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02 June 2025, Volume 21 Issue 3 Previous Issue   

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Application of pedicled axial flaps for repairing electric burn wounds in wrist and hand LI Mingyu, WANG Huajun, DU Xuanyu, et al 2025, 21 (3):  215.  Abstract ( 18 )   PDF (11622KB) ( 6 )   Objective To explore the effects of pedicled axial flaps in repairing high-voltage electrical burns of the wrist and hand， and to summarize the flap selection strategy. Methods A retrospective study was conducted. From January 2018 to December 2023， 12 patients with high-voltage electrical burns of the wrist and hand were treated. All patients were male， aged from 31 to 55 years. A total of 13 wounds were found on the fingers （8）， back of the hand （1） and wrists （4）， with exposure of bone， tendon or joint cavities associated with the traumas， except in the palm. The Allen test， colour Doppler ultrasound， CTA or DSA were used to observe the condition of the vascular network of the wrist and hand. The appropriate pedicled axial flaps was selected to repair the wound based on location， area and vascularity. The donor area was repaired with skin grafts. Microcirculation perfusion and other treatments were performed postoperatively. After 6-24 months of followup， the appearance and function of the wrist and hand were evaluated. Results In this series of cases， the pedicled axial flaps included paraumbilical perforator flaps（ 3）， reverse flow ulnar artery island flaps（ 1）， forearm dorso-ulnar flaps（ 1）， reverse homodigital dorsal ulnar flaps of the thumb（ 1）， digital artery flaps（ 5）， and retrograde flow digital artery flaps（ 2）. All flaps survived， presenting a relatively satisfactory appearance. At final follow-up， wrist and hand function scores ranged from 45 to 90， 2 cases were rated excellent， 6 were rated good， 3 were rated acceptable and 2 were rated poor. Conclusion  For wrist and hand electrocution wounds， selecting appropriate pedicled axial flaps for wound repair based on the location， area and vascularity can achieve good results. Related Articles | Metrics

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Clinical application of the long vascular pedicle peroneal artery perforator flap in repairing soft tissue defects of the lower knee joint NIU Xuetao, ZHANG Xiaofeng, HE Xiao, et al 2025, 21 (3):  220.  Abstract ( 27 )   PDF (4067KB) ( 7 )   Objective To evaluate the clinical efficacy of long vascular pedicle peroneal artery perforator flap in repairing soft tissue defects of the lower knee joint. Methods Clinical data of 15 patients with lower knee joint wounds repaired by long vascular pedicle peroneal artery perforator flaps from January 2021 to December 2023 were retrospectively analyzed， including 10 males and 5 females， aged 18-67 years old. The flap harvest area ranged from 18 cm² to 40 cm². The donor area was directly sutured in 10 cases， and skin grafting was performed in 5 cases. The duration of the surgery， intraoperative bleeding， healing time， survival of flaps and skin grafts， postoperative complications， etc.， were recorded. The final followup evaluation was conducted using the British Medical Research Council （BMRC） sensory function assessment criteria and the Lower Extremity Functional Scale （LEFS）. Results All patients received an average follow-up of （20.6±6.6） months postoperatively. In 10 cases， the vascular pedicle of the flap was a full segment perforator， and in 5 cases， it was a full segment perforator plus part of the peroneal artery trunk. The pedicle length averaged（ 7.8±3.8） cm. All 15 cases of skin flap and 4 cases of donor area skin graft survived in the first stage， and 1 case of local necrosis of donor area skin graft was cured after dressing change. At the last follow-up， all flaps were soft in texture and had good blood circulation. The BMRC sensory assessment showed S2 level in 3 cases， S3 level in 10 cases， and S4 level in 2 cases， with an average two-point discrimination of（ 12.1±4.5） mm. There were no complications such as scar hyperplasia or contracture in the surgical area， and the walking function of the affected limb was normal， with an average LEFS score of （72.8±4.7） points. Conclusion The repair of skin and soft tissue defects in the lower part of the knee joint using a long vascular pedicle peroneal artery perforator flap is not only relatively simple and easy to perform， but also results in good recovery of lower limb function， with no deformities in the local appearance and high patient satisfaction， demonstrating good clinical efficacy. Related Articles | Metrics

