Functional evaluation of a "two in one" urethroplasty for hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the functional result of a "Two in One" urethroplasty which combined oral mucosa graft and local flap.</p><p><b>METHODS</b>17 patients with hypospadias underwent a "Two in One" urethroplasty, which combined buccal mucosa and local flap for urethral reconstruction. Uroflowmetry was performed 1 day before and 1 year after operation. The urine flow rate, voided volume and urine flow curves were detected using a rotating sensor. The results of maximum urine flow rate (Qmax) were expressed as percentiles and compared to the Toguri value from normal children.</p><p><b>RESULTS</b>Before corrective operation, 12 of 17 patients (70.6%) produced a plateau urine flow curve. 5 patients (29.4%) produced a very low flow curve. The average maximum flow rate was (7.89 +/- 2.29) ml/s per second compared to Toguri values, 12 of 17 patients (70.6%) had a Qmax below the normal 5th percentile. After a "Two in One" urethroplasty, a hell-shaped curve was obtained in 10 patients (58.8%). The maximum flow rate was (11.30 +/- 3.01) mL/s per second. 7 of 17 patients (41.2%) had a Qmax above the normal 25th percentile, 8 patients (47.1%) had a Qmax between the normal 25th percentile and 5th percentile, only 2 patients (11.8%) had a Qmax below the 5th percentile.</p><p><b>CONCLUSIONS</b>The functional result of the "Two in One" urethroplasty is ideal. The maximum urine flow rate of the patients increases after the operation.</p>

Which vessel, the artery or the vein is more important in vascular supercharge: an investigation of vascular changes on rat abdominal supercharging flap models / 中华整形外科杂志

<p><b>OBJECTIVE</b>The study was to reveal the vascular changes in three different supercharging flap models. From this study, we want to investigate which vessel, the artery or the vein is more important in elongating perforator flap survival and why.</p><p><b>METHODS</b>Twelve rats were divided into three experimental groups. The left side flaps in all groups were pedicle using xiphoid perforator as control group. The right side flaps were supercharging experimental group. Group I, flap supercharged based on artery and vein of pubis perforator. Group II, flaps supercharged based on artery of pubis perforator. Group III, flaps supercharged based on vein of pubis perforator. Near-infrared fluorescent angiography was performed using SPY imaging system pre-and-aft operation and all angiography videos were compared and analyzed.</p><p><b>RESULTS</b>Showed in angiography video of SPY, in control group and vein supercharging group, blood supply could be observed the immediately reducing, and almost be disappeared the amount of perfusion to distal area. It shows relatively constant necrosis in the distal side of control group and vein supercharging group, and the necrosis of vein supercharging group smaller than these of control group. In artery, vein supercharging group and artery supercharging group, blood perfusion could be observed separately perfusion in the upper and low area of flap. There are complete survival showed on the artery supercharging group and artery and vein supercharging group.</p><p><b>CONCLUSIONS</b>These findings indicated that congestive flap necrosis attribute to insufficiency of arterial blood. Arterial inflow was demonstrated more important for improved survival of distal flap than venous outflow.</p>

Applied anatomy of cervico-acromial crossing skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the applied anatomy of the blood supply of the cervicoacromial crossing flap and its feasibility in clinical application.</p><p><b>METHODS</b>5 fresh adult and 10 forman fixed adult cadaver specimens were used. The arteries, veins, cutaneous arteries, subdermal vascular network, and vascular network of the superficial layer of deep fascia in the cervico-acromial area were observed and studied under the microscope. The frontier border of the cervico-acromial area is clavicle, the posterior border is the spine of scapula, the outer border is acromion and the inner border is cervical base.</p><p><b>RESULTS</b>(1) The perforator branches concentrate at the front edge of trapezius muscle; (2) The vessel network around the front edge of trapezius muscle is abundant. Among the anastomosis, two or three anastomosis which across the area from the base of the neck to acromion can be observed in the axial of every cervico-acromial area. Abundant vessel network can be observed in the superficial layer of deep fascia.</p><p><b>CONCLUSIONS</b>The blood supply of the cervico-acromial flap is abundant, which constains constant perforator point. The cervico-acromial crossing skin flap can be applied with the rich blood supply and abundant vessel network in the superficial layer of deep fascia.</p>

