Application of skin and soft tissue expansion in repairing pediatric patients with superficial defects / 中华烧伤杂志

Skin and soft tissue expansion can provide skin tissue similar to the recipient area in color and texture, which is one of the ideal methods in the repair of superficial defects. However, due to the long treatment cycle and relatively high complications rate in pediatric patients, expansion still faces many challenges. Based on the clinical practice and the current progress in skin and soft tissue expansion, this paper briefly discusses the change of skin after expansion, and the application, prevention and treatment of complications in the application of expansion in pediatric patients, aiming to provide reference for expansion in pediatric patients.

Chemical constituents from tuber of Bletilla striata / 中国中药杂志

Eighteen compounds were isolated from the EtOAc soluble fraction of Bletilla striata by various chromatographic techniques, such as silica gel, ODS, Sephadex LH-20, RP-HPLC. Their structures were identified by spectroscopic methods and physicochemical properties, as 5-hydroxy-2-(p-hydroxybenzyl)- 3- methoxybibenzyl(1), shancigusins B(2), shanciguol(3),arundinan(4), 3',5-dihydroxy-2,4-di(p-hydroxybenzyl)-3-methoxybibenzyl(5), arundin(6), 3,3'-dihydroxy-2-(p-hydroxybenzyl)-5-methoxybibenzyl(7), 3, 3'-dihydroxy-2', 6'-bis(p-hydroxybenzyl)-5-methoxybibenzyl(8), 7-hydroxy-2,4-dimethoxyphenanthrene(9), bleformin B(10),nudol(11), 3,7-dihydroxy-2, 4-dimethoxyphenanthrene(12), 2, 7-dihydroxy-4-methoxy-9,10-dihydrophenathrene(13), bleformin D(14), 4,4'-dimethoxy-9,10-dyhydro-[6,1'-biphenanthrene]-2,2',7,7'-tetraol(15),gymconopin C(16),(2,3-trans)-2-(4-hydroxy-3-methoxyphenyl)-3-hydroxymethyl-10-methoxy-2,3,4,5-tetrahydro-phenanthro[2,1-b]furan-7-ol(17),shanciol(18). Among them, compound 1 was a new compound, Compounds 2-6,9,15-18 were isolated from this genus for the first time.

Repair of cervical scar contracture with flaps containing cervical cutaneous branch of the transverse cervical artery / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery.</p><p><b>METHODS</b>Sixty-six patients with scar contracture after burn in anterior region of neck hospitalized from 1988 to 2011. The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery. They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded). After removing the scar and releasing the contracture, flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region. The axial vessel of the flap was the cutaneous artery, which perforated in the crossing area of sternocleidomastoid muscle and omohyoid muscle and originated from the transverse cervical artery. The posterior borderline of the flap reached the anterior border of the trapezius muscle. Its exterior borderline reached the middle part of deltoid muscle, and its interior borderline ended at the midsternal line. The lower borderline was located 3.0-4.0 cm below the nipple. The incisions at the interior, lower, and exterior borders of the flap were first made. Then after sharp dissection to the clavicle, blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension. The pre-expanded donor sites were sutured directly, while the un-expanded ones were covered with skin graft.</p><p><b>RESULTS</b>Out of the 66 flaps, 64 flaps survived. Two flaps showed partial necrosis at the distal end due to sub-flap hematoma, and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue. The flaps regained sensation pertaining to the chest in the early stage, and complete sensation pertaining to the neck appeared 6 months after surgery.</p><p><b>CONCLUSIONS</b>The flap containing cervical cutaneous branch of the transverse cervical artery is a good choice for repairing severe cervical scar contracture for its simple harvest, reliable blood supply, and similar color and texture to the skin of cervical region.</p>