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Clinical experience of autologous flap reconstruction of chest wall defects after breast cancer surgery CAO Weigang, YANG Zhenlin 2025, 21 (3):  225.  Abstract ( 17 )   PDF (7336KB) ( 5 )   Objective  To investigate the methods and therapeutic efficacy of autologous flap transplantation for reconstructing massive thoracic wall defects following radical resection of locally advanced breast cancer. Methods  A retrospective analysis was conducted on 29 breast cancer patients treated between January 2017 and November 2023. All patients underwent neoadjuvant therapy followed by extended tumor resection and autologous flap reconstruction. Surgical parameters and prognostic outcomes were evaluated. Results The patients， aged 41-58（ mean 48.2±8.1） years， included 19 cases of invasive ductal carcinoma， 5 fibroepithelial tumors， 3 adenocarcinomas， and 2 encapsulated breast cancers. Molecular subtypes comprised Luminal A（ 14 cases）， Luminal B（ 7 cases）， HER-2 overexpression（ 3 cases）， and basallike（ 5 cases）. Key outcomes included a mean hospital stay of（ 13.8±5.2） days， operative duration of（ 4.6±1.6） hours， and intraoperative blood loss of（ 298.3±94.7） mL. Tumor sizes ranged from 6 cm×11 cm to 26 cm×19 cm， with flap dimensions spanning 13 cm×7 cm to 22 cm×29 cm. Flap types included local flaps（ 18 cases）， pedicled latissimus dorsi myocutaneous flaps （9 cases）， transverse rectus abdominis myocutaneous （TRAM） flap （1 case）， and free deep inferior epigastric perforator （DIEP） flap （1 case）. There were 8 cases with combined sternum or rib defects. Among them， 7 cases did not require titanium mesh repair， and 1 case used titanium mesh to reconstruct the chest wall. Of the 29 patients， 27 had normal chest wall function， 1 had necrosis of autologous flap， and 1 had blood supply disorder of autologous flap. The necrotic flap healed after secondary debridement and suture. The median follow-up time for 29 patients after the operation was 39 months. The 3-year local recurrence rate and overall survival rate were 65.6% and 34.4%， respectively. Conclusion Autologous flap reconstruction after neoadjuvant therapy and extended resection effectively restores thoracic wall function and enhances quality of life in locally advanced breast cancer patients. Related Articles | Metrics

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Carnosol inhibits the formation of hypertrophic scar XU Wei, LYU Hao, XUE Yaxin, et al 2025, 21 (3):  230.  Abstract ( 19 )   PDF (4952KB) ( 6 )   Objective Hypertrophic scar （HS） is a common fibrotic skin disorder characterized by the activation of fibroblast and the excessive deposition of extracellular matrix（ ECM）. This study intends to explore the inhibitory effect of carnosol on HS. Methods  Human hypertrophic scar-derived fibroblasts （sHSFs） were treated with 5-80 µmol/L carnosol， and CCK-8 method was used to confirm the appropriate concentration of carnosol. Then HSFs were treated with 30 µmol/L carnosol and wound healing assay was used to detect migration ability of HSFs. Moreover， HSFs were treated with 10-30 µmol/L carnosol， qRT-PCR and western blot（ WB） were used to evaluate the effects of carnosol on mRNA and protein expression of collagen secretion and activation-related genes in HSFs. Rabbit ear scar model was established and treated with 10 µmol/L or 30 µmol/L carnosol until 14th day after surgery， on the 14th and 28th day after the establishment of model， samples were collected for HE and Masson’s trichrome staining to evaluate tissue structure， and α -SMA immunohistochemical staining was used to evaluate the fibrosis degree of tissue. Results  Carnosol could inhibit the proliferation of HSFs in a dose-dependent manner. 30 µmol/L carnosol treatment could significantly inhibit the migration of HSFs. And carnosol could inhibit the collagen secretion and activation of HSFs in a dose-dependent manner. The rabbit ear scar model showed that carnosol could significantly inhibit the formation of hypertrophic scar， manifested as decreased fibrosis degree and decreased expression of α -SMA. Conclusion  Experiments have confirmed that carnosol can significantly inhibit the formation of hypertrophic scar both in vivo and in vitro， and its potential mechanism may be related to the effect of carnosol on fibroblast function. Related Articles | Metrics