Penile augmentation and elongation using autologous dermal-fat strip grafting / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of autologous dermal-fat strip grafting in penile augmentation and elongation.</p><p><b>METHODS</b>From May 2004 to December 2010, 24 patients underwent penile enhancement with free dermal-fat strip grafting. Through suprapubic incision, the superior suspensory ligament and part deep suspensory ligament are cutted off to lengthen the penis. The resulted dead space is filled with the autologous dermal-fat strip (6.0-9.5 cm in length, 1.2-1.5 cm in width and 0.6-0.8 cm in depth) to enhance the penis.</p><p><b>RESULTS</b>Primary healing was achieved in 23 cases. Incisional fat liquefaction happened in one case which healed after dressing change. The penile appearance was satisfactory both at rest or erection. The penile length and circumference increased by 2.5-4.8 cm (average, 3.2 cm) and 1.8-3.0 cm (average, 2.4 cm), respectively. 18 patients were followed up for 3 months to 5 years. All the patients were satisfactory on the cosmetic and functional results. No complication happened.</p><p><b>CONCLUSIONS</b>It is safe and effective for penile augmention and elongation with autologous dermal-fat strip grafting and disconnection of penile suspensory ligament.</p>

Tubed oral mucosa for staged treatment of congenital hypospadias in infancy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the treatment of congenital hypospadias in infancy.</p><p><b>METHODS</b>After correction of chordee, the tubed oral mucosa was used to prefabricate urethra in penis as free graft. The urethral anastomosis was performed at the second stage. The scrotum fascia flap, pedicled with scrotal artery, was transferred to cover the penile defect.</p><p><b>RESULTS</b>From Jan. 2007 to May 2010, 42 cases were treated. The tubed oral mucosa was 3.0-4.0 cm in length, and 0.6-0.8 cm in diameter. The maximum size of scrotum flap was 1.5 cm x 3.0 cm. Urethral fistula happened in two cases due to necrosis at the distal end of scrotal flap, which was healed spontaneously after dressing for 1-2 weeks. Primary healing was achieved in all the other cases. After operation, the 26 cases have been visited for 6 months to 3 years, no urethra fistula , narrow and the penis curved. There is an universal urinate for oneself and a good form.</p><p><b>CONCLUSIONS</b>The tubed oral mucosa can be used to prefabricate urethra, which is anastomosed at the second stage. The tubed oral mucosa combined with scrotal fascial flap which has a reliable blood supply, is very suitable for hypospadias in infancy.</p>

Application of tunica vaginalis flap for multi-fistulas after urethroplasty in hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discussed a new technique for multi-fistulas after urethroplasty in hypospadias.</p><p><b>METHODS</b>8 cases with postoperative multi-fistulas, which were not successfully repaired by previous treatment, were reoperated with tunica vaginalis flap combined with urethral stent and elastic dressing. The multi-fistulas were located between glan and scrotum. The number of fistulas was 3-7 (median, 5).</p><p><b>RESULTS</b>Primary healing was achieved in all the 8 cases. The micturition and esthetic result were satisfied. 5 cases were followed up for 8-10 months with no recurrence of fistula. There was also no dysuria and penile curvature.</p><p><b>CONCLUSIONS</b>Tunica vaginalis flap combined with urethral stent and elastic dressing is an effective technique for multi-fistulas after urethroplasty. It is easily performed with reliable result.</p>

