Peutz-Jeghers syndrome(PJS)is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps and pigmentation of the mucosa and skin.While there are a few reports regarding successful treatme...Peutz-Jeghers syndrome(PJS)is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps and pigmentation of the mucosa and skin.While there are a few reports regarding successful treatment of intestinal polyps in PJS,there is little research regarding treatment of mucocutaneous melanosis.This study investigated the many advantages of using a Q-switched alexandrite laser to treat mucocutaneous melanosis.In this case,a 19-year-old male with PJS presented with labial lentigines and received two Q-switched alexandrite laser treatments in 2018.Subsequently,the efficacy of the treatment was evaluated.The result of the evaluation was that,after the two laser treatments,the labial lentigines were successfully removed,and there were no complications.展开更多
Tissue expansion is a naturally-occurring phenomenon.Human skin will stretch and expand naturally under continuous pressure,resulting in extra skin,which is the theoretical basis of expander reconstruction and repair....Tissue expansion is a naturally-occurring phenomenon.Human skin will stretch and expand naturally under continuous pressure,resulting in extra skin,which is the theoretical basis of expander reconstruction and repair.Tissue expansion technique is of great value in the reconstruction of various parts of the human body,especially in the treatment of facial and neck scars.The related complications are as follows:infection,hematoma,seroma,exposure,necrosis,displacement,skin flap retraction and so on.Patient selection,surgical design and technical control are all indispensable for obtaining good aesthetic results and reducing the incidence of complications.展开更多
We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin...We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.展开更多
Background: Lower-lid pretarsal fullness rejuvenation is a popular surgery for Asian women. However, the current procedures have clinical complications and are not stable in the long-term. Here, we analyzed the effect...Background: Lower-lid pretarsal fullness rejuvenation is a popular surgery for Asian women. However, the current procedures have clinical complications and are not stable in the long-term. Here, we analyzed the effect of injectable collagen on lower-lid pretarsal fullness rejuvenation.Methods: To investigate the clinical effect of injectable collagen in lower-lid pretarsal fullness rejuvenation, we observed 32 Chinese Han female patients aged 18–55 years with non-distinctive lower-lid pretarsal fullness and no history of lower eyelid surgery or trauma. The injectable collagen products were used for local filling correction. After surgery, the patients were followed up for 12 months. A correction effect was evaluated through an analysis of volume changes using a visual analog scale. Adverse reactions were also recorded.Results: All patients achieved good aesthetic outcomes and strong stereoscopic impressions of lower-lid pretarsal fullness. Complications, such as edema and bruising, were not observed after the injection. Immediately after the operation, the average visual analog score was 2.65 ± 0.56. Six months after the operation, the average visual analog score was 2.96 ± 0.41. The patients reported high satisfaction levels. Immediately after the operation, the average lower-lid pretarsal fullness volume increase was 0.19 ± 0.04 m L on the left side and 0.21 ± 0.03 m L on the right side. After a 12-month follow-up, the average residual volume was 0.17 ± 0.06 m L on the left side and 0.19 ± 0.04 m L on the right side, suggesting that the injected collagen impact was stable.Conclusion: Injectable collagen promotes a vivid, natural appearance and is highly effective in rejuvenating lowerlid pretarsal fullness with low absorption rates in later stages. Therefore, injectable collagen should be considered in correcting congenital, non-distinctive, lower-lid pretarsal fullness in clinical practice.展开更多
Background:To investigate the common symptoms after Covid-19 infection,characteristics of adverse events after vaccination,changes in clinical manifestations related to Neurofibromatosis type 1(NF1),as well as the cur...Background:To investigate the common symptoms after Covid-19 infection,characteristics of adverse events after vaccination,changes in clinical manifestations related to Neurofibromatosis type 1(NF1),as well as the current vaccination status and factors related to vaccine hesitation among NF1 patients,in order to provide a basis for scientific protection and vaccine acceptance in NF1 individuals in the new phase of pandemic management.Methods:From December 29,2022,to January 10,2023,we conducted a self-assessment questionnaire survey among diagnosed NF1 patients.General data were provided including sex,age,main clinical presentations,and current treatment.This study mainly focused on the infection and vaccination status of Covid-19 among these patients with NF1.The data were statistically analyzed using SPSS26.0 software.Results:Of the 250 questionnaires distributed,226 were valid.Among the 164 patients(72.6%)with Covid-19 infection,the most common infection symptoms and incidence of patients were not significantly different from those in the normal population(P>0.05),but the incidence of symptoms such as nasal congestion,headache,myalgia,sore throat,abdominal pain,diarrhea,and eye discomfort was higher than that in the normal population(P<0.05),and no severe infection was observed;186 patients(82.3%)had completed the Covid-19 vaccination,and more than half of those who were not vaccinated had no plans for vaccination.Among the vaccinated patients,there was no significant difference in the incidence of adverse events,such as fever,pain,redness,and swelling at the injection site after vaccination,compared to the normal population(P>0.05),but the incidence of fatigue and headache was higher in NF1 patients(P<0.001).Most patients with NF1 believe that there is no significant progressive change in NF1-related clinical manifestations after Covid-19 infection and vaccination.Conclusion:Currently,some NF1 patients appear to be worried about the evolution of their disease after Covid-19 infection in the face of large fluctuations in the pandemic situation,and some patients hesitate to receive the vaccine due to their special disease condition.Thus,clinical trials should be conducted to develop a refined pandemic response and vaccination program for this special group.展开更多
Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their...Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.展开更多
Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbili...Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.展开更多
Wound healing is a complex biological process that involves proliferation,migration,and differentiation.Endogenous electric field(EF)-directed migration of keratinocytes(galvanotaxis)is an essential step in woun...Wound healing is a complex biological process that involves proliferation,migration,and differentiation.Endogenous electric field(EF)-directed migration of keratinocytes(galvanotaxis)is an essential step in wound re-epithelialization.Endogenous EFs are generated instantaneously after an injury because of the collapse of transepithelial potentials.The application of exogenous EF has become increasingly widespread in promoting wound healing,leading to a paradigm shift in patient outcomes.Here,we summarize the role and value of EF in wound healing through a review of the current research.展开更多
Background: Although the surgical outcomes of free flap reconstruction have improved over time, vascular compromise remains a devastating complication. Near-infrared spectroscopy(NIRS) is a promising new free flap mon...Background: Although the surgical outcomes of free flap reconstruction have improved over time, vascular compromise remains a devastating complication. Near-infrared spectroscopy(NIRS) is a promising new free flap monitoring technique with the potential for better outcomes than clinical monitoring(CM). This systematic review aims to provide a comprehensive review of the current evidence regarding the use of NIRS for free flap monitoring.Methods: A systematic literature review was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on existing NRIS studies, including the clinical outcomes of NIRS monitoring, speed of detection, diagnostic accuracy, variables affecting NIRS accuracy, and cost-effectiveness.Results: A total of 24 articles were included in this analysis. In most instances of flap compromise, NIRS enabled earlier detection of compromise than did CM, by an average of 8.1(0.5±32.0) h. The flap salvage rate of flaps monitored with CM and NIRS(87.2%) was significantly higher than that of flaps monitored with CM alone(50.0%)(P<0.01). The overall survival rate for flaps monitored with CM and NIRS(98.1%) was also significantly higher than that for flaps monitored with CM alone(96.3%)(P=0.02). Blood oxygen saturation was the only variable with a significant effect on NIRS results.Conclusion: NIRS is an objective and reliable flap monitoring technique that provides superior flap salvage and survival rates compared with CM, which translates to cost savings and a reduction in workload for healthcare staff. Further large-scale studies are needed to standardize flap compromise criterion values and efficacy for different flap types.展开更多
Background:We previously reported that interstitial injection of bleomycin(BLM)reduces the size of early-stage extracranial arteriovenous malformation(AVM).Here,we sought to investigate the potential mechanism of BLM ...Background:We previously reported that interstitial injection of bleomycin(BLM)reduces the size of early-stage extracranial arteriovenous malformation(AVM).Here,we sought to investigate the potential mechanism of BLM in treating extracranial AVM.Methods:Samples of human extracranial AVM(n=3)with no pharmacological treatment were harvested.AVM endothelial cells were isolated and cultured in primary cell culture.The transcriptome was examined using RNAsequencing,and differentially expressed C-type lectin domain family 14 member A(CLEC14A)was validated at the transcriptomic and protein levels.Immunocytochemical staining of CLEC14A was performed in samples of human extracranial AVM,with and without BLM treatment.Results:Through second-generation sequencing,we found that the expression of 5689 genes were differentially increased or decreased following 24-h BLM stimulation.We found that CLEC14A may play an important role in the progression of AVM and can be inhibited by BLM treatment.Conclusion:BLM inhibited CLEC14A expression to attenuate the progression of AVM.展开更多
Abdominal contour deformities pose an aesthetic challenge to patients with massive weight loss.This article reviews the similarities and differences in obesity between the Asian and Western populations.A comprehensive...Abdominal contour deformities pose an aesthetic challenge to patients with massive weight loss.This article reviews the similarities and differences in obesity between the Asian and Western populations.A comprehensive classification system combining the objective description of structural deformities with patients’discomfort or physical function is required to classify the abdominal contour deformities.The authors also proposed several controversial issues,including the classification of abdominal deformities,surgical techniques,and complications,providing an evidence-based review for selecting the appropriate surgical method for Asian patients to achieve satisfying clinical outcomes and avoid complications.展开更多
