Transcutaneous lower eyelid blepharoplasty with micro-autologous fat transplantation harvested from orbital fat pads for lower eyelid aging treatment.

The aging process of lower eyelids results in lower eyelid wrinkles, tear troughs, and eye bags. Many therapies have been described for treatment of lower eyelid aging, and transcutaneous blepharoplasty is often used for treating cases with eyebags and dermatochalasis. However, it may cause depression near the medial orbit resulting in a hollowed look. In the present study, we developed an innovative method transferring the herniated fatty tissue to volume loss area during the surgical procedure of transcutaneous lower eyelid blepharoplasty by means of micro-autologous fat transplantation harvested from resected orbital fat pads. Besides, we also analyze it efficacy and safety compared with traditional methods of transcutaneous lower eyelid blepharoplasty. We reviewed the records of the patients who underwent transcutaneous lower eyelid blepharoplasty with and without micro-autologous fat transplantation, for lower eyelid aging improvement. We used global aesthetic improvement scale, Hirmand's classification system, and Wrinkle Severity Rating Scale to evaluate the cosmetic outcome at 1 week, 1 month, and 3 months after operation by two independent investigators. We found patients received transcutaneous lower eyelid blepharoplasty with autologous fat graft had significantly higher global aesthetic improvement scale and Wrinkle Severity Rating Scale improvement than those underwent transcutaneous lower eyelid blepharoplasty only in each evaluation timepoints. There was no significant difference of adverse effects between both surgical methods. The present study demonstrated the efficacy and safety of the lower eyelid blepharoplasty with micro-autologous fat transplantation harvesting from resected orbital fat pads.

Platelet-Rich Plasma Versus Platelet-Poor Plasma for Treating Facial Photoaging: a Double-Blind Randomized Controlled Splitting Face Study.

BACKGROUND: As the demand for non-invasive esthetic procedures to maintain a youthful appearance increases, there has been growing interest in the use of autologous platelet-rich plasma (PRP) and platelet-poor plasma (PPP) for the treatment of facial aging. However, there are few studies directly comparing the efficacy of PRP and PPP for facial rejuvenation. OBJECTIVES: This study aimed to compare the efficacy of PRP and PPP for facial rejuvenation. METHODS: This single-center, double-blind, randomized controlled trial was conducted from January 1, 2022, to July 31, 2022, and included ten participants who completed the follow-up. The participants were randomly assigned to receive 2.5-mL injections of PRP and PPP on different sides of the face in three sessions with 1-month intervals. The outcome was primarily determined by blinded photographic assessments and secondly by scores of the VISIA® system during the follow-up. RESULTS: Both PRP and PPP treatments resulted in significant improvement in the Global Aesthetic Improvement Scales and Modified Fitzpatrick Wrinkle Scale for periocular Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation wrinkles, with no significant difference between the two groups. However, no improvement was observed in the Wrinkle Severity Rating Scales for nasolabial folds in either the PRP- or PPP-treated groups. Furthermore, no severe adverse events were reported. CONCLUSIONS: Both PRP and PPP are effective in treating facial photoaging. PRP exhibited slightly superior efficacy in enhancing overall skin condition, while PPP was slightly more effective in improving shallow wrinkles. This study provides valuable evidence for the use of PRP and PPP in facial rejuvenation procedures. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Autologous Fat Grafting in Female Genital Area Improves Sexual Function by Increasing Collagenesis, Angiogenesis, and Estrogen Receptors.

BACKGROUND: Vulvovaginal laxity, atrophic vaginitis, and orgasmic dysfunction are not only aesthetic but also sexual problems. Autologous fat grafting (AFG) facilitates tissue rejuvenation through the effects of adipose-derived stem cells; the fat grafts serve as soft-tissue filler. However, few studies have reported the clinical outcomes of patients undergoing vulvovaginal AFG. OBJECTIVES: The aim of this study was to describe a new technique, micro-autologous fat transplantation (MAFT), for AFG in the vulvovaginal area. Posttreatment histologic changes in the vaginal canal that imply improved sexual function were assessed. METHODS: This retrospective study enrolled females who underwent vulvovaginal AFG performed through MAFT between June 2017 and 2020. Assessments were based on the Female Sexual Function Index (FSFI) questionnaire and on histologic and immunohistochemical staining. RESULTS: In total, 20 female patients (mean age, 38.1 years) were included. On average, 21.9 mL of fat was injected into the vagina and 20.8 mL in the vulva and mons pubis area. Six months afterwards, the patients' mean total FSFI score (68.6) was significantly higher than that at baseline (43.8; P < .001). Histologic and immunohistochemical staining of vaginal tissues revealed substantially increased levels of neocollagenesis, neoangiogenesis, and estrogen receptors. By contrast, the level of protein gene product 9.5, which is associated with neuropathic pain, was considerably lower after AFG. CONCLUSIONS: AFG performed through MAFT in the vulvovaginal area may help manage sexual function-related problems in females. In addition, this technique improves aesthetics, restores tissue volume, alleviates dyspareunia with lubrication, and reduces scar tissue pain.

