Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer.

BACKGROUND: In patients with facial paralysis, the free functional gracilis muscle transfer is preferred for facial reanimation. The choice of an adequate motor nerve to innervate the transplanted gracilis muscle is one of the procedure's key components. We present a comparative study between cross-facial nerve graft (CFNG) and masseteric nerve as donor nerves for reinnervated gracilis flap transfer in patients with complete facial paralysis. MATERLALS AND METHODS: Retrospective analysis was performed on all patients with complete facial paralysis who had a free functional gracilis muscle transfer for facial reanimation between January 2014 and December 2021. Only those who received gracilis transfer reinnervated by either CFNG or masseteric nerve were included in this study. The smile excursion and lip angle were measured for evaluating the outcomes postoperatively. RESULTS: The inclusion criteria were met by a total of 21 free functional gracilis muscle transfers, of which 11 were innervated by CFNG and 10 by the masseteric nerve. Both surgical procedures resulted in a highly considerable smile excursion of the reanimated side and postoperative improvement of static or dynamic lip angle. Masseteric nerve coaptation led to greater smile excursion and more significant improvement of dynamic lip angle than CFNG. CONCLUSIONS: For patients who have complete facial paralysis, face reanimation can be successfully accomplished by free gracilis transfer reinnervated by the CFNG or the masseteric nerve. In particular, the masseteric nerve is a reliable choice for dynamic smile reanimation.

Phalloplasty With a Free Scapular Flap Improves Postoperative Sensation in Penile Reconstruction.

Objective We aimed to evaluate both the long-term surgical outcomes and patient-reported outcomes of free scapular flap (FSF) phalloplasty. Method The same surgical team performed phalloplasty in 66 patients using a FSF between March 2000 and September 2018. All patients had at least 24 months of follow-up. The surgical techniques used, complications observed, and surgical and patient-reported outcomes were retrospectively described. Results A total of 66 patients with indications of penile trauma (n = 19), micropenis (n = 42), and self-amputation (n = 5) underwent FSF phalloplasty. Two patients (3%) had total flap necrosis and 1 (1.5%) had partial flap necrosis. The urethral complication rate was 18.2% (12/66 patients). All patients were able to void while standing after revision procedures or urethroplasty. We found that an FSF is a reliable donor site for penile reconstruction. Conclusion The FSF phalloplasty creates an esthetically pleasing penis and allows voiding while standing. Most patients can engage in sexual activity. The main drawbacks of using this method are that patients experience different degrees of sensory recovery, and patients undergoing surgery with the "tube-in-tube" technique may find they are be limited by the thickness of the flap. However, by making full use of residual tissue, such as the micropenis glans or scrotal skin, patients can obtain good tactile and erogenous sensation. We believe that using an FSF complements the existing phalloplasty techniques.

RésuméObjectif Les chercheurs ont voulu évaluer les résultats chirurgicaux à long terme et les résultats cliniques déclarés par les patients d'une phalloplastie par lambeau scapulaire libre (LSL). Méthodologie La même équipe chirurgicale a effectué la phalloplastie de 66 patients au moyen d'un LSL entre mars 2000 et septembre 2018. Ceux-ci ont tous reçu un suivi d'au moins 24 mois. Les chercheurs ont décrit rétrospectivement les techniques chirurgicales utilisés, les complications observées et les résultats chirurgicaux et cliniques déclarés par les patients. Résultat Au total, 66 patients ayant des indications de traumatisme pénien (n=19), un micropénis (n=42) et une auto-amputation (n=5) ont subi une phalloplastie par LSL. Deux patients (3 %) ont subi une nécrose totale du lambeau et un (1,5 %) une nécrose partielle du lambeau. Le taux de complications urétrales s'est élevé à 18,2 % (12 patients sur 66). Tous les patients étaient en mesure d'uriner debout après les interventions de révision ou l'urétroplastie. Les chercheurs ont constaté que la région scapulaire est un siège de donneur fiable pour la reconstruction pénienne. Conclusion La phalloplastie par LSL crée un pénis à l'esthétique agréable, qui permet d'uriner debout. La plupart des patients peuvent se livrer à des activités sexuelles. Les principaux inconvénients de cette méthode proviennent du fait que les patients éprouvent divers degrés de récupération sensorielle et que ceux qui subissent la technique chirurgicale « à double tube ¼ peuvent être limités par l'épaisseur du lambeau. Cependant, grâce au plein usage des tissus résiduels, tels que le gland du micropénis ou la peau du scrotum, les patients peuvent éprouver de bonnes sensations tactiles et érogènes. Les auteurs sont d'avis que l'utilisation du LSL complète les techniques de phalloplastie en place.

