Modified suture suspension by annular ligature the frontalis muscle to correct severe congenital blepharoptosis in very young patients / 中华整形外科杂志

Objective@#To explore the effect of the modified suture suspension by annular ligaturing the frontalis muscle to treat severe congenital blepharoptosis in children (age≤3).@*Methods@#From October 2016 to October 2017, 11 patients (16 eyes) with severe blepharoptosis were treated using the modified suture suspension in the Affiliated Hospital of Weifang Medical University. There were 7 males and 4 females, aged from 1 to 3 years old, with the average of 26.3 months. Three suture lines were used in three directions respectively. One end was fixed to the upper edge of the tarsus, the other end was fixed to the frontalis muscle by annular ligation. The operation effect and complications were evaluated 1 week and 6 months after the operation.@*Results@#All the incisions healed well. Hypophasis was observed in 1 eye. The exposed palpebral fissure was less than 3 mm when the eye was closed. No corneal exposure was observed in other cases. One week after surgery, the blepharoptosis of 5 patients were fully corrected (6 eyes, 37.5 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.2 %). One patients was over corrected (1 eyes, 6.3%). Six months after surgery, the blepharoptosis of 5 patients were fully corrected (5 eyes, 31.2 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.3%). However, the blepharoptosis of 1 patient was under corrected (2 eyes, 12.5%).@*Conclusions@#This modified suture suspension by annular ligature the frontalis muscle has the advantages of simple operation, low cost, stable effect, small wound, and satisfactory clinical effect.

Application of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects / 中国医学装备

Objective: To investigate the application effect of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects. Methods: This study is a prospective study, and 50 patients with mandibular tumor were enrolled in the research. And all of them were divided into observation group (25 cases) and control group (25 cases). The patients of observation group were implemented precise remodeling of mandible by using prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap, and that of control group were implemented remodeling of mandible by using virtual surgery assisted to vascularized iliac bone-muscular flap. And the occurrences of surgical effect and adverse reaction between the two groups were compared and analyzed. Results: The surgical effect of observation group (24 cases, 96%) was significantly higher than that of control group (20 cases, 80%) (x2=10.951, P<0.05). And the adverse reaction rate of observation group (5 cases, 20%) was significantly lower than that of control group (13 cases, 52%) (x2=10.624, P<0.05). Conclusion:Prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap can obtain better effect in repairing and reconstructing mandibular defects, and its postoperative adverse reactions are less.

Application of muscular flap and induced membrane technique in the emergency treatment for limb salvage for Gustilo type Ⅲ B and Ⅲ C open fracture of lower leg / 中华显微外科杂志

Objective To investigate the clinical effectivity of the muscular flap transposition and induced membrane technique in the emergency treatment for the limb salvage of Gustilo type Ⅲ B/C open fracture of lower leg. Methods From July, 2015 to December, 2017, 10 cases of Gustilo type Ⅲ B/C fracture of lower leg with bone defects were performed limb salvage surgery. Induced membrane technique was used to fill the bone defects in the emergency room.The gastrocnemius and/or soleus muscular flaps were transposed to cover the bone cement or ex-posed bone simultaneously in emergence treatment. After the wound healed completely, traditional bone grafting was used to repair the bone defects. There were 4 cases of Gustilo type Ⅲ B and 6 cases of Gustilo type Ⅲ C. The aver-age length of bone defect was (5.25±1.70) cm ranging from 3.0 cm to 11.0 cm. The gastrocnemius medial head flaps were performed in 5 cases, the combined application with the gastrocnemius medial head flaps and the medial hemimuscular flaps of soleus were performed in 2 cases, and medial hemimuscular flaps of soleus were transposed in 3 cases. Results The wounds in 6 cases were healed at one stage, but 2 cases healed by dressing because the exudate after skin grafting.In 1 case, the cross-leg flap was used to cover the exposed bone cement due to the necro-sis of soleus flap. The other 1 was performed the transposition of the lateral gastrocnemius flaps because the exposure of bone cement after the necrosis of the upper and lateral muscles in lower leg. In the second-stage, the bone defects were reconstructed by traditional bone grafting. The average healed time of bone was 7.2 months ranging from 5 months to 9 months. At the last followed-up time, all patients recovered their function of weight-bearing. The Paley's score of the adjacent joints: excellent in 8 cases and good in 2 cases. Conclusion The combination with induced membrane technique and local muscular flap transposition in emergency surgery is an effective method to limb salvage for the Gustilo type Ⅲ B/C open fracture of lower leg.

Treatment strategy for severe lepharoptosis / 中华整形外科杂志

Objective@#To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve better accuracy and more stable result.@*Methods@#Evaluate levator muscle function pre-operatively. When levator function ≤ 1 mm, frontalis suspension technique was performed. When levator function more than 1 mm, technique of levator resection, combining excision of tarsus and levator, and tarsus-levator-CFS suspension was performed accordingly until it reaches adequate correction result during the surgery.@*Results@#A total of 275 severe ptosis patients was included from January 2015 to June 2016. 52 cases (388 eyes) received levator resection. 162 cases received combining excision of tarsus and levator. 24 cases received tarsus-levator- CFS suspension. 37 cases received frontalis suspension. 326 eyes achieved adequate correction results. 62 cases were still undercorrected. The asymmetry result showed that 76 cases presented good symmetry. 142 cases presented moderate asymmetry and 57 showed severe asymmetry.@*Conclusions@#The new treatment protocol shows a satisfactory result with better accuracy and more stable correction for severe ptosis correction.

