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Objecive@#To assess the clinical outcomes of patients who received modified penile augmentation by free dermal-fat grafting.@*Methods@#From April 2012 to December 2014, a total of 15 male adults (18-24 years of age) after hypospadias repairs were included. They underwent modified penile augmentation, including girth enhancement using free dermal-fat grafting, and penile elongation (suprapubic skin advancement-ligamentolysis). Penile measurements were performed using ruler before operation and 6 months after operation. The outcome was evaluated by patients, based on the Male Genital Image Scale. SPSS 22.0 was used to analyze the data. In-paired t-test and Wilcoxon test were applied.@*Results@#In 6-84 months of follow-up, all patients achieved excellent cosmetic results, and satisfied with the appearance and diameter. In weak state, the penile length increased from (5.03±0.47) cm to (6.69±0.49) cm. The increased value was (1.67±0.24) cm (t=8.6, P<0.001). Under traction, the penile length increased from (7.29±0.74) cm to (9.21±0.73) cm. The increased value was (1.93±0.21) cm (t=7.8, P<0.001). In weak state, the diameter of the middle part of penis increased from (7.16±0.25) cm to (8.69±0.44) cm, with the increased value of (1.53±0.23) cm (t=8.2, P<0.001). The MGIS score grew from 31.73±4.86 to 40.20±4.54(Z=3.2, P=0.001).@*Conclusions@#This modified technique is safe and effective in enlarging penile size for patients who had underwent hypospadias repair. It is confirmed that physical dimensional enhancement does contribute to improving their self-estimation of penile size.
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Objective@#To evaluate the feasibility of buccal musoca grafting in the treatment of longer anterior urethral stricture.@*Methods@#From January 2012 to December 2017, 42 cases of anterior urethral stricture were treated in staged procedure. Stage 1 included the excision of the narrow urethra and the reconstruction of the urethra by transplanting buccal mucosa sheet or tube. In Stage 2, patients underwent operation including urethra anastomosis and transfer the scrotal flap for coverage, and perform suprapubic puncture cystostomy at the same time.@*Results@#Thirty-eight of 42 cases were followed up for 5-12 months with an average of 8 months. In the followed-up 38 cases, 35 of them obtained satisfactory result. Complications occurred in 2 patients, all of them suffered from urethra restricture. One patient′s urethra stricture was located in the anastomosis, stricture length was 0.5 cm. This patient received excision of the narrow urethra and anastomosis. Stricture in another patient was located in the external urethral meatus, this patient received expansion of the external urethral meatus. With proper treatment, all of them were recovered. One patient was not satisfied with the appearence of penis postoperatively. Of all these patients, no urethral fistula or penile curvature was observed. Urination and ejaculation were normal.@*Conclusions@#A successful treatment of long anterior urethral stricture can be achieved with the excision of affected urethra, reconstruction of defect urethra with buccal mucosa flap in staged procedure, and covering the new urethra by transferring the scrotal flap.
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Objective@#To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities.@*Methods@#Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded.@*Results@#All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion.@*Conclusions@#Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn′t enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.
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Objective To explore the effects of growth group therapy on psychological factors related to interpersonal relationships in college students. Methods Volunteers from a medical university and a non-specialized university in Shenyang participated in growth group therapy once a week for 12 weeks. Before and after the intervention, the 48 volunteers completed the RFQ-54, emotion regulation questionnaire (ERQ), self-esteem scale (SES), and coping style questionnaire (CSQ). Results The RFQ-C, cognitive reappraisal, and SES scores were significantly different before and after intervention (20.54±8.88 vs 23.19±10.85, P ＜ 0.05), (27.27±5.22 vs29.19±4.69; 29.67±4.59 vs 31.48±4.20, P ＜ 0.01), as were the scores of the CSQ subscales, such as problem-solving, seeking support, withdrawal, rebuking oneself, and fantasy (0.72±0.17 vs 0.80±0.15; 0.60±0.25 vs 0.71±0.24; 0.35±0.21 vs 0.28±0.18; 0.36±0.25 vs 0.28±0.20; 0.48±0.23 vs 0.39±0.19, P ＜ 0.01). Conclusion Growth group therapy is effective in college students. It can improve abilities of mentalizing, emotional regulation, self-esteem, and coping in college students.
