Application of ultrasonography in the detection of nasal interdomal fat pad / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the application of ultrasonography in the detection of nasal interdomal fat pad (IFP).</p><p><b>METHODS</b>Thirty-eight patients who underwent open rhinoplasty and other surgeries in our hospital were enrolled in this study. All patients were studied by ultrasonography to evaluate the shape, structure, size, and location of IFP. The results of ultrasonography were compared with intraoperative findings.</p><p><b>RESULTS</b>The boundaries between IFP and the subcutaneous fat were clear under ultrasonography in 32 patients (84.2%), but were not clear in 6 patients (15.8%) who had undergone injection rhinoplasty (n=2) or augmentation rhinoplasty (n=4). As shown by ultrasonography,the average length,width,and height of IFP were (11.81∓1.28) mm, (2.49∓0.57) mm, and (1.90∓0.61) mm, respectively,which were not significantly different between male and female patients (P>0.05). In addition, the length, width, and height of IFP were significantly larger in nasorostral hypertrophy group than in normal group (P0.05).</p><p><b>CONCLUSION</b>Ultrasonography can accurately evaluate the size and morphology of IFP pre-operatively, and therefore is helpful to ensure the success of rhinoplasty.</p>

Effect of rhIGF-1 on cytochrome C and caspase-3 expression in neonatal rats with hypoxic-ischemic brain damage in vivo / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of rhIGF-1on the mRNA and protein expression of cytochrome C (Cyt-C) and caspase-3 in neonatal rats with hypoxic-ischemic brain damage (HIBD).</p><p><b>METHODS</b>Ninety neonatal Sprague-Dawley rats were randomly divided into three groups: normal control, HIBD, and HIBD+rhIGF-1 (rhIGF-1 was given intraperitoneally right after HI). Rat HIBD model was prepared according the Rice-Vannucci method. RT-PCR and Western blot methods were used to measure the mRNA and protein expression of Cyt-C and caspase-3 24, 48 and 72 hrs after HI (n=10 each time point).</p><p><b>RESULTS</b>At all time points, both Cyt-C mRNA and caspase-3 mRNA expression levels in the HIBD group increased compared with those in the normal control group, and those in the HIBD+rhIGF-1 group also increased compared with that in the normal control group but decreased compared with that in the HIBD group. There were statistical significances among the three groups (P<0.01). At all time points, the changes of both Cyt-C and caspase-3 protein expression in the three groups were similar to those of the mRNA expression: both Cyt-C and caspase-3 protein expression levels increased in the HIBD group compared with those in the normal control group, and those in the HIBD+rhIGF-1 group also increased compared with those in the normal control group but decreased compared with those in the HIBD group. There were statistical significances among the three groups (P<0.01).Pearson correlation analysis showed that mRNA and protein expression of Cyt-C were positively correlated to casapse-3 mRNA and protein expression in the HIBD and the HIBD+rhIGF-1 groups.</p><p><b>CONCLUSIONS</b>rhIGF-1 may inhibit the Cyt-C release and caspase-3 expression, and thus provides neuroprotection against HIBD in neonatal rats.</p>

Mammaplasty after polyacrylamide hydrophilic gel removal from breast / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between mammaplasty and results after polyacrylamide hydrophilic gel (PAHG) removal from breast.</p><p><b>METHODS</b>From Feb. 2003 to Aug. 2009, 130 patients with bilateral breast augmentation by PAHG injection were treated. Preoperative ultrasound examination and MRI were performed to know the distribution of PAHG and infiltration at the surrounding tissue. According to the conditions after removal, the patients were received implant augmentation immediately, or at the second stage, or no implant.</p><p><b>RESULTS</b>The patients were followed up for 3 months at the most with a very satisfactory rate of 63.84% (83/120), a satisfactory rate of 31.53% (41/120) and a unsatisfactory rate of 4.63% (6/120). Slight capsular contracture (Baker I) occurred in 5 cases with 6 breasts in satisfactory group. All the patients in unsatisfactory groups who selected unsuitable implants by themselves were re-operated to take out the implants. 3 cases with much residue PAHG insisted to receive breast implants. Among them, 2 cases achieved acceptable results even the surface of the breasts were not smooth. No other complication happened.</p><p><b>CONCLUSIONS</b>The breast reaugmentation after PAHG removal should be performed based on the deformity and condition of breast. Both cosmetic result and psychological relief could be obtained after mammaplasty.</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>

