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Objective:To investigate the feasibility and availability of one-stage treatment for congenital lacrimal fistula combined with blepharoplasty and epicanthoplasty.Methods:From November 2014 to March 2021, 6 female patients with congenital lacrimal fistula and epicanthus were treated in the 2nd Department of Maxillofacial Plastic Surgery Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, aged 12-32 years (mean 24 years), including 5 unilateral lacrimal fistula and 1 bilateral.Results:During 3 to 40 months (mean 18 months) of follow-up, the ocular appearances were improved notably and the fistulas were removed completely. There was no secondary infection or cyst occurred, and no ectropion, traction or other deformities. The position of canthus was normal and the shape of canthus was good. The scars in the operation area were inconspicuous.Conclusions:Fistulectomy combined with blepharoplasty and epicanthoplasty can excise congenital lacrimal fistula effectively while improving the ocular appearance by this procedure.
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Objective:To explore the soft tissue composition underlying upper eyelid puffiness and the experience in treating it with tailor-made procedure during upper blepharoplasty.Methods:In a retrospective study from January 2017 to December 2018, 165 patients with upper eyelid puffiness underwent full-incision upper blepharoplasty. During the procedure, the anterior wall of orbital septum was exposed, and the volume of the retro-orbicularis oculus fat (ROOF) and preaponeurotic fat was observed. The orbital septum would be opened if lacrimal gland prolapse was suspected. The puffy upper eyelid would be targeted with tailor-made procedure such as partial ROOF resection, removal or transposition of the preaponeurotic fat, as well as lacrimal gland refixation.Results:All 165 cases were healed by first intention. No relapse was found after a 6 to 24 months follow-up. Persistent mild pain and local skin tightness epiphora chemosis were presented in isolated cases with self-resolution within a short time. There were no severe adverse reaction or complications occurred during the operation and follow-up.Conclusions:The tailor-made procedure during upper blepharoplasty targets the soft tissue anatomy underlying upper eyelid puffiness. It is safe and effective in maintaining a natural look of upper eyelids while retaining the appropriate amount of adipose tissue in the upper eyelid.
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Birth defects is one of the most important problems of human society. External birth defect is one of the major research fields of plastic surgery. This kind of disorders damages the body image of patients in mild or severe way, affects severely the social confidence of the patients themselves and their families. we summarized the research progress of the common external birth defects (the incidence top 10) from the aspects of pathogenesis, prevention, treatments and so on, in order to provide reference materials to the prevention and treatment of them.
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In order to fully demonstrate the clinical significance of the article " Correction of palpebral bags and tear trough deformity by orbital fat repositioning through premaxillary and prezygomatic space with intraoral fixation" [Gao Wei, Lin Xiaoxi, Jin Yunbo, et al.Chin J Plast Surg, 2019, 35(12): 1240-1245], the editor invited professor Xiaolei Jin to write a discussion/review on this paper. Professor Xiaolei Jin affirmed the innovation and practicability of this technique in solving the problem of " the infraorbital edema with mid-face depression" , and proposed that the following questions should be investigated further: (1) indications and contraindications for this procedure.(2) the technical details of the transfer and fixation of orbital septal fat flap.(3) issues for controlling the potential risk of infection. (the editor)
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Craniofrontonasal syndrome/dysplasia(CFNS/CFSD) is a rare X-linked malformation syndrome caused by EFNB1 gene mutations. It is characterized by unilateral or bilateral coronal craniosynostosis, hypertelorism, frontal bossing, broad or bifid nose, grooved nails, agennetic corpus callosum. Female are more commonly and more severely affected than males. Given the classic manifestation, specific hereditary, and complicated treatment, the diagnosis and treatment of CFNS is always a challenge. However, there is only a few studies related to CFNS, and consensus regarding its treatment has not been reached. Thereby, we summarized pertinent literatures and made a thorough review on the diagnosis and treatment of CFNS.
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In October 2017, a female patient, 3 years and 5 months of age, with Crouzon syndrome, associated with multiple craniosynostoses was admitted to Plastic Surgery Hospital. Combined intracranial and extracranial approaches of fronto-orbital advancement and cranial suture release were performed to treat plagiocephaly and scaphocephaly. The patient′s families were investigated. Corresponding mutations were detected by DNA sequencing. Therapeutic effect was satisfactory. The mutation was inherited for 5 generations. Genomic sequencing results showed that the exons of fibroblast growth factor receptor 2 gene in the child was mutated, which excessively activated downstream signals and caused craniosynostosis.
