Effect of precise tension-reducing suturing of skin incisions using buried guiding suture needles / 中华医学美学美容杂志

Objective:To explore the precise layered and tension-reducing sutures for skin pigmented mole surgery to promote tissue healing and reduce scar hyperplasia.Methods:From January 2019 to December 2021, the First Department of Surgery of the Civil Aviation General Hospital and Tenth Department of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences treated 56 patients with skin pigmented moles aged 18-52 years, with an average age of 26 years, including 30 males and 26 females. All patients in this group underwent surgical resection of skin pigmented moles, which reached the subcutaneous fat layer. The dermis and subcutaneous tissue under the skin incision were precisely buried and guided suture by using the middle common hole equal-chord and equal-arc buried guide suture with scale marks on both ends of the needle tip.Results:The incision width of skin tissue defect in this group of patients was less than 30 mm. After the suturing was completed, the tension between the tissues on both sides of the incision and the close-fitting of each layer of tissue on both sides of the incision without dead space were realized immediately. 55 cases achieved primary incision healing. After two years of follow-up observation, there was no scar hyperplasia, and the effect was satisfactory. In only one case, local incision was red and swollen due to suture reaction, and a small amount of scar hyperplasia appeared later.Conclusions:This submerged guided suture method is an effective surgical technique for reducing skin incision scars, and it is more suitable for small incisions with a skin incision length of less than 10 mm, which is difficult to achieve layered suture of the deep tissue of the incision with ordinary suture needles.

A new classification of labia minora hypertrophy and surgical methods / 中华整形外科杂志

Objective@#To introduce a method to classify the labia minora hypertrophy and to investigate its significance to the selection of surgical method.@*Methods@#From August 2014 to April 2018, 1 058 patients with labia minora hypertrophy were treated in the Plastic Surgery Hospital. According to the hyperplastic degree of the labia minora and praeputium clitoridis, the labia minora hypertrophy was classified to three types, namely simple clitoridis hypertrophy, simple labia minora hypertrophy and mixed type. For patients with simple labia minora hypertrophy, the methods of margin resection, or wedge resection or combination were applied. For patients with simple clitoridis hypertrophy, the reduction of clitoris hood could be performed. For mixed type, firstly the relationship of clitoris hood and labia minor should be recognized, then the appropriate surgical method should be taken.@*Results@#The age of the patients was 18 to 46 years (mean age was 25 years). 83 cases (7.8%) were simple labia minora hypertrophy. 25 cases (2.4%)were simple clitoridis hypertrophy. And 950 cases (89.8%) were mixed type. All the patients received appropriate surgical method to repair the malformation. All the surgeries were successfully performed and the cosmetic results were satisfying.@*Conclusions@#As the homologous tissues, whether praeputium clitoridis hypertrophy or labia minora hypertrophy could result poor appearance of female vulva. The concept of holism should be kept in mind when repair surgeries are performed. The labia minora hypertrophy was classified to three types and appreciate surgical methods were applied to repair the hypertrophy. The cosmetic result was satisfying.

A preliminary study on measurements of 512 normal female genital appearance of Han and Uygur nationality in Xinjiang / 中华整形外科杂志

Objective@#To collect preliminary data of normal Chinese female genital appearance, to compare the parameters of Han and Uygur nationality, and to present the preliminary data for normal female external genitalia database.@*Methods@#This study design recruited healthy females referred to the out-patient clinic for physical examination from October 2014 to March 2015 in Xinjiang Petroleum Geological Survey Department Staff Hospital. The recruitment was based on rigid inclusion and exclusion criteria. Demographic data consists of nationality, age, height, weight, marital status, gravidity, parity, vaginal delivery, and intercourse frequency. Anthropometric measurements were taken in 234 females of Han group whereas 278 females of Uygur group. For each individual 16 parameters were measured. The external genitalia appearance in Han and Uygur nationality was compared. The significance of variations in age, height, weight, BMI, gravidity, parity, vaginal delivery and intercourse frequency were analyzed.@*Results@#Primary measurements of Han and Uygur nationality are presented as mean (95% confidence interval). There are many differences in female genital appearance between Han and Uygur nationality. Several parameters were statistically associated with age, BMI, gravidity, parity, vaginal delivery and intercourse frequency. The females with complete labial asymmetry account for 5.6%(13/234) and 5.8%(16/278) in Han and Uygur normal adults, respectively.@*Conclusions@#This study presented the external genitalia measurements of normal Chinese female adults in Xinjiang, thus providing the preliminary data for normal female external genitalia database. Females of Han and Uygur nationality have multiple differences in external genitalia appearances. The parameters are associated with age, BMI, gravidity, parity, vaginal delivery, and intercourse frequency. The labial asymmetry is a universal phenomenon.