Expanded deltopectoral flaps for treatment of cervical cicatricial contracture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of expanded deltopectoral flaps for treatment of cervical cicatricial contracture.</p><p><b>METHODS</b>The cervical cicatricial contracture was corrected in 18 cases with unilateral expanded deltopectoral flaps and 2 cases with bilateral expanded deltopectoral flaps. The size of scar ranged from 8 cm x 5 cm to 12 cm x 13 cm. The size of the unilateral expanded deltopectoral flaps ranged from 9 cm x 16 cm to 12 cm x 18 cm. The defects in donor sites were closed directly. The infraclavicula incision was designed. The flaps were delayed 3 weeks after flap transfer. The pedicle was cut off 4 weeks later.</p><p><b>RESULTS</b>From 2007 to 2009, 20 cases with cervical cicatricial contracture were treated with expanded deltopectoral flaps. All the flaps were survived. 6 cases were followed up for 6 months with satisfactory results in 5 cases and conspicuous scar in 1 case.</p><p><b>CONCLUSIONS</b>Expanded deltopectoral flap is very suitable for large size of cervical cicatricial contracture.</p>

Repair of inframammary scars with expanded skin flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate suitable treatment method for contracture of inframammary scars.</p><p><b>METHODS</b>Nine female patients with contracture of inframammary sear hospitalized in our hospital from July 2000 to July 2007 were subjected to skin expansion around the breast. The sites of incisions were mainly located on the inframammary scars. The expanders were placed around the breast and middle chest near the sternum. On the lateral side of chest, the expander should be inserted at the site parallel to upper level of the breast. The expanders should be placed under deep fascia and superficial to the gland. At II stage of operation, the scars were excised and the subcutaneous tissues should be thoroughly loosened to assure that the soft tissue and mammary gland would be restored to its anatomical position. Expanded skin was then designed as advancement or transposition flaps to repair the defects, or effects were closed with suturing.</p><p><b>RESULTS</b>Blood circulation disturbance occurred at the tip of a flap in one patient, with the size of 4.0 cm x 3.0 cm, and the resulting wound healed after skin grafting. Flaps in the other 8 patients survived, and the wounds healed satisfactorily. Nipples and mammary areola were successfully restored to the anatomical positions. Three patients were followed up for 6 months to 2 years, and the result was satisfactory.</p><p><b>CONCLUSIONS</b>Expanded flap is feasible for repairing contracture of inframammary scar and with good result.</p>

Expanded skin flaps for the treatment of large scalp and face scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method to repair large scalp and face scars.</p><p><b>METHODS</b>1-3 expanders under the scalp were needed for repair the scalp scar. The expanded deltopectoral flaps were transferred to repair the face scar.</p><p><b>RESULTS</b>12 cases were treated with satisfactory results. All the flaps survived and the donor sites were closed primarily. 2 cases had expander exposure which didn't affect the treatment results. Atrophic cutaneous striae was occurred because of overexpansion.</p><p><b>CONCLUSIONS</b>Skin expansion is a good method for large scalp and face scar.</p>

Repair of facial and cervical scars with expanded deltopectoral flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods for repair of facial and cervical scars after burn.</p><p><b>METHODS</b>One hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later.</p><p><b>RESULTS</b>Among 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting.</p><p><b>CONCLUSION</b>Expanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars.</p>

Management of severe postburn scar contracture in the lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience in the management of severe postburn scar contracture in the lower extremities.</p><p><b>METHODS</b>The scars in popliteal fossa and ankle joint were excised. Traction and skin grafting were employed in the management of contracture deformity in these areas.</p><p><b>RESULTS</b>Severe postburn scar contracture deformity in sixty postburn patients could be corrected by constant traction and skin grafting.</p><p><b>CONCLUSION</b>Scar excision and lysis with constant traction might be an optimal method in the management of severe postburn scar contracture deformity of joints in the lower extremities and satisfactory results could be obtained without tendon grafting and elongation.</p>

The design of the expanded flap for the repair of the temporal and cheek area / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the design of an expanded flap at the temporal and cheek area.</p><p><b>METHODS</b>The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision. In the frontal area, the rotational flap was usually used. For the repair of the cheek, the applied flap included the rotational, advanced, and transposition flap from the neck, as well as the pedicle flap from the thoracic area.</p><p><b>RESULTS</b>Eight thoracic-deltoid flaps had distal necrosis of 1 approximately 5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0.5 approximately 1 cm. Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases (6.62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases.</p><p><b>CONCLUSIONS</b>According to our experience, careful design of the flap is very important for obtainingbetter surgical results and decreasing complications.</p>