The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients / 中华整形外科杂志

<p><b>OBJECTIVE</b>Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias.</p><p><b>METHODS</b>In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath.</p><p><b>RESULTS</b>Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up.</p><p><b>CONCLUSIONS</b>The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.</p>

Treatment of the congenital exstrophy of bladder / 中华整形外科杂志

<p><b>OBJECTIVE</b>To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy.</p><p><b>METHODS</b>The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm.</p><p><b>RESULTS</b>12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting.</p><p><b>CONCLUSIONS</b>Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.</p>

Treating later facial nerve palsy with the method of combining free graft of de-nerve short extensor muscle of toe with the technique of inducted undermined suture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a more effective operative method for later facial nerve palsy.</p><p><b>METHODS</b>A synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was used in 432 cases of later facial nerve palsy.</p><p><b>RESULTS</b>82% of 432 cases acquired satisfactory effect that consisted of static symmetry and dynamic rough symmetry in facial expression. 12% cases only acquired static symmetry in facial expression but the dynamic symmetry were insufficient. Unsatisfactory results were occurred in 6% cases as both the static and dynamic symmetry of their facial expression were insufficient, which acquired preferable results 2 another suspending operation 8 to 12 months later. 4 cases got post operation infection; through cases happel in foot and 2 in face. All of them were cured by the treatment of drain and antibiotic in 3 weeks. 46% cases were followed up by further consultation or telephone. The longest followed up was period 12 years, while the shortest was 1 year, and the average was 28 months. 93% patients were satisfactory with the results, and 7% patients thought that their facial expression symmetry were insufficient though their facial abnormality were improved obviously.</p><p><b>CONCLUSIONS</b>The synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was an effective method for later facial nerve palsy, and most of the patients could acquired satisfactory results. This operative method is good for popularize because of its simple operation, slight tissue injury and fews complication post-operation.</p>

Combination of multiple procedures to repair of severe lower eyelid ectropion / 中华整形外科杂志

<p><b>OBJECTIVE</b>Lower eyelid ectropion is one of the most severe complications following lower eyelid blepharoplasty. Combination of multiple procedures was used to repair this deformity and the results were observed.</p><p><b>METHODS</b>Severe lower eyelid ectropion following blepharoplasty was repaired with the combination method of multiple procedures, including transferring the island forehead flap, buried guiding suture of the lower eyelid skin to orbital periosteum and horizontal lid-shortening. 10 patients (15 eyelids) with lower eyelid ectropion after blepharoplasty were treated with the above method from Mar 2001 to Mar 2004.</p><p><b>RESULTS</b>The lower eyelid ectropion was repaired effectively. All the patients were satisfied with the results.</p><p><b>CONCLUSIONS</b>The combination method of multiple procedures was an effective method for severe lower eyelid ectropion.</p>

Autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>Applicate autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias by staging.</p><p><b>METHODS</b>From 1999 to 2003, 40 patients have been treated by method of autologous buccal mucosal graft pre-placing. There were two models: graft onlay and graft-tube for urethral reconstruction, and the 2rd operation was accomplished half year later.</p><p><b>RESULTS</b>All patients healed without urethral fistula.</p><p><b>CONCLUSION</b>The method is valuable for treatment of complicated hypospadias.</p>

Hemodynamic study of an over-midline axial flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the hemodynamic changes of an over-midline axial flap.</p><p><b>METHODS</b>An over-midline axial flap, based on the iliac artery and veins, was raised on the back of each selected Wistar rat (n = 30), vascularied by contralateral. The flap size is 7 cm x 3 cm. The over-midline part is 3 cm x 3 cm. A laser doppler flowmetry (LDF) was used to evaluate the hemodynamic changes preoperatively, and 6 hours, 24 hours, 48 hours, 72 hours, 7 days, and 14 days after the operation respectively.</p><p><b>RESULTS</b>All of the flaps survived well. But, in the first three days after the operation, the blood perfusion of the flap in the areas of the midline and the distal part was significantly lower than the preoperation's level. Thereafter, the values of the blood perfusion started to increase till to the maximum 7 days after the operation. On the 14 days after the operation, the vascular structures was axially matched to the base of the flap. In the distal part of the flap, the choke vessels were gradually opened and resulted in the blood perfusion to the normal level.</p><p><b>CONCLUSION</b>The hemodynamic changes of the over-midline axial flap transmidline flap could occur to match the need of the base of the flap.</p>

Microvascular study of the transmidline scapular flap vascularized by the contralateral circumflex scapular artery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the microvascular distribution of the transmidline scapular flap supplied by the contralateral circumflex scapular artery.</p><p><b>METHODS</b>The integument and deep tissues of 6 fresh cadavers were dissected and radiographed after vermilion mixture was injected to the unilateral circumflex scapular artery.</p><p><b>RESULTS</b>The vascular tree passed the midline and reached to the contralateral acromion. The vessel density was the highest in the irrigating side of the back, which was higher in the middle area. In the contralateral side,the high vessel density concentrated in the upper part of the back.</p><p><b>CONCLUSIONS</b>The result revealed the direct evidence for the clinical application of the transmidline scapular flap. In design and elevating of the transmidline scapular flap, it should be slanting to the upper part of the contralateral back.</p>