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Objective To discuss a surgical treatment to correct prominent mandibular angle with long chin.Methods From July 2015 to October 2017,21 patients with malocclusion who suffered from prominent mandibular angle with long chin underwent en-bloc mandibular U-shaped osteotomy through oralincision in order to shorten mandibular angle,the body of mandible and the chin and to improve the facial contour.We assessed the surgical effect through comparison of radiologic images,satisfaction of patients and surgical complications between pre-operation and post-operation.Results In this group,all oral incisions had healing by first intention,without hematoma,infection and osteonecrosis.Low lip numbness occurred in 16 patients.After following up for 6-12 months,the lower lip numbness was recovered in 14 patients and relieved in 2 patients.All patients satisfied with the appearance after the operation.Conclusions En-bloc mandibular U-shaped osteotomy is an improvement for mandible surgery treatment.Its osteotomy line involves the whole mandible,which makes the length and width of mandible smaller apparently.This procedure can effectively correct prominent mandibular angle with long chin.
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Objective@#To evaluate the clinical outcomes of a series of patients who have undergone reconstruction of craniofacial defects after resection of intracranial tumors or craniofacial trauma with free composite anterolateral thigh flaps.@*Methods@#Retrospective analyses the clinical cases from September 2007 to September 2016. Data included flap survival rate, complication, satisfaction survey was reviewed to evaluate the efficacy and safety of this surgical strategy.@*Results@#Totally 10 free anterolateral thigh flaps including 3 cases of fasciocutaneous flaps, 2 case of adipofascial flaps, 4 cases of myocutaneous flaps, 1 case of chimeric flap, were adopted to reconstruct craniofacial defects. Follow-up ranged from 3 to 17 months (average, 12 months). All flaps were transferred successfully. There were no cranial spinal fluid(CSF) leaks, intracranial infections or donor site complications. All patients were satisfied.@*Conclusions@#Because of its abundance of tissue, matched vessels to recipient site, versatility of muscular flaps to fill irregularly intracranial defects, reliable blood supply, feasibility of simultaneous fascia lata harvesting, free composite anterolateral thigh flap is the reconstructive method of choice for craniofacial defects reconstruction after resection of intracranial tumors or craniofacial trauma. The use of ALT flap was reliable in the decrease of CSF leak and infection rate and dependable according to long time follow-up.
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Objective@#To explore the application of the 3D precise digital technology in restoring structural defects of the orbital region.@*Methods@#Structural defects of the orbital region concerning on osseous structure and soft tissue were restored in one stage or stages using EH composite artificial bone prosthesis with complex three-dimensional structure. The fabrication of EH composite artificial bone prosthesis was based on CT scanning and 3D reconstruction of the skull with computer aided data analysis and design. The appearance, degree of satisfaction and the complications were evaluated in postoperative regular follow-up.@*Results@#Five cases of structural defects in the orbital regions presenting bone defect and soft tissue abnormality, received treatments in the department from January 2016 to September 2017. The cases consist of one patient with dysplasia following surgical treatment, three with post-traumatic and one with Treacher-Collins syndrome. With the application of individualized EH composite artificial bone fabricated by aforementioned method, all the repair materials presented the ideal three-dimensional structure and coincided well with the defects, and soft tissue restoration of 2 cases was performed in one stage or by stages. Appearance and symmetry of the 5 cases was significantly improved, without complications of infection, rejection, exposure or graft tissue necrosis. All the patients were satisfied with the results.@*Conclusions@#In consideration of the capacity to fabricate accurate individualized repair materials, the three-dimensional digital technology plays an important role in the treatment of structural defects in the orbital region, especially the reconstruction of the bony contour. The simple orbital deformities can be treated with the repair materials and correction of soft tissue. For special orbital deformities, attention should be paid to bone structure repair, eye socket reconstruction and filling of orbital contents sequentially.
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Objective@#To perform a comparative study of different fat-processing techniques to explore which technique could obtain higher fat content.@*Methods@#Lipoaspirates was purified with three groups of fat-processing techniques (sedimentation, centrifugation, and cotton pad filtering). Isometric purified fat tissue was centrifuged at 5 000 g for 5 minutes to quantify the oil, aqueous, and fat content from them. HE staining was applied to evaluate the effect of different fat-processing techniques on the integrity of adipocyte.@*Results@#The fat content, aqueous content, and oil content of three groups was respectively 86.0%, 9.6% and 4.4% for the cotton pad filtering group; 74.4%, 14.8% and 10.8% for the centrifugation group; 62.0%, 28.4% and 9.6% for the sedimentation group. In the HE histologic findings, no significant difference was observed in the integrity of adipocyte of three groups (P>0.05).@*Conclusions@#In comparison with the sedimentation group and the centrifugation group, more fat content, less oil content and aqueous content was observed in the cotton pad filtering group. The cotton pad filtering technique was helpful in postoperative volume retention.
