Chinese Journal of Plastic and Reconstructive Surgery最新文献

Background

Recently, microbotulinum, a new technique that involves injecting botulinum toxin type A (BoNTA) microdroplets into superficial cutaneous tissue, has gained popularity. The precise distribution of BoNTA in the targeted area profoundly affects outcomes. Many factors may influence the effective area of BoNTA in the dermis. This study aimed to determine the dermal distribution properties of BoNTA to guide microbotulinum injection.

Methods

Ten healthy males aged 18–65 years without BoNTA treatment in the previous year were recruited to receive intradermal injections in the chest and back. Ultrasound was used to ensure the intradermal delivery of injections and measure the dermal thickness. The minor iodine starch test was performed at baseline and 3 days, 7 days, 21 days, 1 month, and 2 months after treatment.

Results

All participants received intradermal injections. The dermis was thinner on the chest (thickness, 0.20 ± 0.03 ​cm) than on the back (thickness, 0.39 ​± ​0.07 ​cm) ​(P<0.05). An injection in the thicker dermis had a significantly smaller effective area at every follow-up visit. The drug concentration did not affect the effective area except at 3 days after treatment. Injection speed did not influence the effective area at any follow-up visits.

Conclusion

An injection in a thicker dermis leads to a smaller effective area for intradermal injections. When the BoNTA dose is the same, the drug concentration and injection speed do not matter.

Trial registration

ChiCTR, ChiCTR2100046507. Registered May 18, 2021. Retrospective registration, https://www.chictr.org.cn/ChiCTR2100046507.

Melasma is a prevalent and challenging skin condition that affects the face and causes distress in many patients and physicians. Tranexamic acid (TA) has been found to be effective for treating melasma and can be administered through multiple routes. This review details the mechanisms of action of TA in treatment of melasma and assesses the efficacy and safety associated with different administrations, which can contribute to selecting appropriate melasma treatment plan for different patients.

Molten aluminum is among the most common causes of burns in the metal industry. However, only few reports are available on molten aluminum injuries. Herein, we report an unusual case of molten aluminum burn. The patient had burns not only on the body surface but also in the respiratory tract and esophagus, adding to the difficulty of treatment. Multidisciplinary consultation and cooperation led to the development of a treatment plan for the patient, which included tracheotomy, respiratory management, endoscopic therapy, infection control, and psychological support. To our knowledge, this is the first report of molten aluminum-induced burns involving the face, neck, respiratory tract, esophagus, and eyes. We also describe our experience with multidisciplinary treatment for the management of molten aluminum burns.

Background

Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty. To avoid extra trauma, we developed a new technique for correcting iatrogenic upper eyelid retraction by post-migrating a compound flap of the orbicularis muscle and fascia (OFC) on the anterior surface of the tarsal plate. This method extends the aponeurosis of the levator palpebrae superioris muscle (LPS), which can achieve a good correction for post-blepharoplasty retraction.

Methods

We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019. The OFC was used to replace the missing part of the LPS, and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted. Postoperative outcome measurements included postoperative binocular symmetry, double eyelid smoothness, eyelid fullness, margin reflex distance (MRD1), degree of eyelid closure, and exposure keratitis. The patients were followed-up at seven days, one month, and six months postoperatively.

Results

One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively, with the upper eyelid margin located at the upper edge of the pupil. The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 ​mm below the upper corneal margin. Other observational indicators were satisfactory, including binocular symmetry, double eyelid fluency, and eyelid fullness. During the follow-up, no exposure keratitis was identified. The MRD1 indexes after the operation were significantly different (P<0.001) from those before the procedure.

Conclusions

Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

Lipedema is a chronic disorder primarily affecting women, characterized by abnormal fat deposition in the extremities, leading to pain, mobility issues, and psychological distress. These fat deposits are clear-cut and spare hands and feet. Often misdiagnosed as lymphedema, its prevalence remains uncertain due to a lack of universally accepted diagnostic criteria and difficulty in differentiating it from obesity or lymphedema. Genetic factors and hormonal influences are likely related to the pathophysiology of the disease, though the specific causes remain unknown. Imaging techniques may aid evaluation, but no definitive test exists, and diagnosis is made clinically. Conservative treatments such as lifestyle modifications and compression garments are considered first-line treatments, while surgical options such as liposuction and lipectomy are reserved for severe or refractory cases. Psychological support may be recommended, given lipedema’s impact on quality of life and self-esteem. This review aims to present the current understanding of this condition, including challenges in diagnosis, current guideline recommendations for clinical care, and associated comorbid conditions.

