Abstract Postburn deformities, including hypertrophic scars, scar contracture and defect or deformity of tissue or organ, are the commonest disorders in plastic surgery. It is also difficult to deal with. If the diformity involved multiple organs, oftentimes the teatmentis very difficult because the material for repair is limited and the donorsite usually could not provide adequate amount of skin for repair. Since 1978,2496 cases of various postburn deformities were admitted. In this article, theoptimal time to operate was discussed. The use of flap transfer and soft tissueexpander was described. Prolonged traction in the treatment of severe contracture of large joint was also described.
Objective To evaluate the linkage between the proxmal as well as long term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis.Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.
The authors reported nine patients with burn scar contracture of head and face treated by operation. The varieties of operations ineiuded: (1) excision of the scar and primary closure of the wound; (2) excision of the scar and coverage of the wound with split or full thickness skin grafts; (3) excision of the scar and repaired by pedicled flap, and (4) skin expansion by expander, followed by excision the scar and transfer of the "more available skin flap" to the wound. According to certain characteristics of children, the choice of the time for operation, the indications of each methods, and some problems related to operation ahd been discussed.
【摘要】 目的 探讨肥胖人群减肥后体重急剧下降导致腹壁松弛行腹壁整形手术的疗效。 方法 2003年4月-2009年10月，24例减肥后体重下降导致腹壁松弛患者中男3例，女21例，年龄28~44岁，平均36岁。其中1例合并甲状腺功能亢进，1例合并糖尿病病史；20例均通过运动、控制饮食等方式致体重下降，4例接受胃减容手术后体重下降。体重下降稳定后至腹壁整形手术时间间隔2~4年，平均2.5年；减肥前至腹壁整形手术前体重下降37~67 kg，平均下降45 kg。手术采用屈髋位，切除松弛皮肤组织，收紧腹壁及腰部松弛组织，耻骨上沿皮瓣远端去表皮后与耻骨上沿骨膜缝合固定。所有患者随访5个月~2年。 结果 23例术后2周皮瓣完全成活，切口愈合良好，无切口感染；1例术后出现耻骨上切口约2 cm表皮裂开，换药2周后切口愈合，术后腹壁平整、对称，无皮下血肿发生。随访期间切口疤痕隐蔽，阴阜无上移，腹壁平坦、对称。 结论 该腹壁整形手术方式效果良好，术后并发症少，值得推广。From April 2003 to October 2009, 24 obese patients, including three males and 21 females, developed abdominal chalastodermia caused by weight loss. Their age ranged from 28 to 44 years old with an average age of 36 years. Among them, one had hyperthyroidism and one had a medical history of diabetes. Twenty patients lost weight by exercise and diet, while the other four lost weight through stomach reduction surgery. Time span from weight loss to abdominal plastic surgery was two to four years, averaging at 2.5 years. During the time from before weight loss until the surgery, weight loss ranged from 37-67 kg, averaging at 45 kg. The surgery adopted the position of bending hip. The loose skin was removed; abdominal wall and loose waist tissues were tightened; and the far end of flap without skin along the upper edge of pubis was sutured with the periosteum. All patients were followed up for a time ranged from five months to two years. Results Flaps survived within two weeks after the surgery, incision healed perfectly, and no infection occurred to the incision for all the patients except in one case, there was a 2 cm of skin fissure in the upper incision which was cured after two weeks of dressing. After the surgery, the abdominal wall was flat and symmetrical without subcutaneous hematoma. During the follow-up, scars were well hidden, mons pubis was not shifted upward, and the abdominal wall was flat and symmetrical. Conclusion The abdominal wall plastic surgery has a good clinical outcome with few complications, which is worth being popularized.
