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Objective:To investigate the therapeutic effect of conjoint fascia sheath suspension and levator palpebrae muscle shortening on congenital severe blepharoptosis.Methods:From June 2014 to December 2018, 30 cases (40 eyes) of congenital severe ptosis were treated in Ningbo First Hospital and Shaoxing Women and Children＇s Hospital. All patients were corrected by conjoint fascia sheath suspension and levator palpebrae muscle shortening. Six months after operation, the distance between the middle point of upper eyelid margin and corneal reflex point was measured to evaluate the correction effect of blepharoptosis; the improvement of upper eyelid appearance was evaluated by 5-point Likert scale (LS), and the incidence of complications was counted.Results:Thirty patients (40 eyes) were followed up for 6-12 months. Correction effect showed that preoperative marginal reflex distance (MRD) was (0.10±0.05) and postoperative MRD was (3.80±0.55); the difference was statistically significant ( t=0.95, P<0.05); 38 eyes (95%) were corrected and 2 eyes (5%) were undercorrected; appearance of upper eyelid showed that preoperative LS was (0.50±0.05) and postoperative LS (3.80±0.55); the difference was statistically significant ( t=0.98, P<0.05). Only one case was complicated with keratitis caused by improper early nursing after incomplete closure exposure, and the patient was cured by sealing the eyes combined with drug conservative treatment. Conclusions:Combined conjoint fascial sheath suspension and levator palpebrae shortening in the treatment of severe blepharoptosis has significant effect, with the advantages of simple operation, small surgical trauma, low recurrence rate, low incidence of complications, high predictability of surgical results and high satisfactory rate of patients.
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Objective@#To investigate the clinical effect of reconstruction of sensory anterolateral thigh perforator flaps in repairing soft tissue defects after radical operation for Paget disease of perineum.@*Methods@#From April 2017 to July 2017, Ningbo First Hospital treated 3 male patients with Paget′s disease of perineum, 2 patients with RayA2 stage and 1 patient with RayB stage. The range of soft tissue defect after resection of tumors is 8 cm×10 cm to 10 cm×12 cm. The anterolateral thigh perforator flaps were designed to repair skin defect, and the lateral thigh cutaneous nerve branch was contained to reconstruct protective sensation and restore autonomic nerve function. Tension-free direct suture was performed in part of the donor site, of which 3 cases were difficult to suture directly, 2 cases were treated with skin grafting and 1 case was closed with skin distractor.@*Results@#All 3 flaps survived. The average area of the flaps was about 12 cm×14 cm. The average follow-up period was 3 months. The appearance and function of the flaps were satisfactory. The average sensory recovery of the flaps was as high as S3. The autonomic nervous function was partially restored. Some of the skin had sweating function and normal skin temperature. At the same time, there was no difference between the urination function and sexual competence before operation. The donor site wound healed well and its appearance and function recovered well.@*Conclusions@#The reconstruction of sensory anterolateral thigh perforator flaps is an good method for repairing soft tissue defect after radical resection of Paget disease of perineum. It has satisfactory results in the protection and reconstruction of donor and recipient areas.
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To investigate the clinical efficacy of one-stage repairing the wounds after excision of soft tissue malignant tumor in lower limb with deep inferior epigastric perforator (DIEP) flaps. Methods From Au-gust, 2016 to July, 2018, 11 patients(8 males and 3 females; aged 35-76 years) with the soft tissue defects in the low-er limb underwent immediate reconstructive operations with DIEP flap after their tumor resection. The defects ranged in area from 11 cm×7 cm to 25 cm×10 cm after extended resection, including 5 cases of bone exposure. The DIEP flap area ranged from 11 cm×8 cm to 26 cm×18 cm.Among them, 9 cases were treated with free transplantation and 2 cases with pedicle transplantation.The donor sites were closed directly. The patients’ limb function, tumor recurrence and the healing of surgical incision had been followed-up. Results Eleven flaps survived and the donor sites healed directly. One flap had skin pigmentation due to postoperative vascular crisis, and the other flaps had satisfied texture and appearance. All patients were followed-up from 6 to 30 months. The lower limb movement was normal. All the donor sites had a good healing with no pain and abdominal complications. No tumor recurrence was observed during the followed-up period. Conclusion DIEP flap have many advantages, such as large cutting area, which is suitable for large-area wound repair after extended excision of soft tissue malignant tumor in lower limb. At the same time, the perforator vessel is constant and the caliber are thick, also the donor area is concealed and can be sutured directly.This kind of the technique for reconstruction of lower limb soft tissue defects after malignant tumor resection is well acceptable.
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Objective To observe the treatment outcome of using reversed island flap based on cutaneous branch of dorsal metacarpal artery for middle-and-distal finger soft tissue defect.Methods From May,2015 to March,2017,21 cases of middle-and-distal finger soft tissue defect were treated with reversed island flaps based on cutaneous branch of dorsal metacarpal artery which were designed on the dorsal hand pedicled by dorsal metacarpal artery.The flap was then elevated and rotated at the point where digital common artery was anastomosed with the terminal branch of the dorsal metacarpal artery.The cutaneous nerve included in the flap was anastomosed with the terminal branch of digital nerve to restore sensation and the donor site was covered directly.Regular followed-up was performed after operation.Results Except 1 case was suffered with distal 1/3 skin flap necrosis,flaps were well developed.Postoperative follow-up period was 3 to 12 months.All these flaps recovered with satisfying appearance and quality,excellent sensation with grade S3 to S4 and 5 to 8 mm of two-point discrimination.Range of motion(ROM)of the metacarpalphangeal and interphalangeal joint of the injured fingers was good.The excellent and good rate was 95.2％.Conclusion Reversed island flap based on dorsal cutaneous branch of dorsal metacarpal artery transfer is an ideal method for repairing middle-and-distal finger soft tissue defect.The surgery is simple.Reliable blood supply and sensation can be achieved without sacrificing the primary artery and nerve.There is minor donor site damage and very few complications.
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Objective To explore the method and clinical efficacy of microsurgical reconstructive surgery af-ter malignant tumors radical resection on the surface. Methods From June, 2015 to March, 2017, a total of 32 pa-tients in this group underwent radical resection of malignant tumors. All of them resulted in a large area of soft tissue defect with loss of function.The average defect area was 10.0 cm×12.0 cm.All types of free flap and pedicle flap were selected. Myocutaneous flaps or local flaps were used to repair large areas of soft tissue defect on the basis of micro-surgical techniques to protect the blood supply of the flaps and to reduce the damage to the donor area by evaluating the defect size, surrounding anatomical characteristics, and other factors. Results Thirty-two flaps survived com-pletely. After 4 to 18 months of followed-up, the color of flap was close to that of the surrounding skin. The texture was good. There was no bloated swelling, and the skin protective sensation was restored. There was no obvious scar hyperplasia, no chills, no pain and no other complications in the donor site. Conclusion After the radical mastec-tomy of the body surface, different types of flaps can be selected for the first-stage microsurgery according to the characteristics of the different parts and the tumor excision wounds to obtain a good clinical efficacy.