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Table of Content

    23 July 2020, Volume 11 Issue 2 Previous Issue    Next Issue
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    Original article
    Application of Latissimus Dorsi Myocutaneous Flap with Breast Implant in Delayed Breast Reconstruction after Mastectomy
    ZHENG Houbing,SHAN Xiuying,CHEN Xiangjin,ZHANG Huihao,ZHU Youzhi,WANG Meishui,WANG Biao
    2015, 11 (2):  61-63.  DOI: 10.3969/j.issn.1673-0364.2015.02.001
    Abstract ( 465 )  
    Objective To explore the application of latissimus dorsi myocutneous flap and breast implant in delayed breast reconstruction surgery after mastectomy. Methods From 2009 to 2013, 8 cases received delayed breast reconstruction operation after mastectomy. The breast volumetry measurement technique was used to determine the mass of the breast preoperatively, then the donor flap was designed at the chest-back region according to the condition of the dorsal skin and the shape of the contralateral breast. The mass of graft flap was measured intraoperatively, then the suitable implant was selected based on the difference between the volume of the contralateral breast and the graft flap. The breast implant was then placed in the interspace between the latissimus dorsi muscle and the pectoralis major muscle to reconstruct the breast (secondary phase). Results All patients were followed up for 6 months to 4 years. The overall appearance of the constructed breast were satisfactory, no significant complications were observed in the donor region. Conclusion For young patients of breast cancer with relatively large breast volume, who also have fertility demands, the coalition usage of the latissimus dorsi myocutaneous flap and breast implant in breast reconstruction is proved to have ideal operative results.
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    The Application of Prosthesis and Dermal Matrices in Breast Reconstruction after Skin-Sparing Mastectomy
    WU Min,REN Yuping,XU Yi,HOU Kai,SUI Wenwen,WANG Ningning,WU Yiping
    2015, 11 (2):  64-66.  DOI: 10.3969/j.issn.1673-0364.2015.02.002
    Abstract ( 438 )  
    Objective To evaluate the clinical outcome of one-stage breast reconstruction with prosthesis and dermal matrices after skin-sparing mastectomy (SSM). Methods From 2012 to 2014, 28 cases suffered breast cancer were received one stage breast reconstruction after SSM, and were divided into group A and group B. The silicone prosthesis and dermal matrices was performed in group A (n=19) to reshape the breast and strengthen the inframammary fold, and silicone prosthesis without dermal matrices was used in group B (n=9). The incidence of complication was compared between two groups 1 year after operation. Results In group A, only 1 case (5.26%) with hematoma was observed. In group B, 1 case (11.11%) with prosthesis exposure, 3 cases (33.33%) with prosthesis shelloft, 1 case (11.11%) with hematoma and 4 cases (44.44%) with capsular contracture were observed. There were significant differences between two groups in the evidence of prosthesis shelloft and capsular contracture (P<0.05). All the patients were followed up for 1 year, no local recurrence and distant metastasis were observed. Conclusion Combination with prosthesis and dermal matrices had a better breast shape, higher satisfaction and less complication. It was a safer and more effective method of breast reconstruction.
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    Symmetrization Management in Breast Reconstruction with Implant after Tissue Expansion
    LI Bi,XIA Youchen,ZHANG Jie,PAN Bolin,MA Jianxun
    2015, 11 (2):  67-94.  DOI: 10.3969/j.issn.1673-0364.2015.02.003
    Abstract ( 459 )  
    Objective To explore different techniques for bilateral symmetry in breast reconstruction with implant after tissue expansion. Methods From June 2006 to June 2014, 48 patients received breast reconstruction with implant after tissue expansion. The following symmetrization procedures were used during breast reconstruction. (1) Expander was chosen according to controlateral size and was placed 2 to 3 cm lower than controlateral IMF and then over-expand. (2) The implant was chosen according to the expander, the sizer or the data from 3D photography. (3) Ipsolateral fat transfer, latissimus dorsi muscle flap transplantation, NAC transposition, and contralateral breast reduction, mastopexy, augmentation were used for symmetrization. Results All the patients were followed up for 6 to 48 months, mean 11.9 months. Bilateral symmetry were achieved through these procedures and all patients were satisfied with the results. Conclusion Accurate measurement of the breast, the appropriate choice of the expander and implant, and symmetrization procedures of both side are necessary for better symmetry in breast reconstruction.
