Reservation of pretarsal orbicularis muscle in double-eyelid blepharoplasty / 中华医学美学美容杂志

Objective To explore the methodology of suturing the upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap to the levator aponeurosis,simulating the mechanism of fibers from the levator aponeurosis to the dermis in natural double-eyelid in blepharoplasty.Methods Pretarsal orbicularis myocutaneous flap was harvested.Dissection between the orbital septum and the levator aponeurosis was performed originating from the upper margin of the tarsi until to the levator muscle.The upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap was sutured to the levator aponeurosis.The lower skin margin to the orbital septum to the upper skin margin was sutured interruptedly.Patients with medial epicanthus were performed epicanthoplasty at the same time.Results 136 eyes in 68 patients were performed with double-eyelid blepharoplasty using this method.62 patients were followed-up for 1 month and 53 patients were followed-up for 3 months.They all reported satisfactory aesthetic results.Conclusions Double-eyelid blepharoplasty using this method accords with the physiological mechanism in natural double-eyelid.Postoperative double-eyelid is natural with little tumefaction.This method can avoid double-eyelid fold retraction and multi-fold occurrence.

Significance of MRI before surgery to remove polyacrylamide hydrogel used for augmentation mamma-plasty / 中华医学美学美容杂志

Objective To evaluate the significance of MRI before surgery to remove polyaeryl-amide hydrogel (PAMHG) which has been used for augmentation mammaplasty. MethodsTwenty female patients with 40 breasts, having been injected PAMHG as augmentation mammaplasty, under-went bilateral breast axial T1WI, T2WI-fat saturation (FS) and sagittal T2WI-FS by 4-channal phased-assay breast coil at 3.0T (Philips) before removal surgery, in which 8 patients underwent axial multiphase contrast-enhanced MRI with THRIVE after Gd-DTPA (2.0 ml/s, 0.1 mmol/kg) adminis- tration. The results of MRI were compared with that of operation and pathology. ResultsPAMHG showed iso-intensity compared with breast gland on T1WI and hyperintensity on T2WI-FS. Low signal septa were noted within PAMHG in 40 breasts (20 patients), 90% (36/40) PAMHG without capsule, 10 % (4/40) with smooth capsule which showing homogenous low signal on T1WI and T2WI-FS. Subcutaneous lump of PAMHG was 70 % (28/40), lump of that in breast gland was 20% (8/40). Diffuse gel along spatium intermusculare of pectoralis major was 100 % (40/40), that along spatium intermusculare of intercostal muscle was 10 % (4/40). All PAMHG in breast of the 8 patients showed no enhancement, an irregular enhanced mass was found in gland of 1 patient. All distributions of PAMHG and appearances of its complications on T2WI-FS were consistent with the results of operation. ConclusionsT2WI-FS can accurately display the distribution of PAMHG and its complication before removal surgery. MRI plane scan combined with muhiphase contrast-enhanced MRI can differentiate PAMHG from the lesions in the gland and find the breast carcinoma, so that it can guide clinicians before surgery to remove PAMHG used for augmentation mammaplasty.

Multi-factors analyses affecting cosmetic results after breast conservation therapy / 中华医学美学美容杂志

Objective To investigate the factors affecting the cosmetic results in the breast cancer treated with breast conservation to get the better cosmetic results.Methods Treated breasts were scored by the plastic surgeon and the patient independently.Mann-Whitney U test was used in univariate analyses whereas logistic regression was used in multivariate analyses.Results In the surgeon's evaluation, the satisfactory rate was 65.7 %.In univariate analyses,age(P=0.003),body mass index(BMI)(P=0.002),menopausal status(P=0.002),the radiation dose(P=0.022),the number of the incisions as the tumour was located in the outer-upper quadrant(P=0.036),the resection times(P=0.036),fibrosis(P=0.002),the type of surgery(P=0.002) were the significant factors affecting cosmetic results.In multivariate analyses,fibrosis,the type of surgery and the radiation dose(P=0.009,0.001,0.019) were the significant factors affecting cosmetic results.In the patient's evaluation,the satisfactory rate was 76.1%.In univariate analyses,the type of surgery (P=0.001) and fibrosis(P=0.045) were found to be significant factors. In multivariate analyses using logistic regression,the type of surgery(P=0.005) were the most significant factors.Conclusions The satisfactory rate has positive correlation between the surgeon and the patient.In the twenty-seven possible factors affecting the cosmetic results,age,body mass index,menopausal status,radiation dose,the number of the incisions as the tumour located in the outer-upper quadrant,the resection times,fibrosis and the type of surgery are the main factors affecting the cosmetic results significantly.

Use of polypropylene mesh for abdominal defect after TRAM flap transfer / 中华医学美学美容杂志

Objective To investigate the ideal method of repair ing the abdominal defect after the TRAM flap transfer. Methods 24 cases of the abdominal defect after TRAM flap transfer were repaired by a polypropypene mesh. The anterior rectus sheaths on the pedicle were directel y sutured. Results Using of polypropylene mesh not only r epaired the abdominal defect but also achieved a superior abdominal aesthetic re sult. No ″abdominal compartment syndrome″ and infection happened d uring the ho spitalization. Mean patient follow-up was 1 year. No abdominal hernia, bulge an d laxity were encountered. The result of the abdominoplasty was continuous and t he functions of the abdomen were good. Conclusions It is an ideal method that using of polypropylene meth repairs the defect of abdomen . It keeps the integrity and the functions of the abdomen, decreases the complica tions, and at the same time gets the abdominoplasty effect.