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Objective@#To evaluate the histological integration process of the buccal mucosa onlay graft applied on the dorsal corpora cavernosa for urethroplasty in an experimental study in rabbits, as well as to preliminarily investigate potential mechanism of the survival of the buccal mucosa and the impact of the tunica and corpus cavernos.@*Methods@#Six New Zealand rabbits were fed with finasteride powder(10 mg/kg, 7 d)from 19th days of gestation, and the rabbit model of congenital hypospadias was established.At the age of 4 months, after releasing the chordee of the dorsal corpora cavernosa, the urethral defect was created by applying buccal mucosa onlay graft for the penile urethral reconstruction. The animals were sacrificed at 1, 2, 4, 12, 24 and 36 weeks post surgery and their genitals were subjected to morphological observation and histological assessment with hematoxyiin-eosin (HE), Masson and Stirus staining.@*Results@#A total of 23 male rabbits were obtained from natural childbirth, 1 of them were normal rabbits, and the other 22 were hypospadias(1 glandular hypospadias, 15 penile hypospadias and 6 scrotal-perineal type). The buccal mucosa graft showed complete uptake in all animals the location of the graft was macroscopically identifiable, demonstrating its good integration. The typical squamous epithelium of buccal mucosa was observed. One week post operation, the tunica albuginea layer and the submucosa were blurred, with inflammatory cells infiltration. Two weeks after surgery, the epithelial layer was getting thick, few neovascularity and young fibroblasts were observed in the subepithelial layer. Gradual arrangement of epithelial layer was visible, the young fibroblasts were increasing and areas of mature collagen could be seen four weeks post operation. The typical squamous epithelium of buccal mucosa and minimal inflammatory cell infiltration in the subepithelial tissues were observed at the grafted mucosa twelve weeks after surgery. It was distinguishable to identify the cell level of subepithelial layer and the tunica of corpus cavernos. Twenty-four weeks after surgery, the epithelial layer was well integrated with adjacent urethral mucosa. Accentuated fibrosis was noticed with extensive mature collagen and without signs of inflammation and scar proliferation of the grafts.@*Conclusions@#The animal model of congenital hypospadias in rabbits could be established using Finasteride. It was feasible to use the animal model to carry out the experimental study of buccal mucosa grafts. The minimal inflammatory cell infiltrations in the subepithelial tissues were observed at the grafted mucosa twelve weeks after surgery. It was distinguishable to identify the cell level of subepithelial layer and the tunica albuginea of corpus cavernos. Buccal mucosa grafting had no obvious limitation effect on the tunica albuginea and the corpus cavernos development.
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Objective@#To explore the blood supply of expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck and the feasibility of this kind of flap for facial vulnus′resurfacing.@*Methods@#At the first stage of the treatment, one rectangular expander was implanted in lateral neck in the subcutaneous pockets, overlying the platysma, the volume of the expander is about 200-600 ml. After 2-3 months inflation, the pre-expanded lateral neck flap combined with posterior auricular flap was advanced at the second stage of the operation, the flap was rotated to lateral face to resurface the vulnus defects located on anterior auricle.@*Results@#Twelve cases of facial wounds were included in this research from January 2009 to November 2016. The size of the expanded flaps were ranged from 6 cm×12 cm to 7 cm×15 cm. According to 2 to 24 months follow-up postoperatively, 10 months in average, two flaps showed venous retardation at distal part of expanded flaps, which were recorvered with one-week dress changing after excoriation. The other ten flaps survived with good appearance and function. The flaps matched well to the recipient defects in terms of color, character and elasticity. The appearance and function of face and neck were ideally adjusted after treatment.@*Conclusions@#By expanding lateral neck skin overlying platysma, the expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck was obtained with high quality and maximum use of blood supply in the anterior neck, which guaranteed appearance and function of the donor area and the recipient area at the same time.
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Objective@#To investigate the therapeuctic effect of one-stage reconstruction of distal urethra with free graft of tublar oral mucosa.@*Methods@#Two strips of oral mucosa graft( 0.4—0.6 cm in width), were harvested and sutured around an oiled silk roll to form mucosa tube. The mucosa tube was used to reconstruct distal urethra. Postoperative pressure dressing and earlier urination were recommended.@*Results@#From May 2007 to October 2015, 16 cases with distal urethra defect or stenosis were treated with this method. The urethra defect was 2—4 cm in length. Urethral fistula happened in 3 patients. All the other 13 cases healed primarily. 10 cases were followed up for 1—5 years by telephone with normal function.@*Conclusions@#One-stage reconstruction with free graft of bulbar oral mucosa is suitable and reliable for distal urethra defect less than 4 cm in length.
