Chinese Journal of Plastic and Reconstructive Surgery最新文献

Background

Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction. However, surgeons worldwide have not agreed on the details of graft harvesting, including rib selection, side preference, operation mode, cutting methods, and handling of the periosteum and perichondrium. This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5 years and identify potential avenues for future research.

Methods

We searched for related articles in PubMed, Embase, and Web of Science from 2019 to 2023, summarized crucial but controversial steps in recent practice, and analyzed their theoretical basis and clinical feasibility.

Results

Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction, with the 5th to 8th ribs and cartilage being the most used. The laparoscopic harvest is gaining attention, being second only to the open harvest, with the 9th/10th ribs and cartilages being particularly convenient. The clinical applications of full-cut and split-cut methods differ in their advantages. Except for some special reasons, almost all studies tended to preserve the periosteum and perichondrium in situ, and few surgeons chose to harvest the grafts on the left side.

Conclusion

Multiple techniques have emerged, requiring surgeons to balance the benefits and risks of various strategies at each step. New theories and techniques should be fully tested promptly and in clinical practice before wide application. Overall, a professional consensus is needed for better directivity, precision, and stability in clinical practice.

Background

This study aimed to evaluate the long-term penile size among patients who underwent extensive metoidioplasty.

Methods

An evaluation was conducted on 7 out of 14 patients (mean age: 29.71 ​± ​13.76 years) who participated in a 2015 study that introduced a postoperative protocol to improve penile size after extensive metoidioplasty. Five transsexual females (46XX karyotype) and two patients with 5-alpha reductase deficiency were retrospectively followed up in 2023 to assess the long-term efficacy of the protocol at a specialized clinic in a general hospital in Tehran, Iran. All participants were informed about the study and consented to participate.

Results

Five patients achieved increased penile size from their 2015 measurements (mean, 29.00 ​± ​13.34 ​mm). Five patients requested a larger sized penile traction device to continue the protocol.

Conclusion

The long-term implementation of this protocol can result in increased penile size. We advise highly motivated patients to continue practicing the protocol to achieve better results.

Background

Reconstruction of large scalp defects after tumor resection is common and challenging. Free skin grafting or free flap transfer is always performed. However, these techniques can result in poor functional and cosmetic outcomes.

Methods

In the Second Affiliated Hospital of Soochow University and the Second Affiliated Hospital of Chengdu Medical College, 35 patients underwent jigsaw puzzle flap procedures based on a free-style perforator to repair large scalp defects after tumor resection from May 2013 to November 2022. The key to this procedure was to divide a large defect into several smaller parts that correspond to adjacent free-style perforators around the scalp defect. The free-style perforator flaps were designed in different ways, such as propeller flaps, rotation flaps, and V-Y advancement flaps, which were pedicled with free-style perforators. All of the small flaps were then mobilized to the defect and sutured to each other to create a new, large jigsaw puzzle-like flap to cover the large scalp defect. Finally, all the donor sites were closed directly.

Results

Overall, 35 patients were treated. The average defect size was 72 ​cm² (range, 25–91 ​cm²). All flaps had a satisfactory appearance after follow-up periods of 6 months–10 years. Local tumor recurrence occurred in one case.

Conclusion

The application of a jigsaw puzzle flap based on a free-style perforator is a suitable option for the reconstruction of large scalp defects after resection, yielding satisfactory functional and cosmetic results.

Cutaneomucosal venous malformations (VMCMs) can manifest as sporadic or familial forms, following an autosomal dominant inheritance pattern. This report highlights the case of a 5-year-old girl presenting with a substantial congenital VMCM attributed to a TIE2 mutation, who underwent percutaneous sclerotherapy followed by surgery. The clinical, three-dimensional computed tomographic angiography (3D-CTA), as well as pathological and genetic findings concerning a patient with an extensive VMCM in the left pro-axillary region, are elucidated. The genetic analysis in this patient verified a missense mutation (c.2545T>C) in TIE2, confirming familial VMCMs. The combined strategy integrating percutaneous sclerotherapy and surgical excision is the most efficacious approach for managing large VMCMs and can successfully attain therapeutic goals.

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.

