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Objective@#To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting.@*Methods@#From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People′s Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher′s exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction.@*Results@#The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma.@*Conclusions@#Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.
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Objective To study the application of artificial dermal scaffold in treatment of large area avulsion injury. Methods The clinical data of twenty inpatients with large area avulsion injury who were treated in the Department of Burn and Trauma Surgery of Changhai Hospital between January 2011 and December 2014 were retrospectively analyzed in this study. The 20 patients, aged 6-68 years old and with avulsion area of 10%-40% total body surface area (TBSA), were divided into 2 groups according to treatments, with ten cases in each group. The wounds in the treatment group were treated with debridement plus artificial dermal scaffold plus Negative PressureWound Therapy (NPWT); NPWT was changed 5-7 days and the vascularization was observed. The wounds in control group were treated with debridement plus NPWT, and autogratt implant surgery was done in both groups according to the vascularization degrees. The time intervals from debridement to skin grafting, the survival rate of the skin-gratt, and the healing time and quality of the donor area were all observed. Results Compared with the control group, the treatment group exhibited a significantly longer time interval from debridement to skin grafting([13. 3 0±2. 06] d vs [7. 9 0±1. 1 0] d, P0. 05). Conclusion Early application of artificial dermal scaffold combined with NPWT for treatment of large area avulsion injury can avoid large grafting and reduce trauma, which can help to keep patients in stable status; meanwhile it can promote vascularization process and improve the healing time and quality of wounds, especially in the donor sites.
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Objective To investigate the prothetic effect of free grafting of microvascular anastomotic peroneal artery perforator flap when used to repair the donor tissue defects of wrap-around flap of toe.Methods From January 2008 to March 2013,twenty-six cases thumb avulsion at proximal and distal phalanx level with skin and nail bed defect caused by trauma were admitted to our hospital.After incising wrap-around flap of toe to repair the thumb defects,microvascular anastomotic peroneal artery perforator flap was transplanted freely to repair the donor site of it.Results The skin flaps of 26 cases all successfully survived.After a followed-up of 3 months to 4 years,the length of donor toes were the same as before.The appearance of skin flaps were no fat and clumsy and the abradability of their skin were well.Algesia,thalposis and thigmesthesia were partially recovery.Two point discrimination reached to 5-10 mm.There were no obvious uncomfortableness in donor feet when standing and walking except wearing flip-flops.Conclusion Free grafting of peroneal artery perforator flap is a good method to repair the donor defect caused by incising wrap-around flap of toe.
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BACKGROUND: The most crucial factor in hair transplantation for male pattern baldness (MPB) patients is the efficient utilization of the donor-recipient ratio. However, there is no known factor that scientifically predicts the rate of progression of alopecia or indicates a permanently safe donor area. METHODS: The study considered 1,008 Korean adult males with MPB; of these, it excluded 56 males with an absence of parietal whorls (PWs). The authors investigated the distance from the vertical bimeatal line (VM) to the PW, from the PW to the upper border of the helical rim (HR), and the distance from the PW to the occipital fringe (OF) in 952 subjects with a PW. Furthermore, we examined the distance from the PW to the OF considering the duration of alopecia and age in 322 subjects with vertex alopecia. RESULTS: The distance between the VM and PW varied from 1.5 to 11 cm, with an average distance of 6.25 cm. The PW-HR distance ranged from 3.4 to 17.5 cm, and the average distance was 7.79 cm. The PW-OF distance ranged from 0.5 to 5.5 cm, and the average distance was 2.37 cm. CONCLUSIONS: For the PW, very large variations existed in the vertical direction. The position of the PW could predict the progression range of the total alopecia of the vertex. Alopecia mostly progresses within 6 cm of the PW toward the occipital side.
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Adult , Humans , Male , Alopecia , Hair Follicle , Hair , Rabeprazole , Tissue Donors , Transplant Donor SiteABSTRACT
BACKGROUND: The pathophysiological events resulting in keloid formation remain unclear. Overabundant levels of VEGF have been reported to contribute to excessive wound healing. There have been many studies describing the relationship between keloids and VEGF expression. However, there have been no reports about VEGF expression related to donor sites. OBJECTIVE: We investigated VEGF expression of cultured normal and keloid fibroblasts obtained from different body areas under normoxic and hypoxic culture conditions. METHODS: Normal fibroblasts from the earlobe (n=2), shoulder (n=2) and chest (n=2) as well as keloid fibroblasts from the earlobe (n=3), shoulder (n=3) and chest (n=3) were collected and cultured. VEGF expression of fibroblasts at 6 hours, 12 hours, 24 hours and 48 hours for cells maintained under normoxic and hypoxic conditions was measured by the use of RT-PCR. Paraffin-embedded tissues (normal and keloid tissue) were assayed by immunohistochemical staining. RESULTS: For the cultured normal fibroblasts, VEGF expression for cells in the hypoxic condition was higher as compared to VEGF expression in cells in the normoxic condition, irrespective of the donor site and time. However, for the cultured keloid fibroblasts, VEGF expression for cells in the hypoxic condition was higher as compared to VEGF expression in cells in the normoxic condition for cultured shoulder fibroblasts. For each donor site, VEGF expression was highest in the shoulder, followed by the chest and earlobe for cultured normal fibroblasts, irrespective of time. For the cultured keloid fibroblasts, the highest VEGF expression occurred at 6 hours for cells in the normoxic condition and the highest VEGF expression occurred at 6 hours and 12 hours for cells in the hypoxic condition. Based on immunohistochemical staining, VEGF expression of paraffin-embedded normal tissue was lower as compared to paraffin-embedded keloid tissue. For each donor site in paraffin-embedded keloid tissue, VEGF expression was highest in the shoulder, followed by the chest and earlobe. CONCLUSION: Oxygen tension and the nature of fibroblasts from different donor sites are involved in keloid pathogenesis.