External rhinoplasty based on the classification of alar retraction associating with exposure of the nostrils / 中华耳鼻咽喉头颈外科杂志

Objective: To introduce a classification of alar retraction, and to discuss the therapeutic strategy of alar retraction with cartilage graft and the satisfaction evaluation of patients after operation. Methods: A retrospective analysis was performed on 88 patients with alar retraction admitted to the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University from January 2015 to December 2020, including 20 males and 68 females, aged 20 to 48 years, with an average age of 28.98 years. All patients underwent external rhinoplasty according to a series of treatment plans determined by the classification of alar retraction based on nostril exposure. Visual Analogue Scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) were used to conduct satisfaction survey before and 12 months after operation. Wilcoxon signed-rank test was used to analyze patient satisfaction. Results: A total of 88 patients were included in this study. According to the classification of alar retraction based on nostril exposure, 45 cases were mild, 23 cases were moderate, and 20 cases were severe. There were 16 cases of unilateral and 72 cases of bilateral alar retraction. The patients were followed up for 12 to 18 months, with an average of 13.37 months. The VAS score and ROE score after each type of surgery were higher than those before surgery, with statistically significant (all P<0.05). Among them, the difference in VAS score (6.75±1.29) and in ROE satisfaction (67.70±7.38) of patients with severe alar retraction were the most significant improvement. Conclusion: The classification of alar retraction based on nostril exposure in the frontal view can comprehensively evaluate the severity of alar retraction, and makes the treatment algorithms systematic and comprehensive. The satisfaction of patients is relatively high.

Repair of defects in lower extremities with peroneal perforator-based sural neurofasciocutaneous flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities.</p><p><b>METHODS</b>From January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm×5 cm to 18 cm×13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm×15 cm. Flap donor sites were closed by direct suture or skin grafting.</p><p><b>RESULTS</b>Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm×1 cm, which was healed after dressing change. Patients were followed up for 6 to 12 months. The appearance and sensation of flaps were satisfactory; no ulcer occurred; the movement of lower extremities was normal.</p><p><b>CONCLUSIONS</b>It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.</p>

The submental artery perforator flap for lower face defect and deformity / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical application of submental artery perforator flap for lower face defect and deformity.</p><p><b>METHODS</b>From Sep. 2006 to Mar. 2009, 22 cases with lower face defects and deformities were treated with the submental artery perforator flaps. The age of the patients ranged from 14 to 36. The perforator point was detected by Doppler flowmeter. The size of the flaps ranged from 4 cm x 5 cm to 6 cm x 7 cm.</p><p><b>RESULTS</b>Distal partial necrosis happened in one flap, which healed through dressing. All the other flaps survived with satisfactory appearance and less morbidity in donor sites.</p><p><b>CONCLUSIONS</b>Submental artery perforator flap is very suitable for lower face defect and deformity with reliable blood supply and less morbidity in donor site.</p>

Application of four-dimensional computed tomography angiography in the study of vascular structure of the deep inferior epigastric artery perforator / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the vascular structure of the deep inferior epigastric artery perforator with the four-dimensional computed tomography (CT) angiography.</p><p><b>METHODS</b>10 abdominal specimens harvested from fresh cadavers were cannulated with trocar and injected with contrast medium in the deep inferior epigastric artery at different levels, including the deep inferior epigastric artery, its bifurcations, the lateral or medial large perforators. During the perfusion of the contrast medium in the flap, the flap was scanned by three-dimensional CT (four-dimensional defined as three dimensional CT plus time). The CT data were sent to CT workstation and the images were processed and reformatted.</p><p><b>RESULTS</b>The deep inferior epigastric artery perforator terminates in the subdermal vascular plexus, with bifurcating superior to the Scarpa fascia and under the skin. The anastomosis in the abdominal midline occurs in the subdermal vascular plexus. The blood flow distributes in two ways, one is the subdermal vascular plexus, the other is the existed vascular structure. The zone overlying the rectus muscle in the pedicle side has the best blood supply, the other adjacent zone on the ipsilateral side of the abdomen, the zone overlying the contralateral rectus muscle and the zone lateral to the contralateral rectus muscle has declining perfusion.</p><p><b>CONCLUSIONS</b>The four-dimensional CT is a useful method to study the vascular structure of the deep inferior epigastric artery perforator in the superficial fascia.</p>

Superior or inferior gluteal artery perforator flaps for the gluteal sores / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of superior or inferior gluteal artery perforator flaps for the gluteal sores.</p><p><b>METHODS</b>Before operation, the perforator artery was detected by Doppler flowmeter and labeled. The perforator flap was designed, including the perforator artery, but not the gluteal maximum muscle.</p><p><b>RESULTS</b>From Aug. 2006 to May 2009, 15 cases were treated. The flap size ranged from 6 cm x 8 cm to 7 cm x 15 cm. All the flaps survived completely without hematoma, seroma or other complication.</p><p><b>CONCLUSIONS</b>The gluteal maximum muscle-reserved gluteal artery perforator flap is a good choice for gluteal sore with reliable blood supply and less morbidity in donor site.</p>

Clinical application of thoracodorsal artery perforator flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analyses the clinical application of thoracodorsal artery perforator flaps (TAP).</p><p><b>METHODS</b>We used free or pedicled TAP flaps in 7 patients from Aug 2006 to April 2007, The age ranged from 7 to 42 years old, the perforator arteries was detected and labeled with a hand held Doppler flowmeter, the size of flaps ranged from 6 cm x 9 cm - 12 cm x 16 cm, the flaps designed with perforator artery included, all the flaps are based on the first perforator artery.</p><p><b>RESULTS</b>All the flaps survived well, no complication occurred with lowest donor site morbidity.</p><p><b>CONCLUSIONS</b>The thoracodorsal artery flap with latissimus dorsal muscle saved is a thin and reliable flaps with robust of blood supply, the flap can reduce significantly donor site morbidity and is a good choice for reconstructive surgery.</p>