Background:Management of severe velopharyngeal dysfunction is best performed by a multispecialty team.This team could include a speech-language pathologist,otolaryngologist,prosthodontist,and a plastic surgeon.The mos...Background:Management of severe velopharyngeal dysfunction is best performed by a multispecialty team.This team could include a speech-language pathologist,otolaryngologist,prosthodontist,and a plastic surgeon.The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps.In this study,a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.Methods:Twenty patients underwent sphincter pharyngoplasty.Preoperative diagnosis was performed using auditory perceptual assessment,nasoendoscopy assessment,nasometry,and videofluoroscopy.Results:There were statistically significant differences between the preoperative and postoperative assessments.Bleeding occurred in two patients.Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months,and one patient experienced slight wound dehiscence.Conclusion:Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.展开更多
Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the relate...Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.Methods:The clinical records and radiographs of 679 patients(1358 sides)who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.Results:Patients with unfavorable fractures who underwent surgical restoration were studied.The incidence of unfavorable fractures was 0.8%(n¼11),with the highest rate in the third year.The unfavorable fractures were divided into three types by location and clinical treatment:(1)SSRO could still be completed after buccal/lingual plate unfavorable fracture(0.6%,n=8);(2)condylar/coronoid process fractures/intermaxillary fixation needed(0.1%,n=2);(3)additional osteotomy required(0.07%,n=1).Conclusion:These results suggest that as a surgeon’s experience increases,the rate of unfavorable fractures may decrease.The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.展开更多
Skeletal muscle regeneration mainly depends on muscle satellite cells;however,these cells are not sufficient for supporting repair and regeneration in volumetric muscle loss(VML),Duchenne muscular dystrophy,and other ...Skeletal muscle regeneration mainly depends on muscle satellite cells;however,these cells are not sufficient for supporting repair and regeneration in volumetric muscle loss(VML),Duchenne muscular dystrophy,and other muscle injuries or muscle diseases.As such,much work has been conducted in recent years to search for myogenic stem cells.Adipose-derived stem cells(ADSCs)have a wide range of sources,rapid growth,and multi-directional differentiation potential,and have become vital candidates for muscle regeneration.Multiple factors influence the myogenic differentiation capacity of ADSCs.This paper reviews the regulatory aspects and possible factors that have been identified in recent years to affect myogenic differentiation of ADSCs.Based on these factors,gene editing,and perfusion concepts,a method was proposed to achieve maximal differentiation efficiency of ADSCs.This study focused on the application of ADSCs in muscle regeneration and disease.Based on the importance of myogenic differentiation of ADSCs for the repair and regeneration of muscle damage,this study provides a basis for future research surrounding the efficient induction of myogenic differentiation of ADSCs in vitro.展开更多
Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear...Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear cartilage,and acellular dermal matrix(ADM)as tarsal plate substitutes were investigated.Two cases were reviewed.Case 1 was a 22-year-old female who had total loss of the right lower eyelid.Ear cartilage(23 mm25 mm)was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilageexpander capsule compound structure for lower eyelid reconstruction.Case 2 was a 7-year-old boy with a unilateral divided nevus.The lid and conjunctiva of the lower eyelid were invaded.A piece of ADM(12 mm4 mm)was used to repair the tarsal plate defect(12 mm3 mm).The conjunctiva of ADM was covered by itself.An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction.In case 1,the compound tissue survived and supported the lower eyelid,the lid margin was clear,and the structure was complete over a 1-year follow-up.The aesthetic appearance of the eyelid improved after depilation.It is the first clinical research on the expander capsule as eyelid conjunctiva.In case 2,the conjunctiva completely covered the superior ADM,and the transplant merged with the surrounding tissues without complications after 5 months.The preserved sclera has the longest application history as a tarsal plate substitute.However,it should be preserved in an eye bank and transplanted with conjunctiva repair.Ear cartilage is an autologous tissue that requires conjunctival reconstruction.Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva.It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure.Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility,supportive strength,conjunctivalization,and not requiring donor site surgery.Plastic surgeons are familiar with autologous ear cartilage and ADM,which are easy to obtain and treat.Both ear cartilage and ADM are expected to be the first-line choices in future studies.展开更多