Anatomy correction of penile epispadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the pathological characters and anatomic correction of penile epispadias.</p><p><b>METHODS</b>The urethra was formed by local urethra plate mucosa flaps. The contracture on dorsum of penis was released by cutting off the superficial suspensory ligament to reposition the penile and urethral sponge.</p><p><b>RESULTS</b>From Jun. 2004 to Dec. 2010, 26 cases with penile epispadias were treated. 18 cases were followed up for 6 months to 5 years. 10 cases were treated successfully with good cosmetic and functional results. Urinary incontinence happened in 8 cases, which healed after tightening operation.</p><p><b>CONCLUSIONS</b>The anatomic correction of penile epispadias can recover the normal anatomic structure, resulting good cosmetic and functional results.</p>

Application of temporal-zygomatic expanded flaps pedicled with orbicularis oculi muscle for sub-orbital defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of temporal-zygomatic expanded flaps pedicled with orbicularis oculi muscle (00M) for sub-orbital defects.</p><p><b>METHODS</b>16 cases with sub-orbital defects were treated. The expanders were implanted at temporal-zygomatic region at the first stage. At the second stage, temporal-zygomatic expanded flaps pedicled with OOM were designed and transferred to repair the suborbital defects.</p><p><b>RESULTS</b>All the expanded flaps survived completely. 11 cases were followed up for 3 months to 3 years. The flaps had no contracture with a good match of color and texture with surrounding tissue. The scar was also inconspicious.</p><p><b>CONCLUSIONS</b>The temporal-zygomatic expanded flaps can be used for large size defects below orbit. It is very flexible, leaving minimal morbidity for the whole face.</p>

Clinical application of expanded submental island flap in facial soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of the expanded submental island flap in facial soft tissue defect.</p><p><b>METHOD</b>12 patients with facial soft tissue defects were treated with the expanded submental island flaps during September 2004 to September 2008. At the first stage, soft tissue expander was implanted in the neck. At the second stage, the submental island flap was designed to repair the facial soft tissue defect. The largest size of the flap was about 16 cm x 9 cm.</p><p><b>RESULT</b>All flaps survived well except for one case of partial epidermal necrosis at the distal part of the flap. The wound healed with dressing. 4 patients were followed up for 6-24 months with satisfactory results.</p><p><b>CONCLUSION</b>The submental artery was a constant branch of facial artery. Large cervical flap with high quality tissue can be provided after expansion. The expanded submental island flap is a good choice for repairing the facial soft tissue defect.</p>

Staged treatment of the severe hypospadias in adult / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the treatment of serious hypospadias in adults with free graft of tubed mouth mucosa and scrotal fascia flaps.</p><p><b>METHODS</b>The tubed mouth mucosa was free grafted to fabricate the distal segment of urethra. It was anastomosed to the urethra at the second stage. The scrotal fascia flap was used to cover the penile wound. The biggest flap was 3 cm in width and 6.5 cm in length.</p><p><b>RESULTS</b>From Jan. 2002 to Dec. 2007, 76 adults with severe hypospadias were treated. Infection happened in 4 cases. 2 cases had urethral fistula due to the partial flap necrosis which was healed automatically within 2-4 weeks. All the other patients healed primarily.</p><p><b>CONCLUSIONS</b>It is a good method for the treatment of serious hypospadias in adults with scrotal fascia flaps and free graft of tubed mouth mucosa which is anastomosed to the urethra at the second stage.</p>

Division of the proximal urethral plate and skin graft at the ventral surface of the penis for severe hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a technique for the treatment of severe hypospadias.</p><p><b>METHODS</b>At the first stage, the proximal end of the urethra plate was divided and the chordee was corrected, followed by skin graft at the ventral surface of penis. The urethroplasty was performed at the second stage half a year later.</p><p><b>RESULTS</b>From Feb. 2004 to Mar. 2005, 17 cases were treated successfully without any complication. After one year of following up, the appearance of glan and the urethral meatus was good and the chordee was corrected completely. The appearance of penis and scrotum was also satisfactory.</p><p><b>CONCLUSIONS</b>The technique is easily performed and very suitable for penile and penoscrotal junction hypospadias with severe chordee.</p>

