Automated 3D Perioral Landmark Detection Using High-Resolution Network: Artificial Intelligence-Based Anthropometric Analysis.

BACKGROUND: 3D facial stereophotogrammetry, as a convenient, non-invasive and highly reliable evaluation tool, has shown great potential in pre-operative planning and treatment efficacy evaluation of plastic surgery in recent years. However, it requires manual identification of facial landmarks by trained evaluators to obtain anthropometric data, which consumes large amount of time and effort. Automatic 3D facial landmark localization may facilitate fast data acquisition and eliminate evaluator error. OBJECTIVES: In this paper, we propose a novel deep-learning method based on dimension-transformation and key-point detection for automated 3D perioral landmark annotation. METHODS: The 3D facial model is transformed into 2D images on which High-Resolution Network is implemented for key point detection. The 2D coordinates of key points are then mapped back to the 3D model using mathematical methods to obtain the 3D landmark coordinates. This program was trained with 120 facial models and validated in 50 facial models. RESULTS: Our approach achieved satisfactory accuracy of 1.30 ± 0.68 mm error in landmark detection with an average processing time of 5.2 ± 0.21 seconds per model. And subsequent analysis based on these landmarks showed an error of 0.87 ± 1.02 mm for linear measurements and 5.62 ± 6.61° for angular measurements. CONCLUSIONS: This automated 3D perioral landmarking method could serve as an effective tool that enables fast and accurate anthropometric analysis of lip morphology for plastic surgery and aesthetic procedures.

Subfascial Mini Muscle-Release Dual Plane Technique: A Modified Procedure for Breast Augmentation.

BACKGROUND: Each breast augmentation technique has advantages and indications, and the quest for the perfect implant pocket plane is ongoing. An ideal dual plane should meet three requirements: adequate implant coverage, optimal control of breast shape, and maximal muscle preservation. This paper reports a modified procedure for breast augmentation named subfascial mini muscle-release dual plane technique. METHODS: From an inframammary or periareolar approach, the implant pocket is dissected in a subfascial plane up to the pectoralis major. The muscle is split 3 cm above the lateral margin and then pocket dissection proceeds in the submuscular plane. A small portion of the costal origin is divided inferomedially creating a dual plane. RESULTS: A total of 178 patients with hypoplasia or breast atrophy were included, among whom 34 had breast ptosis and 20 had tubular breast deformity. The median follow-up period was 20 months. With an average implant volume of 268.8 ml and a smooth implant type of 85.4%, there was 1 case of hematoma, 2 cases of wound healing issues, 2 cases of rippling sign, 2 cases of grade III/IV capsular contracture, 5 cases of implant malposition and 12 cases of mild muscle contraction-associated deformity. Revision surgeries were performed on 2 patients. CONCLUSION: The subfascial mini muscle-release dual plane technique is an easy method for breast augmentation and is especially indicated for ptotic breasts and tubular breast deformities. This technique combines the advantages of traditional dual plane and muscle-splitting techniques, yielding a satisfactory aesthetic outcome.

Botulinum Toxin Treatment for Calf Contouring Based on the Study of Combined Injection of Gastrocnemius and Soleus.

BACKGROUND: Botulinum toxin is administered to paralyze the gastrocnemius muscle and reduce its size, thereby improving the calf contour and reducing the leg circumference of the calf. OBJECTIVES: In pursuit of better efficacy, we designed a new injection protocol that targeted both the gastrocnemius and soleus. An algorithm of botulinum toxin injection for calf contouring was proposed based on the results of the study and ultrasonographic data. METHODS: A prospective, self-controlled, double-blind study was conducted. The gastronemius muscle (GM) group (n = 17) included the patients whose gastrocnemius muscles were treated, and the GM + soleus muscle (SM) group (n = 17) included the patients who had both the gastrocnemius and soleus treated. Parameters including the maximum leg circumference and the subcutaneous fat, gastrocnemius muscle, and soleus muscle thicknesses were collected before and after injection. RESULTS: Both GM and GM + SM injection helped improve calf contour. Although the thickness of the gastrocnemius muscle was reduced, reducing the leg circumference, the subcutaneous fat and soleus muscle had compensatory thickening after injection, especially over the long term, which may affect the efficacy. Compared with the GM group, the GM + SM group effectively reduced the tendency of the soleus muscle to thicken. Calf muscle thickness could be roughly estimated by constructing a fitting equation and measuring height, weight, and leg circumference. CONCLUSIONS: Two injection methods achieved the effect of improving calf contour and reducing the leg circumference with equivalent patient satisfaction. The GM + SM injection group did not show any obvious extra clinical benefit when compared with the GM injection group.