Application of the modified peeling method by divisional design in labia minora reduction / 中华整形外科杂志

Objective@#To investigate the clinical outcome of modified peeling method by divisional design in labia minora reduction in the treatment of labial hypertrophy.@*Methods@#From Feb 2015 to Oct 2017, 32 nympha hypertrophy patients underwent labia minora reduction by the modified peeling method with divisional design. The labia minora area was divided into medial and lateral divisions, from which the dermis and subcutaneous tissue were removed asymmetrically.@*Results@#The patients were followed up 1 to 6 months postoperatively. All incisions healed with excellent blood circulation of labia minora, except for 1 case with V-shaped dehiscence. All of the patients were satisfied with the eventual aesthetic appearance and the functional improvement.@*Conclusions@#The modified peeling method by divisional design in labia minora reduction is a safe and effective method with many advantages, such as nature contour, wide range of indications, fewer complications, and high satisfaction.

Vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermal matrix / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce and evaluate the technical feasibility and anatomical and functional outcomes of one-stage vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis.</p><p><b>METHODS</b>We retrospectively reviewed our experiences with 17 patients with Mayer- Rokitansky-Kuster-Hauser syndrome treated with primary surgery from September 2010 to April 2013. All patients underwent vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis. We describe the details of this technique, observe the time of epithelization and evaluate the long- term anatomical, functional, and sexual outcomes.</p><p><b>RESULTS</b>The time of epithelization was 13 d (range: 12-15 d). At a mean follow-up of 15 months (range: 12-24 months), the mean postoperative dependence on the vaginal stent was 11.7 ± 1.64 months (range: 9-15 months), the mean depth of the neovagina was (9.0 ± 0.94) cm (range: 7-11 cm), the mean circumference was (12.3 ± 1.36) cm (range: 10.0-14.5 cm) and the mean volume was (105 ± 10) ml (range 85-120 ml). The mean female sexual function index score of the 12 sexually active patients was 29.5 ± 2.6. No spouse reported discomfort during intercourse.</p><p><b>CONCLUSIONS</b>Vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis is an effective and feasible approach for patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The procedure has satisfactory long-term anatomical and functional results. The use of the acellular allogenic dermis is limited by the high price and the potential infection.</p>

Changes of muscle induced with injection of botulinum toxin type A in different period of time / 中华医学美学美容杂志

Objective To study the changes of muscle being injected with botulinum toxin A in different period of time,helping for chemically denervated muscle transplantation.Methods Sixteen rabbits were divided into 4 groups.The extensor carpi radialis muscle in one side was chosen for experimental group with the opposite muscle for control group.Morphological changes,histological changes and electron microscopic changes of muscle being injected with botulinum toxin A were observed from the first week to the fouth week.Results The quantity of glycogen and mitochondria in the muscles reduced in the first week.But it was obvious in the third week.We also found some necrotic areas in the fouth week with the muscles restoring.Conclusions The effect of metabolism slowing down and the volume of muscle reducing after botulinum toxin A injection is obvious in third weeks.It could help us choose the best time of chemically denervated muscle transplantation.

Application of botulinum toxin type A in myocutaneous flap expansion.

