Effect of early surgical repair on functional recovery of patients with traumatic facial paralysis / 中国组织工程研究

BACKGROUND: Facial nerve injury causes facial nerve paralysis (or facial palsy) and even results in psychosocial disturbances of the patients. Repair the injured facial nerve and reconstruction of the nerve function as early as possible have been the primary concern in clinical studies.OBJECTIVE: To investigate the timing and surgical approaches for repairing facial paralysis in order to provides evidences for its therapeutic and prognostic evaluation.DESIGN: Case analysis based on patients.SETTING: Hospital of Plastic Surgery of Chinese Academy of Medical Sciences.PARTICIPANTS: Nine patients with traumatic facial paralysis hospitalized in the Hospital of Plastic Surgery of Chinese Academy of Medical Sciences from December 1993 to November 2001.METHODS: Facial nerve anastomosis was performed microsurgically along with the implantation of the sural nerve graft into orbicular muscle of the eye 3 or 4 months after nerve injury in the 9 patients. The clinical data of the patients were retrospectively reviewed.MAIN OUTCOME MEASURES: The facial nerve function was evaluated with House-Brackmann scale and photographs of the patients' faces before and after surgical treatment were taken.RESULTS: In the follow-up of these patients lasting 6 months to 2 years,all the patients attained satisfactory outcome.CONCLUSION: Early operation is crucial for the treatment of traumatic facial paralysis,with facial nerve anastomosis as the primary choice. The implantation of the nerve graft into muscle is also indicated for repairing traumatic facial paralysis in some cases. The importance of individualized treatment choice is reiterated on the basis of cicatrectomy and the extent and specific features of the injury.

Biomechanical properties of skin expanded by different methods in vivo / 生物医学工程学杂志

In plastic surgery, people hope the conventional expansion will be replaced by rapid expansion, which can shorten greatly the expansion period. Also people are concerned about whether the skin properties after rapid expansion approach that after conventional expansion. So we designed and made an apparatus for in vivo measurement of tension, and then measured the biomechanical properties of skin in vivo for the first time. The experimental results showed there was no significant difference between the rapid expansion method and conventional expansion method in respect to the area gain of expanded skin surface. Both the tension in vivo and the instant stretch-back ratio increased during the expansion, but fell almost to the control values after four weeks' maintaining period. So, rapid skin expansion did not produce any deleterious effect when compared with the conventional expansion. Extension of the maintaining period can improve the biomechanical properties of expanded skin and effectively reduce the stretch-back ratio. Therefore, rapid expansion with an extended maintaining period is clinically acceptable.

Microcirculation of lateral groin skin flaps: monitoring and clinical application / 中华整形外科杂志

<p><b>OBJECTIVE</b>To monitor the microcirculation of lateral groin skin flaps.</p><p><b>METHODS</b>The microcirculation in 12 lateral groin skin flaps was monitored continuously by laser doppler flowmetry (LDF).</p><p><b>RESULTS</b>The microcirculatory changes in lateral groin skin flaps were divided into two phases: rapid rising (2-6 days after operation) and plateau (6-11 days after operation). PU values were 2.83 +/- 0.46, 3.21 +/- 0.41, 3.66 +/- 0.43, 4.77 +/- 0.71, 7.08 +/- 0.37; 7.53 +/- 0.41, 7.57 +/- 0.62, 7.70 +/- 0.44, 7.60 +/- 0.26, 7.58 +/- 0.17.</p><p><b>CONCLUSION</b>In clinical application, division of the lateral groin skin flaps within the plateau, and the values (PU) returned to or exceeded 50% of that values (PU) determined before application of the tourniquet, causes flaps survival (100%). The time of division was decreased to 8-11 postoperative days in our clinical application.</p>

The influence of expansion maintenance period upon in vivo skin tension and immediate stretch-back rate of the expanded skin / 中华整形外科杂志

<p><b>OBJECTIVE</b>The study was to investigate the influence of maintenance period of expansion upon skin tension and immediate stretch-back rate of the expanded skin.</p><p><b>METHODS</b>30 expanders (240 ml) were implanted in six adult dogs, which were divided into four groups: group A with 2-week saline injection of the expander; group B with 6-week injection; group C with sham-operation and group D as the blank control group. The first two groups were subdivided into three groups respectively according to different maintaining times of one week, two weeks and four weeks. When full inflation was finished, a 4 cm x 7 cm expanded flap was created and in vivo skin tension and stretch-back ratio of the flap were measured. The Comparison was made in terms of in vivo skin tension and immediate stretch-back ratio between different injection and different maintenance periods.</p><p><b>RESULTS</b>With expansion maintenance time increasing, the in vivo skin tension and immediate stretch-back ratio decreased. After the capsule of the expand skin flap was removed, the in vivo skin tension and immediate stretch-back rate significantly reduced. Based on the experimental results, 16 patients were treated with implantation of 23 expanders. Their average expander injection time was 14 days and the average maintenance time was 25 days. All expanders obtained good results except one extrusion.</p><p><b>CONCLUSION</b>In skin and soft tissue expansion, in vivo skin tension and immediate stretch-back ratio can be reduced through prolonged maintenance of expansion and capsule removal from the expanded skin flap.</p>

Repair of large facial defect with an expanded clavicular-pectoral skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To search for an ideal method to repair large facial defects.</p><p><b>METHODS</b>One or two soft tissue expanders were implanted at the clavicular-pectoral region. After fully expansion, a clavicular-pectoral skin flap was designed and created with similar color, texture, and size to the facial defect. The flap would pass over the neck and transfer to the face to repair a large defect.</p><p><b>RESULTS</b>10 cases were treated with this method. All have been followed up for 12-18 months with satisfactory results.</p><p><b>CONCLUSION</b>The large facial defects could be repaired by the expanded clavicular-pectoral skin flap without damaging the natural neck contour and donor site abnormality was avoided. The patients get an aesthetic look and good function.</p>