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population.

BACKGROUND: Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment. OBJECTIVES: This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol. METHODS: Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients. RESULTS: Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results. CONCLUSIONS: Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

Free Superficial Circumflex Iliac Artery/Superficial Inferior Epigastric Artery Adipofascial Flaps for Facial Reconstruction of Linear Scleroderma.

BACKGROUND: Linear scleroderma is an autoimmune connective disorder characterized by a saber-shaped facial deformity. The superficial circumflex iliac artery/superficial inferior epigastric artery (SCIA/SIEA) adipofascial flap is versatile for facial reconstruction, providing excellent aesthetic outcomes and minimal donor-site morbidity. Thus, this study aimed to share our experience of successfully treating linear scleroderma using single-stage SCIA/SIEA adipofascial flap microsurgery transplantation. METHODS: To correct asymmetric facial malformations, the SCIA/SIEA adipofascial flap transplantation was performed on 5 individuals with linear scleroderma. The flap was harvested based on SCIA or SIEA patterns and diameters. Donor and recipient vessels, postoperative complications, aesthetic outcomes, and patient satisfaction were recorded. RESULTS: All flaps survived with zero necrosis. Regarding the donor artery, SIEA was performed on 1 patient (1 of 5) and SCIA on 2 patients (2 of 5), and the remaining 2 patients (2 of 5) used the common trunk. Patients maintained a satisfactory facial counter-correction 6 to 10 years postoperatively. The complications included localized desquamate and hypotrichosis. CONCLUSIONS: Free SCIA/SIEA adipofascial flaps improved facial linear scleroderma's long-term functional and morphological outcomes. This SCIA/SIEA adipofascial flap offers low mortality, invisible scars, and stable aesthetic outcomes compared with anterolateral thigh flap, parascapular flaps, and fat transplantation.

Faster Return to Daily Activities and Better Pain Control: A Prospective Study of Enhanced Recovery After Surgery Protocol in Breast Augmentation.

BACKGROUND: Enhanced recovery after surgery (ERAS) has been proven to decrease the amount of opioid use and reduce postoperative pain for a variety of surgeries, including breast reconstruction. However, data on ERAS in breast augmentation is lacking. OBJECTIVES: This study aims to investigate the effectiveness and safety of ERAS for breast augmentation. METHODS: A standardized ERAS protocol was established with full consideration of all aspects of perioperative care. Patients undergoing implant-based breast augmentation were prospectively recruited between December 2020 and January 2023, and assigned to either the ERAS or non-ERAS group randomly. The primary outcome was the activity of daily living after surgery. The secondary was postoperative pain and other outcomes included time to freely elevation, vomiting frequency, the use of analgesics, and complications. RESULTS: A total of 122 patients were included, with 70 in the ERAS group and 52 in the non-ERAS group. Compared to non-ERAS patients, ERAS patients had a shorter time to freely elevation of upper limbs (2.3 d vs. 5.5 d, P < 0.001). For ERAS patients, the pain scores were significantly lower on postoperative days 1 to 3, the activity of daily living index was significantly higher on postoperative days 1 to 3 and the opioids consumption was decreased (7.1 mg vs. 46.2 mg, P = 0.018). No difference was observed in complication and hospital costs between the two groups. CONCLUSION: The ERAS protocol significantly reduced postoperative pain and the use of opioids and promoted a return to daily activities without increasing complications in breast augmentation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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 .

