Modified penile augmentation by dermal-fat graft in post-operative hypospadias adults / 中华整形外科杂志

Objecive@#To assess the clinical outcomes of patients who received modified penile augmentation by free dermal-fat grafting.@*Methods@#From April 2012 to December 2014, a total of 15 male adults (18-24 years of age) after hypospadias repairs were included. They underwent modified penile augmentation, including girth enhancement using free dermal-fat grafting, and penile elongation (suprapubic skin advancement-ligamentolysis). Penile measurements were performed using ruler before operation and 6 months after operation. The outcome was evaluated by patients, based on the Male Genital Image Scale. SPSS 22.0 was used to analyze the data. In-paired t-test and Wilcoxon test were applied.@*Results@#In 6-84 months of follow-up, all patients achieved excellent cosmetic results, and satisfied with the appearance and diameter. In weak state, the penile length increased from (5.03±0.47) cm to (6.69±0.49) cm. The increased value was (1.67±0.24) cm (t=8.6, P<0.001). Under traction, the penile length increased from (7.29±0.74) cm to (9.21±0.73) cm. The increased value was (1.93±0.21) cm (t=7.8, P<0.001). In weak state, the diameter of the middle part of penis increased from (7.16±0.25) cm to (8.69±0.44) cm, with the increased value of (1.53±0.23) cm (t=8.2, P<0.001). The MGIS score grew from 31.73±4.86 to 40.20±4.54(Z=3.2, P=0.001).@*Conclusions@#This modified technique is safe and effective in enlarging penile size for patients who had underwent hypospadias repair. It is confirmed that physical dimensional enhancement does contribute to improving their self-estimation of penile size.

Causes and Surgical Outcomes of Lower Eyelid Retraction

PURPOSE: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. METHODS: We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. RESULTS: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. CONCLUSIONS: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Comparative analysis of use of porous orbital implant with mucus membrane graft and dermis fat graft as a primary procedure in reconstruction of severely contracted socket.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2‑4 Krishna’s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed‑up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Congenital orbital teratoma.

revealed mature tissues from each of the three germ cell layers which confirmed the diagnosis of mature teratoma. We describe the successful use of demis fat graft in socket reconstruction following lid‑sparing exenteration for congenital orbital teratoma.

Outcomes of Autogenous Dermis Fat Grafting with Different Donor Sites in Exposed Porous Orbital Implants

PURPOSE: To compare the outcomes of autogenous dermis fat grafting with different donor sites in the treatment of exposed porous orbital implants. METHODS: The present study retrospectively evaluated the medical records of 17 patients (17 anophthalmic eyes) who had undergone autogenous dermis fat grafting based on the diagnosis of exposed porous orbital implants and were regularly followed up for at least 12 months since the surgery from January 2001 to December 2010. The patients were divided into 2 groups (thigh and abdomen) according to the site of the donor grafting. The treatment outcome and complications were compared between the 2 groups. RESULTS: The success rate of thigh dermis fat grafting was 88.9% (8/9) and 100.0% (8/8) in the abdominal dermis fat grafting, and there was no statistically significant difference between the 2 groups (p = 1.000). Regarding ocular complications, graft tissue infection (thigh 11.1%, abdomen 0%) and superior sulcus deformity (thigh 22.2%, abdomen 25.0%) were present. Regarding donor site complications, tenderness (thigh 55.6%, abdomen 25.0%), dehiscence (thigh 22.2%, abdomen 25.0%) and scar formation (thigh 33.3%, abdomen 25.0%) were observed. In the gait associated complications, pain (thigh 55.6%, abdomen 25.0%) and limping (thigh 22.2%, abdomen 12.5%) were observed. The rate of all complications showed no statistically significant difference between the thigh dermis fat grafting and the abdominal dermis fat grafting (all p > 0.05). CONCLUSIONS: Thigh and abdomen can both be considered as an effective donor site for the autogenous dermis fat grafting in the treatment of exposed porous orbital implants.

