Eyebrow Reconstruction With Temporal Hairline Relay Flap.

ABSTRACT: Eyebrow is one of the most important features of the face; the absence of eyebrows will cause a heavy psychological burden to patients. Existing brow reconstruction techniques are not perfect for every case of eyebrow defect. In this study, a patient who suffered from eyebrows loss after radiotherapy for hemangioma underwent eyebrow reconstruction with the relay transfer of a temporal hairline flap. The entire procedure was performed in the outpatient operating room. The temporal hairline flap was transferred to the eyebrow region in a relay and survived well without necrosis. In the 2-month follow-up, the shape and density of the reconstructed eyebrows were satisfactory. The operation showed this technique was innovative, economic, and recommended as a suitable choice for eyebrow reconstruction, especially in those patients with poor hair transplantation recipient area.

Use of Buried Guide Needle to Fix Inferior Eyelid Orbital Septum Fat for Tear Trough Depression Filling.

ABSTRACT: Fat fixation is a key step in filling tear trough depression with inferior eyelid orbital septum fat. The ideal position for inferior eyelid fat fixation is to cross the tear trough ligament causing tear trough depression and the orbicularis retaining ligament, with the distal end fixed at the farthest end of the dissected lacuna deep down the inferior orbicularis oculi muscle. Traditional suturing is difficult in the deep narrow lacunae, but a buried guide needle can be used to suture and fix the fat in the deepest lacuna. In this study, 264 patients who underwent tear trough filling using a buried guide needle to fix the released inferior eyelid orbital septum fat from 2017 to 2020 were followed up. The preoperative and postoperative imaging findings were compared to evaluate the effectiveness of the operation and postoperative complications. The inferior eyelid bulging, loose skin, and tear trough depression significantly improved than that before the operation. None of the patients had any severe complications, such as inferior eyelid ectropion, lagophthalmos, scar hyperplasia, and diplopia, in the long term (6 months) postoperatively. Five patients showed mild eyelid-eyeball separation and recovered in 1 month. Four patients had diplopia, and 3 patients had chemosis; all recovered in 7 days. The tear trough depression was not corrected completely in 2 patients. The operation showed satisfactory results in the improvement of tear trough depression in addition to alleviation of inferior eyelid bulging and loose inferior eyelid skin that is caused by the traditional inferior eyelid pouch removal.

Treatment of facial post-burn hyperpigmentation using micro-plasma radiofrequency technology.

Management of facial post-burn hyperpigmentation is a common and challenging problem for dermatologists and plastic surgeons. The recent development of micro-plasma radiofrequency technology, which allows precise and rapid treatment with controlled thermal injury, can be an effective treatment of post-burn hyperpigmentation. This study aimed to evaluate the effectiveness and complications of micro-plasma radiofrequency treatment of post-burn hyperpigmentation. The study included 35 patients with Fitzpatrick skin type III or IV and facial post-burn hyperpigmentation. Patients received three to five treatments at 8-week intervals. A roller tip was used with the power setting at 60-90 W, and 3-4 passes were made in different directions. The degree of improvement and complications were recorded. Improvement of hyperpigmentation was evaluated by patient self-assessment and by plastic surgeons who compared digital photographs taken before treatment and 2 months after the last treatment. The results showed that post-burn hyperpigmentation responded favorably to micro-plasma radiofrequency treatment with very few complications. The average pain score using a visual analog scale from 0 to 10 was 6.7 ± 0.7. After a series of treatments, 32 of the 35 patients had achieved a >51% improvement of their hyperpigmentation, and 3 patients had achieved a fair improvement. The mean score for improvement of hyperpigmentation was 4.28. Patient self-evaluations indicated good satisfaction with the cosmetic outcomes, and some softening of the scars. Micro-plasma radiofrequency technology is appropriate, effective, and safe for the treatment of facial post-burn hyperpigmentation, and provides a promising noninvasive treatment for superficial facial injuries.

Forty-five cases of chest keloids treated with subcutaneous super-tension-reduction suture combined with postoperative electron-beam irradiation.

BACKGROUND: Chest keloids are challenging to surgeons because of their high recurrence rate. OBJECTIVE: To investigate the effectiveness of the subcutaneous super-tension-reduction suture technique with postoperative electron-beam irradiation in the treatment of chest keloids. MATERIALS AND METHODS: Forty-five patients with chest keloids underwent excision. To minimize the wound-closing tension, subcutaneous super-tension-reduction suture was used. The maximum tension reduction was placed on both dermis and subcutaneous tissue, which were far away from the incision. The consequence of such suturing was that the wound edges were moved centrally to elevate them like a bump after tying the buried knot. All patients received fractionated electron-beam radiation therapy starting within 24 hours after surgery, in a 5-Gy dose daily for 3 to 4 consecutive days, to a total dose of 15 to 20 Gy. RESULTS: The wounds healed primarily in all 45 cases. The bump at the incision began to flatten out after 2 to 3 months and was almost completely flat by 12 months postoperatively. Only 1 case of relapse (2.2%) was observed within 2 years of follow-up examination. CONCLUSION: The use of subcutaneous super-tension-reduction suture after chest keloids excision can greatly decrease tension on the dermis and the subcutaneous tissue and can, in combination with postoperative electron-beam irradiation, decrease the rate of relapse.

