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Objective:To investigate the efficacy of tumescent anesthesia combined with skin and soft tissue expansion for the repair of congenital giant melanocytic nevi.Methods:From July 2015 to December 2019, 41 patients with congenital giant melanocytic nevi, including 24 males and 17 females aged 7 - 45 years, were collected from the Department of Dermatology, Xijing Hospital, the Fourth Military Medical University. Skin lesions ranged from 5 cm × 12 cm to 12 cm × 18 cm in size, and were located on the scalp in 13 cases, on the face in 18 cases, as well as on the trunk in 10 cases. Before surgery, the composition of tumescent solution was adjusted according to the body weight, operation duration, skin lesion area, etc., and the total dose and peak plasma concentration of lidocaine should be below 35 mg/kg and 4 mg/L respectively. All the patients received tissue expander placement and second-stage flap transfer under tumescent anesthesia.Results:During surgery, satisfactory effect of tumescent anesthesia was achieved in all the 41 patients, the pain score assessed by a numerical rating scale was 1.82 ± 0.54. In addition, the surgical field and dissection levels were clear with little bleeding and no related complications. Follow-up of 3 - 36 months showed that the skin flaps matched the surrounding skin tissues well, with relatively concealed incision lines and soft flat scars.Conclusion:For the treatment of congenital giant melanocytic nevi, tumescent anesthesia is effective and safe, which combined with skin and soft tissue expansion can effectively reduce the incidence of postoperative complications, and this strategy is worthy of clinical promotion.
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Objective@#The incidence of complications after skin soft tissue expansion is relatively high. Occurrence of infection often means the expander has to be taken out ahead of schedule. In this retrospective study, we wanted to identify independent risk factors of infection after skin soft tissue expansion, which could be helpful to guide clinical work.@*Methods@#Demographic information of patients who underwent the skin soft tissue expansion at the department of plastic surgery of Xijing Hospital from January 2003 to December 2012 was collected. Univariate associations with infection were measured by logistic regression and represented as odds ratios. The p-value less than 0.1 was identified the potential risk factor. Multivariate logistic regression was used to calculate odds ratios for risk factors of infection. Independent risk factors were identified if the p-value was less than 0.05.@*Results@#A total of 3382 implants were included in the study. The overall infection rate of tissue expansion was 5.2% in 177 implants. The result of multivariate logistic regression showed that preoperative white blood cell count, age, numbers of expander implanted and volume of expander were independent risk factors of infection.@*Conclusions@#Independent risk factors of infection were preoperative white blood cell count, age, numbers of expander implanted and volume of expander. The lower preoperative white blood cell count, age more than 18 years old, more numbers of expander implanted and the bigger volume of the expander, the higher possibility of complications occurred. The result was helpful to guide clinical work and reduce the incidence of infection.