ObjectiveTo systematically review the survival rate of different vascularized bone flaps in mandibular defect repair and reconstruction by Bayesian network meta-analysis. MethodsThe PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The Bayesian network meta-analysis was carried out applying R software. ResultsA total of 24 studies involving 1 615 patients were included. The results of meta-analysis showed that the respective survival rates of fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were 95.62%, 94.09%, 98.16%, and 93.75%. Moreover, the network meta-analysis failed to show a statistically significant difference between all comparators. Conclusion Current evidence shows that different vascularized bone flaps have similar survival rates in mandibular defect repair and reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To summarize and review the development and experience of anastomosis vascular pedicle free composite tissue flap. Methods From July 1987 to March 2007， 321 patients with complete records were treated. Fourteen tissue flaps were applied for the repair of trauma or tumor excision defects of the body, and for organ reconstruction. Results Vascular crisis occurred in 20 patients within 48 hours postoperatively. Necrosis occurred at flap end in 6 patients. The total survival rate was 94.8%. The main experience was: ① Training to grasp the basic microvascular anastomosis technique was very importantstarting up period for surgeons. The basic technique should be often practiced to ensure the safty of clinical application. ②Restoring appearance and function were equally important in practice.③Utilizing the minimal invasive methods and decreasing the loss of function of donor site were important for improvement of reconstruction quality. The purpose was to achieve functional and esthetic restoration in the condition of lowest donor site scarification. Conclusion The application of free composite tissue flap is important for the development of plastic surgery. There are extensive applications for free flap, especially for those critical patients. The application of free flap could decrease the mobility rate, shorten the treatment period, ease the pain of patients and improve the reconstruction effect. The experience of donor site selection, the strategy of poor recipient site condition, the advantages and disadvantages of muscle flap, the applications time, infections wound treatment and application, are helpful for the future application.
To discuss the advantages of two flap contouring methods and to explore the best choice for the flap contouring. Methods From March 2002 to March 2006, 59 patients were admitted for a flapcontouring operation. Of the 59 patients, 40 (32 males, 8 females; average age, 34 years) underwent the multiphase lipectomy (the multiphase lipectomy group). The original flaps included the abdominal flap in 19 patients, the groin flap in 10, the thoracic flap in 4, the free anteriolateral thigh flap in 6, and the cross leg flap in 1. The flaps ranged in size from 6cm×4 cm to 32 cm×17 cm. However, the remaining 19 patients (16 males, 3 females; average age, 28 years) underwent the onephase lipectomy with skin graft transplantation(the onephase lipectomy group). The original flaps included the abdominal flap in 4 patients, the groin flap in 6, the thoracic flap in 3, and the free anteriolateral thighflap in 6. The flaps ranged in size from 4 cm×3 cm to 17 cm×8 cm. The resultswere analyzed and compared. Results In the multiphase lipectomy group, partial flap necrosis developed in 4 patients but the other flaps survived. The followedup of 27 patients for 3 months to 2 years revealed that the flaps had a good appearance and texture, having no adhesion with the deep tissues. However, the flaps became fattened in 22 patients with their body weight gaining. The patietns who had a flap gt; 5 cm×5 cm in area had their sensation functions recovering more slowly; only part of the sensations to pain and heat recovered. The two point discrimination did not recover. In the onephase lipectomy group, total graft necrosis developed in 1 patient but the healing was achieved with additional skin graft transplantation; partial graft necrosis developed in 2patients but the wounds were healed after the dressing changes; the remaining flaps survived completely. The followup of the 16 patients for 3 months to 3 years revealed that all the 16 patients had a good sensation recovery, 12 patientshad the two point discrimination lt; 15 mm, with no recurrence of the fattening of the flaps; however, the grafted skin had a more severe pigmentation, and no sliding movement developed between the skin and the tissue basement. Conclusion The multiphase lipectomy and the onephase lipectomy with skin graft transplantation are two skin flap contouring methods, which have their ownadvantages and disadvantages. Which method is taken should be based on the repair location of the 〖WT5”BZ〗skin flap and the condition of the skin flap.
ObjectiveTo evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.MethodsBetween January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).ResultsThe incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.ConclusionAutologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.