Reconstruction of soft tissue defect of the foot dorsum with trimmed latissimus dorsi free muscle flap with skin grafting / 中华显微外科杂志

Objective To discuss the clinical application of using trimmed latissimus dorsi free muscle flap together with skin grafting to resurface soft tissue defects on the dorsum of the foot. Methods From June 2005 to October 2011,eleven patients (8 males and 3 females,aged from 4-46 years) with large soft tissue defects of the foot dorsum were treated in our department. The size of the defects after debridement ranged from 5.0 cm × 6.0 cm-8.0 cm × 12.0 cm,all with exposed tendons or bones.Trimmed free latissimus dorsi muscular flap with split thickness skin grafting was used for reconstruction for all the 11 patients. Results All the flaps survived with no complications after surgery.During 3-10 months' follow-up,the appearance and walking function were satisfying, no further debulking procedures were needed. Conclusion Trimmed latissimus dorsi free flap with skin grafting is a good option for dorsal defect reconstruction.

Carcinoma espinocelular como complicação tardia em doença pilonidal sacrococcígea: relato de caso / Squamous cell carcinoma as a late complication of sacrococcygeal pilonidal disease: case report

A malignização é uma ocorrência rara na evolução tardia de cistos pilonidais, tendo sido descrito menos de 70 casos até 2007. Assim como em outras etiologias, a ocorrência de malignidades em feridas crônicas é chamada de úlcera de Marjolin. Normalmente, observa-se a ocorrência de tumores de baixo grau e bem diferenciados, sendo o carcinoma espinocelular o mais frequente. Entretanto trata-se de tumores de comportamento agressivo, com elevado índice de recidivas e metástases linfonodais. Relatamos o caso de um paciente masculino, 41 anos, com cerca de 23 anos de evolução de doença pilonidal sacrococcígea, que evoluiu com malignização para carcinoma espinocelular, submetido a tratamento cirúrgico e radioterápico.

Malignancy occurs ever so rarely on pilonidal cyst late evolution, so much so that less than 70 cases have been described until 2007. As in other etiologies, malignancy in chronic wounds is named Marjolin’s ulcer. Generally, the incidence of low grade and differentiated tumors is most frequently noticeable. Squamous cell carcinoma is the most frequent one. However, these are aggressive tumors, with high rates of recurrence and lymph node metastasis. We report the case of a male patient, 41 years-old, about 23 years of sacroccygeal pilonidal disease evolution, whose has developed malignancy (squamous cell carcinoma), submitted to surgical and radiotherapic treatment.

Selecting flap repaire hemifacial atrophy by digital technology / 中华显微外科杂志

ObjectiveTo explore clinical application of selecting flap by using of digital technique in treatment of hemifacial atrophy.MethodsSeven patients with hemifacial atrophy were selected,preoperative CT angiography was performed,deformity and flap three-dimensional reconstruction and design bone and soft tissues using Mimics 14.3 software, latissimus muscular flap or femur anterolateral flap were selected,according to tilt donor area and recipient area blood vessel diameter. Defect model were printed using rapid prototyping. ResultsHemifacial atrophy had a good postoperative shape,and the flaps survived in all the 7 cases.Follow-up 3 years,the flaps look well and the patients get expecting results. ConclusionsThe digital technique was a relatively useful tool that can assist surgeons with reconstruction of the flap,and accurate marking of the extent of the flap to be harvested.Therefore avoiding intraoperative injuries to the blood vessels to better survival of the flaps.

Medial gastrocnemius muscle transferring reconstruction the patella tendon with long following-up / 中华显微外科杂志

Objective To evaluate the long following-up outcome of the medial gastrocnemius muscle transferring reconstruction the patella tendon after the wide resection of aggressive bone tumors in the proximal tibia. Methods With the 69 patients of the osteogenetic sarcoma in the proximal tibia were treated with the wide resection and reconstruction the patella tendon. After the long following up the knee extensor,function and complications were evaluated. Results With the 69 patients, the 45 survival patients were followed up for the average 68.6 (24-128) months. The local recurrence rate was 8.7%(6/69). The strength of knee extending was in the average of grade 4.2(3.6-5.0), the degree of knee flexion was in the average of 95°(75°-135°), the degree of knee extension was in the average of-2°(0°-12°), the knees of five patients cannot fully extension. The MSTS functional score was in the average of 77% (23.1/30). Conclusion During the limb salvage of the proximal tibial aggressive bone tumors, the medial gastrocnemius muscle transferring reconstruction the patella tendon could offer the knee extension strength; improve the soft tissue coverage and functional results.

