Objective To investigate the application of the fibrous envelope of tissue expanders for the tension reduction. Methods Between June 2005 and May 2011, 21 patients with facial scar were treated with skin soft tissue expansion. There were 6 males and 15 females, aged 19-33 years (mean, 24.5 years), including 19 cases of hypertrophic scar and 2 cases of atrophic scar with disease duration of 1-31 years. The scars ranged from 4 cm × 2 cm to 25 cm × 10 cm. The tissue expander was implanted under normal skin adjacent to lesions in the first stage. And the post-expanded skin flap was designed as advance flap or transpositional flap as supplement in the second stage. Fibrous envelope at the base was fixed to the periosteum or fascia nearby first, and then sutures were used between envelopes at the base and on the skin flap or to the dermis of the skin flap to keep the mouth and lower eyelid in proper position. It reduced the tension of incision and maintained the contour of the face and neck. Results After the first stage operation, 2 cases had replaced expanders because of infection and leakage. No complication of infection or hematoma occurred after the second stage operation. The patients were followed up 1-18 months (mean, 10.2 months); of them,12 were followed up more than 1 year. No secondary deformity (deviation of mouth angle, eyebrows pulling, or eyelid ectropion) occurred. The flaps had good appearance and color. The satisfactory results were achieved. Conclusion In skin soft tissue expansion of the face, the fibrous envelopes at the base could reduce the tension of the incision and prevent the deformity of the mouth and lower eyelids.
Objective To study the method to prepare the animal model of goat cleft palate by injection of anabasine and the effect of the malformation on the development of the facial mid-part. Methods A total of 40 female boer hybrid goats were selected, aging 8-12 months and weighing 35-55 kg. The mating day was 0 day, and at 30 days the goats assured pregnant byB type ultrasonic test were divided into 4 groups (n=10) according to intramuscular injection of 10 (experimental group 1), 15 (experimental group 2), 20 (experimental group 3) mg/ d, and no injection (control group), respectively, from the 31st to 42nd day. At pregnant 120 days and 1 month after birth, 5 fetal goats of each group were used for three dimensional reconstruction ofskull with CT scan. The maxillary bone width named as PPMM and the maxillary bone length named as APMM were measured then the hard palate general observation was performed and dry skull of goats was harvested to observe the development of maxillary. Results After injection, all pregnant lambs aborted in experimental group 3; 2 pregnant lambs aborted and 8lambs maintained pregnancy in experimental group 2. At 120 days of pregnant, no cleft palate was observed in 5 fetal lambs of experimental group 1 and control group, respectively; cleft palate and maxillary dysplasia occurred in 3 fetal lambs of experimental group 2. Among 11 newborn lambs of experimental group 1 and 8 newborn lambs of control group, no cleft palate was observed;among 7 newborn lambs of experimental group 2, cleft palate occurred in 5 with obvious maxillary dysplasia and eating difficultly. General observation of hard palate and dry skull showed obvious hypoplasia of maxillary in experimental group 2. There were significant differences in PPMM and APMM between the experimental group 2 and the control group at pregnant 120 days and 1 month after birth (P lt; 0.05). Five lambs with cleft palates of experimental group 2 survived for 1-2 months. Conclusion The animal models of goat cleft palate can established by intramuscular injection of anabasine at a dose of 15 mg/d from the 31st to 42nd day of pregnant. The facial character of the induced cleft palate goat is similar to that of human cleft palate.
Objective To study the mid-facial development characteristics of the goats with cleft palate after in-utero surgical repair at different stages. Methods Twenty-four Boer hybrid female goats were selected, aged from 8 to 12 months and weighing from 35 to 55 kg. The mating day was designated for 0 day. At 30 days, pregnant was confirmed by B-ultrasound test, and the goats were divided into 5 groups (experimental groups 1, 2, 3, 4, and normal control group). Twenty pregnant goats of 4 experimental groups (n=5) were injected DL-anabasine (15 mg/day) from 31 to 42 days to establish cleft palate model of fetal lamb, 4 pregnant goats of normal control group used as controls without injection. At pregnant 65, 90, and 120 days, cleft palate was repaired in the uterus in experimental groups 1, 2, and 3, while cleft palate was not repaired in experimental group 4. After 1 month of birth, the maxillary bone width (posterior premolar morphological measurement, PPMM) and the maxillary bone length (anterior premolar morphological measurement, APMM) were measured with CT scanning. The dry skull of goats were harvested for gross observation. Results There was no significant difference in PPMM and APMM between experimental group 1 and the normal control group (P gt; 0.05), but there were significant differences between experimental groups 1 and 4 (P lt; 0.05) at 1 month after birth. Significant differences were oberved in PPMM and APMM between experimental group 2 and normal control group, experimental group 4 (P lt; 0.05). There were significant differences in PPMM between experimental group 3 and normal control group, experimental group 4 (P lt; 0.05), in APMM between experimental group 3 and normal control group (P lt; 0.05). Five goats with cleft palate in experimental group 4 died at 1-2 months after birth. Conclusion At pregnant 65 days, in-utero surgical repair of cleft palate has less influences on mid-facial development. The earlier repair is performed, the higher risk of miscarriage was.