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>

Treating later facial nerve palsy with the method of combining free graft of de-nerve short extensor muscle of toe with the technique of inducted undermined suture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a more effective operative method for later facial nerve palsy.</p><p><b>METHODS</b>A synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was used in 432 cases of later facial nerve palsy.</p><p><b>RESULTS</b>82% of 432 cases acquired satisfactory effect that consisted of static symmetry and dynamic rough symmetry in facial expression. 12% cases only acquired static symmetry in facial expression but the dynamic symmetry were insufficient. Unsatisfactory results were occurred in 6% cases as both the static and dynamic symmetry of their facial expression were insufficient, which acquired preferable results 2 another suspending operation 8 to 12 months later. 4 cases got post operation infection; through cases happel in foot and 2 in face. All of them were cured by the treatment of drain and antibiotic in 3 weeks. 46% cases were followed up by further consultation or telephone. The longest followed up was period 12 years, while the shortest was 1 year, and the average was 28 months. 93% patients were satisfactory with the results, and 7% patients thought that their facial expression symmetry were insufficient though their facial abnormality were improved obviously.</p><p><b>CONCLUSIONS</b>The synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was an effective method for later facial nerve palsy, and most of the patients could acquired satisfactory results. This operative method is good for popularize because of its simple operation, slight tissue injury and fews complication post-operation.</p>

Surgical strategy for congenital blepharophimosis syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>So far, most of the surgical techniques for congenital blepharophimosis syndrome are two-stage procedures. In this study, we investigated a modified one-stage procedure to reduce the suffering of patients.</p><p><b>METHODS</b>From 2003 to 2005, we adopted an one-stage technique combining blepharoptosis correction with medial canthoplasty in 16 patients with congenital blepharophimosis syndrome (10 male, 6 female; aged from 6 to 21). All the patients had bilateral severe blepharoptosis, epicanthus inversus, and flat dorsum nasi. The movement of the upper lid was 0 to 3 mm, vertical length of the eye fissure 2 to 4 mm, horizontal length 13 to 22 mm, and the distance between the eyes was 35 to 39 mm. The patients were followed up for one half to 2 years after the operation.</p><p><b>RESULTS</b>In all the patients, after the operation, the horizontal length of the eyelid > 25 mm, the vertical length > 6 mm. and the distance between the eyes < 35 mm. The appearance of their double eyelids was satisfying.</p><p><b>CONCLUSION</b>The modified one-stage technique combining blepharoptosis correction with medial canthoplasty can achieve favorable outcomes for patients with congenital blepharophimosis syndrome.</p>

Hemodynamic study of an over-midline axial flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the hemodynamic changes of an over-midline axial flap.</p><p><b>METHODS</b>An over-midline axial flap, based on the iliac artery and veins, was raised on the back of each selected Wistar rat (n = 30), vascularied by contralateral. The flap size is 7 cm x 3 cm. The over-midline part is 3 cm x 3 cm. A laser doppler flowmetry (LDF) was used to evaluate the hemodynamic changes preoperatively, and 6 hours, 24 hours, 48 hours, 72 hours, 7 days, and 14 days after the operation respectively.</p><p><b>RESULTS</b>All of the flaps survived well. But, in the first three days after the operation, the blood perfusion of the flap in the areas of the midline and the distal part was significantly lower than the preoperation's level. Thereafter, the values of the blood perfusion started to increase till to the maximum 7 days after the operation. On the 14 days after the operation, the vascular structures was axially matched to the base of the flap. In the distal part of the flap, the choke vessels were gradually opened and resulted in the blood perfusion to the normal level.</p><p><b>CONCLUSION</b>The hemodynamic changes of the over-midline axial flap transmidline flap could occur to match the need of the base of the flap.</p>