Background Many cases of ClassⅡdeformities have been reported to be treated with prefabricated appliances.The aim of this study was to distinguish the clinical effect of traditional custom-made appliances and prefabr...Background Many cases of ClassⅡdeformities have been reported to be treated with prefabricated appliances.The aim of this study was to distinguish the clinical effect of traditional custom-made appliances and prefabricated appliances in the treatment of ClassⅡdivision 1 malocclusion.Therefore,soft and hard tissue changes following treatment of ClassⅡdivision 1 malocclusion using the twin-block(TB)appliance was compared to that using the Myofunctional Research Company(MRC)appliance(K1+K2)combined with oral myofunctional treatment(OMT)(MRC+OMT).Methods The study included 22 children(6 boys and 16 girls aged 9–11 years)with ClassⅡdivision 1 malocclusion along with mandibular retrognathism with a 5–12 mm overjet,basic normal maxillary status,and stage 2 or 3 cervical vertebral maturation(CVM).Participants were randomly assigned into two groups,the TB group and the MRC+OMT group for 12 months.Standardized lateral cephalograms were used to assess skeletal,dental,and soft tissue changes from pre-to post-treatment.Independent t-tests were used to compare the initial and final cephalometric status and tissue changes between the groups.Results The TB and MRC+OMT groups resulted in different degrees of lateral changes;however,improvements of skeletal and soft tissue indices were significantly greater in the TB group than in the MRC+OMT group.Conclusion TB was more effective than MRC+OMT in treating children aged 9–11 years with ClassⅡdivision 1 malocclusion.However,further research using custom-made appliances with OMT is recommended,and further investigations are needed to confirm these findings.展开更多
Objective To review the advances in research on factors of cranioauricular angle formation after auricular reconstruction.Methods The related literature concerning the main surgical methods and influencing factors for...Objective To review the advances in research on factors of cranioauricular angle formation after auricular reconstruction.Methods The related literature concerning the main surgical methods and influencing factors for the ear elevation by Nataga method and dilated method was reviewed and summarized.Results The ear elevation by Nataga method and dilated method has achieved satisfactory clinical results.Although rapid prototyping technology and tissue engineering have developed rapidly,it is still some time before a beautiful and practical cranioauricular angle can be reconstructed.Conclusion The surgical programs for ear elevation by Nataga method and dilated method have been constantly improved in recent years,which provides a great deal of reference for obtaining a beautiful and practical cranioauricular angle.展开更多
Since the emergence of microsurgery in reconstructive surgery, free flaps have become a key tool in the management of patients with breast cancer. One such flap is the profunda artery perforator(PAP) flap. To date,the...Since the emergence of microsurgery in reconstructive surgery, free flaps have become a key tool in the management of patients with breast cancer. One such flap is the profunda artery perforator(PAP) flap. To date,there is no scientific consensus on whether voluminous free flaps remain dependent on their vascular pedicle throughout their lifespan. Therefore, the pedicle should always be carefully protected during revision surgery.In this article, we review the case of a middle-aged woman who suffered a pedicle transection needing reanastomosis during revision surgery six months after free-flap breast reconstruction. A 52-year-old woman who noticed a firm nodule in her right breast and armpit was referred to our department for surgical management. The Caucasian woman presented with no significant medical history or symptoms at the first consultation. Ultrasound-guided biopsy confirmed an invasive grade Ⅲ lobular carcinoma. Following staging,the patient underwent neoadjuvant chemotherapy before a right mastectomy with a complete homolateral axillary lymph node dissection and postoperative radiotherapy. One year after completing radiotherapy, free flap reconstruction with a PAP flap was performed, and six months later, revision surgery was required to enhance the volume of the reconstructed breast with a tissue expander and later an implant. Unfortunately,pedicle transection occurred during revision surgery, causing complete devascularization of the flap, which was confirmed by intraoperative Indocyanine Green imaging. The authors elected to perform salvage reanastomosis during the surgery. In keeping with the author’s 23-year experience with free flaps, the vascular pedicle should always be preserved in voluminous free flaps, as neovascularization alone may not ensure whole flap survival. The authors suggest always attempting re-anastomosis if vessels are compromised during revision surgery.展开更多
This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure an...This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure and displacement of the lower lateral cartilage were observed.All flaps survived,and the patient was completely satisfied with the surgical results.This surgical treatment is simple and reliable,can greatly improve the nasal appearance of patients with alar clefts,and may be an alternative to the current surgical treatment.展开更多
文摘Peutz-Jeghers syndrome(PJS)is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps and pigmentation of the mucosa and skin.While there are a few reports regarding successful treatment of intestinal polyps in PJS,there is little research regarding treatment of mucocutaneous melanosis.This study investigated the many advantages of using a Q-switched alexandrite laser to treat mucocutaneous melanosis.In this case,a 19-year-old male with PJS presented with labial lentigines and received two Q-switched alexandrite laser treatments in 2018.Subsequently,the efficacy of the treatment was evaluated.The result of the evaluation was that,after the two laser treatments,the labial lentigines were successfully removed,and there were no complications.