Periorbital Rejuvenation for Asians.

A primary concern in facial aesthetics is the rejuvenation of periorbital areas through soft tissue recontouring, skin texture improvement, and harmoniousness with souring anatomic tissues. Currently, the ease of harvesting, abundance in volume, and lack of immune rejection make autologous fat transplantation a disruptive strategy in aesthetic medicine. The evolution and improvements made by myriad surgeons have contributed to the popularity of periorbital rejuvenation and have highlighted its indispensability in Asian patients. Lin and colleagues have advocated the technique of microautologous fat transplantation since 2007 for facial recontouring and rejuvenation. This article illustrates more in-depth technical details and innovative concepts for the improvement of the periorbita.

Application of nanofat grafting to rescue a severe ischaemic hand with thromboangiitis obliterans: A case report about promising salvage procedure.

RATIONALE: Currently, there is no consensus regarding the best treatment for patients with thromboangiitis obliterans (TAO). Regenerative medicine, such as bone marrow stem cells or adipose-derived stem cell (ASC) transplantation, have proven efficacy in improving tissue perfusion and wound healing in clinical trials. In this case, we used nanofat grafting to treat severe conditions in a patient with TAO, with promising outcomes. PATIENT CONCERNS: This is a case of a 48-year-old smoker who presented with cyanosis in both hands and the right foot, with gangrenous changes. Investigative angiography showed severe vasospasm in the radial and ulnar arteries of the patient's left hand. Progressive cyanosis of the patient's left hand was noted which may eventually require amputation if left untreated. DIAGNOSES: He was diagnosed with TAO under the Shionoya diagnostic criteria. INTERVENTIONS: Fasciotomy and necrotic tissue debridement were performed, followed by centrifuged nanofat grafting. The nanofat graft was prepared using Pallua method and deployed with a MAFT-GUN (Dermato Plastica Beauty Co., Ltd., Kaohsiung, Taiwan). OUTCOMES: Three months later, computed tomography angiography revealed a radial artery patency. The patient's wrist function was preserved with uneventful wound healing. LESSONS: The regenerative ability of centrifuged nanofat grafts not only helps wound healing but also helps reverse vasospasm and preserve remnant tissue perfusion.

Fat Grafting for Facial Contouring (Nose and Chin).

The concept of microautologous fat transplantation (MAFT), proposed by Lin and colleagues in 2007, emphasized that the volume of each delivered parcel should be less than 0.01 mL to avoid potential fat grafting morbidities. The MAFT-GUN facilitates control of the parcel volume and therefore substantially avoids central necrosis and associated complications. In this article, the authors present a simple, reliable, and consistent procedure based on MAFT for profiloplasty. Favorable outcomes with sustainable long-term effectiveness were obtained, further confirming that the MAFT technique is an alternative for facial contouring in the nose and chin.

Three Simple Steps for Refining Transcutaneous Lower Blepharoplasty for Aging Eyelids: The Indispensability of Micro-Autologous Fat Transplantation.