Clinical breast reconstruction with various methods / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate and clarify the indications of breast reconstruction after mastectomy with various methods.</p><p><b>METHODS</b>A clinical analysis was made, based on 44 patients with the 45 breasts who had received breast reconstruction after mastectomy in our hospital from 2003 to 2005. The methods of breast reconstruction included in tissue expander/implant (5 cases), implants covered by latissimus dorsi flap (13 cases), latissimus dorsi flap along (3 cases), DIEP flap (6 cases), TRAN flap (10 cases) and solid double-pedicle TRAM flap (8 cases).</p><p><b>RESULTS</b>All of the flaps survived well in total 40 patients (40 breasts) who were used a flap for breast reconstruction. Superficial skin necrosis occurred in 1 case with the method of tissue expander/implant; rupture of breast prosthesis and infection occurred in 1 case with the technique of implant with a latissimus dorsi flap; subcutaneous seroma occurred in 1 case with the method of DIEP flap; partial flap necrosis occurred in 2 cases with the method of TRAM flap. By the follow-ups of 3 - 12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia.</p><p><b>CONCLUSIONS</b>These 6 methods for breast reconstruction achieved the satisfactory results for the requirement of breast reconstruction in Chinese women. With the development of plastic surgery technique, the indications of breast reconstruction were enlarged.</p>

Clinical study of preoperative analgesia for liposuction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the effect of the preoperative analgesia with Oxycodone/Acetaminophen for liposuction.</p><p><b>METHODS</b>In the double-blind, placebo-controlled clinical trial, 40 patients undergoing the liposuction were randomly assigned into two groups which were received a single oral dose of Oxycodone/Acetaminophen or calcium gluconate respectively before the operation. The degrees of pain were evaluated by visual analogue scale (VAS) at the beginning and the end of the operation. Adverse effects and the overall satisfaction on analgesic therapy were assessed when operation finished.</p><p><b>RESULTS</b>The VAS scores of the experimental group were significantly lower than the control group at the beginning and the end of operation (P < 0.05). There were no significant differences between the two groups in side effects (P > 0.05).</p><p><b>CONCLUSIONS</b>Oxycodone/Acetaminophen could produce preemptive effect. Preoperative oral administration of Oxycodone/ Acetaminophen may provide patients with good analgesia in plastic and cosmetic operation.</p>

Microsurgical tissue transfer for the reconstruction of hemifacial atrophy (Parry-Romberg syndrome) / 中华整形外科杂志

<p><b>OBJECTIVE</b>To reconstruct the soft tissue defect of the hemifacial with free anterolateral thigh fascioadipose flaps or scapular dermal-adiposal flap.</p><p><b>METHODS</b>The free anterolateral thigh fascioadipose flaps based on the perforators of lateral circumflex femoral artery or scapular dermal-adiposal flap based on the circumflex scapular artery has been designed and reconstructed hemifacial atrophy with the donor artery and vein anastomosed to the facial artery and vein.</p><p><b>RESULTS</b>Anterolateral thigh fascioadipose flaps were performed in 7 patients. Scapular dermal-adiposal flap was applied in 1 patient. All the flaps survived well and aesthetic appearance of reconstructed face achieved good result.</p><p><b>CONCLUSIONS</b>The microsurgical tissue transfer, especially the free anterolateral thigh fascioadipose flap is a good and reliable choice for hemifacial reconstruction.</p>

The application of pedicled anterolateral thigh fasciocutaneous flaps for reconstruction of perineal and inguinal defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate a method for the reconstruction of defects of perineum and groin with pedicled anterolateral thigh fasciocutaneous flaps.</p><p><b>METHODS</b>From July 2003 to February 2005, 12 pedicled anterolateral thigh fasciocutaneous flap based on the perforators of lateral circumflex femoral artery had been designed and transferred to the defects of perineum and groin.</p><p><b>RESULTS</b>Anterolateral thigh fasciocutaneous island flaps were performed in twelve patients. The size of the transferred flap ranged from 8 cm x 11 cm to 18 cm x 20 cm. Only one patient developed superficial cutaneous necrosis in the posterior aspect of the flap because of fecal contamination and infection. The wounds healed secondarily.</p><p><b>CONCLUSIONS</b>Despite variable vascular anatomy and technical difficulties in elevating the anterolateral thigh flap, the anterolateral thigh flap is a good choice for perineum and groin reconstruction.</p>

The periareolar approach management of postoperative complications of breast augmentation by injected polyacrylamide hydrogel / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision.</p><p><b>METHODS</b>All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision.</p><p><b>RESULT</b>All the symptoms were relieved after remove of polyacrylamide hydrogel.</p><p><b>CONCLUSIONS</b>Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.</p>

The reverse first dorsal metatarsal artery flap for the defects of the distal foot / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a new method to reconstruct the defect of the distal foot.</p><p><b>METHODS</b>A distally based dorsum pedis island flap pedicled with the first dorsal metatarsal artery was designed and transferred to the defect of the distal foot.</p><p><b>RESULTS</b>Five patients were treated with this flap, which ranged from 2 cm x 4 cm to 6 cm x 7 cm in size. Four flaps survived completely, one flap had marginal necrosis and healed after conservative therapy.</p><p><b>CONCLUSIONS</b>The reverse first dorsal metatarsal artery flap, with good blood circulation and easy manipulation, is a good option for the defects of the distal foot.</p>