Chinese Journal of Plastic and Reconstructive Surgery最新文献

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 (1 358 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% (n=11), 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.

Rhinoplasty in Asia is becoming increasingly widespread. When taking into consideration the anatomical differences between the features of Caucasian and Asian patients, it is unsurprising that knowledge gained from research on Caucasian rhinoplasty is not always applicable to Asian rhinoplasty. Furthermore, reviews aimed at describing the recent developments in Asian rhinoplasty are rare. This review aims to provide a comprehensive summary of the latest trends in rhinoplasty for Asians by classifying it into three parts: methods, materials, and three-dimensional techniques, hopefully providing surgeons with references to aid in conducting rhinoplasty on Asians.

Background

Skin expansion is a useful method for harvesting extra tissue. However, the outcome is hardly predictable.

Methods

A total of 158 patients with 277 expanded skin cases were reviewed and evaluated via photographs. The review and evaluation were conducted to determine the skin’s regenerative condition. The overall texture of the expanded skin, which was deemed good, fair, or poor, was evaluated. The occurrence of five indications of the limitation of skin regeneration (thinning, color change, stretch marks, varicose vessels, and skin lesions) during expansion was recorded. The correlation between the five indications and the overall texture was statistically analyzed.

Results

Among the 277 retrospectively reviewed expansion cases, the occurrence rate of skin deterioration showed significant differences between the expansion sites (P<0.01). Skin deterioration was most commonly seen on the neck and at the back. The occurrence of each indication varied among locations. The odds ratios of color change, stretch marks, varicose vessels, thinning, and skin lesions between good and poor skin conditions were 44.97, 5.09, 22.26, 89.79, and 4.61, respectively (all P<0.001).

Conclusion

Skin color, stretch marks, varicose vessels, thickness, and skin lesions are closely correlated with the skin regenerative capacity. An integrated evaluation can help predict the regenerative capacity of expanded skin.

An increasing number of researchers have demonstrated that poloxamer 188 (P188) can be used as a pharmaceutical excipient for clinical applications. Its membrane-sealing effects and inherent biological activities make it an extremely promising agent for plastic surgery. In this review, we summarize the positive roles of P188 in autologous fat grafting, wound healing, and cartilage transplantation. These roles include improving the survival rate of fat grafts and chondrocytes, stimulating the metabolic activity of adipocytes, promoting wound healing, and contributing to cartilage formation. Although further research is still needed, it is clear that P188 has great potential and application value in the field of plastic surgery.

Although ear reconstruction is a mature procedure, emergency microsurgical replantation has still been regarded as the optimal treatment for ear amputation due to its cost-effectiveness and aesthetically pleasing results. Successful microsurgical ear replantation is rare because of the difficulty in identifying suitable vessels for anastomosis. We describe two cases of total ear microsurgical replants using the parietal branch of the superficial temporal vessels (STV) as the recipient vessels. The STV parietal branch was dissected up to a sufficient length after thorough debridement, and the amputated ears were revascularized using end-to-end anastomosis. Our experience shows that the parietal branch of the STV is an ideal recipient vessel option for total ear replantation.

Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion. Based on the causes of lower eyelid retraction, we divided the forming factors of lower eyelid retraction into three categories: (1) change in the balance of forces associated with the lower eyelid margin; (2) excessive loss of lower eyelid volume; (3) changes in the relative position of the eyeball and lower lid margin. In this review, the corresponding treatment methods are elaborated on individually for the above three forming factors. We also reported, for the first time, a new treatment for lower eyelid retraction. We created a dermal-orbicularis oculi suspension flap on the lateral side of the canthus and suspended it upward and inward on the dense connective tissue over the lateral bony surface of the orbital rim. The longest follow-up time was one year, and the results were satisfactory.

