The significance of ultrasound and mammography in the diagnosis of fat necrosis after fat transplantation in breasts / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the significance and images characters of ultrasound and mammography in the diagnosis of fat necrosis after fat transplantation in breasts(FTB).</p><p><b>METHODS</b>From June 2005 to June 2012, 13 cases with 96 fat necrosis lumps after FTB, were retrospectively reviewed. The pre-operative images of ultrasound and mammography, as well as the post-operative histologic results were collected.</p><p><b>RESULTS</b>All the 96 lumps were histologically diagnosed as fat necrosis. They were lipo-necrotic cysts with thin wall(29 lumps), or thick wall(52 lumps), or no wall(15 lumps). The cysts with wall could be distinguished both in the images of ultrasound and mammography, but the cysts without wall could only be found in mammography images, not in ultrasound images.</p><p><b>CONCLUSIONS</b>Most fat necrosis lesions show a special cystic images with thin or thick wall in ultrasound and mammography. Irregular lesions without wall can be distinguished in the mammography images, but may be mis-diagnosed in the images of ultrasound. The images characters of fat necrosis lesions in mammography are not confused with the breast tumor.</p>

Integrated autologous fat graft in face recontouring / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the integrated autologous fat graft technique in face recontouring.</p><p><b>METHODS</b>In this study we treated 83 cases of face recontouring with 3L3M technique (low pressure suction, low speed centrifugation, low volume, multi-plane, multi-tunnel, multi-point injection). Each case was treated 1-3 times and the interval period is 3-6 months. The result was based on comparing the photos taken from pre-operation and post operation, observing the expression recovery, cysts, local absorption, and patients self evaluation.</p><p><b>RESULTS</b>Long time follow up showed that fat graft can be alive in the recipient site for long time after 1-3 times autologous fat injection. More than 73.5% patients were satisfactory with the curative effect while less than 4.8% patients were unsatisfactory.</p><p><b>CONCLUSION</b>3L3M integrated fat graft technique is an effective and safe treatment in face recontouring.</p>

Three case reports of abdominal compartment syndrome after full abdominoplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To improve the safety of the abdominoplasty by the study of the complication of abdominal compartment syndrome after abdominoplasty.</p><p><b>METHODS</b>Three cases were analyzed and discussed respectively in aspects of clinic symptoms, pathological reason, treatments and follow-up results. The treatment was the incision of musculoaponeurotic system, which usually cause defect of abdominal wall after pressure releasing. The defect of musculoaponeurotic system was reconstructed by Mesh, and the defect of skin was repaired by skin graft.</p><p><b>RESULTS</b>The pathologic change of the complications was the shrinking of the belly cavity's volume and the increasing internal pressure of the abdomen caused the internal pressure of the thoracic cavity increase. The clinical manifestations included compressive feelings of chest and abdomen, high urinary frequency and psychiatric symptom. 2 patients accepted the operation. The abdominal compartment syndrome disappeared after the operation, and the results of the two years follow-up were satisfied.</p><p><b>CONCLUSIONS</b>Full abdominoplasty has the risk of causing abdominal compartment syndrome. This complication can be cured by decompression of abdominal wall. The effect is stable after long time's follow-up. Special preventive methods should be used in high-risk patients to avoid this complication.</p>

Application of aesthetic sub-unit principle in nasal reconstruction and repairing of nasal defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the significance and effect of nasal aesthetic sub-unit principle.</p><p><b>METHODS</b>Based on nasal aesthetic sub-unit, 27 patients were divided into 5 groups according to their nasal defects. They were nasal dorsum, tip, alar lobule, soft triangle and two or two above nasal subunit defects groups. Local restore were applied in defects which were less than 50 percent of one nasal subunit. Total nasal subunit reconstruction were applied, if areas of defects were larger than 50 percent of one nasal subunit 10 cases were received free tissue transplantation (including free skin transplantation, composite auricle transplantation, etc), 4 cases were received local flap, and 13 cases were received forehead flap. Following up for 5 to 37 months, evaluation item were contour and color.</p><p><b>RESULTS</b>Skin transplantation and local flap were all survived. Auricle composite flap were all survived except for 2 cases whose epidermis looked red and purple. These two case's epidermis regained normal 6 months after operation. Forehead flap for nasal reconstruction were all survived, but one of them had to perform secondary surgery for coverage of the exposed nasal frame. 27 cases were followed up in all. Patients and their family members were satisfied with the nasal's contour and color.</p><p><b>CONCLUSIONS</b>Good aesthetic effects comes from nasal aesthetic sub-unit principle in nasal reconstruction and repairing of nasal defects.</p>

