Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach?

BACKGROUND: Although many authors recently have reported good results with subfascial breast augmentation, it still is controversial whether the integrity of the pectoral fascia can be preserved. Some authors think the pectoral fascia will be broken during the operation because it is thin and weak. Therefore, this study aimed to investigate whether the integrity of the pectoral fascia can be preserved during subfascial breast augmentation through an axillary incision without endoscopic assistance. METHODS: For this study, 10 patients underwent subfascial augmentation mammaplasty through the axillary approach. The technique was used for patients with small or moderate breasts. The pockets were made with the fingers. The area beyond the reach of the fingers was dissected using a breast dissector. Then the pocket and major pectoral fascias were examined with an endoscope. The endoscope was used only to inspect the fascia and major pectoral muscle after the subfascial dissection was completed. The fascia and surgical effects were evaluated. RESULTS: The integrity of 11 (55%) of 20 pectoral fascias in 10 patients was preserved during the surgery. Four fascias (20%) were broken at about the fourth intercostal space or at the fifth costa. In five breasts (25%), the superficial layer of the pectoral muscle was split, but the integrity of the fascia was maintained. All the patients except one with asymmetric breasts achieved satisfactory results. There was no active bleeding, hematoma, infection, or fibrous capsule contracture during the follow-up period. CONCLUSION: The integrity of most pectoral fascias (11 + 5 fascias) could be preserved through the axillary approach during subfascial breast augmentation without endoscopic assistance. Even if the lower portion of the pectoral fascia was broken, this did not interfere with the aesthetic outcome or the normal postoperative recovery.

Clinical effects of Dermatix Ultra silica gel and asiaticoside cream on hyperplastic scar tissue in patients after epicanthoplasty / 中华医学美学美容杂志

Objective@#To observe the clinical efficacy of Dermatix Ultra silica gel and asiaticoside cream for the treatment or repair of scar hyperplasia which was external used in internal corner incision of patients after the internal canthus correction operation.@*Methods@#A total of 90 patients were randomly chosen and divided into three groups. All patients with epicanthus were treated with the same internal canthus correction method by one doctor. There were 30 patients in each group: 30 cases in the control group were treated without any medication, and the postoperative incision healed naturally; 30 cases were treated with Dermatix Ultra silica gel; 30 cases were treated with asiaticoside cream. Patient and observer scar assessment scale (POSAS) was used as the end points to evaluate the clinical efficacy of Dermatix Ultra silica gel and asiaticoside cream 4 weeks and 12 weeks after the operation. The satisfactory degree from all the patients were collected after 6 months follow-up and we compared the scores of three groups.@*Results@#Compared with the control group, the POSAS scores in Dermatix Ultra silica gel group and asiaticoside cream group were low (P<0.05) at 4 weeks and 12 weeks after operation. At 4 weeks after operation, the POSAS score in Dermatix Ultra silica gel group was lower than that in the asiaticoside cream group (P<0.05). At 12 weeks after operation, there was no significant difference in POSAS score between Dermatix Ultra silica gel group and asiaticoside cream group (P>0.05). Follow-up for 6 months, the satisfaction degree of patients in Dermatix Ultra silica gel group and asiaticoside cream group was higher than in the control group (P<0.05); the satisfactory degree of patients in Dermatix Ultra silica gel group was higher than that in asiaticoside cream group (P<0.05).@*Conclusions@#Dermatix Ultra silica gel and asiaticoside cream have good clinical effects in repair of scar tissue after the epicanthoplasty. Dermatix Ultra silica gel is better than asiaticoside cream in scar early improvement.

Clinical effects of platelet rich fibrin in prevention of bleeding and swelling after mandibular angle reduction / 中华医学美学美容杂志

Objective To observe the clinical effect of platelet-rich fibrin (PRF) on prevention of postoperative hemorrhage and facial traumatic swelling in patients with mandibular angle osteotomy.Methods Twenty-five patients with mandibular angle hypertrophy were included in this study from January 2014 to November 2015.Split face comparative study was carried out to use the left and right sides as the experimental side and the control side,respectively.The PRF in the experimental side was placed in the mandibular osteotomy,while the control side was placed in platelet-poor plasma (PPP).After operation,the drainage volume and facial swelling degree were measured.Results The drainage volume of the experimental group (PRF group) was (20.35 ±7.40) ml,the control group (PPP group) was (43.23±11.96) ml,and the difference was statistically significant (P＜0.05).There was no such case without swelling in postoperative third day.The facial swelling score on the experimental side was (1.19±0.40),the control side was (2.62±0.64),and two groups of postoperative facial swelling scores were significantly different (P＜0.05).Conclusions The PRF can reduce postoperative bleeding and facial swelling after mandibular angle osteotomy.