Polyacrylamide hydrogel (PAAG) was once considered a safe, reliable, and compatible injected filler and was widely used in breast augmentation, rhinoplasty, and other cosmetic surgeries. However, numerous complications, such as implant migration, have been observed after PAAG injections. Herein, we report a rare case of distant implant migration after PAAG injection for breast augmentation in which the material became displaced along the abdominal wall to the perineum and pelvic extraperitoneal space. After a well-prepared preoperative evaluation involving magnetic resonance imaging (MRI) and computed tomography (CT) examinations and three-dimensional hologram, debridement surgery was performed to remove the injected material. After the operation, the patient was followed up for two years and was not scheduled for a second operation. Postoperative complications of breast augmentation after PAAG injection, especially gel migration, still affect thousands of patients. Once material migration occurs, surgical removal becomes difficult. Early diagnosis and treatment are recommended.

Background

Massage is generally believed to be a simple and effective method for preventing necrosis when intravascular injection emboli are suspected. Due to its good dispersive properties, polymethyl methacrylate (PMMA) was used as the test filler. The main purpose of this study was to observe whether local massage as a simple remedial measure can promote the diffusion of filler and reduce the necrosis rate for intra-arterial embolism.

Methods

Rabbit ears with the central ear artery (CEA) main trunk totally or segmentally obstructed 5 ​min after PMMA injection were studied. In order to simulate the massage effect of the fingers, the massage group was treated with a small beauty massage bar with a fixed vibration frequency along the direction of the blood flow. CEA blood flow and skin lesions were also analyzed.

Results

The baseline data were similar between the control and massage groups. Compared to the control group, the recanalization rate of the CEA trunk in the treatment group increased significantly after massage. However, there was no significant difference in the visible rate of transparent embolus on the 1st day after treatment, nor in the necrosis degree or area of soft tissue damage on the 7th day after treatment. Further analysis showed that massage tended to have a positive effect on segmentally obstructed cases at 5 ​min after injection but a negative effect on totally obstructed ears at 5 ​min.

Conclusion

Local massage cannot reduce the complications of tissue necrosis after intra-arterial PMMA injection. Prevention is key to reducing complications.

Keloids are a fibroproliferative disorder of the skin and can cause physical discomfort and psychological burden. Apart from local factors such as skin tension and infection, increasing evidence has suggested that systemic endocrine factors also contribute to the emergence and development of keloids. Hormone disorders have long been suspected to be a risk factor; however, previous studies have mainly focused on the role of female hormones and neglected the critical role of male hormones. As we reviewed the published literature addressing sex steroids in pathological scars, we speculated that androgens (i.e., male hormones) could become actively involved through sebum-associated hypersensitivity reactions and acne-derived skin lesions, resulting in persistent cutaneous inflammation. This hypothesis was also supported by previous in vitro studies, in which elevated androgen levels and androgenic receptors were detected in keloid tissues. Moreover, relief of pain and pruritus has been observed in patients with keloids who accidently received anti-androgen treatment for other irrelevant indications. Thus, we propose that androgen-related disorders are critical in the pathogenesis of keloids, and systemic treatment targeting sex hormones may provide long-term benefits for predisposed patients with multiple keloids.

Gynecomastia is emerging as a major cosmetic and physiological concern among adolescents, especially in relation to obesity, acute weight loss following surgery, and other endocrine illnesses. Surgical treatment involves liposuction (mechanical, power-assisted, or ultrasound-assisted), nipple-conserving subcutaneous mastectomies, or nipple transpositions via various techniques. Unsightly scarring, with visible scar hypertrophy and nipple necrosis, continues to plague postoperative cosmetic outcomes; hence, different techniques of performing nipple transposition have been devised, ranging from free grafts to pedicled flaps. In this case report, we draw attention to an old technique, described by Passot in 1925, that was applied primarily for reduction mammoplasty in women at that time. This technique is still not as frequently used as the Wise pattern mastopexy technique in gynecomastia surgery, and we wish to convey that better cosmesis would be achieved in patients with Simon IIB/III and ptotic gynecomastia using this technique, avoiding a vertical scar.