Indications and technical principles of latissimus dorsi myocutaneous flap breast reconstruction / 中国实用外科杂志

Latissimus dorsi musculocutaneous flaps can be used for delayed or immediate breast reconstruction.It can be used in combination with the prosthesis.Latissimus dorsi flap combined with breast prosthesis is recommended for the repair of large local defects after mastectomy and axillary lymph node dissection.For patients who can not use rectus abdominis flap due to abdominal surgery or abdominal diseases,latissimus dorsi flap is the first choice for breast reconstruction.However,the flap shouldn't be used if surgeons suspect any problems of thoracic dorsal artery,subscapularis artery or latissimus dorsi muscle.Comprehensive evaluation and aesthetic design are needed before operation.

The treatment of sternal wound infection by internal fixation of sternum with titanium plate after cardiac surgery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the internal fixation of sternum with titanium plate for the treatment of sternal wound infection after cardiac surgery.</p><p><b>METHODS</b>A retrospective study of 26 patients from Jan 2009 to Dec 2011 was carried out. All the 26 cases with sternal wounds infection after cardiac surgery, were treated by internal fixation with titanium plates.</p><p><b>RESULTS</b>All the patients had chronic infection, lasting for more than 3 months. 3 patients received vacuum-assisted closure treatment after complete debridement. All the wounds were covered with pectoral major muscle flap. All the wounds healed completely with no recurrence of infection.</p><p><b>CONCLUSIONS</b>Internal fixation of sternum with titanium plate can increase the stability. It helps to improve the treatment efficacy of sternal wound infection after cardiac surgery.</p>

Vertical reduction mammaplasty with wide superior pedicle / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the reduction mammaplasty with vertical incision and superior wide pedicle.</p><p><b>METHODS</b>Typical Lejour mosque-dome design was performed. The inferior part of glandular tissue and skin were excised. The nipple-and-areola complex (NAC) was elevated to normal position with superior wide pedicle. The breast morphology was modified with vertical scar left.</p><p><b>RESULTS</b>46 patients were treated. 4 patients had unilateral breast reduction. 14 breasts had wound dehiscence. 3 breasts received debridement, others were treated conservatively with dressings. No complete NAC necrosis occurred.</p><p><b>CONCLUSIONS</b>The reduction mammaplasty with vertical incision and superior wide pedicle is a safe and effective method with a low risk of NAC necrosis.</p>

Plastic surgery after solid organ transplantations / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>More patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation.</p><p><b>METHODS</b>A retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients.</p><p><b>RESULTS</b>All patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results.</p><p><b>CONCLUSIONS</b>Immunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.</p>

A retrospective study of 129 cases with immediate breast reconstruction after skin-sparing mastectomy for breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the oncologic safety, indications and aesthetic results for skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR).</p><p><b>METHOD</b>One hundred and twenty-nine breast cancer patients treated by SSM + IBR from October 1999 to May 2007 were reviewed. Reconstructive techniques included latissimus dorsi flaps (38 patients), implants only (2 patients), latissimus dorsi flaps plus implants (61 patients), pedicled transverse rectus abdominis myocutaneous (TRAM) flaps (25 patients) and deep inferior epigastric artery perforator (DIEP) flaps (3 patients). Aesthetic results were judged by patients' self-evaluation.</p><p><b>RESULTS</b>Mean duration of hospitalization was 18.6 days. Time of first chemotherapy was 5.2 days after operation. Eleven patients (11/63, 17.5%) developed capsular contracture and 24 patients (24/99, 24.2%) developed seroma in the donor site. Nine patients (9/28, 32.1%) developed partial fat necrosis in TRAM and DIEP flaps. The satisfaction with the aesthetic results of the reconstructive breast was significantly lower in irradiated patients than non-irradiated ones. Median follow-up time was 11 months. Five patients developed local recurrence and 7 patients with metastasis.</p><p><b>CONCLUSIONS</b>SSM with IBR can be used for the 0 to II a stage breast cancer patients, with surgical oncologic and aesthetic satisfaction. Radiotherapy has an adverse effect on the reconstructive breast. Delayed or delayed-immediate reconstructions are recommended for patients indicated to postoperative radiotherapy.</p>

The study on donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the prevention and treatment on the donor site sequelae after autologous breast reconstruction with extended latissimus dorsi flap.</p><p><b>METHODS</b>88 patients received breast reconstruction with extended latissimus dorsi flap between May 1999 and Nov 2004 were concerned. We analyzed the donor site sequelae by objective and subjective evaluation and we assessed the functional condition. Results Dorsal hematoma developed in 1 patient. There are 7 patients with dorsal seromas and 2 of them developed capsules; 5 patients with mild skin exfoliate and 1 patient with dry skin necrosis, 2 winged shoulders. No infection and no hypertrophic scars appeared in donor site. There is no significant functional limitation and no influence in daily life.</p><p><b>CONCLUSIONS</b>The main complication after autologous breast reconstruction with extended latissimus dorsi flap was seromas and it can be controlled to decrease. There is no severe complication. It's a worthy method in autologous breast reconstruction in oriental people.</p>

Evaluation of a compound with dan-shen root and azone for scar treatment / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of the compound of Dan-shen root and azone for scar treatment.</p><p><b>METHODS</b>The rat skin in vitro and the human skin in vitro and vivo were separately examined their permeability of the mixture of the Dan-shen root and azone. The 301 patients with hypertrophic scar were randomly divided into two groups: one treated with elastic cloth paste (including silicone) contained in Dan-shen root with azone, and the another treated with only elastic cloth paste (including silicone).</p><p><b>RESULTS</b>The permeability of Dan-shen root with azone, passing through the rat skin in vitro and the human skin in vitro and vivo was significantly higher than both the distilled water and the normal saline (P < 0.05). In the clinical study for treatment of the hypertrophic scars, the efficient rate of the group with the Dan-shen root with azone was significantly higher than the control (91.4% vs. 71.3%) (P < 0.01).</p><p><b>CONCLUSION</b>The Dan-shen root with azone could be easier to permeate the skin and more effective to treat the hypertrophic scar.</p>

Vertical reduction mammaplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>The inverted "T" operation is a typical and classic method for breast hypertrophy. Although having good results, it leaves significant scar and tends to have bottom-out deformity with time. The purpose of this study is to introduce our experience in vertical mammaplasty.</p><p><b>METHODS</b>The typical Lejour's design was used. The lower part of the breast was excised. The nipple-alveolar complex was elevated to a proper position with the superior dermal-glandular pedicle. Only vertical scar was left after the skin was closed.</p><p><b>RESULTS</b>24 patients were treated using this method. The results were satisfactory except unilateral nipple-alveolar complex necrosis occurred in one patient. Another patient had a minor revision for the dog-ear 6 months after breast reduction.</p><p><b>CONCLUSIONS</b>Vertical reduction mammaplasty is effective with reduced scar and highly satisfactory results. It deserves recommendation.</p>

Flap transplantation combined with liposuction to treat upper limb lymphedema after mastectomy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a new surgical method to treat unilateral limb lymphedem after radical mastectomy.</p><p><b>METHODS</b>10 cases of upper limb lymphedema after radical mastectomy were treated using flap transfer (the lateral thoracic skin flap or latissimus dorsi musculocutaneous flap combined with liposuction).</p><p><b>RESULTS</b>After the treatment, the upper limb perimeter reduced in varied degrees. Nuclear lymphatic radiography showed notable changes in lymphatic circulation. The effective results were steady during the follow-up of 3-18 months.</p><p><b>CONCLUSION</b>Flap transplantation combined with liposuction is a useful treatment for limb lymphedema from radical mastectomy.</p>