Opportune time and method of reconstruction of penile defects caused by devastating electrical burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the timing and suitable method of reconstructing penile defects caused by devastating electrical burn.</p><p><b>METHODS</b>Thirteen patients with penile defects after devastating electrical burn, hospitalized from September 1998 to August 2013, were included in this study. After the necrotic tissues in the wounds were removed by dressing changes, a local or a hinge-like flap constructed from scrotum or abdominal wall, a prelaminated hinge-like flap from forearm, or a free forearm flap was selected, according to the injury degree of the penis, for the repair of the defect or reconstruction of penis respectively.</p><p><b>RESULTS</b>The flaps survived and the wounds healed well in 2 patients repaired with local flaps from scrotum or abdominal wall. Urethritis occurred in 2 patients 6 to 9 months after the transplantation of hinge-like flaps from scrotum, and they were cured by appropriate drugs. Functions of urination and erection of penis were recovered in these 4 patients. All flaps survived in the 5 patients repaired with hinge-like flaps from abdominal wall or prelaminated flaps from forearm. The wounds in 2 patients healed; wound dehiscence occurred in the other 3 patients in different degrees, and they healed after suturing for 2 or 3 times. The function of erection of penis recovered in these 5 patients, but with discontinuity of urinary stream during urination. Among them, 3 married patients enjoyed satisfactory sexual life. All free forearm flaps survived and the wounds healed well in 4 patients. Urinary fistula occurred in 1 patient, and it was repaired by a secondary operation. These 4 patients experienced normal urination function, but only 2 patients in whom corpus spongiosum partially remained retained the function of erection of penis to certain degree. All these 4 patients could not perform normal sexual intercourse. All patients were followed up for 6 to 13 months after surgery. Under ordinary state, the length of penis was 5.9-9.3 cm, and the circumference of penis was 8.4-10.0 cm. Wound scar was not obvious in all cases. Nine patients reported a restricted erection.</p><p><b>CONCLUSIONS</b>Penile defect caused by devastating electrical burn should be repaired with a suitable flap after necrotic tissues are removed with dressing change. To repair affected penis with necrosis of a small part of cavernous body and/or corpus spongiosum, or combined with urethra defects, local flaps from scrotum or abdominal wall or hinge-like flap from scrotum should be employed. To repair those with necrosis of a large part or the whole of corpus spongiosum combined with urethra defects, hinge-like skin flaps from abdominal wall or prelaminated flaps from forearm should be employed. In patients with necrosis of a large part of cavernous body and corpus spongiosum combined with urethra defect, or total loss of penis, free forearm flaps should be employed to reconstruct penis.</p>

Plastic and reconstructive surgery of cicateicial cryptotia / 中华医学美学美容杂志

Objective To probe the definition of cicateicial cryptotia and its plastic and reconstructive surgery.Methods Local skin flaps combined with full-thickness skin graft by zonation grafting technique were used to treat twenty-six patients with thirty-three cicateicial cryptotia.A cicateicial adhesion between auricle and cranial wall and mastoidea was removed,cranioaural angle was reformed,and helix and auricular lobule were reconstructed.Results All skin flaps survived,and the survival rate of skin grafts reached over 95 ％.The appearance of auricle was very good,its major constructions might be noted,and cranioaural angle nearly returned to normal.The follow-up results from three months to one year post-operation showed that the appearance of auricle kept well,and the patients felt satisfactory.Conclusions In view of deformity characteristics of cicateicial cryptotia,it might be an effective approach to treat cicateicial cryptotia to take a seris of appropriate surgical procedures.

Application of suture and ligature and swelling anesthesia technique in excision of giant skin benign tumor in sites other than extremity / 中华医学美学美容杂志

Objective To study the application of suture and ligature and swelling technique in the removal of giant skin benign tumor in none-extremity position.Methods The swelling technique was merely used in those whose lesions were located on face and neck before operation.If the lesions were located on scalp or truck,suture and ligature and swelling technique would be combined in the treatment.Firstly,the lesion was sutured and ligated one or two circles all around.Then swelling fluid was injected under lesion,and incision was done inside or between sutures.Results The area of lesion once excised was 154.00-2394.75 cm2,and the quantity of swelling fluid was 150 1950 ml.The longest time to suture and to ligate the lesion was one hour,and operative bleeding was obviously decreased.Conclusions Suture,ligature and swelling technique might be helpful to decrease operative bleeding during excision of giant skin benign tumor in none-extremity position,and therefore increase operative safety.

Emergency treatment and cosmetic repair of facial trauma / 国际外科学杂志

Objective To summarize the experience of emergency treatment and cosmetic repair of facial trauma.Methods The clinical materials of 584 wounds from 291 cases of facial trauma,recruited in hospital from January 2010 to August 2012,were summed up retrospectively.The principles of medical aesthetics and plastic and cosmetic surgery were followed.A high pressure douching technique was employed to carry out thorough debridement,but occasion of the debridement did not emphasize with intensive attention.A wound without skin and soft tissue defect was sutured accurately according to tissue zonation with a new suture technique,and the needle distance or side distance was limited in 0.2 cm to 0.3 cm.Otherwise,the wound was repaired by full-thickness skin graft or various flaps according to the repair principle ofrather near than further,rather simple than complicated.Attention was paid to rehabilitation care.Results After debridement,328 wounds were sutured directly,147 wounds were repaired by full-thickness skin grafting and 109 wounds by various flaps.A total of 571 wounds healed on the first stage,and the healing rate reached 97.8％.The wounds were in satisfactory apposition and without obvious cicatrix.Five senses did not appear in malposition and deformity.The other 13 wounds did not heal because of bad taking of skin grafts and flaps or wound splitting.Among them,4 wounds were repaired by second operation,and 9 wounds healed by changing dressings.By means of rehabilitation care,scar hyperplasia and pigmentation appeared slightly in those 13 wounds.A total of 454 wounds from 217 cases were followed up.The results showed good appearance and slight cicatrix hyperplasia,a pigmentation in different degree appeared in 11 wounds covered by skin grafting.In addition,eyebrow excalation,auricle excalation or total lose appeared in 12 cases.Conclusion During treating emergency cases of facial injuries,if an idea cosmetic repair of traumais followed,the theory of aesthetics and the techniques of plastic and cosmetic surgery are fully used,a multiple-discipline cooperation is brought into full play,and a prompt and accurate treatment is put into practice,the aim of cosmetic repair would come true.