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Objective@#To investigate the functional recovery and cosmetic effects of pre-expanded pedicled deltopectoral flap.@*Methods@#From January 2008 to December 2018, 42 patients with 56 pre-expanded pedicled deltopectoral flaps from Xijing Hospital of Air Force Military Medical University were followed up at least 6 months. 18 of them were male, the remaining were female. And the average age was (24.7±7.3) years. Then the indicators were tested and evaluated. Tubes with different temperatures were used for temperature sensation test. The flaps were stabbed using a 27 G blunt needle to test algesthesia. Tactile threshold was measured by Semmes-Weinstein monofilament. Two-point discrimination was measured by Disk-Criminator. Elasticity of skin flaps was measured by CK-MC®960. Colors of skin flaps were analyzed by ANTERA®3D system, including L*a*b*, melanin and hemoglobin content. And the postoperative scars were evaluated by the Patient and Observer Scar Assessment Scale (POSAS). The flap retraction rate [(flap area immediately after operation-flap area at the follow-up time)/flap area immediately after operation]was calculated. The satisfaction of patients, doctors and third parties was investigated as well. Statistical analysis of data was performed with SPSS 23.0, satisfaction rate was expressed as percentages. Scar scores were compared by Wilcoxon rank sum test. The values of elasticity, color L*a*b*, melanin and hemoglobin between skin flaps and normal skin were analyzed by paired t test. The difference was statistically significant at P<0.05.@*Results@#The scores of pain, heat and cold sensation were (4.61±0.78), (3.48±0.90) and (4.39±0.81), the tactile threshold was (0.26±0.23) g/mm2, and the distance of two-point discrimination was (10.09±4.79) mm. There was no significant difference in elasticity, color b*and melanin content between skin flap and normal skin of face and neck (P>0.05). The color of flap L*, a*and hemoglobin content of flaps were significantly different from those of normal skin from face and neck (P<0.05). The result of self-assessment of patients (POSAS) showed that there were significant differences (P<0.05) in pain, itch and stiffness between facial and chest donor scar. The result of observer evaluation (POSAS) showed that the scar score for all items around facial flap was better than that of chest donor area, the difference was statistically significant (P<0.05), and the retraction rate of flaps was (10.44 ±3.36)%. The satisfaction rates of doctors, patients and the third party were 92.86% (39/42), 71.43% (30/42) and 61.90% (26/42), respectively.@*Conclusions@#Excellent functional recovery and reliable cosmetic effect were observed in the facial-cervical scar repair with pre-expanded pedicled deltopectoral flap. Transfer of pre-expanded pedicled deltopectoral flap is an effective method for the treatment of facial-cervical scars.
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As a revolutionary plastic treatment, skin soft tissue expansion has become one of the three conventional techniques of plastic surgery after skin grafting and flap transplantation. At present, expansion is widely used in the treatment of various lesions in multiple parts of the body. It plays an irreplaceable role in many areas such as scar repair, alopecia treatment, ear, nose, breast, penis and other organ reconstruction and surface tumor management. In recent years, the application of expansion has been constantly evolving, and it has renewed its vitality by combining with new technologies. However, the prevention and treatment of complications of expansion should be paid more attention, the expansion efficiency needs to be improved, the basic research on the skin regeneration mechanism and micro-environment changes of expansion is still lacking, and further exploration is needed. Based on this, the clinical application principles, new progress and experimental exploration of skin soft tissue expansion were reviewed and summarized, and the possible development directions were analyzed.
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Objective@#To explore the blood supply of expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck and the feasibility of this kind of flap for facial vulnus′resurfacing.@*Methods@#At the first stage of the treatment, one rectangular expander was implanted in lateral neck in the subcutaneous pockets, overlying the platysma, the volume of the expander is about 200-600 ml. After 2-3 months inflation, the pre-expanded lateral neck flap combined with posterior auricular flap was advanced at the second stage of the operation, the flap was rotated to lateral face to resurface the vulnus defects located on anterior auricle.@*Results@#Twelve cases of facial wounds were included in this research from January 2009 to November 2016. The size of the expanded flaps were ranged from 6 cm×12 cm to 7 cm×15 cm. According to 2 to 24 months follow-up postoperatively, 10 months in average, two flaps showed venous retardation at distal part of expanded flaps, which were recorvered with one-week dress changing after excoriation. The other ten flaps survived with good appearance and function. The flaps matched well to the recipient defects in terms of color, character and elasticity. The appearance and function of face and neck were ideally adjusted after treatment.@*Conclusions@#By expanding lateral neck skin overlying platysma, the expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck was obtained with high quality and maximum use of blood supply in the anterior neck, which guaranteed appearance and function of the donor area and the recipient area at the same time.