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Unveiling hypoxia-related biomarkers for diabetic foot ulcers through integrated bioinformatics analysis and machine learning GUO Genyu, ZHANG Chuqiao, XU Yinmei, et al 2025, 21 (3):  238.  Abstract ( 19 )   PDF (6473KB) ( 4 )     Objective  Diabetic foot ulcer （DFU） is a severe complication in diabetic patients， where the hypoxic microenvironment plays a critical role in its pathogenesis and delayed healing， though the underlying molecular mechanisms remain unclear. To systematically analyze the regulatory network of hypoxia-related genes in DFU using bioinformatics approaches， identify key biomarkers， and provide insights for targeted therapies. Methods Integrated datasets from GEO and MSigDB hypoxia-related gene sets were utilized. Differential expression analysis（ limma， DESeq2）， weighted gene coexpression network analysis （WGCNA）， and GO/KEGG functional enrichment were performed. Hub genes were screened using three machine learning algorithms（ Lasso， SVM-RFE， and random forest）， and their diagnostic efficacy was validated. Results  A total of 152 differentially expressed genes （DEGs） were identified， including 14 hypoxia-related DEGs （HRDEGs）. Enrichment analysis revealed HRDEGs involvement in glucose metabolism， lipid metabolism， and immune cell regulation. Machine learning further pinpointed the hub gene BGN. BGN exhibited significantly lower expression in DFU groups， with area under the ROC curve （AUC） values of 0.833 （training set） and 0.931 （validation set）， indicating high diagnostic accuracy. Single-gene GSEA demonstrated that BGN participates in DFU pathology by regulating tissue repair， inflammatory responses， and extracellular matrix interactions. Conclusion BGN is a key biomarker in the hypoxic microenvironment of DFU and may serve as a potential molecular target for early diagnosis and targeted therapy. This study provides new directions for understanding DFU mechanisms and clinical interventions. Related Articles | Metrics

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The survey research of epidemiology and risk factors of large to giant congenital melanocytic nevi in China LAI Bohan, WEI Boxuan, JIN Jiamin, et al 2025, 21 (3):  250.  Abstract ( 19 )   PDF (1053KB) ( 3 )   Objective  To explore the relationship between clinical phenotype and clinical manifestations of large-togiant congenital melanocytic nevi （LGCMN）， analyze the differences in risk factors during the embryonic period between normal children and patients with congenital melanocytic nevi （CMN）， and provide a new strategy for the prevention of this disease. Methods In total， 125 patients diagnosed with congenital melanocytic nevi （CMN） were recruited and completed the questionnaire， which contained questions about phenotype， clinical manifestations， family history， and risk factors during pregnancy. In the control group， 66 parents of children without CMN were asked questions about their family history and pregnancy risk factors. Results Pruritis or ulceration was correlated with projected adult size（ P=0.007）， satellite nevi （OR=4.712， P=0.035）， and complications（ OR=13.377， P=0.006）. Lesion rugosity was significantly associated with lesion bulge （OR=22.873， P<0.001）. Malignant melanoma developed in 1.6% of the CMN patients； both had LGCMN and >20 satellites. CMN incidence was significantly associated with a family history of hyperpigmentation disorders（ 26.4% vs. 6.06%， P<0.001）， complications during pregnancy （48.0% vs. 28.8%， P=0.019） and a history of chemical substance exposure （15.2% vs. 1.5%， P=0.007）. Conclusion This study provides novel clues about the association between phenotypes and manifestations and provides potential knowledge on the LGCMN aetiology. In addition， analysis of family history and risk factors during pregnancy also provides strategies for prevention of the disease. Related Articles | Metrics