How Camera-to-Subject Distance and Height Affect Breast Measurement and Follow-Up Assessment in Plastic Surgery.

BACKGROUND: Due to several factors that affect photograph quality, bias is inevitably present in two-dimensional (2D) breast photography. The principal variables affecting image performance at a fixed focus length are the distance between the camera and the subjects and the photography angles. OBJECTIVE: This study aimed to investigate the effects of camera-to-subject distances and camera height on breast measurement parameters to understand the trend of breast deformation and provide guidance for the accurate evaluation of planar follow-up. METHODS: We enlisted 16 volunteers with various breast cup sizes (A-D). Frontal and lateral photos were obtained with a steady focus of 50 mm at distances between 1.10 m and 2.20 m and at heights between 30 cm above the nipple and 30 cm below the nipple at intervals of 10 cm. Two researchers independently evaluated each volunteer's breast aesthetic parameters, including 11 linear parameters, 3 area parameters, and 3 ratio parameters, using Vernier calipers and Photoshop. RESULTS: The correlation coefficient of the two investigators ranged from 0.922 to 0.999. The results measured by Photoshop were 29.67 ± 5.23% greater than those of the Vernier caliper (p < 0.01). In contrast to ratio parameters, which showed no significant changes in each distance group (p = 1.00), linear parameters and area parameters significantly increased as object distance decreased (p < 0.05). The lower pole of the breast grew wider and flatter and occupied a larger proportion of the breast as height declined. CONCLUSION: Camera-to-subject distances of 1.5-1.7 m are recommended for stabilized and uniform breast photography. Varying shooting height affects breast distortion. Quantifying the relationship between photographic conditions and breast morphology enables plastic surgeons to conduct more comprehensive and accurate assessments. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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. Bullet point list: 1. The breast morphology will get more distortion with a smaller camera-to-subject distance. 2. Camera-to-subject distances of 1.5~1.7m are recommended for stabilized and uniform breast photography. 3. Height rather than distance affects the breast proportion.

Development and Validation of a Comprehensive Perioral Evaluation Method Using Three-Dimensional Stereophotogrammetry.

BACKGROUND: The non-invasive three-dimensional (3D) stereophotogrammetry is widely used in anthropometry for medical purpose. Yet, few studies have assessed its reliability on measuring the perioral region. OBJECTIVES: This study aimed to provide a standardized 3D anthropometric protocol for the perioral region. METHODS: 38 female and 12 male Asians were recruited (mean age 31.6 ± 9.6 years). Two sets of 3D images using the VECTRA 3D imaging system were acquired for each subject, and two measurement sessions for each image were performed independently by two raters. 25 landmarks were identified, and 28 linear, 2 curvilinear, 9 angular and 4 areal measurements were evaluated for intrarater, interrater, and intramethod reliability. RESULTS: Our results showed high reliability of 3D imaging-based perioral anthropometry by mean absolute difference (0.57 and 0.57 unit), technical error measurement (0.51 and 0.55 unit), relative error of measurement (2.18% and 2.44%), relative technical error of measurement (2.02% and 2.34%), and intraclass correlation coefficient (0.98 and 0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.78 unit, 0.74 unit, 3.26%, 3.06% and 0.97 for interrater reliability; and respectively 1.01 unit, 0.97 unit, 4.74%, 4.57% and 0.95 for intramethod reliability. CONCLUSIONS: This standardized protocol utilizing 3D surface imaging technologies are feasible and highly reliable in perioral assessment. It could be further applied for diagnostic purpose, surgical planning and therapeutic effect evaluation in clinical practice in relation to perioral morphologies. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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 .

Comparison of Total and Nontotal Endoscopic Transaxillary Breast Augmentation Techniques: A Retrospective Study.

