Chinese Journal of Plastic and Reconstructive Surgery最新文献

Limb length discrepancy (LLD) is a common orthopedic condition that can result in significant functional impairment, pain, and cosmetic deformities. Current reconstructive techniques for severe LLD are primarily based on callus distraction, which is a time-consuming process that can lead to complications, such as significant infection, joint stiffness, and stress fractures. To reduce the therapeutic time and minimize the risk of complications, we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs. We present two cases of severe LLD in the upper and lower legs, in which a two-stage reconstruction approach was used. In the first stage, external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect. In the second stage, the bone defect was reconstructed using bilateral (patient A) or unilateral (patient B) free vascularized fibula bone grafts. Both patients had complete survival of the fibular grafts without stress fractures, and bone consolidation took 8 months (patient A) and 4 months (patient B). Compared to the traditional callus distraction, the two-stage approach was found to be more time-saving and reliable. The entire reconstructive scheme required 18 and 4 months for patients A and B, respectively, whereas the traditional callus distraction required 41 and 17 months, respectively. These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD. Further studies are needed to validate these results and assess the long-term outcomes of this approach.

The clinical use of fat grafts for breast reconstruction post-mastectomy or radiotherapy has the disadvantages of limited retention and survival rates. To solve this problem, adipose-derived stem cells (ADSCs) have been suggested as an alternative cell source for breast reconstruction, because they are simple to access, have low immunogenicity, and support the survival of mature adipose grafts. However, despite their outstanding properties, the use of ADSCs in patients with breast cancer is controversial, and the oncological safety of this method has been questioned. The biological effects of ADSCs on breast cancer are complex, and clinical research on ADSC-assisted fat grafting is limited. Here, we review the current experimental findings on the effects of ADSCs on breast cancer, mainly focusing on the role of ADSCs in breast cancer proliferation and growth processes, such as epithelial-mesenchymal transition (EMT) and angiogenesis. We also discuss the safety of ADSCs in clinical breast reconstruction.

Nasal defects can be reconstructed with a nasolabial perforator flap, resulting in good aesthetic outcomes based on the facial subunit principle, owing to the combined advantages of the traditional nasolabial flap and the perforator flap. However, the localization of perforators makes the clinical application of a nasolabial perforator flap difficult. This review aims to provide a comprehensive summary of the nasolabial perforator flap from anatomical, methodological, and clinical application aspects, intending to provide plastic surgeons with a reference on conducting nasal reconstruction with a nasolabial perforator flap.

Facial infiltrating lipomatosis (FIL) is a congenital asymmetrical deformity of the maxillofacial region that can significantly affect a patient’s facial appearance and function. With the development of sequencing technologies, PIK3CA mutations are considered among the potential etiologies of FIL. The management and treatment of FIL involves plastic surgery; more recently, an improved understanding of its pathogenesis has given rise to new treatment options, including targeted therapy. Here we report the clinical data of two patients diagnosed with FIL and present current curative concepts.

Background

The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.

Methods

In this novel article, we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane. The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.

Results

The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.

Conclusion

Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction, for the surgical treatment of ectropion including recurrent cases, and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Facial prostheses have developed significantly in the last 10 years, especially between 2016 and 2021. This development is mainly due to the great progress made in the fields of biocompatible materials, digital technology, and three-dimensional printing technology, which provides guarantee for low allergy, high biosimulation, comfort, and satisfactory usability. Treatment teams typically consist of plastic surgeons, material experts, engineers, and computer scientists who have extensive clinical experience. These teams successfully implement an integrated, multidisciplinary model by prioritizing the reasonable expectations of both the physician and patient, leading to improved patient satisfaction and compliance with prosthetic constraints. This study aimed to review the concept, development status, existing problems, and future of facial prosthesis.

Background

Traditional lecture-based teaching (TLT) has long been the primary method of teaching plastic suturing techniques and even surgical education. It has been challenging to adapt this approach to fit the educational objectives of plastic surgery, which is a very practical science. Additionally, it is mainly teacher-led, and the course content is teacher-driven, which has disadvantages such as difficulty in motivating students and disconnection from clinical practice. Therefore, we developed a video point-to-point teaching (VPT) method and teamwork-based teaching (TBT) to study the effect of the new teaching model on fine cosmetic suturing operation (FCSO) and training outcomes for plastic surgeons.

Methods

We selected 30 junior doctors from the Department of Plastic and Reconstructive Surgery of the Chinese PLA General Hospital. All trainees were randomly assigned to three groups: TLT, VPT, and TBT. All trainees had their performances photographed, and a senior attending physician was appointed as a rater. We rated the process and results of FCSO according to a uniform rubric following the double-blind principle to compare the effects of different teaching modes on the trainees’ FCSO and differences in training outcomes.

Results

There was no significant effect of video recording on trainees’ FCSO (P>0.05). The total scores of the first suturing in the three groups were as follows: TLT group (13.18 ​± ​1.66), VPT group (13.63 ​± ​1.97), and TBT group (13.50 ​± ​2.26), with no significant difference among the groups (P>0.05), indicating that the starting level of the trainees in the three groups was basically the same. There was no significant difference (P>0.05) between the VPT (20.30 ​± ​2.17) and TBT (20.38 ​± ​2.29) groups, but both of these groups were significantly better than the TLT group (16.43 ​± ​1.86, P<0.01).

Conclusion

The TBT and VPT methods are significantly better than TLT. However, the TBT method is more economical and optimal for teachers and better utilizes students’ initiative in learning and operation, which improves the teaching level and training efficiency.

Pilomatrixomas are benign tumors derived from hair stromal cells; however, their exact etiology is unknown. A 31-year-old woman presented with a subcutaneous mass located precisely above the left eyebrow, with shedding of eyebrow hair around the mass, and the shedding area gradually expanded. Surgical removal of the mass failed to prevent eyebrow loss, and the entire left eyebrow shed 6 months postoperatively. Pathology and histology of the biopsy specimen revealed a pilomatrixoma comprising basaloid cells and ghost cells, with basaloid cells expressing high bcl-2 levels. Instead of apoptosis, the emergence and growth of pilomatrixoma-induced microinflammation around the hair follicles of the eyebrow may lead to eyebrow loss.

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.