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Objective@#To explore the clinical effect of the multi-point, multi-level suspension as well as fixation using midfacial soft-tissue spaces for midface lifting.@*Methods@#A total of 65 patients with aging midface were admitted at the First Affiliated Hospital of Fujian Medical University from October 2017 to February 2019. Among them, 47 patients underwent primary blepharoplasty and midface lifting. Eighteen patients, including 5 patients with lower eyelid retraction or ectropion after blepharoplasty, underwent secondary midface lifting after blepharoplasty. The preseptal space was separated under orbicularis oculi muscle by palpebral margin incision. The orbicularis retaining ligament and the tear trough ligament were severed through preperiosteal plane. The preseptal space was connected with premaxillary space and prezygomatic space. The malar fat pad and superficial fascia were vertically suspended and fixed on the periosteum of infraorbital ridge by selected medial, middle and lateral points. The orbicularis oculi muscle was suspended and superolaterally fixed at lateral orbital periosteum. Therefore, the midface could be lifted by multi-point, multi-level suspension and fixation.@*Results@#All incision healed in the first stage. Eyelid separation occurred to 1 patient, around 1 month after the operation. Tarsal strip lateral canthoplasty was performed for repair. Local protuberance of lateral lower eyelid occurred to another patient shortly after the operation, but improved after 3 months by lid massaging. No other complication was observed in the rest of the cases. All patients were followed up for 1 to 8 months and the results were satisfactory.@*Conclusions@#It is simple and practicable to utilize midfacial soft-tissue spaces. This method could benefit patient of less trauma, bleeding, and complications, and good clinical effect. It is a good choice for rejuvenation of the midface, especially for secondary midface rejuvenation after blepharoplasty, or complicated with lower eyelid retraction and ectropion.
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Objective@#To explore the clinical application of subpectoral silicone implant associated with autologous fat grafting after tissue expansion, for breast reconstructions.@*Methods@#From Jan 2013 to Dec 2016, a total of 15 female patients were admitted to the plastic surgery department of the First Affiliated hospital of Fujian Medical University. They were after or were prepared to unilateral modified radical mastectomy. Patients were aged 18-50 years old, with the average of 33.5 years. There were 8 cases of T1N0MO (T1micN0MO, n=1), 3 cases of T2N0MO, 1 case of T2N1MO, 1 case of T1N2MO, 1 case of T2N2MO and 1 case of T3N3MO. A tissue expander was inserted beneath the posterior pectoralis major in first surgery. The cavity stripped range is greater than the expander around 1cm. The lowest position of the expander was determined according to the IMF of the other breast. The tissue expander was gradually filled intraoperatively and postoperatively periodically, until the expander exceeds 30%-50% of the volume of the other breast. Three months later, as the soft tissue over the breast area has stretched enough, the expander was removed in a second operation and a permanent implant was inserted. Meanwhile, the autologous fat particles, harvested from thigh or abdomen, was centrifuged at 800×g for 3 minutes. Then it was injected into the subcutaneous and posterior pectoralis major space. And the other breast may be adjusted if necessary for symmetry.@*Results@#Fifteen patients was included in this study (immediately tissue expander implanted, n=8; delayed tissue expander implanted, n=7). All the expanders are round in shape. The interval between the two operations was 6-12 months, with an average of 7.4 months. The total salt-water solution injected was 310-450 ml per patient, with an average of 365 ml. The volume of breast implants was 180-280 ml. The injection volume of autologous fat was 65-230 ml, 122.7 ml on average. All incisions healed well. The follow-up period was 1-3 years, with an average of 2 years. The reconstructed breasts were in a natural shape, with a slight drop and bilateral symmetry. According to Harris breast shape evaluation criteria, all reconstructed breasts were graded as excellent.@*Conclusions@#The permanent implant associated with autologous fat grafting after tissue expansion is alternative for breast reconstruction.
RESUMEN
<p><b>OBJECTIVE</b>To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method.</p><p><b>METHODS</b>The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface.</p><p><b>RESULTS</b>From July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months).</p><p><b>CONCLUSIONS</b>The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.</p>