BACKGROUND: The aim of this retrospective study was to compare the clinical outcomes of total endoscopic transaxillary (TET) breast augmentation with those of non-TET (NTET) breast augmentation. For the purposes of this study, the term NTET refers to the combination of blunt dissection and endoscopic techniques, whereas TET did not involve blunt dissection. METHODS: We conducted a retrospective review of 119 consecutive cases of primary breast augmentation from May 1, 2020, to August 31, 2020. The primary outcomes were the number of drainage days and pain scores as assessed using the visual analog scale on the first postoperative day. The secondary outcomes were the daily drainage volume recorded during the postoperative drainage days, the presence of postoperative daily pain that required the administration of tramadol for relief, reoperation rate, and operative time. RESULTS: The number of drainage days was significantly lower in the TET group than in the NTET group (TET vs NTET: 2.56 ± 0.57 vs 3.78 ± 1.30 days, P = 0.000). The visual analog scale score on the first postoperative day was significantly lower in the TET group than in the NTET group (TET vs NTET: 4.96 ± 0.63 vs 5.93 ± 0.93, P = 0.000). CONCLUSIONS: We observed that the major outcomes of the TET group were more favorable than those of the NTET group. Based on our results, we recommend the avoidance of blunt dissection during endoscopic transaxillary breast augmentation. LEVEL OF EVIDENCE: III.

The Dorsal Nasal Complex in Asians: Anatomical Variations and Injection Guide for Botulinum Toxin Type A.

BACKGROUND: Multiple muscles contribute to the formation of dorsal nasal lines (DNLs) and affect nasal aesthetics. Few attempts have been made to explore the range of distribution of DNLs in relation to injection planning. OBJECTIVES: The aim of this study was to classify the distribution types of DNLs and propose a refined injection technique validated by clinical study and cadaver dissection. METHODS: Patients were classified into 4 types according to their DNL distribution type. Botulinum toxin type A injections were administered at 6 regular points and 2 optional points. The effect on wrinkle reduction was assessed. Patient satisfaction was recorded. Cadaver dissection was conducted to explore the anatomical evidence of DNL variation. RESULTS: The study included 349 treatments in 320 patients (269 females and 51 males), whose DNLs were classified into complex type, horizontal type, oblique type, and vertical type. The severity of DNLs was significantly reduced after treatment. Most patients were satisfied. From the cadaver study, connecting muscular fibers were clearly observed among the muscles involved in the formation of DNLs, and these muscles were collectively named the dorsal nasal complex (DNC) by the authors. Four anatomical variations of the DNC were discovered, corroborating the DNL classification system. CONCLUSIONS: A novel anatomical concept, the DNC, and a classification system for DNLs were proposed. Each of the 4 distribution types of DNLs corresponds to a specific anatomical variation of the DNC. A refined injection technique for DNLs was developed, and its efficacy and safety were demonstrated.

An Easy Way to Harvest a Superthin SCIP Flap with Long Pedicle: Reappraisal of the Inferolateral Branches of the SCIA.

SUMMARY: Despite being the first free flap used in reconstructive surgery, the groin flap slowly fell out of fashion because of its short pedicle length, small vessel diameter, variable vascular anatomy, and bulkiness. Over the years, the authors have found that perforators consistently exist inferolateral to the deep branch of the superficial circumflex iliac artery (SCIA), forming an F configuration with the main branch. The authors propose a new type of superficial circumflex iliac artery perforator (SCIP) flap design based on the perforators derived from these inferolateral branches of the SCIA. These perforators have the advantage of anatomic consistency and can be easily found by making an exploratory incision 2 cm caudal to the inguinal ligament. The perforators of the inferolateral branches extend directly into the dermal plexus, and thus can yield superthin flaps without microdissection defatting. Retrograde dissection allows the surgeon to elongate the pedicle to include a section or full length of the SCIA as needed and involving minimal muscle dissection. SCIP flaps harvested based on the perforators of the inferolateral branches of the SCIA were used successfully for six head and neck reconstructions and two trunk reconstructions with no major complications, including flap loss or lymphedema. The best indications for SCIP flaps based on the inferolateral branches of the SCIA are superficial soft-tissue defects that do not require much volume replacement.