文摘Tissue expansion is a naturally-occurring phenomenon.Human skin will stretch and expand naturally under continuous pressure,resulting in extra skin,which is the theoretical basis of expander reconstruction and repair.Tissue expansion technique is of great value in the reconstruction of various parts of the human body,especially in the treatment of facial and neck scars.The related complications are as follows:infection,hematoma,seroma,exposure,necrosis,displacement,skin flap retraction and so on.Patient selection,surgical design and technical control are all indispensable for obtaining good aesthetic results and reducing the incidence of complications.
文摘We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.
文摘Background: Lower-lid pretarsal fullness rejuvenation is a popular surgery for Asian women. However, the current procedures have clinical complications and are not stable in the long-term. Here, we analyzed the effect of injectable collagen on lower-lid pretarsal fullness rejuvenation.Methods: To investigate the clinical effect of injectable collagen in lower-lid pretarsal fullness rejuvenation, we observed 32 Chinese Han female patients aged 18–55 years with non-distinctive lower-lid pretarsal fullness and no history of lower eyelid surgery or trauma. The injectable collagen products were used for local filling correction. After surgery, the patients were followed up for 12 months. A correction effect was evaluated through an analysis of volume changes using a visual analog scale. Adverse reactions were also recorded.Results: All patients achieved good aesthetic outcomes and strong stereoscopic impressions of lower-lid pretarsal fullness. Complications, such as edema and bruising, were not observed after the injection. Immediately after the operation, the average visual analog score was 2.65 ± 0.56. Six months after the operation, the average visual analog score was 2.96 ± 0.41. The patients reported high satisfaction levels. Immediately after the operation, the average lower-lid pretarsal fullness volume increase was 0.19 ± 0.04 m L on the left side and 0.21 ± 0.03 m L on the right side. After a 12-month follow-up, the average residual volume was 0.17 ± 0.06 m L on the left side and 0.19 ± 0.04 m L on the right side, suggesting that the injected collagen impact was stable.Conclusion: Injectable collagen promotes a vivid, natural appearance and is highly effective in rejuvenating lowerlid pretarsal fullness with low absorption rates in later stages. Therefore, injectable collagen should be considered in correcting congenital, non-distinctive, lower-lid pretarsal fullness in clinical practice.