Long-term changes after transplantation of expanded skin in dogs / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the long-term changes of expanded skin after transplantation.</p><p><b>METHODS</b>The expanded skin in dogs at 0 week, 3 weeks, 6 weeks, 3 months and 6 months after transplantation was observed through areas, histomorphological, electron microscopic, collagen content, biomechanical, and immunohistochemical methods.</p><p><b>RESULTS</b>The expanded skin was close to the control groups in all observations.</p><p><b>CONCLUSION</b>The biological changes after expansion remain in 3 months. The expanded skin will gradually recover to normal in 3-6 months. It is similar to a wound repair process.</p>

Adhesive deformity from the upper eyelid fold formation and its treatment / 中华整形外科杂志

<p><b>OBJECTIVE</b>On the basis of the concept of adhesive deformity from upper eyelid fold formation, the clinical results after using various methods to correct the adhesive deformities are summarized.</p><p><b>METHODS</b>A total of 33 cases of adhesive deformity from upper eyelid fold formation have been treated using various corrective methods including taking off the sutures, shifting of the septal fat or the pre-septal orbicularis muscle, transferring of pretarsal orbicularis muscle, grafting of autogenous fat tissue, and repairing or/and shortening of the palpebral levator. Postoperative follow-up ranged from 3 months to 2 years.</p><p><b>RESULTS</b>The effective results have been got with the used methods except shifting of the pre-septal orbicularis muscle or transferring of pretarsal orbicularis muscle.</p><p><b>CONCLUSIONS</b>The suitable methods to correct the adhesive deformity from upper eyelid fold formation must be chosen according to the causes and the local situations.</p>

Analyses of EGF and TNF contents in fetal wound healing process / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the role of EGF and TNF in the fetal wound healing process.</p><p><b>METHODS</b>On a fetal wound healing model with the maternal rabbit on 22-23 days of pregnancy (term = 31-32 days), the contents of EGF and TNF were analyzed with a RIA kit, compared to the maternal rabbit group and the adult rabbit group.</p><p><b>RESULTS</b>The EGF and TNF contents in the fetal wound were both increasing 3 days after the operation and maintained in a high level until the 7th day of the wound healing process(P < 0.05). However, the EGF and TNF contents in the maternal and adult rabbit groups were only kept at a high level during the 3 days after the surgery.</p><p><b>CONCLUSION</b>The results are indicated that the EGF and TNF may play an important role in fetal wound healing.</p>

Breast volume measurement with computer aid and its clinical application / 中华医学美学美容杂志

Objective To introduce three new methods for measuring breast volume. Methods The breast volume was measured and the 3D image yielded with a special software or calculated with two mathematical formulas, according to its base, horizontal and saggital sections. Results The average deviations of these protocols were less than 10 % of the actual sizes in our investigation. Conclusion The computer aided measurement for the volume of the breast is an accurate and reliable method and can be used in the designs for augmentation and reduction of mammaplasty.

Surgical treatment of early traumatic injuries to the facial nerve / 中华医学美学美容杂志

Objective To investigate the choices of the timing and methods of the surgical operation after traumatic injuries to the facial nerve, and to emphasize the importance of the excision of perineauial scar,technique of microsurgery with no injuries and the methods selected for nerve coaptation according to the morphologic feature of the injuried nerve.Methods From December 1993 to November 1997, by microsurgical technique, seven cases with traumatic injuries to the facial nerve were treated in two stages from three months to four months after the trauma. Different methods were used including facial nerve anastomosis and implantation of the sural nerve transplant into the muscle. Results All cases have been followed up for six months to two years. The results of functional rehabilitation were excellent. Conclusions Whenever possible, the authors emphasize that the early repair with microsurgical technique should be performed to all of facial nerve with injury. Facial nerve anastomosis is the best choice for repair of early facial nerve severance. Implantation of nerve transplant into muscle has a certain clinical value of and the indication for the treatment of nerve injury.

Changes of biomechanical properties and collages of expansive skin in different maintenance and expansion periods / 中华医学美学美容杂志

Objective The study was to investigate a new method of rapid expansion by biomechanical methods. Methods Dogs were set up as animal models. Six areas, 5 cm?8 cm each, were symmetrically designed on a dog. Expanders of 240 ml were implanted in each area. Four groups were divided: A. Injection of 2 weeks. B. Injection of 6 weeks. C. Sham operation group. D. Blank control group. The first two groups were subdivided into three groups respectively according to maintaining times: one week, two weeks and four weeks. The following indexes were measured on the second stage surgery: biomechanical properties of the skin, stress strength, stress strain, stress relaxation and creep, the collagen content and alignment of skin. Results After expansion, maximal stress strength fell off, and stress strain curve moved backward. Relaxation curve fell off as well, as creep curve rose up. With elongation of the maintaining period, viscoelasticity of the skin gradually approximated normal skin, and had less relation with injection time. With the maintaining period increased, the collage content increased distinctly, and the alignment became much order. Conclusion Two week maintaining period is very important for expanded skin to recover the biomechanical properties and the content of collagen and alignment.

Clinical observation of blood flow changes in exceedingly expanded skin / 中华医学美学美容杂志

Objective To investigate the relationship between the change of blood flow in exceedingly expanded skin and the viability of the flaps. Methods In 21 expansions of 10 patients, the skin blood flow and its amplitude were measured by laser Doppler in different stages. The results were compared with the final outcomes of patients. Results The volume of blood flow and its amplitude of normal skin were very low and stable, but after expanded, the volume of blood flow and the amplitude grew up, which were significantly higher than that of normal skin (P