Treatment of large defects in the pelvic limb by dorsal vascularized muscular flaps or myo-cutaneous flaps

25 patients with defects of soft tissue or complex defects of soft tissue and bone joint in the pelvic limbs received the dorsal vascularized myocutaneous transplantation and monitored continuously within 3 months - 9 years. The results have shown that the operations had a good outcomes, even complex lesions of soft tissue and bone such as open bone fracture, osteitis, bone defect. The dorsal vascularized myocutaneous flaps had a good viability and high antisepsis so that can be used in the bone operation or plastic reconstruction for defects of soft infected subchronically or chronically

Study on the anatomy of dorsal muscular flaps in adult Vietnamese

The dorsal muscular flap was pedicular flap. The flap’s pedicle comprised a thoracic artery, a dorsolumbar nerve and vein of bulb. When coming into the dorsal muscle, 88.37% of thoracic arteries divided into 2 branches. Extra branch was far from the anterior edge of medial muscle about 1.95 cm and intra-branch was far from the supra edge of medial muscle about 2.69cm. The thoracic artery can supply fully the blood for the dorsal muscular flap.

A restauração da integridade esofágica com o uso de "flap" muscular, sem formação de estenose clínica, em ovinos / The esophageal integrity reconstitution with muscular flap, without clinical stricture in sheep

A pouca seletividade na preensão de alimentos, o manejo, além da própria localização anatômica predispõem os ovinos a uma série de lesões esofágicas que podem interferir na sua alimentação, produtividade e mesmo na sobrevivência dos mesmos. O desenvolvimento desse trabalho visou testar a eficiência do músculo esternomastóideo na vedação de ferida cirúrgica na parede esofágica, na sua capacidade de servir como leito para proliferação da mucosa e observação da cicatrização decorrente de lesões com dimensões de 2x5cm na parede do esôfago. Para esse experimento foram utilizados quinze ovinos, os quais foram divididos em dois grupos. Os animais foram submetidos à cirurgia com remoção de um retalho de 2x5cm da parede esofágica e substituição pelo músculo estemomastóideo em forma de "flap" e fixado ao esôfago com fio poliamida 0-20 em pontos de Wolf. Um grupo foi observado durante um período de noventa dias e outro por cento e cinquenta dias. Ao final do período de observação designado para cada grupo, os animais foram abatidos, necropsiados e colhidos os segmentos esofágicos operados, onde foi observada a regeneração da mucosa sobre o leito de tecido muscular. Foi detectada ainda discreta estenose de origem cicatricial do lume esofágico, não sendo considerada clinicamente significativa. Ao exame histológico observou-se proliferação epitelial sobre a musculatura. Conclui-se dessa forma, que o músculo foi eficiente na vedação da ferida cirúrgica provocada, servindo ainda de leito adequado para a proliferação epitelial. A retração cicatricial não foi considerada significativa em qualquer um dos animais necropsiados ao final do período de observação.

The poor selection of food, the management associated to the anatomic localization predispose the sheep to esophageal lesions which intefere in nutrition, productivity and survival. The scope of this experiment was to test the stemomastoid muscle efficiency to cover an esophageal wound, its capacity to offer adequade surface for epithelization and consequent cicatrization of 2x5cm excision of the esophageal wall. In this experiment, fifteen sheeps were divided in two groups and submitted to a remotion of an esophageal segment with 2x5cm.The esophageal wall deffect was covered by a stemomastoid muscle flap, which was fixed to the esophagus with poliamida line 0-20 with horizontal mattress suture. One group was controled during 90 days and the other during 150 days. At the end of these periods, the animais were euthanized, and the segment of the esophagus was coilected and evaluated by gross and microscopic examination. A discrete cicatricial reaction and epithelial regeneration was observed. The conclusion is that the muscle is efficient for closure of the esophageal wall deffect, leading to an epithelial regeneration. The cicatricial retraction observed was no clinical importance during the observed periods.

Macro-micro-anatomy of Blood Vessels of Sternocleidomastoid Muscle Flap / 第三军医大学学报

The description of the origin of the arteries supplying the middle and lower thirds of the sternocleidomastoid muscle (SCM) was not consistent in the literature. 50 specimens of SCM on adult cadavers were studied with macro-micro-dissections. The relative distribution areas of various muscular arteries of SCM were displayed on a diagram. It was clearly shown that the upper, middle and lower thirds of SCM were mainly supplied by the muscular branches of the occipital, external carotid and superior thyroid arteries respectively. In 39 out of the 50 specimens, there was an additional muscular artery coming from a branch of the subclavian artery to supply the origin of SCM. The distribution area of this additional artery was so limited that it could not be considered as one of the main muscular arteries of SCM.Thus the muscular arteries of SCM came from different origins. If a single- eaded myocutaneous flap of SCM is made, seperate muscular artery must be peserved for each head of the muscle to avoid necrosis of the muscular flap as well as the remaining muscle. If free arterial pedicle is employed, the musular branch of the external carotid or superior thyroid artery is the artery of choice since either branch is superficially located and has a diameter of 1.1 mm on average.The muscular arteries of SCM entered the muscle in a dispersed way, and there was no vascular porta formed on SCM.