Reconstruction of the mentum in the surgical management of cervical scar contracture / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of the reconstruction of the mentum with cervical tissue flaps in the surgical management of postburn cervical scar contracture.</p><p><b>METHODS</b>Thirteen postburn patients with severe cervical scar contracture and mental deformity were enrolled in the study. The platysma flap (3 cases), scar tissue flap (6 cases) and cervical deep fascia tissue flap (3 cases), with the pedicle containing the facial and the superior thyroidal artery, were turned upwards to replenish mental soft tissue, and to form new mentum and sulcus mentolabialis. The cervical scars were repaired with expanded flap (11 cases), free flap (1 case) or trapezius muscular flap.</p><p><b>RESULTS</b>The post-operative cervical configuration was found to be good, and the tissue flaps for mental reconstruction healed satisfactorily. Ten patients were followed-up for 6 to 24 months. All flaps were successful and achieved good results, except that scar formation was found in the cervical linear incision in 4 patients.</p><p><b>CONCLUSION</b>Transfer of the platysma flaps, scar tissue flaps, or deep cervical fascial flaps for the reconstruction of cervical scar were simple and effective. The use of cervical scar tissue flaps could not only loose the constructed scar, but also beneficial in rectifying the configuration of the chin.</p>

Repair of facial defect with expanded skin flap from medial upper arm / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the blood supply of the expanded skin flap from medial upper arm and its application on the reparation of facial defect due to scar resection.</p><p><b>METHODS</b>The operation was carried out for three steps: 1) The expander was embed under the superior proper fascia. 2) The skin flap from medial upper arm was created with superior ulnar collateral artery as blood supply and attributive branches of basilic and axillary veins as blood collection and was grafted onto the facial defect. 3). After being separated from donor site, the skin flap was employed to cover the facial defect with maximal area of 15 x 10 cm(2).</p><p><b>RESULTS</b>Seven patients in all with facial scar and defects were managed with the skin flap. All the grafted skin flaps survived at last with nearly normal skin color, texture and contour. And the scar in donor sites seemed to be neglectable.</p><p><b>CONCLUSION</b>Reparation of facial defects with medial upper arm skin flap after expanding could be recommended. But longer treatment time and some obsessive action of upper limbs and head might be disadvantages.</p>

Clinical applications of the buried-guided-suture method in the treatment of facial depression / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop a method for the treatment of facial depression without incision scar.</p><p><b>METHODS</b>In repairing the facial depression, the ruptured subdermal adipocellular tissue was approximated and reunite with the buried-guided-suture method through an intraoral or a concealed skin incision.</p><p><b>RESULTS</b>17 patients with facial depressions from trauma were treated. Postoperative follow-up of 10 patients for one year showed satisfactory results without recurrence.</p><p><b>CONCLUSION</b>The buried-guided-suture method for repair of facial depression from trauma is simple, reliable and worth recommendation.</p>

Using scar tissue flap to repair secondary nasal deformities of unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the clinical application of the upper lip scar tissue flap in correcting secondary nasal deformities of unilateral cleft lip.</p><p><b>METHODS</b>Two types of the upper lip scar tissue flap were developed in correcting nasal deformities with Millard's technique.</p><p><b>RESULTS</b>The procedure was performed on 51 patients. All the scar tissue flaps survived completely. The deformities were better corrected than before.</p><p><b>CONCLUSION</b>The scar tissue flap has adequate blood supply. This procedure is routinely combined with other commonly used techniques to correct secondary deformities of cleft lip. It is particularly applicable for repairing the nasal deformity when usable tissue is not enough.</p>

Autologous buccal mucosal graft for urethral reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To search for a new method for urethra reconstruction using autologous buccal mucosal graft while lacking of local skin.</p><p><b>METHODS</b>Since 1998, a total of 25 patients with complex hypospadias have been treated using buccal mucosal grafts for urethral reconstruction. The reconstructed urethra was anastomosed with the meatus half year later.</p><p><b>RESULTS</b>All the reconstructed urethra survived without contracture or stricture except one infection, which healed with no adverse consequence.</p><p><b>CONCLUSION</b>The key points for operation success is rich capillary network, thick epidermis and thin lamina propria of the buccal mucosa. Buccal mucosa is an excellent tissue for urethral reconstruction.</p>

Penile reconstruction by using a scapular free flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the scapular free flap for penile reconstruction.</p><p><b>METHODS</b>Six patients with penile loss were reconstructed by transferring a scapular free flap with implanting a Malleable penile prosthesis.</p><p><b>RESULTS</b>All of the flaps survived completely. With the follow-ups from six to twelve months, the reconstructed penile had excellent configuration and good function.</p><p><b>CONCLUSION</b>The above mentioned technique could be a good method for penile reconstruction.</p>

Repair of eyelid defect with a prefabricated flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce a new method for repair of eyelid defects.</p><p><b>METHODS</b>Eyelid reconstruction was performed using a prefabricated island flap with an expanded forehead myocutaneous flap and hard palate mucoperiosteal graft.</p><p><b>RESULTS</b>Five patients with congenital or acquired eyelid defects were successfully treated with this method.</p><p><b>CONCLUSION</b>The introduced method is rational and practical for clinical applications.</p>

Long-term results of whole piece, full-thickness skin grafting for facial post-burn reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method for repair of the whole facial burn scar and evaluate the long-term results of skin grafting.</p><p><b>METHODS</b>18 patients with facial burn scar were treated with whole piece, full-thickness skin grafting. All of them have been followed-up for 5 to 20 years. The color, elasticity, sensation and gland secretion of the grafted skin were evaluated. The skin samples were taken for light and electron microscope examinations.</p><p><b>RESULTS</b>The long-term results of whole piece, full-thickness skin grafting were satisfactory. The grafted skin was smooth and elastic, with sebaceous and sweat glands. The histological structure of the grafted skin was similar to that of the normal facial skin and different from that of the donor site.</p><p><b>CONCLUSION</b>Whole piece and full-thickness skin grafting may be a valuable method for the treatment of facial burn scar. The morphological and histological structure of the grafted full-thickness skin is similar to the normal facial skin through the long-term follow-up.</p>