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Predictive modeling of risk factors associated with complications after microtia external ear reconstruction and analysis of structural versus narrative therapy QIN Wenying, HAN Wenjuan, GUI Yuanyuan 2025, 21 (3):  258.  Abstract ( 17 )   PDF (1287KB) ( 4 )   Objective To explore the related risk factors of complications after microtia external ear reconstruction and establish a predictive model， as well as the effect analysis of structural versus narrative therapy. Methods  Thirty-two patients who developed complications after microtia external ear reconstruction from January 2020 to December 2023 were selected as the complication group， and 153 patients who did not develop complications after microtia external ear reconstruction performed in the same period were selected as the non-complication group. The clinical data of the two groups were collected， the risk factors were evaluated using logistic regression model， the predictive value was assessed using the receiver operating characteristic （ROC） curve， and the decision tree model was constructed based on the risk factors. Meanwhile， 56 patients who underwent external ear reconstruction for microtia from March 2023 to December 2023 were selected as the control group， and conventional therapy was implemented， while 49 patients who underwent external ear reconstruction for microtia from January 2024 to September 2024 were selected as the observation group， and structural and narrative therapy was implemented. The two groups were compared in terms of psychological resilience， fear state and complication occurrence. Results  Logistic regression analysis showed that age ≥10 years （OR=6.709）， auricular malformation Max grade Ⅲ （OR=3.049）， atresia grade Ⅲ （OR=5.440）， having chronic diseases （OR=3.958）， intraoperative bleeding ≥50 mL （OR=5.029）， and admission time from April to September （OR=6.676） were independent risk factors for complications after microtia external ear reconstruction （P<0.05）. The ROC curves showed that age， Max grading of auricular deformity， atresia grading of the external auditory canal， chronic disease， intraoperative bleeding， admission time， and joint prediction were statistically significant in predicting the occurrence of complications after microtia external ear reconstruction （P<0.05）. Among them， the area under the curve（ AUC） of the joint prediction was 0.916， the 95% CI was 0.874-0.957， the sensitivity was 0.906， the specificity was 0.850， and the predictive value was relatively high. The decision tree model showed that grade Ⅲ of external auditory canal atresia grading was the most important predictor， and the classification accuracy of the model was 81.00%. After the intervention， the psychological resilience scale （CD-RISC） score of the observation group was higher than that of the control group （P<0.05）， and the children′s medical fear scale （CMFS） score was lower than that of the control group（ P<0.05）. The complication rate of 2.04% in the observation group was significantly lower than 12.50% in the control group （P<0.05）. Conclusion Age ≥10 years old， auricular deformity Max grading grade Ⅲ， external auditory canal atresia grading grade Ⅲ， chronic diseases， intraoperative bleeding ≥50 mL， and admission time from April to September were independent risk factors for complications after external ear reconstruction for microtia. In addition， structural and narrative therapy interventions are more effective， can improve the psychological state of patients and reduce the complication rate， which is worthy of clinical promotion and application. Related Articles | Metrics