The long-term contrastive result of neo-urethra reconstructed with different kinds of tissue / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the long-term apparent and structural change of the neo-urethra inner wall reconstructed with different kinds of tissue. To compare the difference between normal and reconstructed urethra for urethra reconstruction with more appropriate materials.</p><p><b>METHODS</b>The neo-urethra inner wall was observed during operation, through urography and urethroscope. The tissue section of neo-urethra inner wall was observed through light microscope and electron microscope.</p><p><b>RESULTS</b>With unchanged structure, the appearance of neo-urethra reconstructed with skin or mucosa could be close to normal urethra after a long time. Neo-urethra made of buccal mucosa possesses some of the most important basic structures for normal urethral microenvironment to form. The structure of neo-urethra made of bladder could be close to normal urethra after a long time.</p><p><b>CONCLUSIONS</b>Buccal and bladder mucosa may be a better material than skin for urethra reconstruction.</p>

New concept of the treatment for redundant prepuce / 中华整形外科杂志

<p><b>OBJECTIVE</b>Literatures on the development and function of prepuce was reviewed. To compare the merit and demerit of treatment for redundant prepuce by conventional circumcision or by removing the root skin of the penis. To investigate the ideal method and time of treatment for redundant prepuce.</p><p><b>METHODS</b>The extended length of the penis and the extended skin of penis were carefully measured and the excess skin at the root of the penis was removed from the surface of Colle's fascia. Then the remaining distal skin was drew back to suture to the root of the penis. As for the cases complicated with stenosis of prepuce, longitudinal incision was performed along the constricted area to release stenosis, followed by transverse closure of the wound.</p><p><b>RESULTS</b>110 adult cases of simple redundant prepuce and 40 cases complicated with stenosis were treated by this way. Functional and cosmetic results were achieved without any complications in all cases. All patients were satisfied with the result.</p><p><b>CONCLUSIONS</b>Removal of the excess skin at the root of the penis should be preferred to the conventional circumcision for treatment of redundant prepuce. The ideal time for intervention is at or after adolescence, when the prepuce has developed maturely. Non-operative methods should be taken to treat phimosis and adherent prepuce before adolescence.</p>

A rhombus shape excision of the soft palate to treat obstructive sleep apnea hypopnea syndrome / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a surgical treatment for obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>12 cases were treated during the period from Jan 1998 to Aug 2006. Partial soft palate was resected in rhombus shape from the middle to shorten the soft palate and enlarge the pharyngeal cavity. The uvula was reserved.</p><p><b>RESULTS</b>The patients were followed up for six months to five years. There was no complication. Good results were achieved in 9 patients. 2 cases got some kind of improvement. No improvement happened in one case who received a partial tongue resection later.</p><p><b>CONCLUSIONS</b>A rhombus shape excision of the soft palate from the middle is effective for the treatment of OSAHS with few complication.</p>

Partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy of partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia.</p><p><b>METHODS</b>There were 4 patients performed this procedure. We took a rhombus shape incision in the middle of the tongue and performed a wedge excision.</p><p><b>RESULTS</b>The mouth can close entirely in all of patients and there weren' t hemorrhage and obviously swollen; Tongue's sensory function hadn't disturbance. Masticate function were normal. One patient still had the symptom that tongue lied outside the oral cavity occasionally after operation. The symptom was disappeared after Temperature-controlled radiofrequency (TCRF) ablation. All of patients' parent were satisfied with the results.</p><p><b>CONCLUSIONS</b>Partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia is an effective, much safer and less invasive procedure without obvious adverse reactions. There are better prospects for applying.</p>

The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients / 中华整形外科杂志

<p><b>OBJECTIVE</b>Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias.</p><p><b>METHODS</b>In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath.</p><p><b>RESULTS</b>Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up.</p><p><b>CONCLUSIONS</b>The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.</p>