Establishment of composite facial and scalp allograft transplantation model in canine / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop an experimental model of composite facial and scalp allograft in canine in order to investigate technical and immunological aspects and functional recovery of facial muscles of this new approach to facial reconstruction.</p><p><b>METHODS</b>(1) Anatomic study: Four mongrel dogs were used for anatomical dissection of the head and neck region and for harvesting flap experiment. (2) Autologous transplantation (group I): Three types composite facial and scalp autologous transplantation were performed in five mongrel dogs. Type I composite tissue flap (group I a n = 2) included bilateral external ear and orbicularis oculi muscle. Type II (group I b n = 1) included single-lateral external ear, orbicularis oculi muscle, external nose upper and lower lip. Type III (group I c n = 2) included single - lateral external ear and orbicularis oculi muscle. (3) Allograft transplantation (group II): In group II a (n = 2), two allograft transplantation were performed with type III composite facial and scalp . In group II b (n = 4), four allograft transplantation were performed with the modified type III composite facial and scalp which included single - lateral external ear, orbicularis oculi muscle and one third of inferior tarsal plate and palpebral conjunctiva. To prevent allograft rejection, Cyclosporin A (CsA) and Methylprednisolone (MP) or Prednisone (PS ) were combined used as immunosuppressive protocol . Dose of CsA was adjusted depending on its blood drug level. Electromyogram (EMG) of orbicularis oculi muscle was carried out at 4 weeks, 6 weeks, 12 weeks and 6 months postoperation.</p><p><b>RESULTS</b>(1) The facial anatomic characteristic of dog is similar to that of human being, external carotid artery and external jugular vein afford good blood supply to composite facial and scalp. (2) The dogs in group I c were long-term surviving with leakage of salivary juice. (3) In group II a (n = 2), one dog presented rejection reaction at 28th day postoperation, the reversal of rejection was achieved by increasing the dose of CsA and prednisone and with topical clobetasol for 2 weeks, the dog survived indefinitely( > 309 days). In group II b (n = 4), there were three dogs survived indefinitely ( > 159 days, > 129 days, > 108 days) without complication, EMG showed the function of orbicularis oculi muscle was gradually improving.</p><p><b>CONCLUSION</b>The modified type III composite facial and scalp allograft transplantation model is an ideal model for facial allograft transplantation study.</p>

Research of the preservation of the composite facial allograft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effective method of preserving composite facial allograft so as to attenuate ischemic injury.</p><p><b>METHODS</b>The composite facial allografts were harvested from dog, perfused and preserved with 4 degrees C physiological sodium chloride and UW solution respectively. Immediately after the removal of the flap, after 12, 24, 48 h of preservation, MTT assay was used to determine the viability of several kinds of tissue, including skin, mucosa, muscle, bleed vessel, nerve and gland. The results of the two groups were compared in term of viability percentage. The pathology of several tissues were observed after 24 and 48 h of storage.</p><p><b>RESULTS</b>The viability percentage of every tissue conserved in UW solution for 48 hours was more than 75%. There was significant difference between physiological sodium chloride group and UW group (P < 0.05). Some changes, including Porous arrangement of fibers in connective tissue of skin and mucosa, hyalinization of tissue around the hair follicle and edema of cell in hair follicle, enlargement of space between muscle bundles and unclearness of boundary of acinus could be seen in physiological sodium chloride group while no significant change in UW group.</p><p><b>CONCLUSIONS</b>UW solution could be considered as preservation solution for composite facial allograft.</p>

Nasal reconstruction with forehead skin flap and muscle flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To improve the paramedian forehead flap for nasal reconstruction.</p><p><b>METHODS</b>Based on the findings of the Cutaneous branch of supratrochlear artery, the forehead musculo-cutaneous flap was divided into the musculo-flap and the skin-flap in 3 patients. The musculo-flap were used to reconstruct the septi-bone structure, and envelop silicon nasal-frame, while the skin-flap were used to reconstruct the nose. In 6 patients, the forehead flap was used as a skin-flap just with the muscle pedicle to reconstruct a nose with good appearance of nasal subunits, without the secondary operation.</p><p><b>RESULTS</b>In all of 9 cases, the cutaneous-branch of supratrochlear artery was found 1.7-2.0 cm above the orbital-rim. Eight patients got good results, only 1 patient had to do the secondary operation to coverage the exposed nasal frame.</p><p><b>CONCLUSIONS</b>The cutaneous-branch of supratrochlear artery could be an anatomical finding to form the forehead skin-flap and it is a good choice to be used to reconstruct a nose, even in complicated cases.</p>