External rhinoplasty based on the classification of alar retraction associating with exposure of the nostrils / 中华耳鼻咽喉头颈外科杂志

Objective: To introduce a classification of alar retraction, and to discuss the therapeutic strategy of alar retraction with cartilage graft and the satisfaction evaluation of patients after operation. Methods: A retrospective analysis was performed on 88 patients with alar retraction admitted to the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University from January 2015 to December 2020, including 20 males and 68 females, aged 20 to 48 years, with an average age of 28.98 years. All patients underwent external rhinoplasty according to a series of treatment plans determined by the classification of alar retraction based on nostril exposure. Visual Analogue Scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) were used to conduct satisfaction survey before and 12 months after operation. Wilcoxon signed-rank test was used to analyze patient satisfaction. Results: A total of 88 patients were included in this study. According to the classification of alar retraction based on nostril exposure, 45 cases were mild, 23 cases were moderate, and 20 cases were severe. There were 16 cases of unilateral and 72 cases of bilateral alar retraction. The patients were followed up for 12 to 18 months, with an average of 13.37 months. The VAS score and ROE score after each type of surgery were higher than those before surgery, with statistically significant (all P<0.05). Among them, the difference in VAS score (6.75±1.29) and in ROE satisfaction (67.70±7.38) of patients with severe alar retraction were the most significant improvement. Conclusion: The classification of alar retraction based on nostril exposure in the frontal view can comprehensively evaluate the severity of alar retraction, and makes the treatment algorithms systematic and comprehensive. The satisfaction of patients is relatively high.

Research advances on the mechanism of extracellular vesicles of adipose-derived mesenchymal stem cells in promoting wound angiogenesis / 中华烧伤杂志

Wound healing involves complex pathophysiological mechanism, among which angiogenesis is considered as one of the key steps in wound healing, and promoting wound angiogenesis can accelerate wound healing. In recent years, mesenchymal stem cell-derived extracellular vesicles have been proven to produce equivalent effects of wound healing promotion comparable to stem cell therapy, with the advantages of low antigenicity and high biocompatibility. The specific mechanism by which extracellular vesicles facilitate wound healing is still not fully understood and is thought to involve all stages of wound healing. This article focuses on the possible mechanism of extracellular vesicles of adipose-derived mesenchymal stem cells in promoting wound angiogenesis, so as to provide ideas for further study on the mechanism of extracellular vesicles to promote wound healing.

Repair of defects in lower extremities with peroneal perforator-based sural neurofasciocutaneous flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities.</p><p><b>METHODS</b>From January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm×5 cm to 18 cm×13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm×15 cm. Flap donor sites were closed by direct suture or skin grafting.</p><p><b>RESULTS</b>Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm×1 cm, which was healed after dressing change. Patients were followed up for 6 to 12 months. The appearance and sensation of flaps were satisfactory; no ulcer occurred; the movement of lower extremities was normal.</p><p><b>CONCLUSIONS</b>It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.</p>

Superior or inferior gluteal artery perforator flaps for the gluteal sores / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of superior or inferior gluteal artery perforator flaps for the gluteal sores.</p><p><b>METHODS</b>Before operation, the perforator artery was detected by Doppler flowmeter and labeled. The perforator flap was designed, including the perforator artery, but not the gluteal maximum muscle.</p><p><b>RESULTS</b>From Aug. 2006 to May 2009, 15 cases were treated. The flap size ranged from 6 cm x 8 cm to 7 cm x 15 cm. All the flaps survived completely without hematoma, seroma or other complication.</p><p><b>CONCLUSIONS</b>The gluteal maximum muscle-reserved gluteal artery perforator flap is a good choice for gluteal sore with reliable blood supply and less morbidity in donor site.</p>

Application of computed tomography angiography in preoperative design of deep inferior epigastric artery perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the application of computed tomography angiography (CTA) in preoperative design of deep inferior epigastric artery perforator (DIEAP) flap.</p><p><b>METHODS</b>From Jan, 2007 to Mar, 2008, preoperative CTA of deep inferior epigastric artery was performed in 13 patients, including 5 patients with congenital absence of the vagina, 4 patients with penile and scrotal Paget's disease and 4 patients after mastectomy. The images were analyzed, including multiple planar reformation (MPR), maximum intensity projection (MIP) and volume rendering (VR). Then the distributions, branches and locations of perforators of deep inferior epigastric artery were measured. The images from CTA were compared with intraoperative observation.</p><p><b>RESULTS</b>The images demonstrated the distributions of deep inferior epigastric artery and locations of its perforators, which were proved to be true by intraoperative observation.</p><p><b>CONCLUSIONS</b>The preoperative CTA of deep inferior epigastric artery is very useful for preoperative design of DIEAP flaps.</p>

Vaginal reconstruction with pedicled deep inferior epigastric perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a new surgical procedure for vaginal reconstruction with pedicled deep inferior epigastric perforator (DIEP) flap.</p><p><b>METHODS</b>Since June 2007, 6 cases underwent vaginal reconstruction, including five congenital vaginal absence and one immediately after total vaginal resection due to carcinoma. Intensive CT scans were performed preoperatively for perforator selection. The DIEP flaps were designed vertically on the anterior abdominal wall and transferred for vaginal reconstruction.</p><p><b>RESULTS</b>All the patients recovered uneventfully with no flap loss and other complication. The patients were followed up for 1 to 8 months (mean, 4 months) with satisfactory results.</p><p><b>CONCLUSION</b>Vaginal reconstruction with vertical DIEP flaps is a safe and reliable method.</p>

Extensor digitorum brevis and extensor hallusis brevis transplantation for treatment of long-standing facial paralysis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy of free transplantation of denervated muscles and vessels in the treatment of long-standing facial paralysis.</p><p><b>METHODS</b>A total of 26 patients with facial paralysis (10 males and 16 females, aged 16-65 years, mean: 47 years) were enrolled in this study to receive transplantation of denervated extensor digitorum brevis (EDB) and extensor hallusis brevis (EHB). The muscle tendon was slung to the ala nasi, the middle point of the nasolabial sulcus, the angulus oris and the chin to correct the nasal and oral deformity. The muscle belly was buried around the nerves that innervated the masseter muscle. Microsurgery was applied to anastomosing the tarsus lateral vessels to the superficial temporalis vessels.</p><p><b>RESULTS</b>After operation, all the patients immediately obtained satisfied static appearance. The movement of the paralyzed corner of the mouth could be obtained one month later and the smile of the paralyzed side could be restored after 3 months of training. And 88% patients achieved perfect results, 8% obtained satisfactory results, and 4% got improvement 6 months after operation according to Stennert's paresis scoring system.</p><p><b>CONCLUSIONS</b>Free transplantation of denervated muscles and vessels for the treatment of long-standing facial paralysis, which seldom causes atrophy or liquefaction of the transferred muscles, can maintain muscle viability and induce reliable nerve regeneration. Therefore, it is a safe and efficient treatment method for the patients suffering from facial paralysis.</p>