BACKGROUND: Lower blepharoplasty has been used for rejuvenating lower eyelids, and diverse modifications have been used to treat conjunct deformities at the tear trough/lid-cheek junction. Strategies for recontouring prominent tear trough/lid-cheek junctions, including orbital fat manipulation, have been reported with good results in the literature. Micro-autologous fat transplantation (MAFT) is a previously unevaluated, potentially advantageous approach to blending the prominent tear trough/lid-cheek junction. OBJECTIVES: We determined the long-term results after 3-step transcutaneous lower blepharoplasty with MAFT for patients with aging eyelids and prominent tear trough/lid-cheek junctions. METHODS: We evaluated 205 patients with aging lower eyelids who underwent transcutaneous lower blepharoplasty with MAFT between October 2010 and September 2016. The 3-step procedure involved a subciliary elliptical skin excision, resection of 3 orbital fat compartments, and MAFT for the tear trough/lid-cheek junction employing a MAFT-GUN under intravenous anesthesia. RESULTS: The mean patient age was 52 years (range, 34-78 years). The mean operating time was 61 minutes. The mean fat volumes delivered to the tear trough/lid-cheek junctions were 2.80 mL and 2.76 mL for the left and right sides, respectively. The average weights of the 3 resected orbital fat compartments were 0.58 g for the left side and 0.56 g for the right side. Patients showed significant improvement and maintenance at an average follow-up of 60.2 months (range, 18-90 months). CONCLUSIONS: Three-step transcutaneous lower blepharoplasty with MAFT is an effective, reliable, and promising method with high patient satisfaction and minimal risk of complications. Long-term results demonstrated its utility for aging lower eyelid treatment.

Micro-Autologous Fat Transplantation for Treating a Gummy Smile.

BACKGROUND: A gummy smile is treated using many techniques, including botulinum toxin injection and various surgical interventions. Micro-autologous fat transplantation (MAFT) is a potentially advantageous alternative approach that has not been previously evaluated. OBJECTIVES: This study sought to determine the long-term results of MAFT in patients with a gummy smile. METHODS: Seven patients with gummy smiles were evaluated for MAFT treatment between October 2015 and April 2017. Centrifuged purified fat was micro-transplanted into the nasolabial groove, ergotrid, and upper lip areas using the MAFT-GUN while the patients were under total intravenous anesthesia. RESULTS: The mean age of the 7 patients was 31 years (range, 23-40 years). The mean operating time for MAFT was 52 minutes (range, 40-72 minutes), and the mean volume of fat delivered to the nasolabial groove, ergotrid, and upper lip was 16.1 mL. The mean decreases of gingival display in the right canine incisor, left canine incisor, right canine, and left canine teeth were 4.9, 4.6, 3.8, and 4.4 mm, respectively. The smiles of the 7 patients showed significant improvement at an average follow-up time of 12.9 months. CONCLUSIONS: Gummy smile treatment using MAFT is an effective, reliable, and relatively simple method, with high patient satisfaction and minimal risk of complications.

Long-Term Outcome of Microautologous Fat Transplantation to Correct Temporal Depression.

OBJECTIVE: Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results. METHODS: Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison. RESULTS: On average, the MAFT procedure took 48 minutes to complete. The average delivered fat was 6.8 ±â€Š0.2 mL/6.5 ±â€Š0.3 mL for the right/left side. The average follow-up period was 18 months. No complication including skin necrosis, vascular compromise, nodulation, fibrosis, and asymmetry was noted. The patient-rated satisfaction 5-point Likert scale demonstrated that 81.3% of all patients had favorable results (38.5% very satisfied and 42.8% satisfied). CONCLUSIONS: The concept and technique of MAFT along with the micro- and precise controlling instrument enabled surgeons to perform fat grafting accurately and consistently. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated the patients' high satisfaction with the long-term results. Therefore, the potential of MAFT as an alternative strategy in sunken temporal fossa in Asians was emphasized.

Fat grafting for resurfacing an exposed implant in lower extremity: A case report.

RATIONALE: Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery. PATIENT CONCERNS: An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy. DIAGNOSES: The diagnosis of a tibia and fibula shaft open fracture (type IIIA) complicated with an exposed implant was made. INTERVENTIONS: The procedure was performed by deploying purified and emulsified fat with a Micro-Autologous Fat Transplantation gun. The required lipoaspirate amount was grossly estimated using a standard formula: 0.5 cc of a lipoaspirate per square centimeter of wound. We prepared the lipoaspirate simply through centrifugation followed by physical emulsification. The endpoint of fat grafting was when lipoaspirate began to flow out of the wound. The initial dressing after the procedure included the topical usage of biomycin ointment with AQUACEL Foam (ConvaTec Inc., NC, USA) coverage, which was later changed to INTRASITE gel (Smith & Nephew, London, UK) with a gauze dressing for 4 weeks. After 4 weeks, dressing components were changed to Mepilex (Mölnlycke Health Care, Gothenburg, Sweden) alone. OUTCOMES: The wound healed completely without requiring major flap surgery by 18 weeks after surgery. LESSONS: Fat grafting is one kind of cell therapy and potentially has regenerative effects during wound healing. Fat grafting is critical in the healing processes of complicated wounds and might be considered a step in reconstruction surgery.