Clinical application of combined platysma-fascial flap with free dermis fat graft to fill sunken cheek deformity / 中华医学美学美容杂志

Objective To explore the method of treatment of sunken cheek deformity.Methods The longitudinal platysma-faseial flap was overturned 180 degree upward,the flap's pedicle located in the margin of mandible,and then combined with abdominal dermis fat graft to form as a sandwich,which filled in the sunken area of face.Results Five patients were treated with this method from 2003 to 2007,and satisfactory results were gained but only mild absorption was found in the transplanted tissue area during followed up for 3 months to 3 years.Conclusion Platysma-fascial flaps survive easily with rich blood supply and strong anti-infection,and are also easy to incise and operate as well,which,together with free abdominal dermis fat flap,could increase the amount of the needed tissue.It is a better approach to repair the sunken cheek deformity and in particular suitable for the more serious deformity in patients with sunken cheek.

The Therapeutic Efficacy of Exposed Orbital Implant (Medpor(R)) Using Tenon's Capsule

PURPOSE: To evaluate the therapeutic efficacy of primary closure of subtenon's capsule contained with normal ocular blood vessels in the case of exposed porous orbital implant. METHODS: The subjects consisted of five patients who had failed dermis-fat grafts or scleral graft previously presented with re-exposed Medpor orbital implant and three patients who showed primary exposure of Medpor without other operations. We completely cured the exposed area of Medpor using subtenon capsule closure. The range of superficial exposed size of Medpor was about 3~8 mm 4~8 mm. Under local infiltration with 2% lidocaine, the contaminated superficial margin of Medpor was partially removed and then the subtenon's capsule was isolated from the conjunctiva and the orbital implant was directly sutured with Prolene 5-0 without any tension of ocular tissue. Finally, conjunctival suture was performed with Vicryl 7-0. RESULTS: Seven patients were healed well but one patients experienced a 1.5-mm sized. The exposure of Medpor was treated after re-operation using closure of the subtenon's capsule. The only complication observed were forniceal shortening and decreased orbital implant volume, but there ware no clinically significant complications in wearing artificial eyes. CONCLUSIONS: We succeed in complete recovery of exposed Medpor using tenon's capsule without tissue graft. When the Medpor exspoure was less than 1 X 1 cm, it should be useful a technique to repair the exposed surface by using primary closure of subtenon's capsule.

Management of Exposed Porous Orbital Implants

PURPOSE: With its increasing popularity, several complications, such as infection, exposure, and extrusion have been reported in the use of the porous orbital implants. Exposure of the implants is one of the most difficult complications to treat. We evaluate the effect of treatment in exposed porous orbital implants with various techniques. METHODS: From January 1995 to December 2000, 15 patients visited our clinic with exposure of implant after porous orbital implantation. The following procedures were used to cover the implants: observation with delayed prosthesis fitting and posterior vaulting of the prosthesis, burring away the anterior surface of the hydroxyapatite implant and placing dermis fat graft, removing infected implants and dermis fat graft, and removal and 180degrees rotation and replacement of porous implants according to the degree of exposure. RESULTS: Porous implants exposures occurred 1 to 12 weeks after implantations (mean, 5.2 weeks). Small areas of exposure (<3mm) closed spontaneously (2 cases), remained stationary (2 cases), and increased the exposure area requiring dermis fat graft (1 case). During the follow-up period (mean, 19 months), no porous orbital implant was exposed again except 1 case who received previous orbital irradiation therapy. CONCLUSIONS: Small exposure of porous orbital implants less than 3 mm in diameter may be closed with nonsurgical methods. In the case of exposure larger than 4 mm, dermis fat graft or removal and 180degrees rotation and replacement of porous implants were effective in the treatment of exposure.