Studying Dynamics of Mid-face Lifting During Hyaluronic Acid Filler Injection Using Ultrasound Imaging.

BACKGROUND: The ageing in the mid-face involves volume deficiency in multiple anatomical units, including the zygomatic arch, infraorbital region, medial and lateral cheek and nasolabial fold (NLF). Hyaluronic acid (HA) is extensively used in the minimally invasive procedures of mid-face rejuvenation. OBJECTIVES: MD CodesTM is proposed to perform combined treatment of multiple sites to reduce treatment variability and increase clinician success rates. Although the detailed procedure of this technique, aesthetic effects and complications have been disclosed, its anatomical information has yet to be discussed. This paper elaborated on the static and dynamic anatomical characteristics of MD CodesTM through cadaveric dissection and ultrasound imaging. METHODS: Anatomical dissection and ultrasound imaging help us look back on the injection methods and anatomical principles of MD CodesTM. RESULTS: The treatment is threefold: (1) the bolus injections, for lifting purposes, are performed at the most depressing point along the zygomatic arch, zygomatic eminence, the prominent optimal point in the zygomatic region, the most depressed point of upper NLF with 0.2-0.3 ml HA. (2) The linear injections, featuring facial contouring refinement, are performed at the deep fat pad of the medial cheek and infraorbital region with 0.4 ml HA. (3) The linear injections, featuring volume replacement, are performed at the subcutaneous fat layer of lateral cheek and NLF with 0.8 and 0.4 ml HA. CONCLUSIONS: MD CodeTM is led by the principle of "less dosage and better effect", and a special injection sequence is formulated based on the anatomical characteristics. Ultrasound is a useful tool to make for a dynamic anatomical understanding of MD CodeTM and visualize the anatomical information such as layers and thicknesses. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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 .

The modified inframammary fold suture method and its clinical significance in primary augmentation mammoplasty.

BACKGROUND: The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three-layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. METHODS: Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. RESULTS: One hundred eighty-four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound-related adverse events (p = 0.026) and IMF-indented scarring (p = 0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF-indented scarring (OR = 16.9), followed by BMI (OR = 2.9). CONCLUSIONS: We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound-related adverse events and IMF-indented scarring.

Retraction Notice to: Tumor-Suppressive MicroRNA-216b Binds to TPX2, Activating the p53 Signaling in Human Cutaneous Squamous Cell Carcinoma.

[This retracts the article DOI: 10.1016/j.omtn.2020.01.022.].

The reconstructive strategy for pelvic oncological surgery with various types of MS-VRAM flaps.

BACKGROUND: Muscle-sparing vertical rectus abdominis myocutaneous (MS-VRAM) flaps are widely used in pelvic reconstruction. Aiming at optimal reconstructive outcomes, flap design and modification should be individualized to restore various kinds of defects. OBJECTIVE: Summarize an empirical strategy about MS-VRAM selection for different pelvic and perineal reconstructions. METHODS: Thirty patients who underwent total pelvic exenteration and pelvic reconstruction surgery from 2009 to 2017 were enrolled. The patients were divided into four groups according to the type of MS-VRAM-based flap used in the procedure: the modified long vertical flap (n = 10), the wrapping flap (n = 6), the de-epithelialized flap (n = 6), and the cork flap (n = 8). The follow-up period was 1 year after the surgery. Flap size, drainage volume, postoperative satisfaction, and complications were recorded, and postoperative photographs were collected. RESULTS: All of the patients achieved satisfying effect under the targeted reconstruction strategy. Of the four groups, the accurate cork flap finally acquires higher satisfaction, the shortest hospital stay, and the least total drainage volume. Meanwhile, the incidence of complications was not increased compared with the other groups. CONCLUSIONS: A new reconstructive strategy for pelvic reconstruction was established. Functional or non-functional reconstruction was accomplished by using various MS-VRAM flaps. Among them, the cork flap is the most economical flap to reconstruct pelvic floor defects with minimal tissue requirement and donor trauma.