基金supported by the National Natural Science Foundation of China (grant nos. 82102344 and 82172228)Shanghai Rising Star Program supported by Science and Technology Commission of Shanghai Municipality (grant no. 20QA1405600)+4 种基金Science and Technology Commission of Shanghai Municipality (grant no. 19JC1413)Natural Science Foundation of Shanghai (grant no. 22ZR1422300)“Chenguang Program” supported by Shanghai Education Development Foundation (grant no. 19CG18)Shanghai Municipal Key Clinical Specialty (grant no.shslczdzk00901)Innovative Research Team of High-level Local Universities in Shanghai (grant no. SSMUZDCX20180700)
文摘Background:To investigate the common symptoms after Covid-19 infection,characteristics of adverse events after vaccination,changes in clinical manifestations related to Neurofibromatosis type 1(NF1),as well as the current vaccination status and factors related to vaccine hesitation among NF1 patients,in order to provide a basis for scientific protection and vaccine acceptance in NF1 individuals in the new phase of pandemic management.Methods:From December 29,2022,to January 10,2023,we conducted a self-assessment questionnaire survey among diagnosed NF1 patients.General data were provided including sex,age,main clinical presentations,and current treatment.This study mainly focused on the infection and vaccination status of Covid-19 among these patients with NF1.The data were statistically analyzed using SPSS26.0 software.Results:Of the 250 questionnaires distributed,226 were valid.Among the 164 patients(72.6%)with Covid-19 infection,the most common infection symptoms and incidence of patients were not significantly different from those in the normal population(P>0.05),but the incidence of symptoms such as nasal congestion,headache,myalgia,sore throat,abdominal pain,diarrhea,and eye discomfort was higher than that in the normal population(P<0.05),and no severe infection was observed;186 patients(82.3%)had completed the Covid-19 vaccination,and more than half of those who were not vaccinated had no plans for vaccination.Among the vaccinated patients,there was no significant difference in the incidence of adverse events,such as fever,pain,redness,and swelling at the injection site after vaccination,compared to the normal population(P>0.05),but the incidence of fatigue and headache was higher in NF1 patients(P<0.001).Most patients with NF1 believe that there is no significant progressive change in NF1-related clinical manifestations after Covid-19 infection and vaccination.Conclusion:Currently,some NF1 patients appear to be worried about the evolution of their disease after Covid-19 infection in the face of large fluctuations in the pandemic situation,and some patients hesitate to receive the vaccine due to their special disease condition.Thus,clinical trials should be conducted to develop a refined pandemic response and vaccination program for this special group.
文摘Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.
文摘Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.
基金This work was supported by the National Nature Science Foundation of China(NSFC no.81873936).
文摘Wound healing is a complex biological process that involves proliferation,migration,and differentiation.Endogenous electric field(EF)-directed migration of keratinocytes(galvanotaxis)is an essential step in wound re-epithelialization.Endogenous EFs are generated instantaneously after an injury because of the collapse of transepithelial potentials.The application of exogenous EF has become increasingly widespread in promoting wound healing,leading to a paradigm shift in patient outcomes.Here,we summarize the role and value of EF in wound healing through a review of the current research.
文摘Background: Although the surgical outcomes of free flap reconstruction have improved over time, vascular compromise remains a devastating complication. Near-infrared spectroscopy(NIRS) is a promising new free flap monitoring technique with the potential for better outcomes than clinical monitoring(CM). This systematic review aims to provide a comprehensive review of the current evidence regarding the use of NIRS for free flap monitoring.Methods: A systematic literature review was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on existing NRIS studies, including the clinical outcomes of NIRS monitoring, speed of detection, diagnostic accuracy, variables affecting NIRS accuracy, and cost-effectiveness.Results: A total of 24 articles were included in this analysis. In most instances of flap compromise, NIRS enabled earlier detection of compromise than did CM, by an average of 8.1(0.5±32.0) h. The flap salvage rate of flaps monitored with CM and NIRS(87.2%) was significantly higher than that of flaps monitored with CM alone(50.0%)(P<0.01). The overall survival rate for flaps monitored with CM and NIRS(98.1%) was also significantly higher than that for flaps monitored with CM alone(96.3%)(P=0.02). Blood oxygen saturation was the only variable with a significant effect on NIRS results.Conclusion: NIRS is an objective and reliable flap monitoring technique that provides superior flap salvage and survival rates compared with CM, which translates to cost savings and a reduction in workload for healthcare staff. Further large-scale studies are needed to standardize flap compromise criterion values and efficacy for different flap types.
基金supported,in whole or in part,by the Project of Biobank(grant no.YBKA201902)from Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of MedicineMulti-center Clinical Research Programs(grant no.DLY201613),Clinical Research Center,Shanghai Jiao Tong University School of MedicineRare Disease Registration Platform of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(grant no.JYHJB02).
文摘Background:We previously reported that interstitial injection of bleomycin(BLM)reduces the size of early-stage extracranial arteriovenous malformation(AVM).Here,we sought to investigate the potential mechanism of BLM in treating extracranial AVM.Methods:Samples of human extracranial AVM(n=3)with no pharmacological treatment were harvested.AVM endothelial cells were isolated and cultured in primary cell culture.The transcriptome was examined using RNAsequencing,and differentially expressed C-type lectin domain family 14 member A(CLEC14A)was validated at the transcriptomic and protein levels.Immunocytochemical staining of CLEC14A was performed in samples of human extracranial AVM,with and without BLM treatment.Results:Through second-generation sequencing,we found that the expression of 5689 genes were differentially increased or decreased following 24-h BLM stimulation.We found that CLEC14A may play an important role in the progression of AVM and can be inhibited by BLM treatment.Conclusion:BLM inhibited CLEC14A expression to attenuate the progression of AVM.
