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BACKGROUND: Hyperbaric oxygen can improve the survival rate of the flap, but whether hyperbaric oxygen therapy can reduce the scar adhesion between the delayed flap and the base, and shorten the time of delayed flap revascularization have not been documented. OBJECTIVE: To observe the changes of the delayed skin flap and the scar tissue at the base on the back of the rat after hyperbaric oxygen therapy, and to seek a safer and more time-saving method of delayed flap formation. METHODS: This experiment simulated the delayed flap model of the human reconstructed ear on the back of Sprague-Dawley rats. Healthy male Sprague-Dawley rats were randomly divided into two groups: a control group and a hyperbaric oxygen treatment group. In the latter group, the rats were placed in the infant hyperbaric oxygen chamber for hyperbaric oxygen treatment for 5 days after surgery. The blood flow of the flap was recorded preoperatively and daily after surgery. Scar tissue thickness, type I/III collagen ratio, vascular number, vascular diameter and the number of vascular endothelial growth factor-positive cells in the flap were recorded preoperatively and on the 1st, 7th, 14th and 21st days postoperatively. RESULTS AND CONCLUSION: The blood flow of the flaps in both groups decreased significantly on the 1st postoperative day, and then began to increase. The blood flow in the hyperbaric oxygen treatment group was significantly higher than that in the control group on the 1st, 7th, 14th and 21st days postoperatively (P < 0.05). The subcutaneous tissue edema in the hyperbaric oxygen treatment group was slighter than that in the control group, and the tissue inflammatory cell infiltration was less. On the 21st postoperatively day, the thickness of scar tissue adhesion at the base in the hyperbaric oxygen treatment group was smaller than that in the control group (P < 0.05). The ratio of type I/III collagen in the hyperbaric oxygen treatment group was lower than that in the control group (P < 0.05). On the 7th, 14th, and 21st days postoperatively, the number of blood vessels in the hyperbaric oxygen treatment group was higher than that in the control group (P < 0.05). The vascular diameter in the two groups was the smallest on the 1st postoperative day, and the largest on the 14th postoperative day. The vascular diameter in the hyperbaric oxygen treatment group was significantly larger than that in control group on the 1st postoperative day (P < 0.05). The number of vascular endothelial growth factor positive cells in both groups began to increase on the 1st postoperativel day, and reached the maximum value on the 14th postoperative day. The number of vascular endothelial growth factor positive cells in the hyperbaric oxygen treatment group was higher than that in the control group at each observation time point (P < 0.05). To conclude, hyperbaric oxygen can reduce the scar adhesion between delayed skin flap and the basement and increase the blood flow of the delayed flaps in rats. Its mechanism may be related to the promotion of revascularization.
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Objective@#To explore a good method for locating reconstructed auricle.@*Methods@#An X-ray film ear template was modelled with the opposite healthy ear, then the template was reversely placed on the malformed side. The position of template was adjusted according to the observation at a standard frontal view and the relations with local anatomic landmarks until bilateral auricular symmetry was reached. At that time the position of template was fixed, and three points were marked. The first point was the most front point of helix, that is in front of the junction of helix and inferion crura of antihelix. The second point was the junction of superior edge of earlobe and tragus. The third point was the junction of inferior edge of the earlobe and face.After marking the three points, the template was placed in flat based on the three points, and the shape of auricle was drawn.Whether the remnant earlobe was dislocated was decided by the difference between the position of remnant earlobe and the marked points.@*Results@#In this study, 118 cases had completed the three stages of ear reconstruction. In the first stage of the operation, 28 cases were residual earlobe moved, 1 case had hematoma postoperatively, and no case had serious complications such as infection and skin flap necrosis.In the second stage of the operation, the position of reconstructed ears were nearly symmetrical to the opposite sides. There were partial necrosis of grafted skins in 2 cases and partial necrosis of skin flaps in 3 cases, which were repaired with simple skin grafting or skin grafting after coverage of superficial temporal fascia flap. In the third stage of the operation, the position of reconstructed auricles was mostly symmetrical to the opposite side, and the wound were healed primarily.The satisfaction rate was 81.4%.@*Conclusions@#Triple-point Marking at a standard frontal view is a simple and practical method for locating reconstructed auricle in ear reconstruction.
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Objective To explore the clinical effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design.Methods We retrospectively reviewed the application and effect of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmetric Z-plasty with a two curve design between January 2015 and June 2016.There were 36 cases of severe epicanthus in this group,including 20 cases of thin eyelid,13 cases of mild swollen eye and 3 cases of moderate swollen eye.Results Follow-up by telephone or WeChat,satisfactory for the 26 cases,the basic satisfaction of 9 cases,1 case of dissatisfaction,moderate swollen eye and severe epicanthus.Conclusions In the case of severe epicanthus with a single eyelid and a mild swollen eyelid without thinning of the eyelid,the use of three-point double eyelid blepharoplasty combined with correcting epicanthal folds by using asymmet ric Z-plasty with a two curve design is one of good choices of methods for the correction of epicanthus.