Prostate cancer is the second most prevalent cancer in men. Robot-assisted radical prostatectomy (RARP) has altered the landscape of prostate cancer treatment. Despite the excellent oncological outcomes associated with RARP, the rate of erectile dysfunction (ED) remains high. Primary repair of disrupted cavernous nerves with interpositional nerve grafts has been described; however, the outcomes have been inconsistent. We hypothesize that this is attributed to Schwann cell atrophy and axonal regeneration limitations caused by long nerve grafts. We proposed the use of nerve transfer to support axonal regrowth via an inter-positional graft with additional donor axons. A cadaveric study was performed to evaluate the anatomical feasibility of a vastus lateralis nerve (VLN) transfer to the distal recipient cavernous nerve stump. The VLN is long with multiple branching patterns that allow tension-free coaptation of the cavernous nerve. We postulate that a dual innervation method using VLN nerve transfer together with interpositional nerve graft repair of the transacted cavernous nerves may improve the outcomes of ED post-RARP.

Background

No standard monsplasty technique has existed until now. Although various monsplasty methods have been described, they exhibit high complication rates with sparse postoperative data. Studies that used pubic suspension techniques did not describe exact anatomical landmarks for the mons pexy. This study aimed to improve the aesthetic and functional appearance of the pubic region with long-term results for all grades of pubic ptosis or bulging with abdominoplasty and provide exact anatomical points to anchor the mons to the rectus sheath.

Methods

This non-randomized prospective clinical trial included 30 patients with various degrees of abdominal wall laxity between December 2017 and September 2019. The surgical procedure was performed for female patients with pendulous abdomen, pubic ptosis or bulging, body mass index ≤35 ​kg/m², and age 18–60 years. All patients were followed for up to one year; patient satisfaction was assessed before and after surgery regarding aesthetic results and impact on outfits, hygiene, and sexual activity.

Results

The marginal homogeneity test revealed a statistically significant patient satisfaction rate regarding outfits, sexual function, hygiene, and aesthetics. Regarding postoperative complications, seroma (one case) was managed by aspiration, and one case of wound dehiscence was managed conservatively with dressings.

Conclusion

This study recommends a quick and reproducible monsplasty technique with a low complication rate, a technique that helps determine specific anatomical landmarks for anchoring the mons to the rectus sheath. Combining this technique with abdominal contouring is advisable for optimal aesthetic results and maintained lymphatic drainage in the pubic region.

Trial registration

Pan African Clinical Trial Registry, PACTR202407819592984. Registered December 22, 2017. Prospective registration, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30636.

Congenital unilateral lower lip palsy (CULLP), or congenital hypoplasia of the depressor anguli oris muscle, also known as asymmetric crying facies, is a rare condition that results in asymmetry of the lower lip during smiling, laughing, and crying. Although the etiology is unknown, weakness of the depressor labii inferioris (DLI) muscle is implicated as a contributing factor. Currently, no well-established treatment options are available. This case report describes an 18-year-old male patient diagnosed with CULLP. Physical examination revealed a symmetric face at rest, but asymmetry when smiling and opening the mouth. Following the administration of lidocaine into the affected DLI muscle, the patient’s smile and lower lip symmetry were immediately restored without any adverse effects. Subsequently, administration of botulinum toxin for neuromodulation of the DLI muscle led to a significant improvement in symmetry and oral function within 2 weeks, which was sustained at 1 month and 3 months post-treatment. No adverse effects were reported, and both patients and families expressed high satisfaction with the outcomes. This case highlights the potential use of neuromodulation as a minimally invasive and effective treatment for CULLP.

In this study, we present a representative case of multiple glomuvenous malformation in a 12-year-old female patient. Approximately five years ago, the patient developed multiple blue-purple papules and plaques on her hypogastrium and right thigh, which progressively enlarged and presented tenderness. Histopathological examination confirmed the diagnosis of glomuvenous malformation. Following two injections of lauromacrogol, a significant improvement was observed in the lesions, including a resolution of tenderness. These findings suggest that sclerotherapy not only exhibits evident therapeutic efficacy but also effectively alleviates pain while addressing both aesthetic and therapeutic concerns.

Background

Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management, are available. In flap surgery for pressure sores, a variety of flap types may be used; each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforator-enhanced rhomboid flap technique for ischial sore construction.

Methods

This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital. The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap. Postoperative follow-ups and evaluations were performed.

Results

The mean age of the study group was 43.7 ​± ​13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases. The mean surface area of sores was 24.8 ​± ​6.3 ​cm². In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ​± ​0.98 ​cm and required around 6.8 ​± ​1.9 weeks to heal.

Conclusion

The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.