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    Clinical Application of the Thoradorsal Artery Perforator Flaps for Reconstruction of Breast Defect and Deformity
    WANG Xiancheng,XIONG Xiang,FANG Bairong,SUN Yang,LI Xiaofang,LU Qin,HE Jiyong,WANG Yuying
    2015, 11 (2):  69-71.  DOI: 10.3969/j.issn.1673-0364.2015.02.004
    Abstract ( 480 )  
    Objective To explore the clinical application of thoradorsal artery perforator flaps (TAP) for reconstruction of breast defect and deformity. Methods From August 2007 to April 2014, 23 cases with breast defect and deformity were treated. TAP flaps were used in 18 cases for breast reconstruction and pre-expanded TAP flaps were used in 5 cases. The size of flaps ranged from 12 cm×22 cm to 7 cm×12 cm. Results All the flaps were survived. No complication was observed. All the patients were followed up for 3-26 months. The flaps were well healed with lowest donor site morbidity. Conclusion The thordorsal artery perforator flap is thin and reliable with long vascular pedicle and constant direction, and could provide a large area of skin flap after pre-expansion. It is an effective method for breast reconstruction.
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    Latissimus Dorsi flap in Breast Reconstruction and Simultaneous-repair of Axillary Fossa Deformity after Axillary Lymph Node Dissection
    LU Nanhang,FENG Zihao,ZHANG Yong,YANG Yanwen,QI Fazhi
    2015, 11 (2):  72-103.  DOI: 10.3969/j.issn.1673-0364.2015.02.005
    Abstract ( 415 )  
    Objective To explore the clinical efficacy of proximal latissimus dorsi (LD) flap in breast reconstruction and simultaneous-repair of axillary fossa deformity after axillary lymph node dissection (ALND). Methods From 2009 to 2014, 23 patients received unilateral breast reconstruction after modified radical mastectomy. During the LD mycutaneous breast reconstruction, the insertion of LD was cut off and the proximal LD was rotated to fulfill ipsilateral axillary fossa. Results The axillary contour deformity were all successfully restored, with no local bulge or flap loss. And the results were stable in the follow-up for 0.5 to 2.5 years. The patients were all satisfied. Conclusion Using proximal LD flap for breast reconstruction and simultaneous-repair of axillary fossa deformity is safe, easy and effective. And it is worthy of application.
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    High Dose, Decentralized, Multi-level Autologous Fat Grafting in Modified Breast Augmentation By Areola Incision
    ZHAI Zhaohui,CHEN Zhenyu
    2015, 11 (2):  74-77.  DOI: 10.3969/j.issn.1673-0364.2015.02.006
    Abstract ( 498 )  
    Objective To explore the effect of high dose, decentralized, multi-level autologous fat grafting in modified breast augmentation with areola incision. Methods From January 2013 to December 2014, 35 women (67 breasts) were received autologous fat injection. Autologous fat was obtained from patient ’s thighs by tumescent liposuction technique. After gotten rid of fibrous insulation, blood and water, autologous fat was injected by means of a blunt needle with the diameter of 2 mm in multiple layers (subcutaneous space, retro-mammary space, pectoralis major muscle and post-pectoralis major muscle space) and multiple tubes through the areola incision at 3 or 9 o'clock direction. The breast shape, volume and chest circumference were assessed within 24 months. The data were analyzed and compared. Results All the patients were followed up for 6 to 24 months. The breast shape, volume, and chest circumference were basically achieved a stable status in all the 35 cases six months after operation, and satisfactory cosmetic results were achieved. No complications such as breast masses or nodules were observed. According to the close follow-up of typical cases, 6 months after injection, the survival rate of grafted fat was over 75%, chest circumference increased by an average of 5.4 cm. Conclusion Large-volume autologous fat grafting through areola incision is a valuable method for breast augmentation with high survival rates, high safety and satisfactory efficacy.