A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs.

Over the past 20 years, we have designed various types of expanded cervical flaps for large facial defects and achieved excellent tissue matching. This study was performed to propose a treatment strategy for flap selection for the reconstruction of different facial units. The authors retrospectively reviewed the application of cervical expanded flaps for facial rehabilitation in our department between January 2003 and January 2023. The study included 122 patients with unilateral (62.3%) and bilateral (37.7%) facial deformities ranging from the zygomatic arch to the chin. The median area of the tissue defect was 15.2 × 8.5 cm2 (ranging from 6 × 4 cm2 to 27 × 12 cm2). The expansion period ranged from 61 to 175 days (mean: 86.5 days). Maximum and minimum sizes of pre-expanded cervical flaps were 30 × 13 cm2 to 7 × 5 cm2. All the flaps could be summarized into type 1, an advanced expanded cervical flap; type 2, a wing-shaped expanded cervical flap with overlapping tissue expansion; and type 3, an expanded single-lobed transposition flap rotated based on the anterior neck. Cervical flaps reliably meet the reconstructive requirements for different facial units, especially for large cutaneous defects in the clinic. The selection of these flaps can be planned preoperatively according to the location and size of the defect or lesion.

Deep inferior epigastric vessels for free scapular flap phalloplasty.

We aimed to present our 20-year experience of using the deep inferior epigastric vessels as recipient vessels for free scapular flaps phalloplasty and evaluate the outcomes. Penile reconstruction was performed using a free scapular flap between 2000 and 2020 by the same surgical team. Deep inferior epigastric vessels were used in all the cases. The surgical techniques and outcomes were described. Overall, 73 patients used the deep inferior epigastric artery (DIEA) as the recipient artery. Regarding the recipient veins, 2 veins were anastomosed in 72 (98.6%) patients, 1 deep inferior epigastric vein (DIEV) was used in 1 patient, 2 DIEV in 14, 1 DIEV + superficial inferior epigastric vein (SIEV) in 13, 1 DIEV + superficial circumflex iliac vein (SCIV) in 38, great saphenous vein (GSV) + SCIV in 4, and GSV + SIEV in 3. The mean age and body mass index of the study cohort was 28 years and 24.3 kg/m2, respectively. The shortest follow-up time was 7 months. Eleven patients had flap-related complications. Three patients were readmitted to the operating room within 24 hours, and 2 of them underwent salvage procedures with venous revision. Two patients lost the entire flap. One patient with 3-cm distal portion necrosis required surgical intervention. Three patients experienced urethral necrosis. DIEA is a suitable receptor artery for inflow. The DIEV, SIEV, and SCIV are available options for venous drainage according to the patient anatomical characteristics. The GSV can be an excellent backup for outflow and salvage procedures.

Risk factors for intraoperative hemorrhage of Type I neurofibromatosis.

INTRODUCTION: Neurofibromatosis (NF) is an inherited disease and a benign tumor originating from nerve sheath cells. Neurofibromatosis type I (NF1) is the most common type, and most cases are characterized by neurofibromas. Neurofibromas in NF1 are mainly treated by surgery. Our study explores the risk factors for intraoperative hemorrhage in Type I neurofibromatosis patients who underwent neurofibroma resection. METHODS: A cross-sectional comparison of the patients who had undergone resection of neurofibroma for NF1. Data regarding patient characteristics and data about operative outcomes were recorded. The definition of intraoperative hemorrhage group was the intraoperative blood loss greater than 200 ml. RESULTS: Of 94 eligible patients, 44 patients were in the hemorrhage group and 50 patients were in the non-hemorrhage group. Multiple logistic regression analysis demonstrated that the area of excision, classification, surgical site, primary surgical, and organ deformation were significant independent predictors of hemorrhage. CONCLUSION: Early treatment can reduce the tumor cross-sectional area, avoid organ deformation, and reduce intraoperative blood loss. For plexiform neurofibroma or neurofibroma of the head and face, the amount of blood loss should be predicted correctly, and preoperative evaluation and blood preparation should be paid more attention to.