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Comparative efficacy of pulsed dye laser in the treatment of salmon patch and port-wine stain and exploration of strategies ZHANG Lixin, MA Gang, LIN Xiaoxi 2025, 21 (3):  267.  Abstract ( 16 )   PDF (3610KB) ( 3 )   Objective To compare the efficacy of pulsed dye laser （PDL） in treating salmon patch （SP） and port-wine stain（ PWS） in V1 area. Methods A retrospective case-control study was conducted on 40 untreated patients（ 22 with SP， 18 with PWS in the V1 area）， who underwent 3 sessions of PDL treatment （spot size： 7 mm； fluence： 8-11 J/cm2 ； pulse duration： 0.45-1.5 ms）. Improvement in lesion color and size （graded 0-5） before and after treatment was evaluated using standardized photographs and visual analog scale（ VAS） scores， while adverse effects were recorded. Differences in efficacy were analyzed using the t-test. Results The mean VAS scores were significantly higher in SP patients than in PWS patients （color improvement： 3.68±1.13 vs. 1.44±1.38； size improvement： 3.36±1.26 vs. 1.22±1.17； P<0.01）. Significant improvement was achieved in SP after ≤3 treatments， and PWS was less effective after 3 treatments. Regarding safety， only one case of SP exhibited transient hyperpigmentation. Histological analysis revealed that the mean depth of SP vessels was （212.90±35.70） µm， significantly shallower than that of PWS （＞400 µm）， suggesting that PDL is more effective for superficial vessels. Conclusion PDL was significantly more effective for SP than for PWS， likely due to differences in vessel depth.  Related Articles | Metrics

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Key aspects of designing an in vitro chromosomal aberration test for mesotherapy products WANG Rui, SHI Jianfeng, KE Linnan 2025, 21 (3):  271.  Abstract ( 16 )   PDF (1071KB) ( 2 )   Objective  Higher standards for the inspection and registration of mesotherapy products have been implemented due to the products reclassification. Since many of these items require genotoxicity screening， the aim of this paper is to provide a scientific method for in vitro chromosome aberration test of these products. Methods A detailed in vitro chromosome aberration test method for sodium hyaluronate solution products was introduced， and a specific product was selected for test analysis. Results The chromosomal aberration rate of CHL cells was not significantly increased under both active and inactive conditions and no dose-response relationship was observed. The test results were negative. Conclusion  This study presents the design and operation details of in vitro chromosome aberration test for mesotherapy products， which can provide references for testing institutions and related research and development enterprises. Related Articles | Metrics

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Anesthetic effect of dexmedetomidine combined with propofol and remifentanil in head and face plastic surgery in plateau area Dawa Wuzhu, Bianba Laji, WU Bin, et al 2025, 21 (3):  277.  Abstract ( 10 )   PDF (1039KB) ( 2 )   Objective To investigate the anesthetic effect of dexmedetomidine combined with propofol and remifentanil in head and face plastic surgery in plateau area. Methods A total of 32 head and facial plastic surgery patients were enrolled in a Grade-III hospital at an altitude of 3，600 meters in Tibet Autonomous Region from March 2023 to December 2024. Patients were anesthetised with dexmedetomidine combined with propofol and remifentanil. Results  All 32 patients had stable hemodynamics， little circulation fluctuation， good postoperative analgesia and sedation， and the total incidence of postoperative adverse reactions was 12.5%. Conclusion  The anesthesia regimen of dexmedetomidine combined with propofol and remifentanil has significant advantages in the plateau area， and can effectively inhibit the stress response caused by intubation and surgical stimulation in terms of hemodynamic stability. Related Articles | Metrics

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Influence of mutual support intervention on the level of family care and social support in patients with prosthesis reconstruction after modified radical breast surgery YANG Qingyu, ZENG Yuanyuan, WANG Qiuzhou, et al 2025, 21 (3):  283.  Abstract ( 15 )   PDF (1013KB) ( 2 )   Objective To investigate the influence of mutual support intervention on the level of family care and social support in patients with prosthesis reconstruction after modified radical breast surgery. Methods From January 2021 to June 2022， 160 patients with prosthesis reconstruction after modified radical breast surgery were prospectively selected. Patients were divided into control group （80 cases） and study group （80 cases） by random number table method， and were given routine health education intervention and mutual support intervention respectively. The scores of quality of life measurement scale， family caring index questionnaire and perceptive social support scale were compared between the two groups. Results  Symptom dimension scores of the study group at 1 month， 3 months and 6 months after surgery were significantly lower than those of the control group（ P<0.05）. The functional scores of the study group at 1 month， 3 months and 6 months after surgery were significantly higher than those of the control group（ P<0.05）. At the same time， the scores of the study group at 3 and 6 months after surgery were significantly better than those at 1 month after surgery （P<0.05）. The family care index questionnaire score and perceptive social support scale score of the study group at 1 month， 3 months and 6 months after surgery were significantly higher than those of the control group（ P<0.05）. At the same time， the scores of the study group at 3 and 6 months after surgery were significantly higher than those at 1 month after surgery （P<0.05）. Conclusion Mutual support intervention can effectively improve the quality of life， improve the state of family care and enhance the level of social support for patients with prosthesis reconstruction after modified radical breast surgery.  Related Articles | Metrics