Objective To investigate the effect of cleft palate on the development of the mid-part of the face so as to provide an optimum animal model for the fetal cleft repair. Methods Twenty female Boer hybrid goats were selected, aging from 8 to 12 months and weighing from 35 to 55 kg. The mating day was identified as 0 day of pregnancy. The goats werediagnosed with pregnancy by the B-ultrasound examination at 30 days, and were allocated into experimental group (n=14) and control group (n=6). In experimental group, uterine cavitory operation was performed at 65 days of pregnancy to form cleft palate which was a fissure between oral and nasal cavity; no treatment was given as the control group. At 120 days of pregnancy, and after 1 month and 3 months of birth, the gross observation and 3-dimensional skull CT reconstruction were performed; and the maxillary bone width named as PPMM and the maxillary bone length named as APMM were measured. Results After operation, 2 goats died of infection, miscarriage occurred in 3 goats; 9 goats were included into the experiment. The operation success rate was 64.3%. In experimental group, maxillary dysplasia occurred in all the fetal goats at 120 days of pregnancy, and more obvious maxillary dysplasia was observed at 1 month and 3 months after birth; no maxillary dysplasia occurred in control group. There were significant differences in PPMM and APMM between 2 groups at different time points (P lt; 0.05). In experimental group, the lambs had poor chewing function, and died of pulmonary infection after aspiration at 1-4 months after birth. Conclusion The surgical procedure for partial ablation of secondary primitive palate in the midl ine could make the model of cleft palate.
ObjectiveTo investigate the feasibility and effectiveness of a modified cross-lip flap with lip artery anatomosis so as to shorten inward time. MethodsBetween August 2010 and January 2014, 11 patients underwent cross-lip flap surgery with lip artery anatomosis to repair upper lip defects. There were 9 males and 2 females with an average age of 62 years (range, 13-70 years). The defects causes were tumors removal in 6 cases, animal bites in 2 cases, and secondary deformity after cleft lip repair surgery in 3 cases. The width and height of defect were 1.5-4.0 cm and 1.8- 3.5 cm respectively; the width and height of flap were 1.5-3.2 cm and 1.5-3.0 cm respectively. The donor site was directly sutured. ResultsAll flaps survived, and wound healed by first intention. The flap pedicle was cut off at 5 days after operation. No blister, desquamation, or circulatory malfunction was found. Delayed healing of incision occurred in 1 patient with diabetes. Eleven patients were followed up 5-24 months (mean, 11 months). The patients had normal facial expression, food intake, and language function. The function of brush directional stroke test sensation recovered in 7 (77.8%) of 9 followed patients at 12 months after operation. ConclusionThe modified cross-lip flap with lip artery anatomosis is feasible and effective in repair of upper lip defects, because it can gain much more blood supply from lip right now in first surgery, shorten inward time, and relief patient's discomfort.
ObjectiveTo investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. MethodsIndocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm×6 cm to 26 cm×12 cm. ResultsA total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis. ConclusionIntraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
ObjectiveTo explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. MethodsBetween April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as TisN0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm. ResultsOne patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. ConclusionAdequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.
ObjectiveTo explore the techniques and short-term effectivness of contralateral breast symmetrization mammaplasty in breast reconstruction. MethodsBetween February 2014 and December 2015, 11 patients received immediate or delayed breast reconstruction after nipple-sparing mastectomy (6 and 5 cases respectively) for contralateral breast symmetrization mammaplasty. The age ranged 36-55 years (mean, 45 years). The disease duration was from 7 days to 6 months (mean, 2.5 months) in 6 patients undergoing immediate breast reconstruction. According to tumor TNM staging, 2 cases were rated as TisN0M0, 3 cases as T1N0M0, and 1 case as T2N0M0. The duration was from 2 to 25 years (mean, 8 years) in 5 patients undergoing delayed breast reconstruction. The implant (7 cases) and latissimus dorsi (4 cases) were used for breast reconstruction; and breast augmentation (6 cases) and breast reduction (5 cases) were performed for contralateral breast symmetrization. ResultsOne patient had local poor wound healing postoperatively and was cured; primary healing was obtained in the other patients, and no other postoperative complication of infection, implant exposure or capsular contracture was found. The patients were followed up 3 to 24 months (mean, 12 months). The reconstructive outcomes were excellent in 9 cases and good in 2 cases, with an excellent and good rate of 100%. There was no recurrence or metastasis. ConclusionSimultaneous contralateral symmetrization with augmentation/reduction mammaplasty after breast reconstruction can obtain satisfactory symmetric outcomes.