Rejuvenation of facial contour for elderly women / 中华医学美学美容杂志

Objective Aged facial contour presents changing facial skeleton and sagging soft tissue.We performed reshaping the facial skeleton simultaneouly during the rhytidectomy to achieve a youthful facial contour.Methods It was a retrospective observational study based on 26 elderly women (42-60 years) that complained of aged face and boosing of the orbital rim,prominent zygoma and mandibular angle.All of them had undergone reduction boosing,malar and mandible combined with rhytidectomy from January 2010 to December 2015.Results The facial skeleton was reshaped with face-lift successfully.No fatal bleeding,respiratory obstruction,cardiovascular accident,severe facial edema,permanent facial nerve injury and other major complications occurred.All of the patients recovered safely.Follow-up for 3-24 months showed that the facial contour and aging were improved,and the youthful face form was preserved.Conclusions The face contour correction combined with face-lift is an effective technique to restore the youthful for elderly patients.

Clinical application and Fuzzy evaluation of autologous platelet-rich plasma mixed with fat graft in facial tissue depression / 中华医学美学美容杂志

Objective To evaluate the clinical effect of the facial soft tissue defect treated with platelet-rich plasma (PRP) mixed with purified fat.Methods 35 patients with facial soft-tissue defects were treated by PRP mixed with centrifuged fat tissue.Using Fuzzy judgment method the clinical effectiveness of therapeutic outcomes were evaluated on fullness,injection of frequency and satisfaction during 3 to 6 months of follow-up.Results The therapeutic outcomes showed that the reconstructed face became a relative symmetrical and natural appearance with not evidently fat resorption and stable after operation.Both patients and surgeons were satisfied with the results.The score of effectiveness was highest in Fuzzy judgment.Conclusions The efficacy of PRP is significant in enhancing fat graft,reducing fat necrosis and resorption.The fat tissue mixed with PRP is a reliable reconstruction option for the facial soft tissue defect.

Value of X-ray combined with ultrasound in the diagnosis and treatment of solitary osteochondroma / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the most appropriate imaging examinations for solitary osteochondroma in primary hospitals.</p><p><b>METHODS</b>A retrospective evaluation was performed to analyze the imaging examinations (including X-ray, CT, and ultrasound) of 62 patients undergoing surgeries for solitary osteochondroma in terms of the diagnostic results and preoperative expenditure of the patients.</p><p><b>RESULTS</b>X-ray and CT have a high diagnostic value for solitary osteochondroma, but X-ray cannot display cartilage and lesions in surrounding soft tissues. Ultrasound is limited in diagnosis of solitary osteochondroma, but performed well as CT in displaying cartilage and lesions in surrounding soft tissues. There was no statistical difference between combined X-ray and ultrasound and CT in diagnosis of solitary osteochondroma (P>0.05), but the former had a lower cost (P<0.05).</p><p><b>CONCLUSION</b>X-ray combined with ultrasound has almost comparable value with CT in the diagnosis of solitary osteochondroma and is more practical for application in primary hospitals.</p>

Lengthening the short nose with bilateral septal spreader graft and columellar strut / 中华医学美学美容杂志

Objective To investigate a safe and effective method of lengthening the short nose.Methods Thirty-nine cases of short nose were corrected by the bilateral septal spreader graft and columellar strut using autologous cartilage,combined with expanded polytetrafluoroethylene (e-PTFE)to reconstruct the supporting structures to improve the forward and upward strength of the nasal tip in order to increase the nasal length and to correct the over rotation of nasal tip.The shield and cap grafts were also used for the patients whose nasal tip were too low with vertical dome division technique.Results All the patients showed preserved nasal length after surgery with well-proportioned nasal features and the nasal lip angles were normal.There was no evidence of postoperative nasal shortening.No operative or postoperative complications were observed by follow-up for 6 months to 1 year,except for 2 cases with graft cartilage being apparent on nasal tip.All the patients were satisfied with the surgical results achieved.Conclusions It is necessary to provide powerful forward and upward strength to lengthen nose and correct the over rotation of nasal tip effectively and safely.The application of bilateral septal spreader graft and columellar strut using autologous cartilage and combined with e-PTFE represents a valuable tool for the short nose and proper cartilage grafts of nasal tip can improve the height of the nasal tip and further correct the over rotation of the nasal tip.