基金grants from National Natural Science Foundation of China(81671923)National Natural Science Foundation of China(81971839).
文摘Abdominal contour deformities pose an aesthetic challenge to patients with massive weight loss.This article reviews the similarities and differences in obesity between the Asian and Western populations.A comprehensive classification system combining the objective description of structural deformities with patients’discomfort or physical function is required to classify the abdominal contour deformities.The authors also proposed several controversial issues,including the classification of abdominal deformities,surgical techniques,and complications,providing an evidence-based review for selecting the appropriate surgical method for Asian patients to achieve satisfying clinical outcomes and avoid complications.
文摘Background:Management of severe velopharyngeal dysfunction is best performed by a multispecialty team.This team could include a speech-language pathologist,otolaryngologist,prosthodontist,and a plastic surgeon.The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps.In this study,a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.Methods:Twenty patients underwent sphincter pharyngoplasty.Preoperative diagnosis was performed using auditory perceptual assessment,nasoendoscopy assessment,nasometry,and videofluoroscopy.Results:There were statistically significant differences between the preoperative and postoperative assessments.Bleeding occurred in two patients.Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months,and one patient experienced slight wound dehiscence.Conclusion:Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.
基金the University-Industry Collaborative Education Program of the Ministry of Education of China(grant no.201801301030).
文摘Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.Methods:The clinical records and radiographs of 679 patients(1358 sides)who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.Results:Patients with unfavorable fractures who underwent surgical restoration were studied.The incidence of unfavorable fractures was 0.8%(n¼11),with the highest rate in the third year.The unfavorable fractures were divided into three types by location and clinical treatment:(1)SSRO could still be completed after buccal/lingual plate unfavorable fracture(0.6%,n=8);(2)condylar/coronoid process fractures/intermaxillary fixation needed(0.1%,n=2);(3)additional osteotomy required(0.07%,n=1).Conclusion:These results suggest that as a surgeon’s experience increases,the rate of unfavorable fractures may decrease.The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.
基金supported by the National Nature Science Foundation of China(grant nos.81873939 and 31970374)the Scientific Research Staring Foundation for the Returned Overseas Chinese Scholars of Peking University Third Hospital(grant no.BYSYLXHG2019001).
文摘Skeletal muscle regeneration mainly depends on muscle satellite cells;however,these cells are not sufficient for supporting repair and regeneration in volumetric muscle loss(VML),Duchenne muscular dystrophy,and other muscle injuries or muscle diseases.As such,much work has been conducted in recent years to search for myogenic stem cells.Adipose-derived stem cells(ADSCs)have a wide range of sources,rapid growth,and multi-directional differentiation potential,and have become vital candidates for muscle regeneration.Multiple factors influence the myogenic differentiation capacity of ADSCs.This paper reviews the regulatory aspects and possible factors that have been identified in recent years to affect myogenic differentiation of ADSCs.Based on these factors,gene editing,and perfusion concepts,a method was proposed to achieve maximal differentiation efficiency of ADSCs.This study focused on the application of ADSCs in muscle regeneration and disease.Based on the importance of myogenic differentiation of ADSCs for the repair and regeneration of muscle damage,this study provides a basis for future research surrounding the efficient induction of myogenic differentiation of ADSCs in vitro.
基金the Shanghai Committee of Science and Technology,China(grant no.19ZR1430100)。
文摘Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear cartilage,and acellular dermal matrix(ADM)as tarsal plate substitutes were investigated.Two cases were reviewed.Case 1 was a 22-year-old female who had total loss of the right lower eyelid.Ear cartilage(23 mm25 mm)was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilageexpander capsule compound structure for lower eyelid reconstruction.Case 2 was a 7-year-old boy with a unilateral divided nevus.The lid and conjunctiva of the lower eyelid were invaded.A piece of ADM(12 mm4 mm)was used to repair the tarsal plate defect(12 mm3 mm).The conjunctiva of ADM was covered by itself.An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction.In case 1,the compound tissue survived and supported the lower eyelid,the lid margin was clear,and the structure was complete over a 1-year follow-up.The aesthetic appearance of the eyelid improved after depilation.It is the first clinical research on the expander capsule as eyelid conjunctiva.In case 2,the conjunctiva completely covered the superior ADM,and the transplant merged with the surrounding tissues without complications after 5 months.The preserved sclera has the longest application history as a tarsal plate substitute.However,it should be preserved in an eye bank and transplanted with conjunctiva repair.Ear cartilage is an autologous tissue that requires conjunctival reconstruction.Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva.It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure.Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility,supportive strength,conjunctivalization,and not requiring donor site surgery.Plastic surgeons are familiar with autologous ear cartilage and ADM,which are easy to obtain and treat.Both ear cartilage and ADM are expected to be the first-line choices in future studies.
