A Subunit-Based Concept for Preoperative Design of the Cauliflower Ear.

PURPOSE: Cauliflower ear is an ear deformity caused by a closed ear injury with varying severity. Several studies on the systematic reconstruction of cauliflower ear have been reported. Here, the authors aim to introduce a simplified subunit-based reconstruction concept for the cauliflower ear. METHODS: The authors retrospectively analyzed all patients who underwent surgery to repair cauliflower ear in our department from April 2021 to April 2023. Patients' demographic information, clinical characteristics, and outcomes were recorded. All patients were followed up for 1 year. TECHNIQUE: The authors assessed each subunit of the cauliflower ear in sequence in terms of the change in size and shape and decided whether tissue removal or grafting is needed. The surgical design was obtained by a combination of all subunits. RESULTS: The authors included a total of 5 patients with mild and moderate cauliflower ear repaired by the subunit-based method. The shape of all the involved ear subunits of our patients was almost restored. No patient needed the use of cartilage grafts and flaps. The authors summarized 5 common subunits with deformity: helix, scaphoid fossa, antihelix crura and triangular fossa, antihelix body, and concha. The pathology results reported a keloid in 1 case. All patients reported no recurrence and were satisfied with the surgery after 1 year. CONCLUSIONS: The authors reported a simplified subunit-based method of preoperative evaluation and design of cauliflower ear, as a new alternative option to complement the current clinical strategies. The authors also reported the first case of a keloid in cauliflower ear.

CLC-3 regulates TGF-ß/smad signaling pathway to inhibit the process of fibrosis in hypertrophic scar.

Objective: To study the role and mechanism of chloride channel-3 (ClC-3) in the formation of hypertrophic scar by constructing ClC-3 interference vectors and examining their effects on human hypertrophic scar fibroblasts (HSFB). Methods: Human HSFB and human normal skin fibroblasts (NSFB) were used in this study, and ClC-3 interference vectors were constructed to transfect cells. ClC-3 inhibitors NPPB and Tamoxifen were used to treat cells. Cell migration and the expression of TGF-ß/Smad, CollagenⅠ,CollagenⅢ were examined to explore the role of ClC-3 in the formation of hypertrophic scar. Results: Compared with the normal skin tissue, the positive expression of ClC-3 and TGF-ß in the scar tissue was significantly increased. The relative expression of ClC-3 and TGF-ß1 in HSFB cells was higher than that in NSFB cells. Interfering with the expression of CLC-3 can inhibit the migration of HSFB cells and the expression of TGF- ß/Smad, CollagenⅠ/Ⅲ. The experiment of HSFB cells treated by CLC-3 inhibitors can also obtain similar results. Conclusion: Inhibiting CLC-3 can reduce the formation of hypertrophic scars.

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury.

Purpose: The key point of eyelid margin reconstruction is to keep both the support function and aesthetic appearance. The eyelid's complex anatomical structures make eyelid margin reconstruction demanding. Eyelid margin defects are conventionally classified by their width relative to the eyelid width: small, medium, or large. In this study, we introduce a reconstruction method for small to medium defects. Patients and Methods: We conducted a single-center case series of patients from the practice of a single experienced plastic surgeon at a tertiary center. We included consecutive outpatients from 2014 to 2021. The inclusion criteria were (1) eyelid margin mass and (2) willingness to receive eyelid margin reconstruction by the reported method. The exclusion criteria were (1) eyelid margin mass involving most or all of the tarsus and (2) less than one year of follow-up. Patients were followed up face to face or online. Patients' demographics, clinical characteristics and outcomes, and satisfaction were collected. The clinical outcomes were assessed and scored by two plastic surgeons. Procedure: We reconstructed the anterior lamella with an advancement musculocutaneous flap and repaired the posterior lamella with a specially designed advancement tarsoconjunctival flap, of which a piece of tarsus was shaved and the corresponding remnant conjunctiva was bent forward to cover the tarsus edge to avoid ocular injury. Results: We included 24 patients (25 lesions). Almost all patients had eyelash discontinuity. One patient presented slight notching of the lower eyelid margin. The other patients reported no complications or recurrence. The average outcome score was 1.23±0.69, indicating that our method was excellent. All patients were very satisfied with the surgery. The average follow-up time was 5.75 years. Conclusion: We report a reconstruction method for small to medium eyelid margin defects and a novel design for preventing ocular injury, which is an especially good option for transverse defects.

Parameter-Adaptive TVF-EMD Feature Extraction Method Based on Improved GOA.

In order to separate the sub-signals and extract the feature frequency in the signal accurately, we proposed a parameter-adaptive time-varying filtering empirical mode decomposition (TVF-EMD) feature extraction method based on the improved grasshopper optimization algorithm (IGOA). The method not only improved the local optimal problem of GOA, but could also determine the bandwidth threshold and B-spline order of TVF-EMD adaptively. Firstly, a nonlinear decreasing strategy was introduced in this paper to adjust the decreasing coefficient of GOA dynamically. Then, energy entropy mutual information (EEMI) was introduced to comprehensively consider the energy distribution of the modes and the dependence between the modes and the original signal, and the EEMI was used as the objective function. In addition, TVF-EMD was optimized by IGOA and the optimal parameters matching the input signal were obtained. Finally, the feature frequency of the signal was extracted by analyzing the sensitive mode with larger kurtosis. The optimization experiments of 23 sets of benchmark functions showed that IGOA not only enhanced the balance between exploration and development, but also improved the global and local search ability and stability of the algorithm. The analysis of the simulation signal and bearing signal shows that the parameter-adaptive TVF-EMD method can separate the modes with specific physical meanings accurately. Compared with ensemble empirical mode decomposition (EEMD), variational mode decomposition (VMD), TVF-EMD with fixed parameters and GOA-TVF-EMD, the decomposition performance of the proposed method is better. The proposed method not only improved the under-decomposition, over-decomposition and modal aliasing problems of TVF-EMD, but could also accurately separate the frequency components of the signal and extract the included feature information, so it has practical significance in mechanical fault diagnosis.