Correction of bent cartilaginous vault / 中华医学美学美容杂志

Objective To seek a method to correct the bent cartilaginous vault.Methods This study included 18 patients (12 women,6 men,aged 18-45 years) suffering from the bent cartilaginous vault with the various degrees of nasal obstruction from January 2005 to December 2009.A open surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the dorsum or nasal tip.The approach depended on full mobilization of deviated cartilage,removal of the deviated part of the quadrangular cartilage,followed by straightening of a caudal septal extension graft and its fixation in the corrected position.Rhinoplasty was performed to correct bent cartilaginous vault.Results A satisfactory result was gained in all clinical cases,except a septum still to remain light tilt (not affect the breathing function).Follwing-up for 3-24 months,all cases dorsum of nose was straighten and nasal septum situated mediately.All patients indicated cosmetic satisfaction of nasal dorsum and tip and improvement in nasal obstruction.No nasal deformity and septum tresis was found in all patients.Conclusions ()pen rhinoplasty is a helpful technique in the treatment of the bent cartilaginous vault.Septal surgery is necessary in the patients with cartilage framework,not only to improve breathing but also to achieve a straight,symmetrical and external nose as well.

Piezosurgery-assisted sliding genioplasty / 中华医学美学美容杂志

Objective To evaluate the value of the clinical application of piezosurgery-assisted sliding genioplasty.Methods A total of 9 patients (7 women,2 man,aged 19-40 years) with microgenia were performed operation by intraoral V incision with subperiosteal exposure of the mandibular mentum area.Note relaxtion and preservation of the mental nerves.A horizontal osteotomy of cortical bone on anterior mandible was underwent by the conventional electric bone saw and internal plate bone was sectioned with the piezoelectric device.The segment was divided with preservation of the lingual soft tissue attachment and was advanced in the mandibular mentum area.These was fixed in the reposition by titanium plate and screw for preventing displacement.Results The piezoelectric device produced selective sectioning of the mineralized bone structures,bone was cut precisely without damage to vital anatomic structures and dental pulp,and was much easier to control and less aggressive,creating only minimal damage to soft tissues.The operative effects were satisfactory during 3- 6 months of follow-up.Stable chin contours were created and became nature.Iatrogenic problems with bleeding,in fection,mental nerve injury had been avoided.Conclusions Piezosurgery is a safe and precise technique to reduce the complication rate and to improve the treatment outcomes of genioplasties.

Anatomy and clinical significance of pectoral fascia.

BACKGROUND: The submuscular or subglandular plane for breast augmentation is widely used. Recently, the subfascial plane for breast augmentation was reported by some authors who achieved satisfactory results. The anatomy of the pectoral fascia in Chinese female corpses was investigated to explore the possibility for a location of augmentation mammaplasty under the pectoral fascia. METHODS: The anatomy of 30 side pectoral fascias on 15 corpses was studied. The thicknesses of the pectoral fascias were measured. RESULT: The pectoral fascia is attached to the clavicle and sternum and covers the pectoralis major muscle. It is continuous inferiorly with the fascia of the abdominal wall. Furthermore, the pectoral fascia extends laterally to be continuous with the fascia of the back. The pectoral fascia, which can be successfully dissected bluntly along the subfascial plane, varies in thickness from 0.2 to 1.14 mm. Perforating branches of vessels and nerves emerging from the pectoral fascia are located mainly at the medial lateral and lower fascias. CONCLUSIONS: The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. The pectoral fascia may provide the breast implant with more soft-tissue coverage.