Expansion Technique for Reconstruction of Craniofacial Defect after Plexiform Neurofibroma Excision.

Reconstruction of large craniofacial defect after plexiform neurofibroma excision poses a continuous challenge for plastic surgeons, on account of characteristics of plexiform neurofibroma and patients' aesthetic requirements. Skin graft or free flap is hard to obtain satisfactory results or may pose technical challenges. In an attempt to provide the coverage with 'like tissue', we chose local tissue expansion technique. The expansion period was about an average of 3.4 months. We performed 19 expanded flaps located in the head, face, neck, forearm and superclavical regions to reconstruct the craniofacial defect and achieved satisfactory results. Preoperative endovascular embolism in some cases and several intraoperative hemostatic methods for all cases were undertaken to control the perioperative bleeding. For patients who request aesthetic results and are allowed two-staged operations, our method is viable.

Blood Supply of the Temporal Flap Pedicled With Orbicularis Oculi Muscle: Anatomy and Its Clinical Implications.

BACKGROUND: Traumatic injury or tumor resection can lead to eyelid defects, nasal defects, and cheek defects. The temporal flap pedicled with orbicularis oculi muscle (OOM) can be used to repair these defects. This cadaver-based anatomic study aimed to evaluate the blood supply of this flap and investigate its clinical implications. METHODS: Twenty hemifaces from 10 cadavers were used in this study. The number of arteries supplying OOM of the flap, the diameter of the artery entering OOM, and the maximum width of OOM were recorded. All data were presented as mean±SD values and analyzed using Student t -test. A P value<0.05 was considered statistically significant. RESULTS: Of these 10 specimens, 7 were males and 3 were females. The average age was 67.7 years (range, 53-78 y). The number of arteries supplying OOM was 8.5±1.4 in the male and 7.8±1.2 in the female. The diameter of the zygomatico-orbital artery was detected as 0.53±0.06 mm in the male and 0.40±0.11 mm in the female. The maximum width of OOM was detected as 2.5±0.1 cm in the male and 2.2±0.1 cm in the female. Males had significantly larger average values than females in the diameter of zygomatico-orbital artery and maximum width of OOM ( P =0.012, P <0.001, respectively). However, the number of arteries supplying OOM did not differ significantly between sex ( P =0.322). CONCLUSIONS: We conclude that the blood supply of the temporal flap pedicled with OOM is abundant and reliable. The findings provide surgeons with valuable anatomic knowledge for repairing facial defects with this flap.

Using an Expanded Cervical Flap With an Overlapping Tissue Expansion Technique to Resurface Middle and Lower Facial Defects.

BACKGROUND: Extensive facial burn scars are a tragedy for patients and often pose a great challenge to surgeons because of the high esthetic and functional demands. For patients with healthy skin in the neck region, a cervical flap is highly recommended for facial resurfacing; however, the skin on the midline of the neck often needs more expansion than that on either side, especially for the treatment of large facial defects. The sufficient longitudinal soft tissue in the anterior neck ensures a normal neck shape as well as a normal range of cervical extension, rotation, and lateral flexion. To overcome this, we developed an expanded cervical flap with an overlapping tissue expansion technique to gain more length centrally. METHODS: First, 2 tissue expanders were embedded in the anterior neck region overlapping each other at the midline of the neck. After adequate inflation of the expander, the expanded flap was dissected and rotated to repair defects in the middle and lower face. The anchor position of the flap was placed on the horizontal line of the thyroid cartilage to restore the cervicomental angle. RESULTS: Sixteen patients were treated with this method in this single-center study. All defects affected the middle and lower face, with an area ranging from 135 to 185 cm 2 , and were caused by a massive facial burn. Among them, 12 patients suffered ectropion of the lower lip, 3 suffered limited mouth opening due to scar contraction, and one patient had a cervicomental adhesion. The area of the expanded flap was approximately 163 to 266 cm 2 . The average period of expansion was 89.5 days. Patients were followed up after the operation, with the follow-up period ranging from 6 to 12 months. In all cases, good defect coverage was achieved, with primary closure of the donor sites and a good postoperative cervical configuration. CONCLUSION: We conclude that the expanded cervical flap with the overlapping tissue expansion technique proved to be a reliable method for facial skin reconstruction with functional and aesthetic improvement.