Injected Implant of Uncultured Stromal Vascular Fraction Loaded Onto a Collagen Gel: In Vivo Study of Adipogenesis and Long-term Outcomes.

BACKGROUND: Stromal vascular fraction (SVF) cells were used to increase the efficacy of a newly formed adipose tissue in a collagen gel in vitro. However, the outcome of the seeded cells in the collagen gel in vivo remains unknown. We traced the SVF cells in the host tissue and evaluated the efficacy of SVF for fat tissue engineering. METHODS: The aggregates implanted in the experimental and control groups were prepared by mixing SVF with the collagen gel and Dulbecco's modified Eagle medium with the collagen gel, respectively. The aggregates were implanted using a subcutaneous injection into the backs of immunodeficient mice. The aggregates were harvested 1, 2, 4, and 6 months after implantation; and 9 mice were euthanized each time. Macroscopic changes in the volume and wet weight of the aggregates were assessed. The formation of adipose tissue was studied using hematoxylin and eosin and Nile red staining. The origin and survival of adipocytes in the aggregates were examined through the immunostaining of leptin antibodies, DNA assay, and tracing of SVF cells by 1,1'-dioctadecyl-3,3,3',3'- tetramethylindocarbocyanine perchlorate labeling. RESULTS: The formation of adipose tissue was observed in all of the aggregates. Implanted human SVF cells remained in the experimental aggregates harvested after 1, 2, and 4 months but not after 6 months. At 6 months, viable adipocytes in both groups were of murine origin. Furthermore, at 6 months, the mean volume of the aggregate (P < 0.001) and the mean percentage of adipocytes (P < 0.001) were significantly higher in the experimental group than in the control group. CONCLUSIONS: Implanted SVF cells could not be traced in the aggregates harvested at 6 months but promoted the recruitment of host adipocytes to generate more adipose tissue in the experimental group than in the control group.

Microautologous Fat Transplantation for Primary Augmentation Rhinoplasty: Long-Term Monitoring of 198 Asian Patients.

BACKGROUND: Numerous techniques and materials are available for increasing the dorsal height and length of the nose. Microautologous fat transplantation (MAFT) may be an appropriate strategy for augmentation rhinoplasty. OBJECTIVES: The authors sought to determine the long-term results of MAFT with the so-called one-third maneuver in Asian patients who underwent augmentation rhinoplasty. METHODS: A total of 198 patients who underwent primary augmentation rhinoplasty with MAFT were evaluated in a retrospective study. Fat was harvested by liposuction and was processed and refined by centrifugation. Minute parcels of purified fat were transplanted to the nasal dorsum with a MAFT-Gun. Patient satisfaction was scored with a 5-point Likert scale, and aesthetic outcomes were validated with pre- and postoperative photographs. RESULTS: The mean age of the patients was 45.5 years. The mean operating time for MAFT was 25 minutes, and patients underwent 1-3 MAFT sessions. The mean volume of fat delivered per session was 3.4 mL (range, 2.0-5.5 mL). Patients received follow-up for an average of 19 months (range, 6-42 months). Overall, 125 of 198 patients (63.1%) indicated that they were satisfied with the results of 1-3 sessions of MAFT. There were no major complications. CONCLUSIONS: The results of this study support MAFT as an appropriate fat-transfer strategy for Asian patients undergoing primary augmentation rhinoplasty. LEVEL OF EVIDENCE 4: Therapeutic.

Fat Grafting for Recontouring Sunken Upper Eyelids With Multiple Folds in Asians-Novel Mechanism for Neoformation of Double Eyelid Crease.

BACKGROUND: This study reviewed the mini invasive technique, microautologous fat transplantation (MAFT), as a strategy in simultaneously treating sunken upper eyelids with multiple folds and recreating a double eyelid crease in Asian people. METHODS: The MAFT was performed with the assistance of a patented medical device, the MAFT-GUN, on 34 patients who had sunken upper eyelids and multiple folds. Each delivered fat parcel was accurately and consistently maintained at 1/240 mL during placement. Follow-up was regularly performed with photography for comparison. RESULTS: Fifty-eight sunken upper eyelids with multiple folds were reconstructed. In addition to the ameliorative recontouring of hollowness, a natural eyelid crease was created postoperatively. Temporary swelling and bruising were noted several days after surgery without morbidities, such as fibrosis or nodulation. All of the patients were satisfied with the 1-time MAFT procedure. CONCLUSIONS: Fat grafting for sunken upper eyelids with multiple folds has been reported in the literature. However, temporal effects and complications, such as nodulation and irregularity, have often occurred. A new method, MAFT, demonstrated its reliability as a modality for sunken upper eyelids with multiple folds in Asians. Moreover, MAFT might serve as an alternative for neoformation of double eyelids in these candidates.