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Surgical treatment of a child with PROS，a rare giant limb deformity：A case report and review of the literature WANG Junbin, YANG Wenchuan, LIU Xuejian 2025, 21 (3):  287.  Abstract ( 15 )   PDF (6116KB) ( 3 )   PIK3CA-associated overgrowth spectrum （PROS） is a class of rare diseases associated with mutations in the PIK3CA gene， which is mainly characterized by vascular abnormalities and soft tissue overgrowth. Although the clinical application of specific targeted pathway inhibitors has made some progress in recent years， some patients still suffer from drug resistance or poor therapeutic effects. In this paper， a child of PROS with a giant deformity of the right upper limb was reported. The child was found to have multiple swellings on the neck， chest， back， and both upper limbs since birth， which increased in size year by year. Among them， the anterior chest and the right upper limb were particularly obvious. The right upper limb gradually thickened， and was accompanied by spinal deformity， right shoulder dislocation and thoracic deformity. The patient had received sirolimus oral treatment and several times of localized volume reduction treatment， but failed to achieve the desired therapeutic effect. Second-generation gene sequencing showed that the child had missense variants at the ERBB2 and PDGFRA loci. Because oral targeted drug therapy and localized volume reduction therapy could not lead to longterm improvement of the lesion， and the child had severe hypertrophic deformity of the right upper limb， resulting in complete loss of limb function， the child’s clinical problem was finally solved by amputation surgery. By summarizing this case， this paper further supplemented and improved the study of PROS-related gene mutations， providing a new reference for the diagnosis and treatment of this disease. Related Articles | Metrics

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Research progress of 3D printing technology in bone tissue engineering LIU Mingrui, LIN Tao, LIN Zhiwei, et al 2025, 21 (3):  297.  Abstract ( 16 )   PDF (1342KB) ( 3 )    In recent years， 3D printing technology has been widely applied in the field of medicine， especially in the area of bone tissue engineering. 3D printing technology is capable of integrating different types of living cells into threedimensional structures composed of traditional micro- or nano-scale biomaterials， thereby creating artificial bone implants capable of regenerating damaged tissues. This technology enables the customization of the shape and size of bone implants according to the specific needs of patients， as well as the adjustment of material mechanical properties and pore structures to promote cell attachment， proliferation， and bone tissue regeneration. Such personalized treatment methods can provide patients with improved therapeutic effects and functional recovery. This review introduced several commonly used 3D printing methods and materials for bone substitutes， with a particular focus on their technical applications in bone repair and regeneration， aiming to familiarize readers with the latest developments and prospects of this technology in the field of bone tissue engineering. Related Articles | Metrics

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Advances in the research，diagnosis and treatment of Proteus syndromeindenta tion and adhesion WANG Zhibo, WANG Bin 2025, 21 (3):  305.  Abstract ( 18 )   PDF (2691KB) ( 2 )   Proteus syndrome is a localized proliferative disorder caused by a somatic activating mutation in AKT1（ c.49G →A， p.Glu17Lys）. The most common manifestations include cerebriform connective tissue nevi， exostoses， and pulmonary cystic changes， often resulting in a shortened lifespan for affected individuals. The clinical presentation is highly heterogeneous， involving multiple tissues， which complicates diagnosis and treatment. This paper systematically reviewed the etiology， animal models， clinical manifestations， diagnosis， and treatment of Proteus syndrome， aiming to support precise medical interventions for this rare disease. Related Articles | Metrics