Prefabrication-a Vascularized Skin Flap Using an Arteriovenous LoopPrefabricated Flap With Arteriovenous Loop: An Experimental Study in Minipigs.

BACKGROUND: Arteriovenous loops have a high potency to induce angiogenesis and are promising to solve the problem of scarce implanted pedicle sources and insufficient neovascularization in flap prefabrication. But there is a lack of large animal experiments to support their clinical application. Therefore, we aimed to explore the feasibility of prefabricating large flaps based on arteriovenous loops in pigs. METHODS: Five minipigs were used. In the experimental group, a 10-cm-long ear vein graft was microanastomosed with the saphenous artery and vein to form an arteriovenous loop and implanted under the medial thigh flap. A month later, a 10×10 cm prefabricated flap pedicled with the arteriovenous loop was elevated and sutured in situ. In the control group, a 10×10 cm flap with no vascular pedicle was elevated completely and sutured in situ in the same position. The patency of the arteriovenous loop was evaluated by angiography 30 days after implantation, and the viability of flaps was assessed by macroscopic analysis 10 days after elevation. Three animals received arteriovenous loop flaps unilaterally and no-pedicle flaps unilaterally. Two animals received arteriovenous loop flaps bilaterally. RESULTS: In the experimental group, no thrombi were exhibited in any arteriovenous loop. All 7 prefabricated flaps survived uneventfully. In the control group, 3 flaps were completely necrotic. CONCLUSION: The arteriovenous loops with long interpositional venous grafts can be used as vascular pedicles to prefabricated large area and well-vascularized flaps. This approach can greatly expand the application of flap prefabrication.

Bioinformatics analysis and verification of hub genes in 46,XY, disorders of sexual development.

CONTEXT: 46,XY, disorders of sexual development (46,XY, DSD) is a congenital genetic disease whose pathogenesis is complex and clinical manifestations are diverse. The existing molecular research has often focused on single-centre sequencing data, instead of prediction based on big data. AIMS: This work aimed to fully understand the pathogenesis of 46,XY, DSD, and summarise the key pathogenic genes. METHODS: Firstly, the potential pathogenic genes were identified from public data. Secondly, bioinformatics was used to predict pathogenic genes, including hub gene analysis, protein-protein interaction (PPI) and function enrichment analysis. Lastly, the genomic DNA from two unrelated families were recruited, next-generation sequencing and Sanger sequencing were performed to verify the hub genes. KEY RESULTS: A total of 161 potential pathogenic genes were selected from MGI and PubMed gene sets. The PPI network was built which included 144 nodes and 194 edges. MCODE 4 was selected from PPI which scored the most significant P -value. The top 15 hub genes were ranked and identified by Cytoscape. Furthermore, three variants were found on SRD5A2 gene by genome sequencing, which belonged to the prediction hub genes. CONCLUSIONS: Our results indicate that occurrence of 46,XY, DSD is attributed to a variety of genes. Bioinformatics analysis can help us predict the hub genes and find the most core network MCODE model. IMPLICATIONS: Bioinformatic predictions may provide a novel perspective on better understanding the pathogenesis of 46,XY, DSD.

The pedicled gracilis muscle combined with the fascia lata: a preliminary clinical study of a new biomimetic dynamic phalloplasty method.