Application of microautologous fat transplantation in the correction of sunken upper eyelid.

BACKGROUND: Although fat grafting has been clinically applied by surgeons in esthetic and reconstructive surgery, it has widely evolved in processes such as harvesting, processing, and placement of fat, using the fat-grafting procedure, which dates back over 100 years. Surgeons frequently use fat grafting to recontour, augment, or fill soft-tissue defects, facial wrinkles, or skin problems such as depressions or scars. However, fat grafting has not been thoroughly understood and has not been conclusively standardized to ensure superior clinical results. METHODS: This study was intended to determine the role of microautologous fat transplantation (MAFT) under evidence-based medicine, particularly in accurate delivery of small fat parcels. The research method involved the conceptualization of MAFT and the development of an innovative surgical instrument for fat placement. Clinically, 168 patients with sunken upper eyelids with multiple folds underwent this procedure. RESULTS: The major findings suggested that MAFT exhibits promising clinical results and offers a superior guideline for fat placement. Details of the technique and theoretical implications are also discussed. CONCLUSIONS: The therapeutic effects of MAFT and the long-term clinical results of patients with sunken upper eyelids with multiple folds indicated satisfactory outcomes. Based on the results, MAFT offers an alternative option to surgeons for performing fat grafting and provides a more favorable option for the benefit and welfare of patients by reducing the potential complications.

Isolation and identification of mesenchymal stem cells from human lipoma tissue.

Lipoma is a benign neoplasm of normal fat cells that appears as a soft, movable swelling, often with a slight yellowish coloration. Human mesenchymal stem cells (MSCs) that have been isolated from bone marrow, blood, and other adult tissues including adipose tissue have the potential to be useful candidates for therapy. No literature had reported about stem cells from lipoma tissue. Here, a new cell culture method is described and utilized to greatly accelerate the growth rate and prolong the lifespan of lipoma-derived MSCs. Cells produced in early cultures display characteristics similar to those previously reported for multipotential stem cells, including a high frequency of anchorage-independent growth in soft agar and a lack of gap junctional intercellular communication in cell types with serpiginous morphology. These cells can differentiate into adipocytes, osteoblasts, and chondrocytes after induction. In conclusion, lipoma-derived stem cells possessing the characteristics of MSCs are described for the first time.

Isolation and characterization of human gastric cell lines with stem cell phenotypes.

AIM: The aim of this study was to develop an in vitro human gastric stem and/or progenitor cell model that may be used to study the mechanism of gastric carcinogenesis induced by Helicobacter pylori infection. METHODS: Human gastric biopsy was minced and digested with collagenase and dispase and cultured in a low-calcium medium (serum-free keratinocyte medium; keratinocyte-SFM) supplemented with N-acetyl-L-cysteine and L-ascorbic acid 2-phosphate. Actively proliferating epithelial colonies with sustained growth were isolated and characterized for karyotype and phenotypes related to stem cell characteristics including proliferation and differentiation potential, ability of anchorage-independent growth (AIG), gap junctional intercellular communication (GJIC) and the expression of Oct-4, a transcription factor previously shown to be expressed in embryonic stem cells, adult stem cells and undifferentiated tumor cells. To study the carcinogenic effect of H. pylori infection, gastric stem and/or progenitor cells were incubated with H. pylori culture products and/or N-methyl-N-nitro-N-nitrosoguanidine (MNNG), a chemical carcinogen, to see the telomerase activation. RESULTS: Multiple cell lines with stem cell features were isolated by this new cell culture method. The results based on detailed characterization of one cell clone, KMU-GI2, revealed stem cell features of these cells. The initial clone contained mostly undifferentiated epithelial-like cells, which, upon subculture and propagation, gave rise to a heterogeneous cell population. Single cell-derived subclones, similar to the parental population, retained high differentiation potential and were capable of giving rise to many morphologically different cell types (i.e. epithelial-like, glial or neuron-like, round and various peculiar-shaped cells). Although these cells were normal in karyotype and competent in GJIC, they had the ability to grow in soft agar. Cells expressing epithelial membrane antigen (EMA), mucin 5AC, glial fibrillary acidic protein (GFAP), cytokeratin-18 (CK-18), trefoil factor 1 (TFF-1) and Oct-4 were found in the cell culture, but not E-cadherin-, gastrin- or telomerase-expressing cells. Furthermore, spontaneously immortalized non-tumorigenic clones could be derived from the cell population. After treating these cell cultures with the chemical carcinogen, MNNG and H. pylori culture products for 5 days, telomerase activity and telomerase mRNA expression were significantly elevated, while treatment with either of them showed no effect. CONCLUSION: The new cell culture method can be used to develop gastric epithelial cell clones with sustained growth from endoscopic biopsy. The gastric cell clone showed several stem and/or progenitor cell phenotypes (i.e. the ability of AIG, high differentiation capacity, high susceptibility to spontaneous immortalization and the expression of Oct-4). The telomerase expression in these gastric stem and/or progenitor cells can be upregulated by exposure to H. pylori culture products and MNNG, an important step in neoplastic transformation. These results show that putative human gastric stem and/or progenitor cell clones can be developed by our method and these cells could be useful for studying the mechanisms of human gastric carcinogenesis including the mechanism of action of H. pylori, as well as the regulation of the proliferation and differentiation of human gastric mucosa.