BACKGROUND: Although the use of the expanded myocutaneous flap has many advantages, the time course is prolonged. The net gain in surface area during acute expansion is insufficient. In this study, botulinum toxin type A was applied to shorten the flap expansion period while obtaining an adequate surface area that would meet surgical requirements. METHODS: Seven minipigs were used for the authors' experiments. Two sides of the dorsolumbar section in each pig were divided randomly into the botulinum toxin type A-treated and the saline-treated groups. Two 200-ml expanders were implanted in the submuscular pocket. Inflation began 2 weeks later, and the period of expansion was observed in a double-blind manner. Two weeks after the final inflation, the expansion area was measured, and a 10 x 6-cm myocutaneous flap was elevated and sutured in situ, and the contraction of the myocutaneous flap was observed. RESULTS: Botulinum toxin type A shortened the expansion time by 17 days (p < 0.001). The average increment of effective expansion area (p = 0.009) and the average recruitment area (p = 0.001) in the botulinum toxin type A-treated group were significantly higher than in the saline-treated group. Moreover, contraction in axial length and width of the botulinum toxin type A-treated group was lower than that of the saline-treated group at each time point following transposition (p < 0.001). CONCLUSIONS: Botulinum toxin type A could decrease the resistance to myocutaneous flap expansion, speed up the inflation, increase the expansion area, and reduce the contraction of the myocutaneous flap. It is a safe and convenient method with which to assist myocutaneous flap expansion.

Cross-leg Pedicled Free Scapular Flap for the Repair of Extensive Soft Tissue Defect with Tibial Bone Exposure.

Free scapular flaps are suitable for many lower extremity applications and often provide excellent contour reproduction and appearance. However, when the soft tissue defect of the lower leg is extensive and complicated there may not be vessels in the recipient site suitable to be anastomosed. A cross-leg pedicled free flap technique can be applied in this situation. This study extends the indications and reports a successful experience using cross-leg pedicled free scapular flap to cover an extensive soft tissue defect with tibial bone exposure of the lower leg. This study involved 24 patients between May 2000 and October 2005. Wounds were caused by accident (6 patients), burn (2 patients), electrical injury (3 patients), and fall (2 patients). The defects ranged in size from 8 cm x 15 cm to 15 cm x 30 cm. All patients were treated with free scapular flaps to cover the defects and the vessels of the free scapular flaps were anastomosed with the dorsalis pedis vessels of contralateral leg in order to provide temporary blood supply. Both legs were fixed in a cross-leg position by plaster cast. The pedicle was divided after 4 to 5 weeks and the donor site of dorsum pedis was re-sutured. Blood supply was re-established in all 13 patients. All free scapular flaps survived and the defects were covered completely. The defective lower extremities regained function with no deformities in donor sites of the contralateral lower leg. The authors believe that use of the cross-leg pedicled free scapular flap in patients with a difficult lower extremity wound with extensive tissue defect and tibial bone exposure is a worthwhile procedure and should be attempted if possible. The scapular flap has several advantages applicable to the cross-leg pedicled free flap technique. Although the operation is divided into 2 stages, it solves the problem and can offer temporary blood supply when there is no vessel for anastomosis in the recipient site, which decreases the risk of microanastomosis and produces good results.

Microvascular structure of the transmidline scapular flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the microvascular structure of the transmidline scapular flap pedicled with the unilateral circumflex scapular artery.</p><p><b>METHODS</b>Latex and ink mixture was injected into the unilateral circumflex scapular artery of 6 fresh cadavers. The transmidline scapular flap was dissected and the pellucid specimen was made. The artery perforators were traced to their underlying parent vessels that accompanied the segmental arteries. A series of cross-sectional studies were undertaken in one subject to illustrate the course of the perforators in the tissues of different depth.</p><p><b>RESULTS</b>In deep and superficial fascia, the subdermal and dermis layer, rich microvascular connection was found which showed in three patterns: the vascular arch, communicating branches, and the arterial rate. They interrelated to form a three-dimensional framework. The vascular tree not only passed the midline but also reached the contralateral acromion. The densest vessels were exhibited at the injection side of the back. In the midline area the vessels were in less density and at the contralateral side, the vessels mainly concentrated in the upper part of the back.</p><p><b>CONCLUSION</b>The result evidenced the vascular pattern and the applicable safety of the transmidline scapular flap. In elevating a transmidline scapular flap, the distal part should mainly locate at the upper part of the back.</p>