BACKGROUND: Phalloplasty is a challenging procedure in the field of repair and reconstruction. Traditional skin flap methods with prostheses or autologous tissue implantation are still common; however, with this method the reconstructed phallus is static and has a high risk of complications. AIM: We aimed to use novel methods for phalloplasty to mimic the normal structure of the phallus while maintaining the patient's ability to obtain sufficient hardness and subjective controllability. METHODS: The neophallus comprised the bilateral pedicled neurovascular gracilis muscle, which provided neophallus volitional control; the pedicled fascia lata, which mimicked the tunica albuginea; the pedicled anterolateral thigh flap, which was used to reconstruct the neourethra and neoglans; and the thin split-thickness skin grafted on the surface of the fascia lata. The urethral anastomosis was performed simultaneously. The appearance and function of the neophallus, as well as patient satisfaction, were evaluated postoperatively. OUTCOMES: The biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata was successfully performed in 4 patients. RESULTS: During follow-up at 10-21 months after the procedure, all 4 patients could complete sexual intercourse and were satisfied with the appearance and self-controllability of the neophallus. The size of the neophallus stabilized within 6 months. The tactile, deep touch sensation, and pain sensations of the neophallus partially recovered. All of the patients could stand to urinate. CLINICAL IMPLICATIONS: We used the gracilis muscle combined with the fascia lata to mimic the basic structure of the corpus cavernosum and tunica albuginea and successfully reconstructed the biomimetic dynamic neophallus. STRENGTHS AND LIMITATIONS: This is to our knowledge the first report of biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata to mimic the complex structure of the phallus and enable the achievement of erection. However, due to the small number of patients included in this study, the data have no statistical significance. More cases are needed to obtain conclusive data and examine the long-term clinical effects of this procedure. CONCLUSION: Using novel methods for phalloplasty, we successfully maintained the patient's ability to obtain sufficient hardness and subjective controllability without the use of implants, and the preliminary clinical results are encouraging.

Human adipose-derived stem cells can optimize the filling material in rats.

BACKGROUND: Human adipose-derived stem cells have been identified as a promising candidate for cell-assisted therapy to improve graft survival. OBJECTIVE: To objective of the study was to add human adipose-derived stem cells into filling materials. METHODS: The filling materials were prepared and divided into 6 groups: fat particles with phosphate buffer saline or human adipose-derived stem cells; acellular dermal matrix particles with phosphate buffer saline or human adipose-derived stem cells; mixture of fat particles and acellular dermal matrix particles with phosphate buffer saline or human adipose-derived stem cells. The survival rate, vascular density and histological at 2, 6 and 12 weeks were investigated. RESULTS: Human adipose-derived stem cells significantly improved survival rate in each group at 6 and 12 weeks, and it significantly increased the vascular density in the fat particles and porcine acellular dermal matrix combined group and porcine acellular dermal matrix group at three time points, but human adipose-derived stem cells did not have a significant effect in the fat particles group. CONCLUSION: Human adipose-derived stem cells as assisted cells added into filling material can improve survival rate and vascular density in rats.

Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle.

BACKGROUND: Owing to the special esthetic and functional role in the face, red lip reconstruction presents a challenge to plastic surgeons. Various reconstructive techniques can be employed to fix the red lip defects close to the mouth angle. The purpose of this study was to demonstrate that the buccal myomucosal flap could be an available option to repair red lip defects with preservation of its esthetics and function. METHODS: A single-center, retrospective study of 7 patients with red lip defects who were treated with buccal myomucosal flap was conducted between June 2017 and March 2022. All patients were followed up for at least 6 months including questionnaires and photography. RESULTS: Of these 7 patients, 2 were women, and 5 were men. The average age was 14.3 years (range, 1-32 y). All the buccal myomucosal flaps survived well. All the donor sites were closed directly without complications. The average follow-up time was 33.4 months (range, 6-57 mo). All patients were satisfied with the aesthetic and functional results. CONCLUSION: The buccal myomucosal flap is versatile and reliable, with the advantages of rich vascularity, flexible design, and easy access. This study was presented to highlight that the flap could be a good candidate to treat red lip defects close to the mouth angle.

Reduced expression of CXCL16/CXCR6 is involved in the pathogenesis of hidradenitis suppurativa.