Treating later facial nerve palsy with the method of combining free graft of de-nerve short extensor muscle of toe with the technique of inducted undermined suture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a more effective operative method for later facial nerve palsy.</p><p><b>METHODS</b>A synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was used in 432 cases of later facial nerve palsy.</p><p><b>RESULTS</b>82% of 432 cases acquired satisfactory effect that consisted of static symmetry and dynamic rough symmetry in facial expression. 12% cases only acquired static symmetry in facial expression but the dynamic symmetry were insufficient. Unsatisfactory results were occurred in 6% cases as both the static and dynamic symmetry of their facial expression were insufficient, which acquired preferable results 2 another suspending operation 8 to 12 months later. 4 cases got post operation infection; through cases happel in foot and 2 in face. All of them were cured by the treatment of drain and antibiotic in 3 weeks. 46% cases were followed up by further consultation or telephone. The longest followed up was period 12 years, while the shortest was 1 year, and the average was 28 months. 93% patients were satisfactory with the results, and 7% patients thought that their facial expression symmetry were insufficient though their facial abnormality were improved obviously.</p><p><b>CONCLUSIONS</b>The synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was an effective method for later facial nerve palsy, and most of the patients could acquired satisfactory results. This operative method is good for popularize because of its simple operation, slight tissue injury and fews complication post-operation.</p>

The establishment of hypospadias rat model and embryoteratogenic test of Atrazine / 中华整形外科杂志

<p><b>OBJECTIVE</b>To establish an easily reproducible animal model of hypospadias and to test whether Atrazine can induce hypospadias in animal experiment.</p><p><b>METHODS</b>From the 11th to 16th day after conception, 120 conceived SD rats were divided randomly into 6 groups: one coin oil group (1 ml/kg/d), two finasteride groups (10 mg/kg/d, 20 mg/kg/d), three Atrazine groups (25 mg/kg/d, 100 mg/kg/d, 200 mg/kg/d). When all pregnant rats had delivered, the new born rats were counted and the penis appearance, urethral orifice position and micturition were observed with magnifying lens and anatomy microscope.</p><p><b>RESULTS</b>Hypospadias were found in new born male rats treated prenatally with Finasteride (10 mg/kg/d, 20 mg/kg/d) and 200 mg/kg/d Atrazine groups. The incidence was 28.30%, 67.03%, 10.23% respectively. Embryotoxic effects were observed at 25 mg/kg/d Atrazine group in 2 rats and associated with no severe maternal toxicity.</p><p><b>CONCLUSIONS</b>(1) A hypospadias SD rats model can be established by Finasteride and it is easily reproducible. (2) The Atrazine was teratogenic to the SD rats, embryotoxic effects were observed at the low dose level and associated with no severe maternal toxicity.</p>

Treatment of the congenital exstrophy of bladder / 中华整形外科杂志

<p><b>OBJECTIVE</b>To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy.</p><p><b>METHODS</b>The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm.</p><p><b>RESULTS</b>12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting.</p><p><b>CONCLUSIONS</b>Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.</p>

Unilateral buccinator myomucosal island flap with double opposing Z-plasty for wider palatal cleft repair / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a method to repair larger cleft palate and lengthen soft palate without oral palate raw surface and scar formation, reduce the effect on maxilla and dental arch development.</p><p><b>METHODS</b>A modified double opposing Z-plasty was used to lengthen soft palate and the nasal palate was closed by using large turn-over mucoperiosteal flaps on the oral surface of the junction of the hard palate and soft palate, oral raw surface on the palate was closed by a buccal myomucosal island flap.</p><p><b>RESULTS</b>Thirty-six palates have been repaired by this procedure, all of which had satisfactory results without flap necrosis, infection, difficulties in opening mouth and facial nerve injury except two post-operative fistulas. Eight patients were followed up and all display complete velopharyngeal closure.</p><p><b>CONCLUSIONS</b>Using unilateral buccinator myomucosal island flap with double opposing Z-plasty to repair wider palatal cleft can get a satisfactory soft palate lengthening. At the same time it can avoid bone surface exposing and scar formation; it is a safe and reliable procedure.</p>