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    Brava Assisted Autologous Fat Transfer in Breast Augmentation
    MU Dali,LUAN Jie,GUO Xiaoshuang,XIN Minqiang,LIU Chunjun,CHEN Lin
    2015, 11 (2):  78-79.  DOI: 10.3969/j.issn.1673-0364.2015.02.007
    Abstract ( 479 )  
    Objective To explore the feasibility of Brava assisted autologous fat transfer in breast augmentation. Methods From January 2010 to October 2010, 39 cases with breast partial defect or deformity were treated with Brava plus autologous fat transfer. From one month before autologous fat transfer till the day of surgery, patients were arranged to wear Brava as required for 8 hours everyday. Autologous fat were harvested and treated, then were injected into the part of tissue defect by layer. And a 16G syringe needle was used to release subcutaneous adhesion and cut down funicular fiber. Results All the patients were followed up for 1 to 12 months, no fat liquefaction, nodule and calcification were observed. According to the postoperative satisfaction survey, 37 cases were quite satisfied (94.9%), 1 case was satisfied (2.6%), and 1 case was not satisfied due to inadequate breast deformity correction (2.6%). Conclusion Brava assisted autologous fat transfer is an ideal method for the treatment of breast partial defect after local tumor resection and PHAG extraction.
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    Breast Prosthesis Implantation Combining with Correction for Capsular Contracture after Augmentation Mammoplasty
    CHEN Guangping,LUO Shengkang
    2015, 11 (2):  80-82.  DOI: 10.3969/j.issn.1673-0364.2015.02.008
    Abstract ( 509 )  
    Objective To explore the correction for serious capsular contracture after augmentation mammoplasty and the indication of breast prosthesis implantation. Methods From June 2006 to March 2014, 45 cases with serious capsular contracture after breast augmentation (Bilateral, level Ⅳ of Baker classification method) were treated and received breast prosthesis implantation at the same period or at stage Ⅱ. Via breast areola approach, the capsular tissue was kept or removed based on the circumstances, retro-mammary space or posterior pectoralis major space was stripped for prosthesis placing. Results Among all the cases, 38 cases received breast prosthesis at stage I, other 7 cases proceeded the second period of breast prosthesis 6 months later. Postoperative incisions were healed by first intension. Thirty-nine cases were followed up for 6-58 months (mean 13.5 months) successfully and the follow-up rate was 87.9%. Level Ⅳ of capsular contracture was still observed in 7 cases 4 months after the surgery, then the breast prosthesis was removed with no implantation again. The breast shape of remaining cases was good with soft handfeel. Conclusion For serious breast capsular contracture after augmentation mammoplasty, effective processing of the envelope with prosthesis imbedding according to the situation could obtain a better postoperative breast appearance and feel.
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    Treatment after Breast Augmentation with Polyacrylamide Hydrogel Injection
    LI Pengfei,ZHENG Danning,YU Li
    2015, 11 (2):  83-86.  DOI: 10.3969/j.issn.1673-0364.2015.02.009
    Abstract ( 379 )  
    Objective Recently, increasing number of patients, who have received polyacrylamide hydrogel injection for augmentation mammoplasty, are seeking to have this gel removed regardless of whether they're suffering from symptoms or not. Blunt aspiration, which is widely performed but removes only free hydrogel, leaves residual hydrogel in the breast. Here we're going to report and discuss our methods and ideas of the treatment for polyacrylamide hydrogel-injected breasts. Methods During the period of February 2005 to December 2013, 170 women who had undergone injection of polyacrylamide hydrogel for augmentation mammoplasty presented to us for treatment. A peri-areolar incision was made on the lower border of the areola, followed by dissection to the outer surface of the infiltrated fascia of polyacrylamide hydrogel. The fascia was dissected away as completely as possible and the free polyacrylamide hydrogel was removed from the cavity. Results Almost all the patients were satisfied with the surgical results, except for 5 patients who complained about the flat appearance of the breasts. Preoperative symptoms such as breast lumps, pain, uncomfortable upper-extremity movement and breast firmness were relieved and disappeared after removal of the free polyacrylamide hydrogel and infiltrated capsule. Conclusion The removal of the infiltrated capsule and free polyacrylamide hydrogel as much as possible may be successful in removing breast lumps, pain, and uncomfortable upper -extremity movement due to breast firmness. To remove polyacrylamide hydrogel as much as possible, the removal of the infiltrated fascia and capsule together with the free polyacrylamide hydrogel is recommended.
