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>

Triangular flaps and fascia-tissue flaps rotation for correction of severe inverted nipple in shallow and deep areola of breast / 中华医学美学美容杂志

Objective To explore a new methodology for surgical treatment of severe retracted nipple in women. Methods 20 patients with inverted nipple and 4 recurred patients were involved in this study. Firstly, the site of neonipple tip was marked in the central part of the inverted nipple and its mean diameter usually was 1.2-1.5 cm. Then two shallow and deep triangular pedicled flaps were designed, respectively, in both superior and inferior areas near areola. With temporary traction of the nipple apex provided by a stay suture, the fibrotie bands underneath the nipple base might be cautious-ly released. Moreover, the shallow skin flaps should be about 0.5 cm in thickness and their blood sup-ply was from the subdermal arterial rete of the areola, which were used to cover and reconstruct the neck area of neonipple after a clockwise rotation and advancement simultaneously. While the deep fas-cia tissue flaps were revolved and advanced either horizontally to the opposite pedicle or upward to the inner tip through the tunnel underneath the nipple base in order to improve the height or width of the neonipple neck and prevent flattening as the supporting tissue and their blood supply was from some small perforating branch arteries in the deep part of mammary gland. Finally, purse-string suture was necessary in the base of neonipple which played a key role in avoiding recurrence of nipple inversion. Four vertical diamond-shaped excision-suturation treatment in neck area could make improvemts on the height of those stout and short nipples. Results In all 24 cases corrected by shallow and deep triangu-lar flaps rotation, after 3-6 months' follow-up, there were no complications related to surgery such as infection, hematoma, permanent sensory disturbance, or nipple necrosis, and postoperative recovery was rapid and uneventful. Especially, follow-up data revealed no evidence of recurrence of inversion and all patients were satisfied with their results. Conclusions Triangular flaps and fascia-tissue flaps in shallow and deep areola rotation is effective and easy to be popularized in correction of inverted nip-ple. This technique can improve both the diameter and height of the nipple, and certainly lower the re-currence rate of nipple inversion and achieve good aesthetic results.

Super-thin coverage of MEDPOR ear framework:an animal study / 中华医学美学美容杂志

Objective It would make a reconstructed ear more naturally when deep temporal fascia, which is much thinner, cover the MEDPOR ear framework instead of superficial temporal fascia. However, without an axial vascular supply, should skingraft be taken on the islanded deep temporal fascia flap? Perhaps this fascia flap could get a new blood supply from the underlying superficial temporal fascia through the porous framework after a period of time. This study was to test its possibility. Methods A piece of 30?15?2mm MEDPOR material was inserted between superficial and deep fascia on the back of a rabbit. In control group, skin graft on the deep surface of deep fascia was operated at once; in experiment group, the incision was sutured and the skin graft was operated 3 weeks later in the same incision. Results Skin grafts were taken in all the 6 rabbits in the experiment group. 80%～100% of necrosis occurred in all the 6 rabbits of control group. Conclusion Without an axial vascular supply, skin graft can not survive on the islanded deep fascia flap. This fascia flap can get a new blood supply from the underlying superficial fascia through the porous MEDPOR material, through which small vessels grow between the two fascia after 3 weeks.