Construction of a double eyelid: an uncut strip of orbicularis removed through three mini-incisions.

BACKGROUND: In recent years, many mini-incisional techniques for double-eyelid plasty have been developed. However, the removal of pretarsal tissue has not been satisfactory because only small pockets of soft tissue just inferior to the skin have been removed to place the suture. The formed double eyelid may therefore not be durable. This report introduces a modified mini-incisional method that involves removing a long uncut strip of orbicularis through three mini-incisions. METHODS: A strip of orbicularis uncut from the inner canthus to the outer canthus was removed through three mini-incisions made on the upper eyelid, quite similar to that of a full incisional procedure. The left orbicularis then was pruned in three directions: left, right, and down (toward the palpebral margin). Finally, the incisions were sutured, and a vivid fold was created. RESULTS: From 2008 to 2012, the authors applied this technique to 90 patients (174 eyes). Although the trauma may have been more severe due to a large amount of orbicularis removed, including an uncut strip of orbicularis, bleeding during the operation was easy to control and usually very limited. The edema period for most patients ended within 3 weeks, mainly because of the skin bridge between each incision. The scars became unnoticeable after 3-6 months. Disappearance of the fold was not found in any case at either the 3- or 12-month (average, 9-month) follow-up evaluation or during the 4-year follow-up period. CONCLUSION: The described technique combines the advantages of both full incisional and the usual mini-incisional techniques in developing a long-lasting suprapalpebral fold with inconspicuous scars and a short recovery period. LEVEL OF EVIDENCE V: Opinions of respected authorities, based on clinical experience,descriptive studies, or reports of expert committees.

Superficial temporal fascial flap plus lipofilling for facial contour reconstruction in bilateral progressive facial hemiatrophy.

Progressive facial hemiatrophy (PFH) was first described by Parry in 1825 and later by Romberg in 1846 and was also known as Parry-Romberg syndrome. Progressive facial hemiatrophy, as the name suggests, usually has unilateral presentation. However, bilateral manifestation has been reported in 5-10% of the cases. It is a rare disorder with few cases reported. Treatment involves augmentation of the atrophic region and restoration of symmetry of the face. Because many tissues are needed, it is very difficult to treat. In this article we report the use of a superficial temporal fascial flap plus lipofilling to treat bilateral progressive facial hemiatrophy. We obtained good facial volume, smooth contour, and soft palpation. It is safer, simple to perform, and more cost effective than free tissue transfer. It is a suitable technique of choice in the treatment of bilateral progressive facial hemiatrophy.

[Clinical application of transverse rectus abdominis musculocutaneous flap reserving partial anterior sheath (TRAM-RPAS) in the one-stage breast reconstruction for patients with breast cancer].

OBJECTIVE: To investigate the clinical application of TRAM-RPAS flap in the one-stage breast reconstruction for patients with breast cancer, and to discuss the method to reduce the incidence of abdominal hernia and abdominal bulging. METHODS: From 2002 to 2004, 16 cases of breast cancer (9 cases in stage I or II and 7 in stage III) received radical resection and breast reconstruction with TRAM-RPAS flaps at the same stage. RESULTS: Good symmetry was achieved in 12 cases. In the other 4 cases, 3 cases had moderate breast poptosis and one case had breast hypoplasia on the unaffected side. All the flaps survived with only one case of abdominal bulging. CONCLUSIONS: TRAM-RPAS flap can achieve the same result as traditional TRAM-RPAS flap in the one-stage breast reconstruction, while the incidence of abdominal complication is lower for TRAM-RPAS flap.

[The endoscopically assisted forehead lift using skull cortical tunnel fixation--a report of 19 cases].

OBJECTIVE: To study the effect of the fixation on skull and thorough mobilization of the brow area on the results of the endoscopically assisted subperiosteal forehead lift. METHODS: The operation procedure included adequate subperiosteal dissection, especially at the frontotemporal transition area; complete mobilization of the brow area and fixation of the incised scalp to the skull through a cortical tunnel without tension. 19 patients received the operation. RESULTS: Long-term follow-up showed that all the 19 patients were satisfied with the surgical results. A transient frontal branch paresis happened in one case, which resolved in 3 months spontaneously without sequelae. CONCLUSIONS: Cortical tunnel fixation well keeps the brows at a lifted position and achieves persistent rejuvenation of the forehead.

[The therapy with rhVEGF gene for ischemic TRAM flap in rats].

OBJECTIVE: To establish a stable ischemic TRAM flap model in rats and observe the effects of rhVEGF gene on the ischemic flap. METHODS: Materials were administrated via subcutaneous injection 5 days before the TRAM flap procedure. 32 animals were divided into four groups. The first group was treated with PcDNA3.1 VEGF; the second group with PcDNA3.1 as the negative control; the third group with normal saline as the frank control, and the fourth group with VEGF as the positive control. The material was given while the procedures were performed. The serum levels of VEGF before and after the operation were measured with ELISA kit. The flap was harvested for immunohistological evidence of VEGF protein expression. The viable area of the flap was calculated with AutoCAD software. The microvessel density(MVD) of the subcutaneous tissue of the flap was counted. RESULTS: The average viable area of the TRAM flap in model animals was (3.61 +/- 1.06) cm2 [(16.04 +/- 4.71)%]. Comparing the mean viable area of the flap in the PcDNA3.1 VEGF group[(7.98 +/- 2.64) cm2] with that in the normal saline group [(4.13 +/- 1.77) cm2], the difference was significant(P < 0.05). There was no significant difference between the PcDNA3.1 VEGF group and the VEGF group[(7.31 +/- 1.22)cm2] in terms of mean viable flap area. The difference of mean MVD values between the PcDNA3.1 VEGF group and the negative control group was significant(P < 0.05), but was not significant between the gene treatment group and the positive control group. The serum level of VEGF did not increase significantly up to 9 days after the administration of PcDNA3.1 VEGF(P > 0.05). Immunohistochemical staining documented the increased deposition of VEGF protein in the plasma of endothelial cells of the flap that was injected with PcDNA3.1 VEGF. CONCLUSION: The unilateral inferior-pedicled TRAM flap as an ischemic flap model is stable and suitable for statistic treatment. Subcutaneous injection of rhVEGF gene can express biologically active VEGF at the site, increase MVD and the viable area of the TRAM flap.