Comparative study of infrared thermal imaging technology and colour Doppler ultrasound in the detection of perforator vessels before anterolateral femoral perforator flap / 中华显微外科杂志

Objective:To compare the reliability between infrared thermal imaging technology(IRT) and colour Doppler ultrasound (CDU) in the detection of perforators for anterolateral femoral perforator flap(ALTPF).Methods:From September, 2017 to September, 2019, a total of 25 patients(16 males and 9 females, aged 12-53 years old with an average age of 38.7 years old) underwent ALTPF surgery for the purpose of resurfacing and reconstruction. All patients had pedicled or free ALTPF sized from 5.0 cm×8.0 cm to 7.5 cm×30.0 cm. Among all cases, 21 received free flaps and 4 received pedicled flaps. All patients underwent routine IRT and CDU examinations to locate the perforators preoperatively.Results:Of the 25 patients, CDU detected 53 perforators and IRT detected 51 "hot spots". There were 50 "hot spots" that corresponded to the findings of CDU with a κ index at 0.712( P<0.05), representing a high degree of consistency. The sensitivity and specificity were 94.3% and 85.7%, respectively. Conclusion:IRT has a high consistency in detecting perforators for ALTPF in comparison with CDU. IRT features portable, low cost, non-invasive, and easy to operate. At the same time, IRT has advantages in the patients who have thin subcutaneous tissue. With higher accuracy, IRT is expected to become an important part of preoperative perforator navigation.

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.