The Origin and Development of Interrupted Subcuticular Suture: An Important Technique for Achieving Optimum Wound Closure.

BACKGROUND: Subcuticular suture is an important technique for achieving optimum wound closure, and there has been no comprehensive summary of subcuticular sutures to date. OBJECTIVE: To summarize the origin and development of interrupted subcuticular suture to help clinicians improve their wound closure skills. MATERIALS AND METHODS: A comprehensive review of subcuticular suture techniques was conducted in PubMed to summarize the advantages and disadvantages of various methods and clinical indications. RESULTS: Buried suture is the oldest subcuticular suture technique, followed by buried vertical mattress suture, intracutaneous butterfly suture, modified/variant buried vertical mattress suture, intradermal buried vertical mattress suture, buried horizontal mattress suture, wedge-section and modified buried vertical mattress suture, set-back suture, and modified buried horizontal mattress suture, which have gradually been applied in clinical practice. Buried vertical mattress suture is currently the most widely used subcuticular suture technique. CONCLUSION: Patients can certainly benefit from the appropriate application of subcuticular suture. There is also no single ideal method for achieving optimal results in all cases. Fully understanding the history of subcuticular suture can help doctors improve their wound closure technique.

Fused Lateral Clitoral Hood and Labia Minora: New Classification Based on Anatomic Variation of the Clitoral Hood-Labia Minora Complex and Simple Surgical Management.

BACKGROUND: Existing classifications of the clitoral hood-labia minora complex (CLC) have neglected its integrity and anatomic variation, resulting in failure to optimize approaches tailored to individuals. OBJECTIVES: The aim of this study was to present a new classification system for comprehensive evaluation of variations of the CLC and to introduce a simple surgical approach for the fused type. METHODS: Anatomic variations of the CLC were classified into 3 types: isolated labia minora or lateral clitoral hood hypertrophy (Type 1); conventional combined hypertrophy (Type 2); and fused lateral clitoral hood and labia minora (Type 3). A modified procedure for the fused type was performed in 4 steps: the anterior border of labia minora was defined first, then the hypertrophic lateral clitoral hood and labia minora were each removed separately, and finally the junction region was trimmed. Satisfaction questionnaires were administered during follow-ups. RESULTS: Among all 301 patients (602 sides), Type 2 was the most common variation (285 sides, 47.3%). Type 3 variations in 67 patients (105 sides, 17.5%) were identified, and 77.6% of these patients answered the questionnaires 3 months after surgery. For patients with type 3 variations, the satisfaction rate in the 4-step excision group was 91.7%, which was significantly higher than that in the wedge excision group (56.3%) (P = 0.01). The complication rate of the 4-step excision was 2.5%. CONCLUSIONS: Preoperative evaluation based on the new classification facilitated recognition of variations of the CLC, especially of the fused type. The 4-step excision is a simple, effective, and safe approach to treat the fused variation with high satisfaction.

CDCA3 is a prognostic biomarker for cutaneous melanoma and is connected with immune infiltration.