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Advances of cell-assisted fat transplantation in plastic surgery YANG Baofeng, LI Xin, MA Jiguang 2025, 21 (3):  311.  Abstract ( 15 )   PDF (1036KB) ( 5 )   Fat transplantation has been widely used in plastic surgery due to its advantages of less surgical trauma， rich sources， and good histocompatibility. However， the main factor restricting the development of fat transplantation is the high absorption rate after fat transplantation. Studies have found that cell-assisted fat transplantation can improve the survival rate and outcome of fat transplantation. This paper summarized the research of cell-assisted fat transplantation world wildly， and introduced the principle， application progress in various fields of plastic surgery， safety and effectiveness of cell-assisted fat transplantation， in order to provide reference for the clinical application of cell-assisted fat transplantation. Related Articles | Metrics

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Overview and comments of multi-dimensional evaluation of the ear reconstruction for congenital microtia GAO Dejin, WANG Bingqing, ZHANG Qingguo 2025, 21 (3):  316.  Abstract ( 14 )   PDF (997KB) ( 4 )   Congenital microtia is a common congenital malformation. The deformity not only affects the appearance， but also causes the anxiety， lack of self-confidence and other problems. At present， there are currently 3 commonly used methods of ear reconstruction. The evaluation methods can be divided into 2 aspects which are function and morphology. This review aimed to summarize and discuss the existing evaluation dimensions of ear reconstruction in an all-round way， so as to help plastic surgeons choose the most suitable treatment for the patients. Related Articles | Metrics

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The mechanisms of midfacial anatomical aging and the research progress on midfacial lifting surgery CHEN Heng, ZHOU Xu 2025, 21 (3):  319.  Abstract ( 13 )   PDF (2809KB) ( 3 )   The anatomical layers of the midface are primarily divided into five layers： skin， subcutaneous tissue， SMAS layer， muscles， and bone. With aging， the midfacial skeleton gradually undergoes resorption； Muscle strength weakens and remains in a persistent hypertonic state； Deep fat atrophies， and superficial fat descends； Facial ligaments degenerate and undergo fibrosis； The skin loses moisture， elasticity decreases， wrinkles form， pigmentation increases， and dryness ensues. These complex anatomical layers interact， collectively leading to the outward appearance of midfacial aging. In response to midfacial aging and soft tissue descent， various facelift techniques have been continuously developed. Skin and subcutaneous tissue lifts are suitable for mild skin laxity； SMAS-layer lifting plays a central role in facial lifting surgery， forming a variety of classic SMAS lift techniques and minimally invasive methods； Deep plane lifting， which involves releasing the deep tissues beneath the SMAS layer， provides lasting rejuvenation effects， but with increased surgical complexity and risk. Related Articles | Metrics

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Application and exploration of virtual simulation technology combined with PBL and CBL education in plastic surgery XU Liang, LI Dong, DUAN Huichuan 2025, 21 (3):  327.  Abstract ( 15 )   PDF (1015KB) ( 4 )   The emergence of problem-based learning（ PBL） and case-based learning（ CBL） has driven the development of medical education models， transforming the traditional teaching methods and enriching students’ learning experiences. Additionally， the application of virtual simulation technology in medicine and education has further advanced medical education methods， making education techniques more comprehensive and flexible. In the plastic surgery education， virtual simulation technology is integrated into the dual-track teaching system of PBL and CBL to construct a comprehensive teaching system of basic theory， clinical practice and surgical operation， and explore the positive role of the new teaching mode in the cultivation of students’ theoretical and practical abilities， so as to meet the teaching needs of cultivating high-quality plastic surgery student in the new era.  Related Articles | Metrics