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Objective To evaluate the reliability and validity of reflective functioning questionary-54 (RFQ-54) in China.Methods School sample:a total of 635 students were selected for the study.Clinical patients:another 75 patients with borderline personality trait who visited Department of Psychiatry in Shengjing Hospital of China Medical University were recruited.All subjects filled the RFQ-54,MIS-BPD,TAS,FFMQ.44 students accepted the retest after three weeks.Results The internal consistency for RFQ-C and RFQ-U were both 0.628.The test-retest reliability was 0.835,0.683,respectively.The correlations with TAS,FFMQ,MIS-BPD supported its validity.The RFQ subscales scores were significant1y different between only-child and non-only child,urban and country,school group and clinical group (22.11 ± 1.34 vs 18.97 ± 1.22,22.59 ± 1.36 vs 17.61 ± 1.12,21.39 ± 1.32 vs 15.34 ± 1.08,10.95 ± 8.43 vs 13.58 ± 8.19,10.95 ± 8.36 vs 13.88 ± 8.26,11.47 ± 8.02 vs 22.43 ± 1.24,respectively.P ＜ 0.01).Conclusion The Chinese version of RFQ-54 shows good reliability and validity,which can be used to assess the reflective function of adults in China.
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Objective To investigate the application of the repeated expanded bilateral deltopectoral flap for resurfacing severe facial cervical scar, with review of relating articles to discuss issue of repeated expanding flap.Methods Nine patients suffered from hyperplastic facial and cervical scar.Two soft tissue expanders were implanted into the anterior chest region at both sides of sternum.The center of inner border of the expander was at the cross of second intercostal and parasternal line, and the lengthways axe of the expander was located at the ligature of the second intercostals and mammary areola.After two weeks when the expander was filled, expanded flap was transferred to cervical defect.The transferred flap was repeated expanded after half a year and transferred to resurface facial defect.Results In the first expansion stage, 600 or 800 ml expander were implanted in each side of sternum.In the second stage, 400 or 500 ml were used.The first stage of expanding process was smooth, and 2 of the expanding flaps were ruptured during the second expansion period.400-520 cm2 (average 440 cm2) additional expanded flap was acquired during two stages of expanding.Conclusions The repeated expanded bilateral deltopectoral flap gives us greater opportunity to repair severe facial-cervical scar.The best interval time of the two-stage expansion is over half a year.The speed of second expansion should be lower than that in the first stage, and protecting the expanding flap carefully from external force compression is needed during the second expasion.
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<p><b>OBJECTIVE</b>To discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.</p><p><b>METHODS</b>The V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.</p><p><b>RESULTS</b>From January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.</p><p><b>CONCLUSIONS</b>Postoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.</p>
Subject(s)
Humans , Male , Hypospadias , General Surgery , Penis , General Surgery , Postoperative Complications , General Surgery , Postoperative Period , Surgical Flaps , Urethra , General Surgery , Urethral Stricture , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face.</p><p><b>METHODS</b>From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers.</p><p><b>RESULTS</b>The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting.</p><p><b>CONCLUSIONS</b>The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.</p>
Subject(s)
Humans , Cicatrix , General Surgery , Facial Injuries , Neck , General Surgery , Necrosis , Plastic Surgery Procedures , Methods , Skin Transplantation , Methods , Surgical Flaps , Tissue Expansion , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To compare the effect of three methods for penile reconstruction.</p><p><b>METHODS</b>From Sept. 2000 to Dec. 2012, penile reconstruction was performed in 48 cases with free scapular flap transplantation, or pedicled superficial circumflex iliac artery skin flap, or anterolateral thigh skin flap pedicled with lateral circumflex femoral artery. The flaps were 12.0-14.5 cm in length, 10-12 cm in width and the urethra perimeter was about 2-3 cm.</p><p><b>RESULTS</b>Free scapular flaps were used in 21 cases, with flap failure in 3 cases due to insufficient blood supply. Malleable penile prosthesis was implanted in 11 cases, which was exposed in 3 cases. Groin skin flaps were used in 21 cases, with flap failure in 8 cases due to insufficient blood supply. Malleable penile prostheses were implanted in 7 cases, which was exposed in 3 cases. Anterolateral thigh skin flaps were used in 6 cases, with flap failure in 2 cases due to necrosis and infection. No prosthesis was implanted in this group. All the failure cases underwent secondary reconstruction with successful results. 37 cases were followed up for 1-6 years, avevage 2.5 years. 26 cases were satisfied with the results of appearance and function.</p><p><b>CONCLUSIONS</b>Among these three methods, the free scapular flap is most recommended for its high survival rate, low complication rate and high patient satisfaction.</p>