Functional evaluation of a "two in one" urethroplasty for hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the functional result of a "Two in One" urethroplasty which combined oral mucosa graft and local flap.</p><p><b>METHODS</b>17 patients with hypospadias underwent a "Two in One" urethroplasty, which combined buccal mucosa and local flap for urethral reconstruction. Uroflowmetry was performed 1 day before and 1 year after operation. The urine flow rate, voided volume and urine flow curves were detected using a rotating sensor. The results of maximum urine flow rate (Qmax) were expressed as percentiles and compared to the Toguri value from normal children.</p><p><b>RESULTS</b>Before corrective operation, 12 of 17 patients (70.6%) produced a plateau urine flow curve. 5 patients (29.4%) produced a very low flow curve. The average maximum flow rate was (7.89 +/- 2.29) ml/s per second compared to Toguri values, 12 of 17 patients (70.6%) had a Qmax below the normal 5th percentile. After a "Two in One" urethroplasty, a hell-shaped curve was obtained in 10 patients (58.8%). The maximum flow rate was (11.30 +/- 3.01) mL/s per second. 7 of 17 patients (41.2%) had a Qmax above the normal 25th percentile, 8 patients (47.1%) had a Qmax between the normal 25th percentile and 5th percentile, only 2 patients (11.8%) had a Qmax below the 5th percentile.</p><p><b>CONCLUSIONS</b>The functional result of the "Two in One" urethroplasty is ideal. The maximum urine flow rate of the patients increases after the operation.</p>

Muscles reposition in correction of nasal deformity after unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effective method for correction of nasal deformity after unilateral cleft lip.</p><p><b>METHODS</b>50 cases with secondary nasal deformity after unilateral cleft lip were retrospectively analyzed. All the patients underwent nasal and lip muscle reposition operation to restore the symmetry of nasal alar.</p><p><b>RESULTS</b>The nasal deformity was greatly improved in all the 50 cases. The malposition of nasal column and nasal alar was corrected. The symmetry was markedly improved. The measurement before and after operation showed significant difference ( P<0.05).</p><p><b>CONCLUSIONS</b>The reasons of secondary nasal deformity after unilateral cleft lip are complicated. The muscle reposition operation can effectively improve the deformity.</p>

A rhombus shape excision of the soft palate to treat obstructive sleep apnea hypopnea syndrome / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a surgical treatment for obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>12 cases were treated during the period from Jan 1998 to Aug 2006. Partial soft palate was resected in rhombus shape from the middle to shorten the soft palate and enlarge the pharyngeal cavity. The uvula was reserved.</p><p><b>RESULTS</b>The patients were followed up for six months to five years. There was no complication. Good results were achieved in 9 patients. 2 cases got some kind of improvement. No improvement happened in one case who received a partial tongue resection later.</p><p><b>CONCLUSIONS</b>A rhombus shape excision of the soft palate from the middle is effective for the treatment of OSAHS with few complication.</p>

Partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy of partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia.</p><p><b>METHODS</b>There were 4 patients performed this procedure. We took a rhombus shape incision in the middle of the tongue and performed a wedge excision.</p><p><b>RESULTS</b>The mouth can close entirely in all of patients and there weren' t hemorrhage and obviously swollen; Tongue's sensory function hadn't disturbance. Masticate function were normal. One patient still had the symptom that tongue lied outside the oral cavity occasionally after operation. The symptom was disappeared after Temperature-controlled radiofrequency (TCRF) ablation. All of patients' parent were satisfied with the results.</p><p><b>CONCLUSIONS</b>Partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia is an effective, much safer and less invasive procedure without obvious adverse reactions. There are better prospects for applying.</p>

Treatment of the congenital exstrophy of bladder / 中华整形外科杂志

<p><b>OBJECTIVE</b>To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy.</p><p><b>METHODS</b>The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm.</p><p><b>RESULTS</b>12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting.</p><p><b>CONCLUSIONS</b>Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.</p>

The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients / 中华整形外科杂志

<p><b>OBJECTIVE</b>Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias.</p><p><b>METHODS</b>In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath.</p><p><b>RESULTS</b>Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up.</p><p><b>CONCLUSIONS</b>The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.</p>