Mutations in the γ-secretase complex have been well-described in familial hidradenitis suppurativa (HS). No gene mutations have been identified in sporadic HS, which comprises 60%-70% of all HS cases. Obesity and smoking are risk factors for HS and are closely related to DNA methylation, an essential epigenetic phenomenon. Hence, we hypothesized that epigenetic modifications might be involved in sporadic HS. To investigate genes with aberrant methylation in sporadic HS cases and assess their expression in skin lesions and blood from patients with HS. Skin lesion samples and corresponding normal skin were obtained from three patients with HS and subjected to whole-genome DNA methylation sequencing. Blood samples were collected from 20 patients with HS and 20 healthy controls (HCs). The HS mouse model was established by applying tamoxifen to NcstnΔKC mice. Target gene expression was analysed by immunohistochemistry, immunofluorescence, western blotting, enzyme-linked immunosorbent assay (ELISA) and semiquantitative real-time polymerase chain reaction (RT-qPCR). Among 10 807 differentially methylated genes, we filtered 2101 genes with hypermethylated promoter regions, and following bioinformatics analyses, we focused on CXC chemokine ligand 16 (CXCL16). Subsequent functional experiments confirmed the downregulation of CXCL16 and its receptor, CXC chemokine receptor (CXCR) 6, in skin tissue from HS patients and NcstnΔKC mice. Serum CXCL16 concentrations were also significantly decreased in patients with HS. Our data revealed the downregulation of CXCL16 and CXCR6 in HS.

Facial Defects With Infraorbital and Zygomatic Area Reconstruction Using an Expanded Flap Based on the Orbicularis Oculi Muscle: A Long-Term Follow-up.

OBJECTIVE: Reconstruction of facial soft-tissue defects may pose a dilemma for plastic surgeons, as the flaps must be reliable to obtain a natural appearance while minimizing donor site morbidities. This clinical study describes a reconstructive method for infraorbital and zygomatic defects using a pre-expanded rotation flap based on the orbicularis oculi muscle (OOM). METHODS: The surgeries were subdivided into 2 stages. In the first stage of the operation, a 100 to 200 mL expander was placed underneath the temporal area through a hairline incision. In the second stage, after adequate inflation of the expander, the pre-expanded rotation flap based on the OOM of the lower eyelid was raised from lateral to medial to cover the facial defects. RESULTS: In this single-center study from February 2010 to February 2017, 16 patients underwent facial defect reconstruction using the pre-expanded flap based on the OOM. All of the defects were located at the infraorbital and zygomatic regions, and their sizes ranged from 3.0 4.0 to 7.0 14.0 cm. The causes of these defects included postburn scars (37.5%), melanocytic nevus (50%), and hemangiomas (12.5%). In all cases, good coverage was provided for the defects that were in the medial cheek or lower eyelids. There were no flap losses of any kind. There were no major complications, and all minor incidences were treated by minimal procedures. The patients were followed up after surgery, with the follow up ranging from 6 months to 108 months. The follow-up data included postoperative consultations, the defect size, the need for further procedures and the degree of satisfaction. CONCLUSION: The pre-expanded rotation flaps in the lateral facial area based on the OOM can ideally and safely be applied for facial defect reconstruction owing to their reliable blood supply and excellent texture match.

Erratum to "Construction and effect evaluation of different sciatic nerve injury models in rats".

[This corrects the article DOI: 10.1515/tnsci-2022-0214.].

Human Adipose-Derived Stem Cells Delay Muscular Atrophy after Peripheral Nerve Injury in Rats.

INTRODUCTION: Given that denervation atrophy often occurs in muscle after peripheral nerve injury, the effects of injections of human adipose-derived stem cells (hADSCs) and platelet-rich plasma (PRP) into muscle after peripheral nerve injury were examined. METHODS: hADSCs were isolated from human subcutaneous fat tissue, and PRP was prepared from rat whole blood before injection into a rat sciatic nerve injury model. Muscle atrophy was evaluated by quantitating the gross musculature and muscle fiber area and walking footprint analysis. RESULTS: At 4 weeks post-surgery, there were significant differences in the sciatic functional index between experimental (injected with hADSCs, PRP, or combined hADSCs + PRP) and non-operated groups (p < 0.0001), but no significant differences were observed between the different treatment groups (p > 0.05). Post hoc Bonferroni tests also showed significant differences in the wet muscle weight ratios of hADSC, PRP, and combined groups compared to PBS group. The gastrocnemius muscle fiber area was larger in hADSC group and the combined group compared to PBS group at 4 weeks post-surgery. CONCLUSION: The injection of hADSCs delays muscular atrophy after sciatic nerve injury in rats; thus, hADSCs are a promising alternative for regenerating atrophied muscle.