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    The Application of ICG Angiography in Breast Reconstruction after Mastectomy
    HU Xueqing,BAO Qi,JIANG Fangzhen,SHAO Zheren,WANG Jianwei
    2015, 11 (2):  87-89.  DOI: 10.3969/j.issn.1673-0364.2015.02.010
    Abstract ( 426 )  
    Objective To explore a visualization method to assess the tissue perfusion during breast reconstruction. Methods From July 2014 to January 2015, 4 patients with breast cancer received breast reconstruction after mastectomy by using intraoperative ICG angiography in order to determine the width and height of flap for flap shaping. Results The results determined by ICG angiography was correlated well with clinical findings. Among 4 cases, 3 cases had good perfusion, 1 case developed partial blood circulation disorder. Conclusion The use of ICG angiography during postmastectomy breast reconstruction may decrease the incidence and severity of flap necrosis, and is a reliable tool for breast reconstruction.
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    Comparison between Bone Marrow-derived Mononuclear Cells and Mesenchymal Stem Cells in Promoting Survival Rates of Random-pattern Skin Flap in Rats
    XU Peng,TANG Zhengya,LU Yang,ZHOU Guangdong,LIU Wei,CAO Yilin,ZHANG Wenjie
    2015, 11 (2):  90-94.  DOI: 10.3969/j.issn.1673-0364.2015.02.011
    Abstract ( 412 )  
    Objective To compare the non-cultured bone marrow mononuclear cells (BM-MNCs) and cultured bone marrow mesenchymal stem cells (BMSCs) in the promotion of random-pattern skin flap survival of rats. Methods BM-MNCs and BMSCs derived from two identical rat bone marrow aspirates were injected in a random-pattern skin flap model of rat (n=6). The survival area was determined by its appearance, color and texture. Capillary density of flaps was measured by histology. Results The flap survival rates were (71.6±8.4)%in the BM-MNC-treated group and (66.2±3.1)%in the BMSC-treated group, both of which were significantly higher than the control group (55.9 ±3.4)%. However, no significant difference was observed between the cell transplanted groups. According to vessel density assay, capillary density in the BM-MNC-treated group (58.2±6.8) was higher than in the BMSC-treated group (42.7±5.1), both of which were significantly higher than the control group (22.8±3.1). Conclusion Pre-culture of BMSCs does not bring therapeutic benefits.