Guillain-Barré syndrome following facial bone fracture.

Guillain-Barré syndrome (GBS) is an inflammatory disorder of the peripheral nerves and nerve roots characterised by lymphocytes and macrophage infiltration and myelin destruction. Two-thirds of cases of GBS emerge from viral or bacterial infection. GBS following facial bone fracture is rare. This article discusses a case of classical GBS following facial bone fracture and its correlative mechanism. The association of GBS with head injury per se is not well recognised. This case highlights the possibility of GBS following facial bone fracture and indicates that medical staff should be alerted to the association.

Management of the primary varicose veins with venous ulceration with assistance of endoscopic surgery.

Two hundred sixty-two cases of primary varicose veins in which the lesions extended to the areas of the lower third of the leg and/or the ankle were treated with the assistance of endoscopic surgery. The conditions of varicose veins were classified by the reporting standards in venous disease. The number of cases in lesions of C2, C4, C5, and C6 were 60, 156, 31, and 15, respectively. They were also classified into 4 clinicoanatomic types according to varicositic changes in normal veins. The number of cases in types I, II, III, and IV were 57, 88, 42, and 75, respectively. The incidence of skin changes resulting from varicosity were 100%, 90.5%, 53%, and 50% in types I, II, III, and IV, respectively. The incidence of skin changes in this series was 77.6%. About one fourth of the cases having skin changes progressed to C5 and/or C6 lesions. Early and radical treatment of varicose veins could prevent the occurrence of skin changes and subsequently avoid the incidence of C5 and/or C6 lesions. The mean number of incisions in each limb was 2.9. With good illumination and magnified monitor view, the varicose veins and incompetent perforating veins were radically excised, but the normal veins were preserved. Forty-six cases of C5 and C6 lesions were followed up at least 1 year postoperatively. Four cases were lost from follow-up. In all cases except 1, there has been no recurrence. The conditions of skin changes improved subsequently. The recurrent rate of ulceration was 2.4%. In treatment of primary varicose veins with or without ulceration, surgery with assistance of endoscopic surgery achieved a low recurrence of ulcerations and minimal operative scarring.

The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications.

Defects in the distal third of the lower leg with bone or tendon exposure may require local or free flap reconstruction. For small and moderate lesions, the distally pedicled peroneus brevis muscle flap may be an effective procedure with less morbidity than a free tissue transfer. Six cadaveric specimens were dissected to determine the location of distal pedicles and the flap type. This flap was found to be a Type IV flap, and the location of distal pedicle was always located within 6 cm from the fibula tip. This flap was performed on 6 patients to cover defects in the distal third of the lower leg. The defect areas were the pretibial region in 2 cases, the lateral malleolus in 3 cases, and the Achilles tendon in 1 case. The peroneus brevis muscle was detached from the uppermost point of the fibula to obtain enough length to cover the defect. All flaps survived except 1 that experienced distal flap necrosis. Minor complications included skin graft failure in 2 cases. However, the final results demonstrated a smooth contour that eliminated dead space. Limited donor site morbidity was obtained in all cases. The distally peroneus brevis muscle flap therefore offers an alternative for reconstructive surgeons dealing with soft tissue defects of the lower leg.