Introduction: Dysregulation of cell cycle progression (CCP) is a trait that distinguishes cancer from other diseases. In several cancer types, CCP-related genes serve as the primary risk factor for prognosis, but their role in cutaneous melanoma remains unclear. Methods: Data from cutaneous melanoma patients were acquired from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). Using a Wilcoxon test, the level of CCP-related gene expression in cutaneous melanoma patient tissues was compared to that in normal skin tissues. Logistic analysis was then utilized to calculate the connection between the CCP-related genes and clinicopathological variables. The important functions of the CCP-related genes were further investigated using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and single-sample Gene Set Enrichment Analysis (ssGSEA). Univariate and multivariate Cox analyses and Kaplan-Meier analysis were used to estimate the association between CCP-related genes and prognosis. In addition, using Cox multivariate analysis, a nomogram was constructed to forecast the influence of CCP-related genes on survival rates. Results: High expression of CCP-related genes was associated with TNM stage, age, pathological grade, and Breslow depth (P < 0.05). Multivariate analysis demonstrated that CCP-related genes were an independent factor in overall survival and disease-specific survival. High levels of gene expression originating from CCP were shown by GSEA to trigger DNA replication, the G1-S specific transcription factor, the mitotic spindle checkpoint, and the cell cycle. There was a negative association between CCP-related genes and the abundance of innate immune cells. Finally, we revealed that knockdown of cell division cycle-associated gene 3 (CDCA3) significantly suppressed the proliferation and migration ability of cutaneous melanoma cells. Conclusion: According to this study, CCP-related genes could serve as potential biomarkers to assess the prognosis of cutaneous melanoma patients and are crucial immune response regulators.

Three-Step Excision: An Easy Way for Composite Labia Minora and Lateral Clitoral Hood Reduction.

BACKGROUND: Hypertrophy of the labia minora with lateral clitoral hood redundancy is common, but the excess clitoral hood is often overlooked during labiaplasty, which may result in imbalanced and unsatisfactory outcomes. The purpose of this study was to present an easy method of three-step excision for composite labia minora and lateral clitoral hood reduction. METHODS: The procedure was performed in three steps: the prominent clitoral hood skin parallel to the labia majora and the clitoral hood sulcus was removed first; then, the protuberant portion of the labia minora was removed by wedge resection; and finally, a triangle at the junction between the labia minora and the clitoral hood was trimmed. Patients were required to return for examination on the first day and within 14 days after surgery. Follow-ups were arranged on the Internet or at the outpatient clinic. Satisfaction questionnaires were completed during follow-up. RESULTS: Between January of 2016 and January of 2020, 136 patients underwent composite labia minora and lateral clitoral hood reduction. Ages ranged from 9 to 55 years. Six patients experienced complications (4.4 percent) and five underwent revision surgery (3.7 percent). The overall satisfaction rate within 14 days and after 3 months following surgery was 91.0 percent and 95.5 percent, respectively. Preoperative discomfort was resolved in 43.0 percent and significantly relieved in 54.2 percent, and sex life was improved in 70.9 percent. CONCLUSIONS: Three-step excision is effective and safe for composite labia minora and lateral clitoral hood reduction with very high satisfaction. Considering the advantages of easy preoperative design and controllable tissue removal, this method could be a better alternative to the present procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Silver Ion Hydrocolloid Gauze and Self-Adhesive Polyurethane Foam Dressing Combination Therapy Can Better Promote Healing of Skin Graft Donor Area Than Traditional Therapy: A Case Control Study.

BACKGROUND: The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician. OBJECTIVE: With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites. MATERIALS AND METHODS: Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the experience of their own doctor. Donor sites were covered with silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group, n = 23]) or petrolatum gauze, sterile gauze, and compression bandage (control group, n = 25]). RESULTS: Wounds healed faster (mean, 12.7 days ± 2.4 standard deviation vs 22.0 days ± 5.8; P < .001), with fewer dressing changes (median [interquartile range, IQR], 2 [IQR, 2-3] vs 4 [IQR, 2.5-5]; P = .002), and with reduced pain on first dressing change (median visual analog scale score, 5 [4-6] vs 7 [6-7.5]; P < .001) in the AG+foam group compared with the control group. The Patient and Observer Scar Assessment Scales and overall scar ratings were better in the AG+foam group than in the control group (P < .001 for all). The AG+foam group had no infections; 2 infections occurred in the control group. CONCLUSIONS: Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.