Treatment of chordee without hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the methods of dealing with chordee without hypospadias.</p><p><b>METHODS</b>From November 1982 to December 2000, 18 cases of chordee without hypospadias were treated using the methods of urethra extension, urethra elongation with a pedicled transverse prepuce entoplastron flap, a longitudinal prepuce flap or a scrotum mediastinum flap.</p><p><b>RESULTS</b>One case was cured with the first method; 5 cases with the second method; 6 cases with the third method; 6 cases with the fourth method. Fistula occurred in one case treated with the second method.</p><p><b>CONCLUSION</b>The essential defect of chordee without hypospandias is short of urethral tissue. The principal treatment is repairing the urethra using tissue transplatation. Different method should be used based on the characteristics of the defects.</p>

Clinical applications of the scrotal skin flaps pedicled on lateral branches of the posterior scrotal arteries / 中华整形外科杂志

<p><b>OBJECTIVE</b>To provide ideal materials for resurfacing penile ventral wounds.</p><p><b>METHODS</b>For hypospadias with scrotal fissure and penile-scrotal transposition, scrotal skin flaps based on lateral branches of posterior scrotal arteries were utilized to resurface penile ventral wounds when urethral reconstruction were finished.</p><p><b>RESULTS</b>9 cases of hypospadias of different types have been treated with the method mentioned above. All flaps survived and good results achieved.</p><p><b>CONCLUSION</b>For hypospadias with scrotal fissure and penile-scrotal transposition, scrotal skin flaps pedicled on lateral branches of posterior scrotal arteries can not only resurface penile ventral wounds, but also correct scrotal fissure and penile-scrotal transposition simultaneously.</p>

Diagnosis and treatment of congenital recessive cleft palate / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore an effective method to diagnose and treat the congenital recessive cleft palate.</p><p><b>METHODS</b>For the treatment of congenital recessive cleft palate, an operation was designed to recover the anatomic length and function mobility of the soft palate. The operation procedure includes incising vertically the midline mucous membrane of the soft palate, creating and pushing back the mucosal flap of the hard palate, making Z-plasty on the nasal mucosa, reconstructing the sling of the levator veli palatini muscle and repairing the palatal defects with the buccinator muscularis mucosae flap. 12 cases of congenital recessive cleft palate have treated with this method.</p><p><b>RESULTS</b>All of the 12 cases obtained good results. Their pronunciation improved obviously.</p><p><b>CONCLUSION</b>The method is effective for diagnosis and treatment of congenital recessive palate, which is worthy of further application.</p>

Clinical study of the hemodynamics of both ends (proximal and distal) of internal mammary artery and its following-up / 中华整形外科杂志

<p><b>OBJECTIVE</b>To verify the value of retrograde flow of Internal Mammary Artery (IMA) used as one of the supplying arteries and to develop a new method of applying IMA in breast reconstruction.</p><p><b>METHODS</b>During breast reconstruction with free bilateral transverse rectus abdominis myocutaneous (TRAM) flap, the pressures and velocities of the two ends (proximal and distal) of internal mammary artery as well as the according perfusion unit (PU) of TRAM were measured in two patients who suffered from mammectomy because of carcinoma.</p><p><b>RESULTS</b>The pressure at distal end was 66 or/and 58 mmHg, the pressure at proximal end was 88 or/and 75 mmHg, the former is 75%-77% of the later. The immediate rate of blood flow of distal anastomotic stoma was 74 or/and 52 ml/min, that of proximal was 94 or/and 70 ml/min, the former is 74%-78% of the later after anastomosed to the two sides of deep inferior epigastric arteries (DIEA) separately. Under condition that both ends (proximal and distal) of IMA contributing as the supplying blood vessels simultaneously, the PU of TRAM was the best. The rates of blood flow at the two anastomotic stomas are similar to each other in late stage (evaluated at the fifth year follow-up).</p><p><b>CONCLUSION</b>The distal end of internal mammary artery can supply blood flow in a considerable level, similar with the proximal end.</p>