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience.

PURPOSE: To present our experience with pre-expanded medial upper arm flap in facial and neck reconstruction. PATIENTS AND METHODS: This was a retrospective study operated between January 1st, 2001 and January 1st, 2021, at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Staged face and/or neck reconstruction was performed. RESULTS: Forty-one patients were treated in our institution and thirty-eight patients (forty-three flaps) were included in this cohort as. They ranged from 6 to 44 years old. There was no total flap loss in the cohort. Partial flap necrosis was observed in the earlier patients (4 cases). CONCLUSION: Pre-expanded medial upper arm flap is well matched to the facial and neck skin in color, texture, and thickness. Considering the excellent aesthetic outcomes, this flap is a good alternative for selected patients with soft tissue defects of the head and neck.

Congenital aphallia associated with congenital urethrorectal fistula: A rare case report.

RATIONALE: Aphallia is an extremely rare congenital malformation of unknown cause, with few reports in the literature. It is usually associated with other urogenital and gastrointestinal anomalies and is believed to be a result of either the absence of a genital tubercle or chromosome polymorphism. Herein, we describe an extremely rare case of congenital aphallia with congenital urethrorectal fistula and describe our treatment for this patient. PATIENT CONCERNS: An 8-year-old boy was brought to our hospital by his parents because of congenital absence of the penis. The child was male per karyotype and had excess heterochromatin on chromosome 9 (46 XY with 9 qh+). No urethral orifice was identified, and urine passed rectally since birth; thus, urinary tract outlet obstruction led to urine reflux from the anus to the epididymis for a long time. The boy had to be placed on prophylactic antibiotics because he developed urinary tract infection and epididymitis almost every day. DIAGNOSIS: Congenital aphallia (46 XY normal male karyotype) associated with congenital urethroretal fistula. INTERVENTIONS: We performed urethral exteriorization via perineal urethroplasty and urethrorectal fistula repair. The parents approved for phallic reconstruction when the boy reached puberty. OUTCOME: A new external urethral orifice was created on the lower scrotum. The urinary reflux was corrected, and the epididymitis symptoms disappeared. The urethral fistula was then closed. At 8 months follow up, the patient was no longer on antibiotics and had no symptoms of urinary tract infection or epididymitis. CONCLUSIONS: Compatible treatment should be adopted to address urinary tract drainage and infection. Management requires a stepwise approach to address needs as they arise. Neophalloplasty should be performed by an experienced team in early adolescence.

Construction and effect evaluation of different sciatic nerve injury models in rats.

Background: The most commonly used experimental model for preclinical studies on peripheral nerve regeneration is the sciatic nerve injury model. However, no experimental study has been conducted to evaluate acute injury modes at the same time. Objective: We conducted sciatic nerve transverse injury, clamp injury, keep epineurium and axon cutting injury, and chemical damage injury in rats to evaluate the degree of damage of the four different injury modes and the degree of self-repair after injury. Methods: The sciatic nerve transverse injury model, clamp injury model, keep epineurium injury model, and chemical damage injury model were constructed. Then, the sciatic nerve function was assessed using clinical evaluation methods and electrophysiological examinations, as well as immunofluorescence and axonal counting assessments of the reconstructed nerve pathways. Results: The evaluations showed that the transverse group had the lowest muscle action potential, sciatic functional index, nociceptive threshold, mechanical threshold, rate of wet gastrocnemius muscle weight, area of muscle fiber, and numbers of myelinated nerve fibers. The chemical group had the highest, while the clamp group and the keep epineurium group had medium. Conclusion: Transverse injury models have the most stable effect among all damage models; chemical injury models self-recover quickly and damage incompletely with poor stability of effect; and clamp injury models and keep epineurium injury models have no significant differences in many ways with medium stability.