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    Effect of Necrotic Cells on Proliferation and Migration of Surrounding Normal Vascular Smooth Muscle Cells and the Underlying Mechanisms
    MENG Liang,GAO Yuan,CHEN Bin,MA Jian,LIU Yong,WANG Wei,ZHAO Yalin
    2015, 11 (2):  95-109.  DOI: 10.3969/j.issn.1673-0364.2015.02.012
    Abstract ( 360 )  
    Objective To observe the effect of necrotic vascular smooth muscle cells (VSMCs) on proliferation and migration of surrounding normal cells and to explore the possible mechanism. Methods VSMCs was cultured in oxygen-and glucose deprived medium and the supernatant was collected to intervene normally growing cells. The control group, NCS group, NCS+IL-1 RA group, NCS+IL-6 RA group, IL-1αgroup and IL-6 group were set in this experiment. CCK-8 and Transwell assays were used to determine the proliferation and migration of VSMCs. The mRNA expression of IL-6 and CRP were detected by RT-PCR, and the protein expression of CRP, Akt and p-Akt were evaluated by Western blot. Results Compared with the control group, the proliferation and migration ability of NCS group, IL-1αgroup and IL-6 group were significantly higher than that in the control group (P<0.05). Meanwhile, the expression of IL-6 were obviously increased in NCS group and IL-1αgroup (P<0.05), and the expression of CRP and p-Akt were also elevated in the three groups (P<0.05). Otherwise, the proliferation and migration ability of NCS+IL-1 RA group and NCS+IL-6 RA group were decreased and the expression of CRP and p-Akt were also declined (P<0.05). Conclusion Necrotic vascular smooth muscle cells may promoting the proliferation and migration of surrounding normal cells by inducing the expression of IL-6 and upregulating the expression of CRP and p-Akt.
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    Rabbit as Animal Model of Fetal Bone Mesenchymal Stem Cells
    ZHOU Quan,QI Meiwu,ZHANG Zhiyong,ZHOU Guangdong,YE Jinyan,ZHOU Xiao
    2015, 11 (2):  99-103.  DOI: 10.3969/j.issn.1673-0364.2015.02.013
    Abstract ( 420 )  
    Objective To construct an animal model of fetal bone mesenchymal stem cells with rabbit. Methods Four pregnant rabbits (pregnancy=3 weeks) were treated with artificial fertilization, and 20 fetal rabbits were obtained with cesarean section. Fetal rabbit bone marrow was harvested and cultured in vitro. The cell morphology, growth curve, cloning efficiency and trilinear differentiation of BMSCs of passage 3 were observed. Cryopreserved primary cells were recovered after 30 days, the growth curve of passage 3 was measured to compare with that non-cryopreserved. With scanning electron microscope, the fetal cells in β-TCP cell-material compound were observed. Finally, after osteogenic induction, the BMSCs-β-TCP compound was implanted into the nude mice subcutaneously and the histological results of tissue-engineered bone at 1, 3, 6 months were observed. Results The BMSCs from fetal rabbit demonstrated a spindle-shaped morphology. After several passages, the morphology and growth curve remained almost the same. The calcium, fat and mucopolysaccharide were witnessed in trilinear differentiation. After cryopreserved for 30 days, the growth curve of passage 3 showed few changes compared with non-cryopreserved. According to SEM, the fetal cells tightly attached to the materials and extended well after seeded on β-TCP for 7 days. The fresh bone tissue were all observed at different time point by histological staining. Conclusion Rabbit as animal model can isolate and procure the fetal BMSCs and has good osteogenic ability in vivo. And it can be the new choice of the animal model for fetal bone mesenchymal stem cells.
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    Application of Modified Ear Elevation in Ear Reconstruction
    WANG Cheng,ZHANG Ruhong,ZHANG Qun,XUZhicheng,XU Feng,LI Datao,LI Yiyuan,LI Tianya
    2015, 11 (2):  104-106.  DOI: 10.3969/j.issn.1673-0364.2015.02.014
    Abstract ( 409 )  
    Objective To investigate the application and effects of the modified ear elevation in ear reconstruction. Methods From Sep. 2012 to Jun. 2014, 161 cases with congenital microtia were received ear reconstruction. The modified elevation in second stage was performed 6 months after first-stage operation for auriculocephalic angle reconstruction. EH composite wedge was transplanted at the rear side of framework, then the homolateral postauricular fascial flap was used to cover the postauriclar-frame, finally split-skin graft were transplanted on the fascia surface. Results All patients were followed up for 6-18 months (mean 12 months). In 151 patients, reconstructed auriculocephalic angle was close to the normal side. In other 10 patients, severe scar contracture was observed. Darker epidermis or partial grafted skin necrosis (<1 cm 2) were observed in 9 cases, and were healed by dressing. Conclusion Modified ear elevation in second stage can achieve satisfactory structure of auriculocephalic angle.