[Treatment of the congenital exstrophy of bladder].

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients].

OBJECTIVE: Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[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].

OBJECTIVE: To explore a more effective operative method for later facial nerve palsy. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias].

OBJECTIVE: Applicate autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias by staging. METHODS: From 1999 to 2003, 40 patients have been treated by method of autologous buccal mucosal graft pre-placing. There were two models: graft onlay and graft-tube for urethral reconstruction, and the 2rd operation was accomplished half year later. RESULTS: All patients healed without urethral fistula. CONCLUSION: The method is valuable for treatment of complicated hypospadias.

[Combination of multiple procedures to repair of severe lower eyelid ectropion].

OBJECTIVE: Lower eyelid ectropion is one of the most severe complications following lower eyelid blepharoplasty. Combination of multiple procedures was used to repair this deformity and the results were observed. METHODS: Severe lower eyelid ectropion following blepharoplasty was repaired with the combination method of multiple procedures, including transferring the island forehead flap, buried guiding suture of the lower eyelid skin to orbital periosteum and horizontal lid-shortening. 10 patients (15 eyelids) with lower eyelid ectropion after blepharoplasty were treated with the above method from Mar 2001 to Mar 2004. RESULTS: The lower eyelid ectropion was repaired effectively. All the patients were satisfied with the results. CONCLUSIONS: The combination method of multiple procedures was an effective method for severe lower eyelid ectropion.

[Microvascular study of the transmidline scapular flap vascularized by the contralateral circumflex scapular artery].

OBJECTIVE: To observe the microvascular distribution of the transmidline scapular flap supplied by the contralateral circumflex scapular artery. METHODS: The integument and deep tissues of 6 fresh cadavers were dissected and radiographed after vermilion mixture was injected to the unilateral circumflex scapular artery. RESULTS: The vascular tree passed the midline and reached to the contralateral acromion. The vessel density was the highest in the irrigating side of the back, which was higher in the middle area. In the contralateral side,the high vessel density concentrated in the upper part of the back. CONCLUSIONS: The result revealed the direct evidence for the clinical application of the transmidline scapular flap. In design and elevating of the transmidline scapular flap, it should be slanting to the upper part of the contralateral back.

[Hemodynamic study of an over-midline axial flap].

OBJECTIVE: To investigate the hemodynamic changes of an over-midline axial flap. METHODS: An over-midline axial flap, based on the iliac artery and veins, was raised on the back of each selected Wistar rat (n = 30), vascularied by contralateral. The flap size is 7 cm x 3 cm. The over-midline part is 3 cm x 3 cm. A laser doppler flowmetry (LDF) was used to evaluate the hemodynamic changes preoperatively, and 6 hours, 24 hours, 48 hours, 72 hours, 7 days, and 14 days after the operation respectively. RESULTS: All of the flaps survived well. But, in the first three days after the operation, the blood perfusion of the flap in the areas of the midline and the distal part was significantly lower than the preoperation's level. Thereafter, the values of the blood perfusion started to increase till to the maximum 7 days after the operation. On the 14 days after the operation, the vascular structures was axially matched to the base of the flap. In the distal part of the flap, the choke vessels were gradually opened and resulted in the blood perfusion to the normal level. CONCLUSION: The hemodynamic changes of the over-midline axial flap transmidline flap could occur to match the need of the base of the flap.

[Correction of nasolabial fold].

OBJECTIVE: To introduce a new method for correction of deep nasolabial fold. METHODS: From May 1998 to May 2002, 20 patients (aging 32-48 years, female) with deep nasolabial fold were treated with the buried guiding suture appliance and method through oral incision. RESULTS: All patients recovered without complications, the scar is minimal. Six patients were followed up 6 to 12 months, stable and permanent result was achieved. CONCLUSION: This method is simple and reliable for correction of nasolabial fold.

[Reconstruction of the mentum in the surgical management of cervical scar contracture].

OBJECTIVE: To investigate the effects of the reconstruction of the mentum with cervical tissue flaps in the surgical management of postburn cervical scar contracture. METHODS: Thirteen postburn patients with severe cervical scar contracture and mental deformity were enrolled in the study. The platysma flap (3 cases), scar tissue flap (6 cases) and cervical deep fascia tissue flap (3 cases), with the pedicle containing the facial and the superior thyroidal artery, were turned upwards to replenish mental soft tissue, and to form new mentum and sulcus mentolabialis. The cervical scars were repaired with expanded flap (11 cases), free flap (1 case) or trapezius muscular flap. RESULTS: The post-operative cervical configuration was found to be good, and the tissue flaps for mental reconstruction healed satisfactorily. Ten patients were followed-up for 6 to 24 months. All flaps were successful and achieved good results, except that scar formation was found in the cervical linear incision in 4 patients. CONCLUSION: Transfer of the platysma flaps, scar tissue flaps, or deep cervical fascial flaps for the reconstruction of cervical scar were simple and effective. The use of cervical scar tissue flaps could not only loose the constructed scar, but also beneficial in rectifying the configuration of the chin.

[Long-term results of whole piece, full-thickness skin grafting for facial post-burn reconstruction].

OBJECTIVE: To explore the method for repair of the whole facial burn scar and evaluate the long-term results of skin grafting. METHODS: 18 patients with facial burn scar were treated with whole piece, full-thickness skin grafting. All of them have been followed-up for 5 to 20 years. The color, elasticity, sensation and gland secretion of the grafted skin were evaluated. The skin samples were taken for light and electron microscope examinations. RESULTS: The long-term results of whole piece, full-thickness skin grafting were satisfactory. The grafted skin was smooth and elastic, with sebaceous and sweat glands. The histological structure of the grafted skin was similar to that of the normal facial skin and different from that of the donor site. CONCLUSION: Whole piece and full-thickness skin grafting may be a valuable method for the treatment of facial burn scar. The morphological and histological structure of the grafted full-thickness skin is similar to the normal facial skin through the long-term follow-up.

[Repair of eyelid defect with a prefabricated flap].

OBJECTIVE: To introduce a new method for repair of eyelid defects. METHODS: Eyelid reconstruction was performed using a prefabricated island flap with an expanded forehead myocutaneous flap and hard palate mucoperiosteal graft. RESULTS: Five patients with congenital or acquired eyelid defects were successfully treated with this method. CONCLUSION: The introduced method is rational and practical for clinical applications.

[Repair of facial defect with expanded skin flap from medial upper arm].

OBJECTIVE: To investigate the blood supply of the expanded skin flap from medial upper arm and its application on the reparation of facial defect due to scar resection. METHODS: The operation was carried out for three steps: 1) The expander was embed under the superior proper fascia. 2) The skin flap from medial upper arm was created with superior ulnar collateral artery as blood supply and attributive branches of basilic and axillary veins as blood collection and was grafted onto the facial defect. 3). After being separated from donor site, the skin flap was employed to cover the facial defect with maximal area of 15 x 10 cm(2). RESULTS: Seven patients in all with facial scar and defects were managed with the skin flap. All the grafted skin flaps survived at last with nearly normal skin color, texture and contour. And the scar in donor sites seemed to be neglectable. CONCLUSION: Reparation of facial defects with medial upper arm skin flap after expanding could be recommended. But longer treatment time and some obsessive action of upper limbs and head might be disadvantages.

[Penile reconstruction by using a scapular free flap].

OBJECTIVE: To evaluate the scapular free flap for penile reconstruction. METHODS: Six patients with penile loss were reconstructed by transferring a scapular free flap with implanting a Malleable penile prosthesis. RESULTS: All of the flaps survived completely. With the follow-ups from six to twelve months, the reconstructed penile had excellent configuration and good function. CONCLUSION: The above mentioned technique could be a good method for penile reconstruction.

[Using scar tissue flap to repair secondary nasal deformities of unilateral cleft lip].

OBJECTIVE: To introduce the clinical application of the upper lip scar tissue flap in correcting secondary nasal deformities of unilateral cleft lip. METHODS: Two types of the upper lip scar tissue flap were developed in correcting nasal deformities with Millard's technique. RESULTS: The procedure was performed on 51 patients. All the scar tissue flaps survived completely. The deformities were better corrected than before. CONCLUSION: The scar tissue flap has adequate blood supply. This procedure is routinely combined with other commonly used techniques to correct secondary deformities of cleft lip. It is particularly applicable for repairing the nasal deformity when usable tissue is not enough.

[Autologous buccal mucosal graft for urethral reconstruction].

OBJECTIVE: To search for a new method for urethra reconstruction using autologous buccal mucosal graft while lacking of local skin. METHODS: Since 1998, a total of 25 patients with complex hypospadias have been treated using buccal mucosal grafts for urethral reconstruction. The reconstructed urethra was anastomosed with the meatus half year later. RESULTS: All the reconstructed urethra survived without contracture or stricture except one infection, which healed with no adverse consequence. CONCLUSION: The key points for operation success is rich capillary network, thick epidermis and thin lamina propria of the buccal mucosa. Buccal mucosa is an excellent tissue for urethral reconstruction.

[Clinical applications of the buried-guided-suture method in the treatment of facial depression].

OBJECTIVE: To develop a method for the treatment of facial depression without incision scar. METHODS: In repairing the facial depression, the ruptured subdermal adipocellular tissue was approximated and reunite with the buried-guided-suture method through an intraoral or a concealed skin incision. RESULTS: 17 patients with facial depressions from trauma were treated. Postoperative follow-up of 10 patients for one year showed satisfactory results without recurrence. CONCLUSION: The buried-guided-suture method for repair of facial depression from trauma is simple, reliable and worth recommendation.