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Objective To evaluate the value of multi-slice spiral computed tomography angiography(MSCTA)scanning and reconstruction technology in detecting anomalous origin of coronary artery(AOCA).Methods Retrospective analysis was done in 3 856 patients who accepted MSCTA.Volume rendering(VR),multi-planar reformation(MPR),curved planar reformation(CPR)and maximum intensity projection(MIP)were used to observe the origin and course of coronary artery.Results 42 patients with AOCA were detected among 3 856 objects,and the detection rate was 1.09%.The detection rates had no statistically significant difference between male(1.17%)and female(0.98%).The rate of patients with anomalous origin of left coronary artery was 30.95%(13/42), and 9 objects(69.23%,9/13)of them had the anomalous origin of left circumflex.The rate of patients with anomalous origin of right coronary was 66.67%(28/42),and 35.71% of them(17/28)were found to have the anomalous origin of right coronary artery from the left sinus of valsalva.Conclusion MSCTA scanning and reconstruction technology is noninvasive,rapid,accurate and intuitive.
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Objective To explore a simple and effective way to correct mild and moderate blepharoptosis,and also to analyze the causes and precautions for postoperative complications.Methods The degree of blepharopotsis was evaluated and mild to moderate patients were selected.Under local anesthesia,a suture with two needles was suspended horizontally under the conjunctiva at the position of CFS in the upper fornix of conjunctiva.The needles went through the tissue between the levator palpebrae muscle and Müller's muscle and went out at the same point of conjunctival surface at the upper edge of the tarsal plate.The needles were pierced again from the original point,went through the entire eyelid and then went out at the small incision on the skin surface,then the two ends of the line were tied knot,and the knot was buried in the subcutaneous tissue.In this way,blepharoptosis was corrected and no obvious wound and knot were found.Results 21 cases (31 eyes) were followed up for more than 6 months;18 cases (27 eyes) were completely corrected,2 cases (3 eyes)were improved and 1 case was ineffective.The effective rate was 96.77 ％,and the satisfactory rate was 87.1％.Conclusions Minimally invasive blepharoptosis correction from CFS power source is a minimally invasive surgery that is worth popularizing because of its ideal effect and rapid recovery.
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Objective@#To identify the special biomarkers and the differentially expressed proteins in keloid tissue and to explore the pathogenesis characteristics of familial keloid by comparing the protein expression differences among familial keloid(FK), sporadic keloid(SK), hypertrophy scar (HS), normal scar (NS).@*Methods@#The tissue specimens of FK, SK, HS and NS(6 specimens in each group), were digested, taged and analysed using quantitative proteomic isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology. A difference greater than 1.2 folds and P<0.05 were selection criteria for differencial expression proteins. Then bioinformatics analysis was applied.The expressions of 2 differential proteins were validated using Western Blot analysis.@*Results@#A total of 2 450 differentially expressed proteins were identified. Compared with NS, 250 up-regulated and 281 down-regulated proteins were identified in FK; 281 up-regulated and 232 down-regulated proteins were identified in SK; 199 up-regulated and 233 down-regulated proteins were identified in HS.Compared with SK, 64 up-regulated and 164 down-regulated proteins were identified in FK; 79 up-regulated and 169 down-regulated proteins were identified in HS.Compared with HS, 124 up-regulated and 115 down-regulated proteins were identified in FK.These different proteins were concentrated in several vital signal pathways such as the extracellular matrix protein, cell adhesion and biological metabolism pathways. The variation trend of 2 differentially expressed proteins (P3H1 and RCN-3) were validated by Western Blot.@*Conclusions@#Proteomic analysis can identify the proteins with variance of keloid, hypertrophy scar and normal skin. Further investigations of these differential proteins may reveal the pathogenesis of keloid and provide new treatments for it.
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Objective To explore the feasibility and validity of the new photograph method for blepharoplasty,which was designed for collecting information of patients originally,such as eyelid abnormalities and poor appearance.Methods A lot of 1068 cases were collected and taken pictures preand post-operation,including six postures of looking straight forward,upward,downward,closing,squeezing and smiling,and then compared with photos taking in traditional way,only looking forward and closing.Results Compared with the traditional method,it contained more details of eyelids by six-position photography in front view,which was beneficial to the comparison of eyelid skin,muscle stretch,adhesion and dynamic changes before and after the operation.Conclusions More static and dynamic information about eyelid can be collected by simple six-position photography in front view.It is appropriate for photograph collection of blepharoplasty,with important clinical significance.