An experimental study on the culture of human oral mucosa epithelium using autologous serum / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the biological properties of cultured human oral mucosa epithelium using autologous serum in order to provide a new material for tissue engineering urethra.</p><p><b>METHODS</b>The cultured oral mucosa epithelium was respectively transplanted beneath the skin, above the deep fascia and in the wound of the athymic mice. The specimens were taken at 2, 3, 4, and 6 weeks posttransplantation, and processed for (1) immunofluorescence anti-HLA staining to determine graft acceptance, and (2) anti-human IV collagen and antihuman laminin immunohistochemical staining procedures to indicate the basement membrane formation.</p><p><b>RESULTS</b>All the grafts survived and grew very well. The grafts were positive to anti-HLA. Collagen type IV and laminin were detected at the dermo-epidermal junction in all groups from day 14, and increasing in density up to day 21.</p><p><b>CONCLUSIONS</b>he cultured human oral mucosa epithelium by autologous serum could develop an excellent functional epithelium tissue, which would be used to reconstruct urethra and repair wound.</p>

Bacteriology study of hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>This clinical study was to explore why the neo-urethra is liable to be infected after hypospadias operation, find the source and the common floras of infection, and accordingly, improve the peroperation procedures so as to reduce postoperative infection rate.</p><p><b>METHODS</b>The pathogenic floras were examined and analyzed by germiculture and karyotype analysis.</p><p><b>RESULTS</b>The bacteria in the neo-urethra mostly came from the orifice and the reconstruction material of the urethra. The most common floras that caused infection were gram-positive coccus. The most sensitive antibiotics for hypospadias infection were demethylvancomycin.</p><p><b>CONCLUSION</b>The postoperative infection of hypospadias is incisional, not the urinary system infection. Because the microenvironment of the neo-urethra is more suitable for infection than that of the skin or mucosa, the reconstructed urethra is likely to be infected.</p>

Rabbit urethral defect repair with freeze-dried acellular bladder submucosa / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the result of urethral defect repair using freeze-dried acellular bladder submucosa.</p><p><b>METHODS</b>The freeze-dried acellular bladder submucosa was obtained from human cadaveric bladder submucosa using freeze-thawed enzymatic treatment and the freeze-drying technique. 18 male New Zealand rabbits were used in this experiment. A defect of 1.0 cm x 0.5 cm was created in the ventral urethra of the animal. The acellular matrix was grafted to the urethral defect in 14 rabbits. The other 4 animals underwent a sham operation as the controls. From postoperative one to twenty-four weeks, the animals underwent retrograde urethrography at certain intervals. The grafts of the acellular matrix were taken and prepared for histological evaluation.</p><p><b>RESULTS</b>No obvious urethral stricture was observed in the 14 matrix-grafted animals. Histological examinations of the specimens showed progressive infiltration of cells and vascular vessels. Complete epithelization was obtained at 2 weeks. The orientation of collagen fibers in the matrix-grafted area tended to be regular with time.</p><p><b>CONCLUSIONS</b>Freeze-dried acellular bladder submucosa may be a suitable material for urethral defect repair, which induces urethral mucous cells to migrate, grow and epithelialize.</p>

The inherent liability to infection of various tissue for urethra reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>Observing the long-term results of reconstructed urethra to reduce the postop infection rate of hypospadias. To explore the standard of selecting tissue for urethra reconstruction by comparing the different inherent liability to infection in use of different kinds of tissue for urethra reconstruction.</p><p><b>METHODS</b>Neo-urethra inner wall and normal urethra were observed through urography and urethroscope. The tissue section of neo-urethra, normal urethra and tissue for urethra reconstruction were observed through light microscope, scanning electron microscope and transmission electron microscope.</p><p><b>RESULTS</b>The structure and liability to infection of neo-urethra made of bladder mucosa, buccal mucosa or skin never changed after long time. Metaplasia never took place in neo-urethra.</p><p><b>CONCLUSIONS</b>The structure and liability to infection of neo-urethra were the same as those of the congeneric tissue. Bladder or buccal mucosa is the best tissue for urethra reconstruction considering urethra microenvironment. Neo-urethra made of skin is more liable to infection by nature. The best opportunity of hypospadias operation should be before puberty.</p>

Autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>Applicate autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias by staging.</p><p><b>METHODS</b>From 1999 to 2003, 40 patients have been treated by method of autologous buccal mucosal graft pre-placing. There were two models: graft onlay and graft-tube for urethral reconstruction, and the 2rd operation was accomplished half year later.</p><p><b>RESULTS</b>All patients healed without urethral fistula.</p><p><b>CONCLUSION</b>The method is valuable for treatment of complicated hypospadias.</p>

Inner preputial skin grafts combined with preputial island flap for treatment of penile hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate new methods of treatment for penile hypospadias. METHODS Urethroplasty was performed for penile hypospadias using inner preputial skin grafts combined with preputial island flap.</p><p><b>RESULTS</b>A total of 10 patients have received this procedure. After a mean follow up of one year, no fistula or urethral stricture was found. All patients obtained excellent cosmetic results.</p><p><b>CONCLUSIONS</b>This method allows for adequate correction of severe chordee. It is a useful procedure for selected cases of primary hypospadias with severe incurvation.</p>

Clinical applications of the buried-guided-suture method in the treatment of facial depression / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop a method for the treatment of facial depression without incision scar.</p><p><b>METHODS</b>In repairing the facial depression, the ruptured subdermal adipocellular tissue was approximated and reunite with the buried-guided-suture method through an intraoral or a concealed skin incision.</p><p><b>RESULTS</b>17 patients with facial depressions from trauma were treated. Postoperative follow-up of 10 patients for one year showed satisfactory results without recurrence.</p><p><b>CONCLUSION</b>The buried-guided-suture method for repair of facial depression from trauma is simple, reliable and worth recommendation.</p>

Oral mucosa graft combined with a local turn-over flap for urethral reconstruction in various hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>Explore a good method for treating various hypospadias.</p><p><b>METHODS</b>Oral mucosa graft combined with a local turn-over flap was used for urethral reconstruction in 39 cases of hypospadias.</p><p><b>RESULTS</b>All the 39 cases were cured successfully in one stage, and satisfactory penile configuration obtained.</p><p><b>CONCLUSION</b>This operation solved the problem of tissue scarcity in urethral reconstruction. It made use of the merits of different materials and avoided the disadvantage of a single tissue. It is good for treating various hypospadias and worthy of popularization.</p>

Long-term results of whole piece, full-thickness skin grafting for facial post-burn reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method for repair of the whole facial burn scar and evaluate the long-term results of skin grafting.</p><p><b>METHODS</b>18 patients with facial burn scar were treated with whole piece, full-thickness skin grafting. All of them have been followed-up for 5 to 20 years. The color, elasticity, sensation and gland secretion of the grafted skin were evaluated. The skin samples were taken for light and electron microscope examinations.</p><p><b>RESULTS</b>The long-term results of whole piece, full-thickness skin grafting were satisfactory. The grafted skin was smooth and elastic, with sebaceous and sweat glands. The histological structure of the grafted skin was similar to that of the normal facial skin and different from that of the donor site.</p><p><b>CONCLUSION</b>Whole piece and full-thickness skin grafting may be a valuable method for the treatment of facial burn scar. The morphological and histological structure of the grafted full-thickness skin is similar to the normal facial skin through the long-term follow-up.</p>

Treatment and pathologic change of pachydermoperiostosis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment and possible pathogenesis of pachydermoperiostosis.</p><p><b>METHODS</b>Facelift was performed on five patients with pachydermoperiostosis. Histological studies were performed to check the affected skin for possible pathogenesis.</p><p><b>RESULTS</b>After the surgery of facelift, appearances of the patients were markedly improved. Histological studies revealed significant changes in the skin, characterized by hyperplasia and thickening of the subcutaneous collagen, as well as an increase of PAS-positive substance.</p><p><b>CONCLUSION</b>Alterations of fibroblast bioactivity might be responsible for the pathogenesis of pachydermoperiostosis. There have been no satisfying treatments to the disease. Facelift is a feasible method to improve the aging appearance of the patients.</p>