文摘Background Many cases of ClassⅡdeformities have been reported to be treated with prefabricated appliances.The aim of this study was to distinguish the clinical effect of traditional custom-made appliances and prefabricated appliances in the treatment of ClassⅡdivision 1 malocclusion.Therefore,soft and hard tissue changes following treatment of ClassⅡdivision 1 malocclusion using the twin-block(TB)appliance was compared to that using the Myofunctional Research Company(MRC)appliance(K1+K2)combined with oral myofunctional treatment(OMT)(MRC+OMT).Methods The study included 22 children(6 boys and 16 girls aged 9–11 years)with ClassⅡdivision 1 malocclusion along with mandibular retrognathism with a 5–12 mm overjet,basic normal maxillary status,and stage 2 or 3 cervical vertebral maturation(CVM).Participants were randomly assigned into two groups,the TB group and the MRC+OMT group for 12 months.Standardized lateral cephalograms were used to assess skeletal,dental,and soft tissue changes from pre-to post-treatment.Independent t-tests were used to compare the initial and final cephalometric status and tissue changes between the groups.Results The TB and MRC+OMT groups resulted in different degrees of lateral changes;however,improvements of skeletal and soft tissue indices were significantly greater in the TB group than in the MRC+OMT group.Conclusion TB was more effective than MRC+OMT in treating children aged 9–11 years with ClassⅡdivision 1 malocclusion.However,further research using custom-made appliances with OMT is recommended,and further investigations are needed to confirm these findings.
文摘Objective To review the advances in research on factors of cranioauricular angle formation after auricular reconstruction.Methods The related literature concerning the main surgical methods and influencing factors for the ear elevation by Nataga method and dilated method was reviewed and summarized.Results The ear elevation by Nataga method and dilated method has achieved satisfactory clinical results.Although rapid prototyping technology and tissue engineering have developed rapidly,it is still some time before a beautiful and practical cranioauricular angle can be reconstructed.Conclusion The surgical programs for ear elevation by Nataga method and dilated method have been constantly improved in recent years,which provides a great deal of reference for obtaining a beautiful and practical cranioauricular angle.
文摘Since the emergence of microsurgery in reconstructive surgery, free flaps have become a key tool in the management of patients with breast cancer. One such flap is the profunda artery perforator(PAP) flap. To date,there is no scientific consensus on whether voluminous free flaps remain dependent on their vascular pedicle throughout their lifespan. Therefore, the pedicle should always be carefully protected during revision surgery.In this article, we review the case of a middle-aged woman who suffered a pedicle transection needing reanastomosis during revision surgery six months after free-flap breast reconstruction. A 52-year-old woman who noticed a firm nodule in her right breast and armpit was referred to our department for surgical management. The Caucasian woman presented with no significant medical history or symptoms at the first consultation. Ultrasound-guided biopsy confirmed an invasive grade Ⅲ lobular carcinoma. Following staging,the patient underwent neoadjuvant chemotherapy before a right mastectomy with a complete homolateral axillary lymph node dissection and postoperative radiotherapy. One year after completing radiotherapy, free flap reconstruction with a PAP flap was performed, and six months later, revision surgery was required to enhance the volume of the reconstructed breast with a tissue expander and later an implant. Unfortunately,pedicle transection occurred during revision surgery, causing complete devascularization of the flap, which was confirmed by intraoperative Indocyanine Green imaging. The authors elected to perform salvage reanastomosis during the surgery. In keeping with the author’s 23-year experience with free flaps, the vascular pedicle should always be preserved in voluminous free flaps, as neovascularization alone may not ensure whole flap survival. The authors suggest always attempting re-anastomosis if vessels are compromised during revision surgery.
基金the Ethics Committee at the Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(approval no.SH9H-2021-T242)。
文摘This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure and displacement of the lower lateral cartilage were observed.All flaps survived,and the patient was completely satisfied with the surgical results.This surgical treatment is simple and reliable,can greatly improve the nasal appearance of patients with alar clefts,and may be an alternative to the current surgical treatment.
