A new type of sillicon rebber, which is a semisolid pairof room temperature vuleanizing silicones,has been used in103cases in plastic surgery, including saddle nose, smallchin,and defect of faicial bone. Satisfactory clinical resultswere achieved in 100 cases. Wound infection occured in2cases and the silicon rubber evacuated. The silicon rubberbody was excised because of infection. No adverse reactionwas observed in 64 follow-up cases.
【摘要】目的 探討分段整形提縮注射術治療脫肛痔的臨床療效。方法 175例重度環狀痔, 沿肛緣弧形切除結締組織外痔以整形肛門, 再于結扎痔核基底及其上端黏膜下層注射消痔靈注射液,并進行療效觀察。結果 術后肛周水腫(72 h)、疼痛(24及72 h)明顯減少； 術后4周臨床治愈145例,好轉23例,總有效率為96.0%； 所有患者均隨訪3~6個月，未見復發。結論 選擇分段整形提縮注射術既比較徹底地去除了痔核使之不易復發，又整形了肛門，保護其大小和功能, 該術式可成為治療脫肛痔的較理想術式。
The authors reported nine patients with burn scar contracture of head and face treated by operation. The varieties of operations ineiuded: (1) excision of the scar and primary closure of the wound; (2) excision of the scar and coverage of the wound with split or full thickness skin grafts; (3) excision of the scar and repaired by pedicled flap, and (4) skin expansion by expander, followed by excision the scar and transfer of the "more available skin flap" to the wound. According to certain characteristics of children, the choice of the time for operation, the indications of each methods, and some problems related to operation ahd been discussed.
Objective To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. Methods Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. ResultsThe operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. ConclusionFor the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.
Abstract Postburn deformities, including hypertrophic scars, scar contracture and defect or deformity of tissue or organ, are the commonest disorders in plastic surgery. It is also difficult to deal with. If the diformity involved multiple organs, oftentimes the teatmentis very difficult because the material for repair is limited and the donorsite usually could not provide adequate amount of skin for repair. Since 1978,2496 cases of various postburn deformities were admitted. In this article, theoptimal time to operate was discussed. The use of flap transfer and soft tissueexpander was described. Prolonged traction in the treatment of severe contracture of large joint was also described.
ObjectiveTo investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. Methods A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. ResultsPatients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points (P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation (P<0.05), but there was no significant difference between 7 days and 6 months after operation (P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. Conclusion After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body’s own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
Objective To investigate the surgical procedures and outcomes of repairing the wound in the posterior wall of vaginal orifice by labium minus flap transfer, when vagina tightening plastic surgery is performed on the patient with scar in the posterior wall of vaginal orifice and labium minus hypertrophy. Methods From May 2007 to May 2008, 10 patients suffering from postpartum vaginal relaxation combined with scar in the posterior wall of vaginal orifice and labium minus hypertrophy were treated. The patients aged 28-40 years old and the width of their labium minus was 3-5 cm. Six ofthem had coitus pain. Vaginal tightening surgery was performed, meanwhile the hypertrophic labium minus was preparedinto the anterior-pedicle labium minus flap (4 cm × 1 cm-5 cm × 1 cm) and the posterior-pedicle labium minus flap (3 cm × 2 cm-4 cm × 3 cm), respectively. The posterior-pedicle labium minus flap was transferred inwards by 90° to repair the wound caused by the resection of the scar, and the anterior-pedicle labium minus flap was sutured in situ to form the new labium minus. Results All the posterior-pedicle labium minus flaps survived, except for 3 cases in which the epidermis 1 cm around the distal end of posterior-pedicle labium minus flap was exfol iated and recovered 2 weeks after hi p bath with potassium permanganate solution (1: 5 000). All the anterior-pedicle labium minus flaps survived, and all the incisions healed by first intention. Over the follow-up period of 2-8 months, all the patients were satisfied with their vulva configuration, good elasticity of vaginal orifice and no tenderness pain of vaginal orifice. The sensitivities to feel ing, such as touch and pain, of the transferred labium minus flap were similar to the normal labium minus. Postoperatively, the coitus pain disappeared, 7 cases had much better sex l ife and 3 cases had no significant improvement in sex l ife. Conclusion Transferring labium minus flap to vaginal orifice is an effective way to improve the coital pain resulted from the scar of vaginal orifice.
ObjectiveTo summarize the research progress of autogenous cartilage scaffold carving method in rhinoplasty.MethodsThe relevant literature about the autogenous cartilage scaffold carving methods in rhinoplasty in resent years at home and abroad was reviewed, and the carving skills, shape, and application scope of different parts of nasal scaffolds were summarized and analyzed.ResultsWillow-leaf shape is still the main method of cartilage scaffold in the back of the nose. However, in nasal reconstruction, it can be carved into an L-shaped scaffold with the nasal columella scaffold through mortise and tenon structure. And it can also crush the autologous cartilage and wrap it with the autologous fascia tissue to form a new nasal dorsal scaffold. The nasal tip scaffold is improved by changing the shape of traditional nasal tip cartilage cap and wrapping with fascia tissue; the nasal alar scaffold has M-shape, q-shape, carving methods; the nasal columella and nasal septum are mostly used “2+2” combined fixed scaffold. The cartilage scaffolds of lateral nose and nasal base are mainly carved in the shape of “八” and crescent.ConclusionAs a rhinoplasty scaffold, there are various carving methods for autogenous cartilage. With the innovation of surgical technique and the improvement of sculpting technique, the effect of autologous cartilage graft in rhinoplasty is getting better and better; meanwhile, tissue engineered cartilage is being applied in rhinoplasty.