Staged breast reconstruction with a subpectoral silicone implant and autologous fat grafting after tissue expansion / 中华整形外科杂志

Objective@#To explore the clinical application of subpectoral silicone implant associated with autologous fat grafting after tissue expansion, for breast reconstructions.@*Methods@#From Jan 2013 to Dec 2016, a total of 15 female patients were admitted to the plastic surgery department of the First Affiliated hospital of Fujian Medical University. They were after or were prepared to unilateral modified radical mastectomy. Patients were aged 18-50 years old, with the average of 33.5 years. There were 8 cases of T1N0MO (T1micN0MO, n=1), 3 cases of T2N0MO, 1 case of T2N1MO, 1 case of T1N2MO, 1 case of T2N2MO and 1 case of T3N3MO. A tissue expander was inserted beneath the posterior pectoralis major in first surgery. The cavity stripped range is greater than the expander around 1cm. The lowest position of the expander was determined according to the IMF of the other breast. The tissue expander was gradually filled intraoperatively and postoperatively periodically, until the expander exceeds 30%-50% of the volume of the other breast. Three months later, as the soft tissue over the breast area has stretched enough, the expander was removed in a second operation and a permanent implant was inserted. Meanwhile, the autologous fat particles, harvested from thigh or abdomen, was centrifuged at 800×g for 3 minutes. Then it was injected into the subcutaneous and posterior pectoralis major space. And the other breast may be adjusted if necessary for symmetry.@*Results@#Fifteen patients was included in this study (immediately tissue expander implanted, n=8; delayed tissue expander implanted, n=7). All the expanders are round in shape. The interval between the two operations was 6-12 months, with an average of 7.4 months. The total salt-water solution injected was 310-450 ml per patient, with an average of 365 ml. The volume of breast implants was 180-280 ml. The injection volume of autologous fat was 65-230 ml, 122.7 ml on average. All incisions healed well. The follow-up period was 1-3 years, with an average of 2 years. The reconstructed breasts were in a natural shape, with a slight drop and bilateral symmetry. According to Harris breast shape evaluation criteria, all reconstructed breasts were graded as excellent.@*Conclusions@#The permanent implant associated with autologous fat grafting after tissue expansion is alternative for breast reconstruction.

The application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method.</p><p><b>METHODS</b>The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface.</p><p><b>RESULTS</b>From July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months).</p><p><b>CONCLUSIONS</b>The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.</p>

Therapeutic effect of Vbeam pulsed dye laser in the treatment of port wine stains / 中华医学美学美容杂志

Objective To evaluate the clinical therapeutic effects of Vbeam 595 nm pulsed dye laser in114 cases of port wine stains.Methods 114 patients with port wine stains were treated with Vbeam 595 nm pulsed dye laser with 3～10 ms pulse width and 7mm spot size.The energy fluence used varied from 10 to 15 J/cm2.Dynamic cooling device(DCD)was used to protect epiderm,with DCD spray 30～40 ms and DCD delay 10～30 ms.The interval of therapy was 4～8 weeks.The results were graded on basis of cleaning and fading as follows:grade Ⅰ(＞75%),gradeⅡ(50%to 74%),grade Ⅲ(25%to 49%),and grade Ⅳ(＜25%).Results 114 patients completed the therapy.The number of treatments ranged from 1 to 10(mean 5.9).The results evaluated as grades Ⅰ,Ⅱ,Ⅲ and Ⅳ were 74 patients(64.9%),29 patients(25.4%),9 patients(7.9%)and 2 patients(1.8%),respectively.The therapeutic effect was analysed according to number of treatments.the ages of patients,site and color of the lesions.It was found that the therapeutic effect was prominent in patients of younger age,with pink lesions located on the neck and face.No recurrence and scar happened after 6 months to 2 years follow-up.Conclnsions Vbeam 595nm pulsed dye laser is a safe and effective method for the treatent of port wine stains,with less complications.

Clinical application of continuous rapid tissue expansion / 中华医学美学美容杂志

Objective To study a simple surgical method for continuous rapid tissue expansion and its clinical application. Methods The operation was accomplished in two-stage procedures. First, expanders were placed in the subcutaneous pocket through interlesional perpendicular short incisions. Continuous expansion by trace syringe pump began from the second day after expander placement. The speed of water injection was set according to patient's algesthesia reaction and vascularity of skin. The second operation was carried out at the third to fifth day after the expansion completed.Results The method was put into clinical practice in 22 cases (16 cases of scar, 2 cases of capillary angioma, and 4 cases of black nevus), and 35 expanders were placed. The speed of water injection was set in 0.2～0.8ml/hr/100ml.The mean time of water injection was 15.3 days. In the process of expansion, all cases were satisfactory except 1 case, in which the expander exposed in the incision. After the second operation, all flaps survived except one showing distal skin necrosis. The result was satisfactory after 3 months to 1 year follow-up. Conclusion The procedure consists of expander placement through interlesional perpendicular short incisions and continuous expansion in advance, which maximally shortens the time of expansion and hospitalization. This expansion method is a simple, safe, reliable, and ideal rapid tissue expansion technique.