Effect of skin soft tissue expansion on repair of large area of scars on extremities / 中华烧伤杂志

Objective@#To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities.@*Methods@#Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded.@*Results@#All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion.@*Conclusions@#Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn′t enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.

Secondary deformity of postoperation of hypospadias and its treatment / 中华整形外科杂志

Objective@#To sum up the clinical manifestations and the method for repairing of secondary deformities of postoperation of hypospadias.@*Methods@#Applying balanus tissue flaps and urethral meatus plastic could correct the flat balanus and prevent urethral meatus from falling back. Resecting scar completely in penis and rebuilding urethral tissues could treat secondary curved penis. Applying modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis) could correct shorter and much smaller penis.@*Results@#Among January 1st 2007 to December 31st 2016, 62 cases were treated.All of them were male. Their ages were from 14 to 34 years old.55 cases were followed up from 6 months to 9 years after operations, but 7 cases could not be followed up because of the change of addresses and phone numbers.All patients achieved excellent cosmetic result. None of them had complications like urethral fistula.@*Conclusions@#After operations of hypospadias, the secondary deformities may happen when the children grow up.And these deformities always need to be corrected with operations. Balanoplasty, correction of penis and the penile augmentation are good methods for secondary deformities.Consequently, a good penis appearance and function can be acquired.

One-stage reconstruction of distal urethra with free graft of tublar oral mucosa / 中华整形外科杂志

Objective@#To investigate the therapeuctic effect of one-stage reconstruction of distal urethra with free graft of tublar oral mucosa.@*Methods@#Two strips of oral mucosa graft( 0.4—0.6 cm in width), were harvested and sutured around an oiled silk roll to form mucosa tube. The mucosa tube was used to reconstruct distal urethra. Postoperative pressure dressing and earlier urination were recommended.@*Results@#From May 2007 to October 2015, 16 cases with distal urethra defect or stenosis were treated with this method. The urethra defect was 2—4 cm in length. Urethral fistula happened in 3 patients. All the other 13 cases healed primarily. 10 cases were followed up for 1—5 years by telephone with normal function.@*Conclusions@#One-stage reconstruction with free graft of bulbar oral mucosa is suitable and reliable for distal urethra defect less than 4 cm in length.

Application of V shape flap for the urethral external meatus and glanuloplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.</p><p><b>METHODS</b>The V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.</p><p><b>RESULTS</b>From January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.</p><p><b>CONCLUSIONS</b>Postoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.</p>

Repeated expanded bilateral deltopectoral flap for resurfacing severe facial-cervical scar / 中华医学美学美容杂志

Objective To investigate the application of the repeated expanded bilateral deltopectoral flap for resurfacing severe facial cervical scar, with review of relating articles to discuss issue of repeated expanding flap.Methods Nine patients suffered from hyperplastic facial and cervical scar.Two soft tissue expanders were implanted into the anterior chest region at both sides of sternum.The center of inner border of the expander was at the cross of second intercostal and parasternal line, and the lengthways axe of the expander was located at the ligature of the second intercostals and mammary areola.After two weeks when the expander was filled, expanded flap was transferred to cervical defect.The transferred flap was repeated expanded after half a year and transferred to resurface facial defect.Results In the first expansion stage, 600 or 800 ml expander were implanted in each side of sternum.In the second stage, 400 or 500 ml were used.The first stage of expanding process was smooth, and 2 of the expanding flaps were ruptured during the second expansion period.400-520 cm2 (average 440 cm2) additional expanded flap was acquired during two stages of expanding.Conclusions The repeated expanded bilateral deltopectoral flap gives us greater opportunity to repair severe facial-cervical scar.The best interval time of the two-stage expansion is over half a year.The speed of second expansion should be lower than that in the first stage, and protecting the expanding flap carefully from external force compression is needed during the second expasion.

Repair of middle and lower face scars using alar thin expanded cervical flap with pedicle in anterior neck / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face.</p><p><b>METHODS</b>From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers.</p><p><b>RESULTS</b>The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting.</p><p><b>CONCLUSIONS</b>The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.</p>

Comparative study of three different methods for penile reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To compare the effect of three methods for penile reconstruction.</p><p><b>METHODS</b>From Sept. 2000 to Dec. 2012, penile reconstruction was performed in 48 cases with free scapular flap transplantation, or pedicled superficial circumflex iliac artery skin flap, or anterolateral thigh skin flap pedicled with lateral circumflex femoral artery. The flaps were 12.0-14.5 cm in length, 10-12 cm in width and the urethra perimeter was about 2-3 cm.</p><p><b>RESULTS</b>Free scapular flaps were used in 21 cases, with flap failure in 3 cases due to insufficient blood supply. Malleable penile prosthesis was implanted in 11 cases, which was exposed in 3 cases. Groin skin flaps were used in 21 cases, with flap failure in 8 cases due to insufficient blood supply. Malleable penile prostheses were implanted in 7 cases, which was exposed in 3 cases. Anterolateral thigh skin flaps were used in 6 cases, with flap failure in 2 cases due to necrosis and infection. No prosthesis was implanted in this group. All the failure cases underwent secondary reconstruction with successful results. 37 cases were followed up for 1-6 years, avevage 2.5 years. 26 cases were satisfied with the results of appearance and function.</p><p><b>CONCLUSIONS</b>Among these three methods, the free scapular flap is most recommended for its high survival rate, low complication rate and high patient satisfaction.</p>

Continuously observing cutaneous vitality of DIEP flap in rat model / 中华显微外科杂志

Objective To carried out rat as deep inferior epigastic perforator (DIEP) flap necrosis model,to reveal the continuous blood fluid change in process of flap necrosis.Methods Seven SpragueDawley rats of male were used.The designed DIEP flap model was pedicled on the right-sided cranial perforator.Near-infrared fluorescent angiography was performed using SPY imaging system pre-and-aft operation and all angiography videos were compared and analyzed.Results Using SPY imaging system could observe the process of the blood fluid scattered from perforator through choke anastomoses to next vascular territories in living body.The study could clearly observe sequence change of blood fluid pr-and-aft operation,which could give the important information in revealing the reason of necrosis in DIEP flap.Cross-midline traffic vascular sparse and eventually could no longer wear through the contralateral abdominal wall vessel area and open in the region of lateral thoracic vascular occlusion of blood vessels to reach the flap to the far left side,and showed no blood flow in the dark zone.Conclusion The reasons of necrosis of contralateral distal zone of the flap model,are the choke anastomoses across the midline to the contralateral side appeared small,less intensity and the blood supply to contralatral distal zone should through twice choke anastomoses.

Clinical efficacy of subcutaneous pedicle flap from temporal region in treatment of lower eyelid ectropion / 中华医学美学美容杂志

Objective To investigate a new method and to observe the clinical effect of repairing the lower eyelid ectropion assisted with the subcutaneous pedicle flap from temporal region. Methods Since 2007, 24 patients with lower eyelid ectropion were treated with the subcutaneous pedicle flap from temporal region which was the donor area without hairs, including 8 cases of scar infection, 6 cases of trauma, and 10 cases of tumor removal. Among the 24 cases of the flap, the maximum area was 5. 5 cm× 1. 5 cm,and the minimum was 4. 0 cm × 1.0 cm. Results All patients were followed up for 6 months to 3 years.All flaps survived completely with excellent texture and appearance. The donor site was hidden and no obvious malformation of the donor site was observed. Conclusions Because the blood supply of flap is reliable and the incision in the donor site is hidden, the subcutaneous pedicle flap from temporal region pedicled with arterial network of the outer canthus is an ideal donor site for repairing the lower eyelid ectropion with full thickness defects.