Arteriovenous malformations (AVMs) are aggressive congenital high-flow vascular anomalies, in which the feeding artery and draining vein are connected through fistulas without normal capillary networks. In severe cases, the condition may cause swelling, ulceration, bleeding, and even heart failure. Various treatment options are available for AVMs, including laser, surgical resection, embolization, and targeted drug therapy. With the development of endovascular treatment technology, absolute ethanol embolization of AVMs has become one of the first-line therapies owing to its sustained efficacy and low recurrence rate. However, administration of this therapy is challenging and may lead to serious complications if inappropriately managed. In this article, we reviewed and summarized previous clinical articles, literature reviews, and clinical trial data to comprehensively describe clinical manifestations of AVMs, the mechanism of ethanol embolotherapy, key points in treatment and management of complications, and issues that need to be addressed. We expect to provide a reliable information reference source for clinical physicians and researchers.

Background

Damage to the skin and underlying tissues due to thermal burns is relevant. Despite the success of modern medicine, repairing thermal damage to the skin is a difficult task in reconstructive plastic surgery because of the nature of the damage and the regenerative features. Characteristic post-burn changes are associated with different depths of damage when areas of deep damage are combined with more superficial areas.

Methods

We described a clinical case of the staged surgical treatment of a cicatricial deformity of the buccal-periorbital-perioral region resulting from a childhood burn injury from a hot object. The 44-year-old patient complained of an aesthetic and functional deformity of the buccal-periorbital-perioral region and had previously undergone repeated nonsurgical corrections.

Results

A comprehensive approach to the surgical treatment of a patient with post-burn deformities using a diplene adhesive membrane directly affected the stage of the surgical treatment and contributed to improved functional and aesthetic results.

Conclusion

The positive treatment results with preserved contraction and relaxation processes of the facial muscles as well as satisfactory aesthetic results allow us to recommend the use of a biodegradable diplene film during facial reconstructive operations.

Arteriovenous malformations (AVMs) are serious congenital vascular anomalies in which the arteries connect directly with veins without capillaries. This condition will continue to worsen without proper intervention and cause ulcers, repeated hemorrhages, and even cardiac insufficiency. Primary treatment options for AVMs include surgery and interventional treatment; however, they are associated with high risk and recurrence rates. Recent studies revealed that excessive activation of the Ras/MAPK pathway can induce the formation and development of peripheral AVM, whereas MEK inhibitors can effectively control nidus progression, making them a potential novel treatment for AVM. This review provides an up-to-date overview of correlated laboratory and clinical research to provide information for further research and clinical practice.

Background

Diabetic foot ulcers (DBFU) are one of the main complications of diabetes. Platelet-rich plasma (PRP) treatment is a commonly used treatment option. Tibial transverse transport (TTT) also has a therapeutic effect on DBFU. Some studies have found that the TTT combined with PRP (TTT&PRP) has a significant effect on DBFU.

Methods

PubMed, Cochrane Library, Web of Science, EMBASE, Chinese Biomedical Literature, CNKI, VIP, and Wanfang databases were used to find literature on the treatment of DBFUs using the TTT and PRP treatment according to the inclusion criteria. The specific inclusion criteria are as follows: (1) research type: clinical controlled trials, including retrospective cohort and randomized controlled studies; (2) diagnosis of DBFUs that does not include a definitively diagnosed traumatic ulcer; (3) original materials of Chinese and English literature published in full text. The exclusion criteria are: (1) the research group was not defined or grouped; (2) nonrandomized controlled trials, non-cohort studies, non-case-control studies, retrospective studies, and case reports; (3) repetitive research and animal experimentation; (4) ulcers caused by other diseases; (5) conservative treatment or no use of invasive treatment methods. Review Manager software (version 5.3) was used to conduct a meta-analysis of the included results.

Result

The literature included 6 randomized controlled studies, including 508 patients, 254 patients in the PRP treatment group, and 254 patients in the TTT&PRP group. The meta-analysis results showed that in terms of treatment efficacy, the TTT&PRP combined treatment group had a higher efficacy than the PRP group. After treatment, the TTT&PRP group had better treatment effects in psychological function, physiological function, and social function compared to the PRP group. After treatment, the TTT&PRP group showed a significant increase in serum epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and platelet-derived growth factor (PDGF) levels compared to the PRP group. In terms of wound healing after treatment, the TTT&PRP group performed better than the PRP group in terms of postoperative wound reduction rate, bacterial clearance rate, granulation tissue coverage rate, and granulation tissue growth thickness.

Conclusion

TTT combined with PRP was more effective than PRP alone in treating DBFUs.