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Objective@#To investigate the modification of the classic techniques of total auricle reconstruction with skin expansion, and its clinical application.@*Methods@#We performed three-dimensional measurement of the normal auricle and the expanded flap on 150 microtia patients. According to the data, we carried out total auricle reconstruction using extended postauricle expanded flap techniques for 82 patients of the group. Firstly, a 50 ml kidney-shaped expander was inserted subcutaneously in the mastoid region. Approximately 65 ml saline was injected in about 30 days, and expansion was kept without injection for another 30 days. In the second stage, we removed the expander and dissected the scalp 4-5 cm around the expanded skin, to make a composite flap consisted of expanded skin and extend scalp. Then we used the flap to encapsulate the three-dimensional rib cartilage framework to accomplish total auricle reconstruction.@*Results@#The blood supply and venous drainage of the flap was good. No obvious postoperative flap swelling was observed. Only 2 cases of helix skin necrosis happened in 48 hours after operation. Small area of skin defect was treated by debridement and suture, while larger area of skin defect was repaired with postauricular fascia flap and free skin graft. Postoperative follow-up period was 4-15 months, about 6.7 months in average. Bilateral ear size and position were similar with clear structures and shapes. Helix seemed more slim, auriculocephalic sulcus was obvious, auriculocephalic angle was similar to the other side. There was no color abberration between the front and back side of reconstructed ear. Scars of retroauricular hairline incision and costal cartilage harvesting incision were not obvious.@*Conclusions@#The novel surgical techniques is reasonable and simple without fascia flap or skin graft, which is worthy of application by more plastic surgeons.
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Objective To observe the influence of chitosan on the skin and soft tissue expansion.Methods Twenty-five patients were selected,who were suitable to be embedded soft tissue expanders in the face,a 100-milliliter expander was implanted in one side of the face,and other side was used as control.A 100-milliliter expander was implanted in each group,and a slender silicon duct was embedded between the expander and subcutaneous tissue in the experimental group.About five to seven days after the operation,the negative drainage tube was removed,and then two-milliliter medical chitosan injected with the silicon duct in the experimental group,but not in the control group.Two groups were injected with normal saline in the second day.The center of expanded skin was pressed and skin elasticity and relaxation were compared between the two groups during the injection interval.The time of injection interval,the quantity of normal saline inside the expanders after two weeks and three weeks and the total time of expansion to 100 milliliters were recorded.After injection was completed in the two groups and maintained for two weeks.In the stage Ⅱ operation,the expanders were taken out,1 cm × 1 cm fibropeplos was removed from the center of the expanded skin flap from the two groups,and pathological section was prepared to measure the thickness of fibropeplos,average gray scale of collagen and the quantity of blood capillaries.The fibroblasts,collagen fiber and capillaries were observed and compared under light microscope.A matched-pairs t analysis was used to analyze the data.Results Compared with the control group,the quantity of normal saline inside the expanders in the experimental group was increased at the same time; the water injection period was shorten and tissue expansion was significantly accelerated.The number of fibroblasts in the fibropeplos decreased with the influence of chitosan.The fibroblasts were restrained to mature period and collegan decreased.The fibropeplos became thinner but the capillaries were not affected.Conclusions Chitoson can inhibit fibroblast proliferation and collagen production,and the effect of accelerating tissue expansion is significant and deserves to be recommended.
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OBJECTIVE To study clinical application technique of skin soft tissue expansion in auricular reconstruction.METHODS 502 patients (517 ears)were selected for skin soft tissue expansion. Skin expander was implanted and liquid injected routinely to expand skin to obtain excessive skin for auricular reconstruction.RESULTS Of 502 patients (517 ears),10 patients(10 ears) had complicated skin hematoma formation which had been cleaned out successfully;12 patients(12 ears) had complicated skin expander uncover,skin expander was taken out and reposted 4 months later in 7 patients(7 ears) without affecting opertative effect;No infection was found and all patients obtain satisfactory effect. CONCLUSION Skillful and normative operation is the key for preventing complication.Fibre layer must be got rid of during operation.Skin expander auricular reconstruction has the advantage of obvious concave and protruding figure as well as satisfactory cubical sense.It is the perfect method for treating ear malformation at present.