Function of ICU to supervise patients after comprehensive correction of facial skeletal contouring / 中华医学美学美容杂志

Objective To investigate the function and necessity of ICU to supervise and cure the patients after comprehensive correction of facial skeletal contouring. Methods 178 patients were examined carefully and perfectly before operation to obviate taboo. After comprehensive correction of facial skeletal contouring operation, all the patients were transferred into ICU in order to be supervised and cured comprehensively. Results 26 (14. 61 %) patients had hypoxemia ( SPO2 ≤90 %),11(6. 18 %)kaliopenia (K+≤3. 5 mmol/L) and 18 (10. 11 %) hypertension. 21 patients appeared arhythmia. Among these 21 arhythmia patients, 15 (8.43 %) patients had pyknocardia (HR≥100/min), 3 (1. 69 %) atrial premature beat, 1 (0.56 %) fibrillation atrial, 2 (1. 12 %) premature ventricular contraction, 1 (0. 56 %) Ⅱ degree atrioventricular block. 8 patients had respiratory tract obstruction. 2 (1. 12 %) had hemorrhea of mandible and 1 transfused 600 ml blood. 17 (9. 55 %) patients had restlessness. 65 patients had nausea and vomitting. All patients in ICU having postoperative complications had been deal with corresponding management. There were no respiratory failure,hemorrhagic shock, cardiac arrest after operation in 178 patients. Conclusions ICU can offer timely, continuous, and systemic supervision and cure to patients after comprehensive correction of facial skeletal contouring,and reduce the postoperative emergency rate.

Combined mandibular angle resection with lateral cortex splitting ostectomy around mandibular angle by intraoral approach for correction of square face / 中华医学美学美容杂志

Objective To search for a procedure for correction of square face. Methods 68 patients with square face (aged from 21～40 years, with 65 females and 3 males) underwent osteetomy combined mandibular angle triangle resection with lateral cortex around the mandibular angle-splitting by intraoral approach. The mandible outer cortex was splited with bone chisel and mandible angle was resected by the high-speed pneumatic drill. The bulky masseter muscle and the enbonpoint buecal fat-pad were scissored. Results The application of high-speed pneumatic drill and bone chisel facilitated resection of the mandibular angle with lateral cortex splitting osteetomy. The operative effects were satisfactory in 56 patients during 3-24 months of follow-up. The bigonial distance was effectively re-duced, and facial shape became ellipse. The gross asymmetry and mandibular fracture were not conse-quences. The lateral contour of the mandibular angle was natural. Conclusion Ostectomy of mandible angle and lateral cortex of the mandible allows the reduction of the mandibular contour of the frontal view and the lateral contour of mandibular angle becomes soft, giving a more natural appearance. This new method is worthy to be applied widely because of the good result with effective reduction of the mandibular width.

Morphological characteristics of craniofacial contour in ageing / 中华医学美学美容杂志

Objective To study the morphological characteristics of craniofacial contour in ageing.Methods Craniofacial morphology was examined in a sample of 20 young men and 20 old men.By multi-slice helical CT,a computer reconstruction technique was used to produce three dimensional images and 3-D reconstruction data were analyzed quantitatively.Results Compared with the young men,old men increased with midface(Zy-Zy),lower face(Go-Go),supraorbital projection(Fb-Sr,T-So),midface depth (N-Po),and lower facial depth(T-Gn),and decreased with maxillary height(N-Sd) and upper facial width(Ft-Ft,T-T).Conclusion Facial width and depth and supraorbital projection tend to be increased and facial height decreased with ageing.

Endoscopic assisted correction of square face / 中华医学美学美容杂志

Objective To evaluate the clinical application of endoscopic technique in corrections of square face. Methods A total of 38 patients (age 21~40 years, 35 women and 3 men) with square face were corrected by endoscope-assisted intraoral approach and resected mandibular angle with the high-speed pneumatic drill or bulky masseter muscle and buccal fat pad. Results The use of an endoscope offered a clear view of the mandibular angle region and the application of high-speed pneumatic drill facilitated accurate and easy resection of the the mandibular angle. These patients were successfully treated for these new techniques: ruduced surgical trauma, operative bleeding and surgical time, along with a reduced risk of infection. Conclusion The endoscopic assisted correction of square face offers more satisfactory clinical results with a clear view of operation and less haematoma, risk of infection, surgical trauma and time.