Correction of Deep Nasolabial Fold using Dermofat Graft of Rhytidectomy Skin

One of the techniques for improvement of the nasolabial fold is the insertion of a fat or dermis fat graft. Guyuron introduced the dermis fat graft from the suprapubic area or the groin region. We innovated a procedure of rhytidectomy and dermis fat graft from rhytidectomy skin to the nasolabial fold area. In casse of a 48-year-old man a conventional cervicofacial flap was elevated from the preauricular and cervico-postauricular regeon to the nasolabial fold. The excess excised skin from the preauricular area was deepithehialized, contoured, and grafted to the nasolabial fold. Three pull-out suture were placed at the medial margin of the dermis fat graft to secure its position. This procedure have several advantages. First, a dermis fat graft under the nasolabial crease not only thickens the soft tissue but also provides a shield to prevent reattachment of the fibrous band to the dermis, which are causative of a recurrent crease. Second, it has no donor site morbidity. Third, the subcutaneous tissue of the preauricular area has much fascial component which survives better than fat injection of strip fat graft. Last, under the direct vision surgeon could place the graft in position he wants. This technique could be used in Asian whose skin is thick and whose maxilla is protruded.

Experimental Comparison of Survival between Dermis-Fat Graft and Fascia-at Graft

The use of autologous fat grafts for soft-tissue augmentation has an extensive history, but it's not popular because of the questionable clinical value due to unreliable grafts survival or infection. To compensate for the volume reduction, transplanted fat is placed intramuscularly and fat graft have been performed, considering basic fibroblast growth factor or endothelial cell growth factor. As is generally known, Watson(1959) stated that the dermal portion exerted a stronger vasoinductive effect than fat alone, thereby increasing the chance of fat survival. However, dermis-fat was harvested from concealed area, the procedure resulted in skin disfigurement. Our hypothesis is that the dermis or fascia, when included in a fat graft, not only makes technical handling and placement easier, but also presumably establishes an early vascular anastomosis with the recipient area, thereby decreases the total amount of resorption of the fat. This study is designed to assess the survival of dermis-fat graft and fascia-fat graft. Sixteen New Zealand White rabbits weighing about 2 kilograms and ranging from 5 to 7 months of age were used. Dermis-fat tissue was removed from the left groin fat pad and fascia-fat tissue from the right groin fat pad. Each graft volume was more than 1.5 cc. To create the ear pockets, a 1 x 1 cm piece of cartilage with its perichondrium was removed. Dermis-fat was implanted below the dermis of the left dorsal ear and fascia-fat below the dermis of the right dorsal ear. Biopsy specimens from each implanted area were taken after 1, 4, 12 and 24 weeks(4 animals at each period). The graft was measured by immersing them in a mass cylinder of normal saline and recording the fluid displaced. Soon after removal, their volume was measured as before. In the first week grafted tissue of dermis-fat and fascia-fat was surrounded by a collagen capsule. In time, specimens showed partial firmness to palpation vn both sides. No obvious gross distinction between the two groups was observed. In specimens taken 1 and 4 weeks after transplantation of dermis-fat and fascia-fat, adipocytes were visible between macrophages and inflammatory cells. At longer intervals, 12 to 24 weeks, the transplanted dermis-fat and fascia-fat were successively replaced by connective tissue; however, inflammatory cell and cystic cavity were still visible. Analysis of volume maintenance(74 versus 71 percent) revealed no significant difference(p<0.05, Wilcoxon signed ranks test) after comparing the volume of dermis-fat versus fascia-fat. Our experimental study proved that volume maintenance and histologic findings between dermis-fat grafts and fascia-fat grafts are similar. Therefore, fascia-fat grafts can be used and offers better aesthetic improvement than dermis-fat grafts without tension on primary closure and hyperpigmentation of donor site.

Clinical Efficacy of Dermis-Fat Graft vs. Posterior Tenon's Capsule Suturing in Anophthalmic Orbit

The anatomic and physiologic changes of the anopthalmic orbit affect cosmetic appearance of the patient and function of the socket and the prosthesis. During the past three years, the authors studied 13 cases of dermis-fat graft and 27 cases of posterior Tenon's capsule suturing with a plastic implant, and compared the post'operative effects of the two procedures. Dermis-fat graft produced good fornix formation with no remarkable fat atrophy after both primary and secondary proceddure. Posterior Tenon's capsule suture technique showes good effect to keep implant from migration or extrusion. Size of the plastic implant and fixation of the extraocular muscles were important factors also for good cosmesis and implant motility. There revealed no significant difference between the two procedures in EOM motility, enophthalmos, deep superior sulcus deformity, implant migration or prolapse etc.