 years).Skin and soft tissue defects in the lower extremities ranged from 18 cm × 13 cm to 32 cm × 15 cm. The T-configuration vascular anastomosis was formed by anastomosing the subscapular and circumflex scapular vessels to the proximal and distal ends of the posterior tibial vessel broken in the normal leg respectively in an end-to-end manner. The latissimus dorsi myocutaneous flap was used to cover the defect at damaged leg where vascular pedicle was wrapped by tube flap from the normal leg. External fixators was used to immobilize the bilateral lower legs postoperatively. Results: Vascular crisis occurred in 3 cases. Vascular crisis was relieved after exploring the vessel.2 cases developed infection at the distal end of flap and cured by debridement. Primary healing was obtained in 11 cases after 2 weeks,and the total survival rate was 100％.The follow-up period lasted for 6 months to 5 years with an average of 3.4 years. The flap appearance was satisfactory and extremity function was restored to normal. Conclusions: The application of the T type of vascular pedicled latissimus dorsi myocutaneous flap by bridge transplantation is an effective method for repair skin and soft tissue defects in lower extremity without damaging for main blood vessels at contralateral limb, when affected extremities have no available vessel for anastomosis.

[TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT].

OBJECTIVE: To investigate the effectiveness of tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft in the treatment of tibial bone defects. METHODS: Between January 2007 and December 2013, 19 cases of traumatic tibia bone and soft tissue defects were treated. There were 14 males and 5 females, aged from 18 to 49 years (mean, 28 years). The tibial fracture site located at the middle tibia in 6 cases and at the distal tibia in 13 cases. According to Gustilo type, 4 cases were rated as type III A, 14 cases as type III B, and 1 case as type III C (injury of anterior tibial artery). The length of bone defect ranged from 4.3 to 8.5 cm (mean, 6.3 cm). The soft tissue defects ranged from 8 cm x 5 cm to 17 cm x 9 cm. The time from injury to operation was 3 to 8 hours (mean, 4 hours). One-stage operation included debridement, external fixation, and vacuum sealing drainage. After formation of granulation tissue, the fresh wound was repaired with sural neurovascular flap or posterior tibial artery perforator flap. The flap size ranged from 10 cmx6 cm to 19 cm x 11 cm. In two-stage operation, tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft was used to repair tibial defect. The periosteal flap ranged from 6.5 cm x 4.0 cm to 9.0 cm x 5.0 cm; bone graft ranged from 4.5 to 9.0 cm in length. External fixation was changed to internal fixation. RESULTS: All flaps survived with soft texture, and no ulcer and infection occurred. All incisions healed by the first intention. All patients were followed up 18-40 months (mean, between normal and affected sides.The function of the knee an ankle joint was good without infection, malunion, and equinus. According to the Johner standard at last follow-up, the results were excellent in 15 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 94.7%. CONCLUSION: Tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft is an effective method to treat bone defect of the tibia.

[Repair of skin defects at fingers by digital dorsal flaps based on vascular network].

OBJECTIVE: To investigate the therapeutic effect of digital dorsal flap based on vascular network for skin defects at fingers. METHODS: From August 2005 to August 2010, 49 cases with 61 skin defects at fingers were treated with the digital dorsal flaps, including 19 at the index fingers, 19 at the middle fingers, 16 at the ring fingers and 3 at the little fingers. The defects were 42 at the distal end, 12 at the middle segment and 7 at the proximal segment. The flaps size ranged from 27 mm x 20 mm to 10 mm x 8 mm. RESULTS: 61 flaps in 49 cases survived completely. 52 fingers were followed up for 6-22 months. The aesthetic and functional results were both satisfactory. The flaps sensation was graded as S3, with a discrimination distance of 6-9 mm (median, 7.6 mm). No complication happened in donor sites. CONCLUSIONS: The digital dorsal flap based on vascular network has reliable blood supply with less morbidity to the main artery. It is safe and easily performed with good effect for skin defect at finger.

[Repair of the soft tissue defects at legs with free tissue flap anastomosed with descendant branch of lateral femoral circumflex artery].

OBJECTIVE: To investigate the therapeutic effect of free tissue flap anastomosed with reverse descendant branch of lateral femoral circumflex artery for severe soft tissue defect at leg. METHODS: The severe soft tissue defect at leg, without any vessels for anastomosis of free tissue flap, was reconstructed with free tissue flap, which was anastomosed with proximal end of descendant branch of lateral femoral circumflex artery and great saphenous vein. From Oct. 2004 to Dec. 2009, 36 cases were treated with 15 cases of latissimus dorsi musculocutaneous flaps, 12 cases of anterolateral femoral flaps, and 9 cases of thoracoumbilicus flaps. RESULTS: All the 36 free flaps survived completely. The patients were followed up for 6 months to 2.5 years with good cosmetic results. CONCLUSIONS: It is effective and practical to repair the severe soft tissue defects at legs with the reverse descendant branch of lateral femoral circumflex artery to carry the free flaps.

[The reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion].

OBJECTIVE: To discuss the application of reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion. METHODS: From Jan. 2005 to Mar. 2008, 28 cases with degloved fingertip avulsion were treated with reverse flaps based on two dorsal metacarpal artery. The defects were located distal to the distant interphalangeal joints and were 0.8-2.2 cm in length. 10 defects was in the index fingers, 13 in the middle fingers and 5 in the ring fingers. 24 fingers were treated in an emergency surgery. 4 fingers were treated due to skin necrosis. RESULTS: Epidermal necrosis happened at the distal end of flaps in 3 cases. All the other flaps survived completely. 25 cases were followed up for 4-27 months with satisfactory cosmetic and functional results. The 2-points discrimination distance was 6.0-9.0 mm (average, 7.6 mm). CONCLUSIONS: The reverse flap based on two dorsal metacarpal artery is easily performed and reliable for degloved fingertip avulsion with satisfactory results.

[Repair of defects at the end of fingers with island flaps pedicled with digital artery].

OBJECTIVE: To investigate the therapeutic effect of island flaps pedicled with digital artery for the defects at the end of fingers. METHODS: 63 cases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm x 11 mm to 21 mm x 27 mm. RESULTS: All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 to approximately 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. CONCLUSIONS: The technique with island flap is simple and reliable for the defects at the end of fingers.