Microvascular study of the transmidline scapular flap vascularized by the contralateral circumflex scapular artery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the microvascular distribution of the transmidline scapular flap supplied by the contralateral circumflex scapular artery.</p><p><b>METHODS</b>The integument and deep tissues of 6 fresh cadavers were dissected and radiographed after vermilion mixture was injected to the unilateral circumflex scapular artery.</p><p><b>RESULTS</b>The vascular tree passed the midline and reached to the contralateral acromion. The vessel density was the highest in the irrigating side of the back, which was higher in the middle area. In the contralateral side,the high vessel density concentrated in the upper part of the back.</p><p><b>CONCLUSIONS</b>The result revealed the direct evidence for the clinical application of the transmidline scapular flap. In design and elevating of the transmidline scapular flap, it should be slanting to the upper part of the contralateral back.</p>

Repair of facial defect with expanded skin flap from medial upper arm / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the blood supply of the expanded skin flap from medial upper arm and its application on the reparation of facial defect due to scar resection.</p><p><b>METHODS</b>The operation was carried out for three steps: 1) The expander was embed under the superior proper fascia. 2) The skin flap from medial upper arm was created with superior ulnar collateral artery as blood supply and attributive branches of basilic and axillary veins as blood collection and was grafted onto the facial defect. 3). After being separated from donor site, the skin flap was employed to cover the facial defect with maximal area of 15 x 10 cm(2).</p><p><b>RESULTS</b>Seven patients in all with facial scar and defects were managed with the skin flap. All the grafted skin flaps survived at last with nearly normal skin color, texture and contour. And the scar in donor sites seemed to be neglectable.</p><p><b>CONCLUSION</b>Reparation of facial defects with medial upper arm skin flap after expanding could be recommended. But longer treatment time and some obsessive action of upper limbs and head might be disadvantages.</p>

Using scar tissue flap to repair secondary nasal deformities of unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the clinical application of the upper lip scar tissue flap in correcting secondary nasal deformities of unilateral cleft lip.</p><p><b>METHODS</b>Two types of the upper lip scar tissue flap were developed in correcting nasal deformities with Millard's technique.</p><p><b>RESULTS</b>The procedure was performed on 51 patients. All the scar tissue flaps survived completely. The deformities were better corrected than before.</p><p><b>CONCLUSION</b>The scar tissue flap has adequate blood supply. This procedure is routinely combined with other commonly used techniques to correct secondary deformities of cleft lip. It is particularly applicable for repairing the nasal deformity when usable tissue is not enough.</p>

Autologous buccal mucosal graft for urethral reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To search for a new method for urethra reconstruction using autologous buccal mucosal graft while lacking of local skin.</p><p><b>METHODS</b>Since 1998, a total of 25 patients with complex hypospadias have been treated using buccal mucosal grafts for urethral reconstruction. The reconstructed urethra was anastomosed with the meatus half year later.</p><p><b>RESULTS</b>All the reconstructed urethra survived without contracture or stricture except one infection, which healed with no adverse consequence.</p><p><b>CONCLUSION</b>The key points for operation success is rich capillary network, thick epidermis and thin lamina propria of the buccal mucosa. Buccal mucosa is an excellent tissue for urethral reconstruction.</p>

Penile reconstruction by using a scapular free flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the scapular free flap for penile reconstruction.</p><p><b>METHODS</b>Six patients with penile loss were reconstructed by transferring a scapular free flap with implanting a Malleable penile prosthesis.</p><p><b>RESULTS</b>All of the flaps survived completely. With the follow-ups from six to twelve months, the reconstructed penile had excellent configuration and good function.</p><p><b>CONCLUSION</b>The above mentioned technique could be a good method for penile reconstruction.</p>

Repair of eyelid defect with a prefabricated flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce a new method for repair of eyelid defects.</p><p><b>METHODS</b>Eyelid reconstruction was performed using a prefabricated island flap with an expanded forehead myocutaneous flap and hard palate mucoperiosteal graft.</p><p><b>RESULTS</b>Five patients with congenital or acquired eyelid defects were successfully treated with this method.</p><p><b>CONCLUSION</b>The introduced method is rational and practical for clinical applications.</p>