Repair of penile wounds in penis lengthening with the scrotal dartos musculocutaneous flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To provide ideal materials for repair of penile wounds in penis lengthening.</p><p><b>METHODS</b>A skin incision was made between the penis and mons pubis. Penis lengthening was performed by complete releasing of the superficial suspensory ligament and partial releasing of the deep suspensory ligament of the penis. Resurfacing of the defects at the penile base was accomplished by transferring a scrotal dartos musculocutaneous flap pedicled on the anterior scrotal vessels.</p><p><b>RESULTS</b>16 patients with short penis were treated with the method. All scrotal dartos musculocutaneous flaps survived and 4-4.5 cm extra length of the penile shaft was achieved. Appearance and function of the penis were improved.</p><p><b>CONCLUSIONS</b>The scrotal dartos musculocutaneous flap is one of the best materials to repair the penile skin defects in penile lengthening operation. The advantages of the flap are: 1. good blood supply; 2. thin and lacking of subcutaneous fat; 3. extensibility with the scrotal dartos muscle.</p>

Evaluation of the facial artery and vein using color Doppler imaging / 中华整形外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to provide the guidelines with respect to the location of the facial vessels, observe the potential reversed flow of the facial artery, and reemphasize the value of color Doppler ultrasound studies in flap planning.</p><p><b>METHODS</b>A study was carried out to investigate the location and dynamics of the facial artery and vein using color Doppler ultrasonography in 12 adults.</p><p><b>RESULTS</b>The facial artery and the vein were located together at the lower border of the mandible. Around the oral commissure and under the nasal ala, they run apart from each other at variable distances. The reverse flow was observed in the 12 patients after the blood flow of the facial artery was blocked by applying pressure manually at the lower border of the mandible.</p><p><b>CONCLUSIONS</b>The divergence of the facial vein from the artery is important information in planning of axial pattern flaps. Observation of the reversed flow confirms the possibility of safe elevation of a retrograde flow-arterialized flap based on the distal portion of the facial artery.</p>

A study of oral epithelial cells cultured with L929 cells as seed cells in vitro / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To purpose of study aimed at investigating the technique of culturing oral epithelia in vitro and to set up an experimental model for further reconstructing oral mucosa in vitro.</p><p><b>METHODS</b>The oral mucosa was taken from young New Zealand rabbits, and the mucosa was digested with enzyme and suspended in liquid to form cellular suspension. Being seeded, the cells were cultured motionlessly. The medium was changed regularly and the cells were subcultured.</p><p><b>RESULTS</b>The cultured cells were all epithelial cells without fibroblasts, and they were proved to be diploid cells. The cells were subcultured in 1-13 generations which survived for 50-60 days.</p><p><b>CONCLUSION</b>The oral epithelium of young New Zealand rabbit can be cultured in vitro, maintaining the ability to proliferate in a certain period. It is a pilot study to reconstruct oral tissue in vitro.</p>

Clinical study of transmidline pre-expanding scapular flap vascularied by ipsilateral circumflex scapular artery / 中华医学美学美容杂志

Objective To reconstruct the soft tissue defect in the back or neck after excision of hypertrophoc scar or giant nevus by using transmidline pre expanding scapula flap vascularied by ipsilateral circumflex scapular artery. Methods The reconstruction can be accomplished in two stage procedures. First, scapular flaps were expanded for 4 6 weeks prior to transfer in 8 patients. Second,the pedicled flaps were designed across the entire back to incorporate both scapular territories but were rotated on a single vascular pedicle. Results All flaps survived. Only two flaps had marginal necrosis, and the wound healed well by dressing. Conclusion Flap expansion produces a delay that augments blood supply and increases the area of skin that survives on a single vascular pedicle. This technique may be useful in selected patients in whom a large and thin fasciocutaneous flap is required and there is sufficient time to allow flap expansion prior to thansfer. It is easy to harvest, and donor site morbidity is negligible. The patients can get better functions and quality of life.

The study of urethral epithelium culture in vitro / 中华泌尿外科杂志

Objective To study urethral epithelium cu lt ure in vitro as a basic role in the further study on tissue engineering urethra. Methods A bit of urethral mucosa was taken from a young male New Zealand hare and was digested by enzyme into single cell liquid.The ce ll was then cultured in a still condition.The medium was renewed regularly and t he cells were subcultured and studied. Results All the c utured cells were urethral diploid cells without fibroblasts.The cells could be subcultured 11～13 generations with a surviving period of 50～60 days. Conclusions The urethral epithelium the cultured cells of young N ew Zealand hare can be cultured in vitro and is able to proliferate within a cer tain period.This provides a strong foundation for the further study on tissue en gineering urethra.