Application of multislice computed tomography volume rendering and 3D printing technique of costal cartilage for auricular reconstruction / 中华整形外科杂志

Objective@#To investigate the value of Multislice computed tomography volume rendering(VR) technique and 3D printing technique in auricular reconstruction.@*Methods@#Six patients were enrolled for auricular reconstruction with costal cartilage, including 5 congenital microtia patients and 1 traumatic auricular defect patient. We harvest the three-dimensional reconstructive data of the contralateral sixth, seventh, eighth and ninth costal cartilage with VR technique. Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format. Preoperative simulation was performed on the models, accordingly, we determined the strategies of costal cartilage harvest and framework fabrication, and operations were performed based on the pre-designed plan.@*Results@#In all 6 patients, the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results, and more scientific than before. The shapes of reconstructed ears were vivid and natural. No complications such as infection, absorption, distortion and chest deformity happened.@*Conclusions@#Through costal cartilage VR and 3D printing technique, we could make more reasonable preoperative design and simulation. The results can be improved with reduced injury, while avoiding the risks of thoracic deformity.

[Quantitative analysis based on three-dimensional CT in the contouring surgery of craniofacial fibrous dysplasia].

OBJECTIVE: To investigate the quantitative analysis based on three-dimensional computed tomography (3D-CT) in contouring surgery of complex craniofacial fibrous dysplasia (FD). METHODS: 14 patients with craniofacial FD underwent 3D-CT scan. Axial images of patients with craniofacial FD were reconstructed into 3D model by using Mimics 10.0. Anatomical landmarks were located and the coordinate of the landmarks obtained. The differences between the right landmarks and the left were calculated and analyzed. Quantitative contouring surgery was performed based on the quantitative analysis result. RESULTS: With the detail data from the 3D-CT analysis, the surgery of contouring was more safe and accurate with less operation time, less bleeding and good results. CONCLUSIONS: The method of 3D CT quantitative analysis can provide precise information in the diagnosis and treatment planning of craniofacial deformity. Based on the result of 3D-CT quantitative analysis, the operations can be performed more accurately and safely with good symmetric consequence.

A microdissection study of perforating vessels in the perineum: implication in designing perforator flaps.

The objective of this study is to determine the quantity, position, and caliber of perforating vessels in the perineum, and to provide an anatomic basis for designing perineal perforator flaps. Eleven adult cadavers (22 sides) were dissected under an operating microscope (x10). Microstructures, including perforating arteries, vena comitantes, vascular anastomoses, and cutaneous nerves, were measured with a sliding caliper (accurate to 0.2 mm). There were 4 relatively constant perforating arteries in the perineum: inguinal and perineal perforating branches of the superficial external pudendal artery, a perforating branch of the anterior cutaneous branch of the obturator artery, and a perforating branch of the lateral branch of the posterior scrotal (pudendal) artery. All 4 arteries were direct perforating branches. These perforating arteries and accompanying veins overlapped with each other and formed the upper, middle, and lower parts of the vascular anastomosis in deep fascia above the adductor wall. There were 4 important cutaneous nerves in the region originating from the following nerves: the genitofemoral nerve, ilioinguinal nerve, posterior scrotum (labium) major nerve, and rami perineales nervi cutanei femoris posterioris. The perineum has abundant blood supply, venous return, and innervation. Due to its covert location and manoeuvrability, perforator flaps from this region are good sources of donor tissue for perineal reconstruction.

Pudendal-thigh flap:anatomic basis and application in repair and reconstruction of male perineal region / 第二军医大学学报

Objective:To investigate the anatomic characteristics of the pudendal-thigh flap and provide anatomic basis for clinical design and application. Methods: The perineal regions of 15 male cadavers were anatomized. The flap was designed on the cadavers and the blood vessels/nerves contained in the flap were studied. Based on the above anatomic findings, we designed the flaps in our operation. The axial arteries were isolated according to the designing and the tissue adjacent to the vessel pedicles was preserved. The flaps were transferred to the recipient site. The incision of donor site was directly sutured; skin graft was transplanted when the incision could not be directly sutured. Results: The perineal regions had rich and constant blood supply and had stable nerve innervation. The blood supplies of the perineal region included external pudendal artery, anterior cutaneous branches of obturator artery, lateral branch of posterior labial or scrotum arteries. The location of the above vessels was comparatively constant, especially external pudendal arteries and posterior scrotum arteries. Three groups of blood vessels went through the lower, middle and upper parts, and there were 4 groups of major nerves responsible for the innervation of the pudendal region. We have used 23 cases of pudenal-thigh flaps, with the largest flap being 17 cm X 9 cm and the smallest being 8 cm X 5 cm, and satisfactory outcomes were achieved in all the cases. Conclusion: The pudenal thigh flap has rich blood supply, convenient incision, and covert donor site. It has satisfactory outcome (morphologic and sensory) in repairing and reconstructing male perineal region and is worth popularizing.

Treatment of hemifacial atrophy by autologous fat injection / 第二军医大学学报

Objective:To assess the clinical outcome of autologous fat injection in treatment of hemifacial atrophy,so as to search for an ideal treatment of hemifacial atrophy.Methods: Autologous fat granules were obtained by tumescent liposuction.After purification,the fat granules were injected in a multi-strata,multi-tunnel,and multi-spot manner to repair facial introcession abnormality.Patients whose introcession was not improved after the stabilization of the fillings were re-injected with autologous fat granules twice or more until satisfactory outcomes were achieved.Results: All the 7 patients in this study obtained satisfactory outcomes after fat injection and basically reached symmetry.The follow-up result was good after 2 years.Conclusion: Local injection transplantation of autologous fat granules is effective for the treatment of facial depression and hemifacial atrophy,with slight trauma,little complication,and satisfactory outcome.