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Objective To investigate clinical characteristics and treatment of upper eyelid lipogranuloma cases that developed after facial autologous fat injection.Methods This retrospective study involved 8 patients who presented with upper eyelids symptoms (final diagnosis of lipogranulo ma) and had history of facial autologous fat injection.The collected data included information on patient sex,age,clinical presentation,laboratory findings,treatment and outcome.Results All 8 cases were managed by exploration and surgical removal through double eyelid surgery.All patients showed complete resolution over 1-12 months follow up period.Conclusions Lipogranuloma can develop in the upper eyelid after autologous fat injection into the face.and surgical removal can yield satisfactory outcomes in cases of repeated failure of conservative therapies.
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BACKGROUND: Classic isolation method of bone marrow mesenchymal stem cells (BMSCs) is Percoll density gradient centrifugation. Blood cell component was removed. However, this method is complicated. Preparation density was needed when isolating dog bone marrow. Moreover, centrifugation was frequent, which had a great damage to cells. OBJECTIVE: To establish methods of the isolation, proliferation, culture and osteoinduction of canine BMSCs, and observe the in vitro proliferation and ability to osteoinduction differentiation. METHODS: 10 mL bone marrow was extracted from dog posterior superior iliac spine, heparin anticoagulation, diluted using Hanks juice, treated with 1.077 g/mL Ficoll solution 3 mL, and centrifuged at 2 000 r/min for 20 minutes. Karyocytes were absorbed to form white cloudlike layering interface, and then centrifuged twice using DMEM supplemented with fetal bovine serum, incubated at 12×10~4/cm~2 at 37 ℃ in a 5% CO_2 incubator. Following subculture, cells were incubated in DMEM containing dexamethasone, β-sodium phosphoglycerol and ascorbic acid 2-phosphate. Immunocytochemical staining and immunofluorescence staining were utilized to detect osteocalcin, osteopontin and type Ⅰ collagen expression in osteoblasts. Alkaline phosphatase staining and alizarin red staining were performed. RESULTS AND CONCLUSION: 1.077 g/mL Ficoll density gradient centrifugation was used to isolate karyocytes that were significant compared with Percoll solution. Obtained BMSCs had high purity, good growth and the mean doubling time was 24 hours. Following in vitro osteogenic incubation of dog BMSCs, osteocalcin, osteopontin and type Ⅰ collagen showed positive expression. Alkaline phosphatase staining demonstrated bluish-green cytoplasm. Alizarin red staining showed red nodes in extracellular matrix, and could differentiate into osteoblasts in vitro.
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Objective To investigate the expression of the cyclin D1 in pubertal mammary hypertrophy and micromastia. Methods The expression of cyclin D1 was detected by SP immunohisto-chemistry in 18 cases of pubertal mammary hypertrophy and 12 cases of micromastia. Results The expression rate of cyclin D1 within breast tissue was 83. 33 % and 16. 67 % in pubertal mammary hypertrophy and micromastia, respectively. There was significant difference between the two groups (P<0. 01). Conclusion The expression level of the cyclin D1 within breast tissue in pubertal mammary hypertrophy is higher than that in micromastia.
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Objective To present a method for breast reconstruction with the deep inferior epigastric perforator (DIEP) flap and to summarize the operative experiences. Methods DIEP flaps were elevated without carrying rectus abdominis muscle. The breast was shaped after the deep inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2000, we have used the DIEP flaps in 15 cases of breast reconstruction. There were 100 % survival in 10 flaps, distal skin necrosis in 2 flaps, and a full loss in 2 flaps. With the follow-up of 6～12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal heria, bulge and weakness in donor sites. Conclusion DIEP flap is the development and refinement of TRAM flap and possesses of advantages such as rich blood supply, abundant tissue volume, minimal donor site morbidity and easy shaping. It is a new but reliable and safe technique for autologous breast reconstruction.
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Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.
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Objective To supply anatomic foundation for TRAM and DIEP flaps breast reconstruction with both sensory innervation and rectus abdominis muscle function preserved. Methods Dissections of T8～T12 nerves in anterior abdominal wall were performed on 9 embalmed female cadavers (18 sides). By reconstructing DIEP flaps in 15 cases, the natures of the intercostal nerves and the relations with deep inferior epigastric perforators were investigated. Results Most intercostal nerves pierced the rectus abdominis muscle in the lateral one third. There were interconnections between muscular branches of segmental nerves. Sensory branches traveling with vascular perforators were divided into medial branch and lateral branch. The mean length of pure sensory nerve was (27.6?12.2)mm. Conclusion It is possible to preserve sensory innervation by coapting lower intercostal nerves to the 4th thoracic nerve in TRAM and DIEP breast reconstruction. Sparing lateral one third of rectus abdominis muscle does not cause denervated atrophy in the rectus abdominis muscle after TRAM breast reconstruction.