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    Effectiveness of Arthroscopic Debridement and Drilling in the Treatment of Knee Articular Cartilage Degeneration
    ZHAN Zufeng,LIU Xiaoxia,YAO Zhongjun,LIAO Youqiao
    2015, 11 (2):  107-109.  DOI: 10.3969/j.issn.1673-0364.2015.02.015
    Abstract ( 496 )  
    Objective To investigate the effectiveness of arthroscopic debridement and drilling in the treatment of knee articular cartilage degeneration. Methods From January 2009 to February 2013, 87 eligible patients with knee joint cartilage degeneration were randomly divided into two groups. Among 87 cases, 45 patients (56 knees, Group A) underwent arthroscopic debridement, 42 patients (51 knees, Group B) underwent arthroscopic debridement plus subchondral bone drilling. And the effectiveness in two groups were observed. Results In group A, 6 months after treatment, the excellent and good rate was 64.29%, while group B was 84.31%. There was significant difference between the two groups (P<0.01). All the patients were followed up for 2 years, the excellent and good rate in B group at 6 months, 1 and 2 years after operation were 89.29%, 80.36% and 75.00% respectively, the curative effect of 2 years after operation was significantly lower than 6 months after operation (P=0.04). Conclusion The effectiveness of arthroscopic debridement plus drilling technique for the treatment of articular cartilage degeneration is better than simple arthroscopic debridement, but the effect may reduce with the time prolonging.
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    Review
    Delayed-Immediate Breast Reconstruction
    HAN Siyuan,LIU Xiaoying
    2015, 11 (2):  110-111.  DOI: 10.3969/j.issn.1673-0364.2015.02.016
    Abstract ( 475 )  
    In delayed-immediate breast reconstruction, a tissue expander is placed in subpectoral position during the primary operation. After overexpansion of tissue expander, the tissue expander is then replaced with permanent implant according to the postoperative radiotherapy. Delayed-immediate reconstruction can receive better aesthetic outcomes and decrease the incidence of complications. In this paper, the indications and surgical methods of delayed-immediate breast reconstruction were reviewed.
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    The Applications and Prospects of Bone Morphogenetic Proteins (BMPs) in Craniofacial Surgery
    LI Dong,WEI Min,XU Haisong
    2015, 11 (2):  112-115.  DOI: 10.3969/j.issn.1673-0364.2015.02.017
    Abstract ( 334 )  
    The repair and reconstruction of facial bone deformities, bone defects, nonunion due to all causes are concerned in the craniofacial surgical work. Craniofacial bone are repaired and reconstructed mainly by means of osteotomy, bone-rearrangement combined with repair materials implantation. With the progress of cell biology and in-depth knowledge of the growth and development of craniofacial skeleton, a growing number of studies have shown that growth factors widely participate in the bone repair and reconstruction in the local regulation of bone tissue regeneration. The bone morphogenetic protein s (BMPs) is one of the focus. In this paper, the BMPs overview, the mechanism of promoting bone formation, animal experiments, preliminary clinical experience and many other aspects were reviewed to provide a theoretical basis for further research and the application of BMPs in the repair of craniofacial bone and reconstruction in the future.
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    Development and Present Situation of Genioplasty
    SHENG Yingxun,ZHANG Ce,CAO Dejun
    2015, 11 (2):  116-119.  DOI: 10.3969/j.issn.1673-0364.2015.02.018
    Abstract ( 530 )  
    The chin plays an important role in the facial balance and harmony. Deformities of the chin are commonly present in cosmetic surgery. Genioplasty is one of the earliest craniofacial contour plastic surgery carried out. There are various techniques for chin deformities including chin augmentation with autogenous grafting or alloplastic materials and genioplasty. Computer assisted surgery, robotics surgery and 3D printing will be widely developed in genioplasty. In this paper, the development and present situation of genioplasty were reviewed.
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