The reevaluation and surgical strategy of the superficial circumflex iliac artery perforator (SCIP) flap / 中华显微外科杂志

Objective To introduce the classification of the perforators of the superficial circumflex iliac artery(SCIA),and the superficial circumflex iliac artery perforator (SCIP) flaps based on different perforators have different characters and harvesting methods.To explore a set of coping strategy for the drawbacks of the SCIP flap.Methods Review 90 cases of SCIP flaps in August,2011 to June,2017.The pre-operative radiology navigation was conducted in all cases.Different surgical approaches were applied in flaps based on different perforators.The pedicle elongation method was adopted when necessary.The thickness of the flap,the length of the pedicle,the survival rate of the flap and the closure of the donor site were analyzed.Regular follow-up was performed after the operation.Results All flaps were followed-up for 6-15 months (average 8 months).Fifty-seven flaps were raised on the basis of the proximal perforators of the superficial branch of the SCIA,whereas 29 cases were based on the distal perforators from the deep branch,and in 4 cases,the pedicle was switched to the superficial inferior epigastric artery.In 8 cases,the arterial pedicle lengthen technique was applied with a maximum length of 10 cm.All donor sites were closed directly.Conclusion These surgical strategies simplified the intraoperative decision-making and conquered the shortcomings of the SCIP flap.It is believed that the SCIP flap can possibly become the new workhorse flap in the field of reconstructive surgery.

The comparison of color Doppler ultrasound and computed tomography angiography in the preoperative planning of lower extremity perforators / 中华显微外科杂志

Objective To compare the application of CDU and CTA in preoperative planning of lower extremity perforator flaps.Methods From February, 2013 to December, 2014, 40 patients who underwent reconstruction with perforator flaps harvested from lower extremities were treated.The position, caliber and route of the perforator vessels were detected by CDU and CTA pre-operatively.The results of the pre-operative navigation with both imaging techniques assisted the selection of the perforators and the flap design and were verified during the operation.Results CDU had a higher accuracy in terms of identification (95.0％ vs.90.0％) and location (95.0％ vs.82.5％) of the perforators in the lower extremity.There was no significant difference between the two methods in examination and image analysis time.All the flaps survived, besides 1 flap presented with a 2.0 cm × 2.0 cm distal necrosis which healed after regular dressing change.For 35 cases, the donor sites were closed directly while partial skin grafting were performed in 5 case.Conclusion Pre-operative imaging techniques are capable of offering valuable anatomical information of perforator vessels, which can make flap design more convenient, reduce donor site morbidity and improve the surgical results.The authors recommend CDU for pre-operative planning when harvesting perforator flaps from the lower extremity.

Monitoring the post-operative lymphedema in prefabricated flap after resurfacing for facial scar / 中华显微外科杂志

Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.

Surgical strategy for postburn cervical scar contracture / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the surgical strategy for postburn cervical scar contracture.</p><p><b>METHODS</b>Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps.</p><p><b>RESULTS</b>All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence.</p><p><b>CONCLUSIONS</b>Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first choice, and skin grafting as the second choice. Satisfactory effect of repair would be achieved by following the above surgical principles.</p>

Recent Developments in the Use of Intralesional Injections Keloid Treatment

Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids.