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01 June 2022, Volume 18 Issue 3 Previous Issue    Next Issue

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Expert consensus on the rehabilitation of congenital syndactyly　 YU Qinyuan, WANG Bin, SHEN Xiaofang, et al 2022, 18 (3):  193.  Abstract ( 178 )   PDF (4982KB) ( 227 )   Syndactyly is the fusion of soft tissues and/or bones between adjacent fingers to varying degrees, and is one of the most common congenital malformations of the hand, for which surgical separation is the most important treatment. By introducing the concept of precision rehabilitation and comprehensive optimization of the postoperative rehabilitation program for syndactyly, the rehabilitation outcome of patients can be further improved. The consensus is based on evidence-based medical evidence and has been repeatedly discussed by a national expert group, while drawing on and referring to recent research results at home and abroad, and is intended for reference use by hand surgeons, rehabilitation physicians, rehabilitation therapists, rehabilitation engineers, and nursing staff in their clinical work nationwide. The main contents of the consensus include the objectives of postoperative rehabilitation of congenital syndactyly, the issues of concern, the main contents of treatment, the composition and responsibilities of the team, the treatment means and measures, and the recommended rehabilitation program. Related Articles | Metrics

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Sequencing analysis on tissue DNA from 55 patients with venous malformations and lymphatic malformations　 LIU Hongyuan, GU Hao, YANG Xi, et al 2022, 18 (3):  209.  Abstract ( 207 )   PDF (823KB) ( 93 )   Objective　To identify the mutations in the tissue DNA from patients with venous malformations or lymphatic malformations and to conduct genotyping for genetic diagnosis. Methods　Based on the next-generation sequencing, 55 tissues from different patients diagnosed as venous malformations or lymphatic malformations were analyzed. The tissues were sequenced in the exons area and part of the introns area of a customized panel for 2 types of mutations (point mutation and loss/insert of small fragments). Results　All 55 samples from 55 patients were collected and analyzed. Three probably driven mutations including 15 variable sites were identified. The most frequently mutated gene was TEK and PIK3CA. The most frequent variable site of TEK was L914F, and for PIK3CA were E542K and E545K. In patients whose tissues were detected as TEK mutations, 86.67% were venous malformations, and 100% involved venous malformation, while in those whose tissues were detected as PIK3CA mutations, 52.63% were KTS, 21.05% were lymphatic malformations and 94.74% involved lymphatic malformation. According to the genetic results, venous malformations and lymphatic malformations can be classified as TEK type, PIK3CA type, double mutations type, and non-mutation type. Conclusion　Gene mutations can be detected in venous malformations or lymphatic malformations. Venous malformations and lymphatic malformations can be classified as TEK type, PIK3CA type, double mutations type, and non-mutation type. Gene tests can provide evidence of lesions involving venous malformation or lymphatic malformations. Related Articles | Metrics

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Clinical features of localized intravascular coagulation in venous malformations　 HAN Yuyu, YU Mingwei, WANG Min, et al 2022, 18 (3):  214.  Abstract ( 130 )   PDF (959KB) ( 90 )   Objective　To analysis the clinical features of localized intravascular coagulation (LIC) in patients with venous malformation (VM), so as to attach more importance to such phenomena. Methods　A total of 41 patients with VMs were included in the study, treated in the Department of Burn and Plastic Surgery in Eastern Theater General Hospital from September 1st, 2019 to August 31st, 2020. All of them were examined by MRI and ultrasound to determine the location and area of the lesions. The blood coagulation profile of lesion and circulation was detected after admission to evaluate LIC and the features. The relationships between the abnormal coagulation profile and the lesion number, location, the tissue involved were analyzed. Results　The main manifestations of LIC in VMs were the abnormalities of FIB, FDP, D-dimer and AT3. The incidence of abnormal coagulation indexes of lesion was obviously higher than that of circulation. Multiple, trunk, and craniofacial lesions were more prone to have systemic coagulation abnormalities. There was no significant correlation between the type of tissue involved and the coagulation abnormality in lesion or circulation. Conclusion　The main manifestations of LIC in VMs are the abnormalities of FIB, FDP, D-dimer and AT3. LIC is significantly correlated with the number and location of lesions, but not the types of tissues involved. LIC in the lesion is probably the cause of abnormal systemic coagulation. Related Articles | Metrics

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Study on construction of myocardial microtissue in vitro by novel gelatin hydrogel combined with human induced pluripotent stem cell derived cardiomyocytes　 LIU Minglu, JIANG Sihan, TAN Yao, et al 2022, 18 (3):  219.  Abstract ( 159 )   PDF (4124KB) ( 133 )   Objective　To explore the feasibility of a gelatin hydrogel combined with human-induced pluripotent stem cells derived cardiomyocytes (hiPSC-CMs) to construct myocardial microtissue in vitro. Methods　A novel gelatin hydrogel was prepared, and its surface structure was observed by freeze-scanning electron microscope and its mechanical strength was measured by cyclic tensile test. HiPSC-CMs were implanted into the materials to evaluate their compatibility and the effect of groove structure on cardiomyocytes. Futhermore, cross-linked gelatin hydrogel was mixed with hiPSC-CMs for myocardial microtissue to explore the viability of cardiomyocytes during the construction of myocardial microtissue in vitro and after freezing. Results　The surface of the gelatin hydrogel showed uniform porous structure by freeze-scanning electron microscopy. The cyclic tensile test showed that the cross-linked gelatin hydrogels had good mechanical properties. The celltest showed that the cardiomyocytes grew well on the materials, and the channel hydrogel could guide the orderly arrangement of the cardiomyocytes. Gelatin hydrogel was mixed with hiPSC-CMs for myocardial microtissue, the results showed that the gelatin hydrogel had a good protective effect on cardiomyocytes during myocardial microtissue construction, and had some protective effects on the frozen-thawed and resuscitated cardiomyocytes. Conclusion　The novel gelatin hydrogel has porous surface microstructure, good mechanical properties and cell compatibility. It can protect cells in the process of myocardial microtissue and after cryopreservation. It is hopeful to be used in tissue engineering in the future for organ regeneration, drug screening and in vitro modeling. Related Articles | Metrics

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Treatment of rabbit ear hypertrophic scar by CO2 fractional laser-assisted silk nanofiber hydrogel-loaded asiaticoside　 YANG Yan, SHANG Ying, LYU Qiang, et al 2022, 18 (3):  227.  Abstract ( 215 )   PDF (1968KB) ( 117 )   Objective　To investigate the feasibility of silk nanofiber hydrogel (SNF) as drug carrier and the efficacy of silk nanofiber hydrogel-loaded asiaticoside(SNF-AC) combined with CO2 fractional laser in the treatment of hypertrophic scar. Methods　SNF-AC was prepared and characterized. Then, the rabbit ear hypertrophic scar model was constructed in vivo, and intervention was performed as follows: ①CO2 fractional laser combined with SNF-AC (L+SNF-AC group); ②CO2 fractional laser(L group) ③SNF-AC (SNF-AC group); ④blank control group(Control group). On day 7 and 14 after intervention, the thickness of hypertrophic scar was measured, the vascularity was evaluated, the histological morphology was observed by HE staining, and the arrangement of collagen fibers was observed by Masson staining. Results　The surface morphology and rheological behavior of SNF-AC were similar to that of silk nanofiber hydrogel, and the characteristic peak of Raman spectrum showed that asiaticoside could be successfully loaded into SNF. The relative thickness change value was L+SNF-AC group > L group > SNF-AC group > Control group on the 7th day after treatment. The difference between the L+SNF-AC group and the Control group was statistically significant, as well as the difference between the L group and the Control group. On the 14th day after treatment, the relative thickness change of L+SNF-AC group was higher than that of the other three groups, but there was no statistical difference among the groups. No matter on day 7 or day 14 after treatment, the vascularity change in L+SNF-AC group was significantly better than that in the other three groups, with statistical differences. HE staining of hypertrophic scar showed that on the 14th day after treatment, the surface of hypertrophic scar tended to be flat in the L+SNF-AC group, while the surface of hypertrophic scar in the other three groups were raised to varying degrees. Masson staining results showed that on the 14th day after treatment, collagen fibers in L+SNF-AC group and L group were flat and tended to normal tissue, while collagen fibers in SNF-AC group and Control group were disordered. Conclusion　SNF is suitable as a drug carrier for hypertrophic scar. And CO2 fractional laser combined with SNF-AC can reduce the thickness of hypertrophic scar and improve the vascular distribution of hypertrophic scar, which is an effective scar treatment method. Related Articles | Metrics

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Improvement of autologous costal cartilage harvest techniques in ear reconstruction　 WANG Fei, SHI Junli, GUO Shuzhong, et al（ 2022, 18 (3):  233.  Abstract ( 118 )   PDF (928KB) ( 88 )   Objective　To explore the improved autologous costal cartilage harvest technique in ear reconstruction, so as to improve the operation efficiency and reduce the complications. Methods　Costal cartilaginectomy was performed in 760 cases of ear reconstruction. The costal cartilaginectomy was improved from the aspects of preoperative preparation, intraoperative incision selection, perichondrium exposure and stripping, incision closure and so on. The surgical effect was evaluated by incision length, operation time and complications. Results　In 760 patients, the average length of the costal cartilage incision was 2.6 cm, and the average operation time was 35 min. The wound healed well without complications such as hemopneumothorax and macrovascular injury. No obvious thoracic deformity was found in half a year follow-up. Conclusion　The modified autologous costal cartilage harvest method could improve the operation efficiency, obtain good operation effect, and effectively reduce the occurrence of complications. It is worthy to be popularized in clinic. Related Articles | Metrics

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Correlation analysis of cleft palate width and postoperative velopharyngeal function　 WANG Yingli, LIU Yang, SONG Qiwen, et al 2022, 18 (3):  238.  Abstract ( 107 )   PDF (845KB) ( 70 )   Objective　To explore the correlation analysis of cleft palate width and postoperative velopharyngeal function. Methods　The data of 44 patients with cleft palate from 2012 to 2020 were collected, and the Furlow method was used to repair the cleft palate. According to the different cleft width of cleft palate before surgery, patients were divided into three groups: narrow group, medium-width group and wide group. The velopharyngeal function of patients in each group was tested and analyzed, including subjective voice judgment and nasopharyngeal fiberoscopy. Results　The results of subjective voice judgment showed that the rate of postoperative velopharyngeal insufficiency in the three groups was 20%, while the results of nasopharyngeal fiberscopy showed 18%. There was no statistical difference between the two detection results (P>0.05). The results showed that the velopharyngeal insufficiency rate in narrow group was significantly lower than that in medium-width group and wide group (P<0.05), and there was no significant difference between medium-width group and wide group (P>0.05). Pearson correlation analysis showed that cleft palate width was positively correlated with postoperative speech intelligibility score and nasopharyngeal fiberoscopy score (r=0.570, 0.560, P<0.05), that is, the wider the cleft palate, the higher the postoperative velopharyngeal insufficiency rate. Conclusion　The velopharyngeal closure function is different after surgery by Furlow's method, which is significantly related to the preoperative cleft palate width. Related Articles | Metrics

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Preliminary study on the comprehensive treatment of lowerextremity lymphedema complicated with perineal lymphedema after gynecology related tumors　 CHEN Jiajia, GAO Minzhe, WANG Li, et al 2022, 18 (3):  242.  Abstract ( 183 )   PDF (1086KB) ( 118 )   　Objective　To compare and analyze the clinical effects of different approaches in patients with lymphedema of lower extremity combined with perineal edema after gynecological tumor operation. Methods　From November 2019 to June 2021, 32 cases of gynecological tumor patients who were diagnosed with lymphedema of lower limbs combined with perineal edema after surgery were selected for 4-week treatment. The patients were randomly divided into groups A, B, C and D, with 8 cases in each group. Group A was treated with complex decongestive therapy (CDT) plus pressure shorts. Group B was treated with intermittent pneumatic compression (IPC) and pressure shorts. Group C was treated with CDT plus IPC and pressure shorts. Group D was treated with CDT plus IPC plus pressure shorts and perineum bandage. The water content, circumference of lower limb segments, waist circumference, degree of local perineal edema, grade of perineal edema, labia width and subjective feeling of patients were compared between the 4 groups before and after treatment. Results　The improvement degree of hindlimb segmental moisture, waist circumference, labial width and perineal edema grade in group D was better than that in group A, B and C, and the difference was statistically significant compared with group A and B (P<0.05). The indexes of group D were better than those of group C. There were no significant differences in limb circumference diameter and local perineum edema among the four groups (P>0.05). The subjective feeling of patients in group C and D was better than that in group A and B, and the difference was statistically significant (P<0.05). Conclusion　Using CDT plus IPC plus pressure shorts and perineal bandage to treat the patients with lymphedema of lower extremity combined with perineal edema after gynecological related tumors, the affected limb moisture and circumference can be significantly reduced, waist circumference can be decreased, the degree of perineum edema, grade and labial width can be significantly restored, the subjective sensation of patients can be improved, no obvious adverse reactions occurs. It is worthy of clinical application. Related Articles | Metrics

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Application of silicone gel breast prosthesis combined with titanium polypropylene mesh in immediate breast reconstruction for early breast cancer  YAO Chengcai, CHEN Ming, LIU Changchun, et al 2022, 18 (3):  247.  Abstract ( 299 )   PDF (1069KB) ( 198 )   Objective　To explore the application effect of silicone gel breast prosthesis combined with titanium mesh patch in immediate breast reconstruction for early breast cancer (EBC). Methods　From March 2018 to May 2021, 42 patients with EBC who underwent breast reconstruction with silicone gel breast prosthesis and titanium mesh patch after nipple-areola complex sparing mastectomy (NSM) were retrospectively analyzed. The intraoperative conditions, postoperative complications, breast aesthetic effect and long-term follow-up results were analyzed. Results　All 42 patients completed the operation successfully, and the operative time was (139.36±2.87) min, the intraoperative blood loss was (85.76±4.23) mL, the total drainage volume was(1 262.53±17.65) mL, and the extubation time was (9.61±2.67) days. The incidence of postoperative NAC ischemia was 11.90% (5/42), the incidence of wound infection/poor healing was 4.76% (2/42), and the incidence of seroma was 2.38% (1/42). There was no postoperative implant displacement/exposure/loss, but 4 cases (9.52%, 4/42) showed mild capsular contracture. The aesthetic effect of breast reconstruction was related to patients' BMI and breast ptosis. For patients with normal BMI and no/mild breast ptosis, the aesthetic effect of breast reconstruction was good, and the excellent rate of breast reconstruction in 42 patients was 83.33% (35/42). No tumor recurrence or distant metastasis was observed during 3-37 months of follow-up. Conclusion　For appropriate patients with early breast cancer, silicone gel breast implant combined with titanium mesh patch for immediately breast reconstruction after NSM is feasible, the near-term tumor safety and the aesthetic effect of breast reconstruction are accurate, and it is worthy of clinical promotion.  Related Articles | Metrics

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Cryolipolysis for local subcutaneous fat accumulation reduction in Asians　 DONG Jiying, LU Wenting, YAO Shanshan, et al 2022, 18 (3):  252.  Abstract ( 177 )   PDF (1333KB) ( 161 )   Objective　To evaluate the efficacy and safety of cryolipolysis for local subcutaneous fat accumulation reduction in Asians. Methods　From March 2019 to February 2021, 40 patients who underwent cryolipolysis were selected and the clinical data were retrospectively summarized. The clinical effect was preliminarily evaluated by comparing the photos before and 3 months after treatment and measuring the circumference of each treatment area with a soft ruler. Postoperative adverse reactions and satisfaction were recorded through follow-up. Results　Comparison of photos before and after treatment and soft ruler measurement results showed that the values of upper abdomen, middle abdomen, lower abdomen, waist, thigh and upper arm were significantly reduced 3 months after surgery (P<0.05). The rate of adverse reactions was 87.5%, and most of them were mild. Most of the symptoms and signs tended to be relieved 2 weeks after operation. The overall satisfaction rate of the patients was 77.5%. Conclusion　The cryolipolysis for the reduction of localized subcutaneous fat accumulation in Asians has definite clinical efficacy, light side effects and high safety, which is worthy of clinical application. Related Articles | Metrics

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Efficiency analysis of quality control circle activities in reducing the loss rate of dressing change devices in Department of Plastic and Reconstructive Surgery　 XUE Yingying, ZHUANG Leilan, BIAN Weiwei, et al 2022, 18 (3):  258.  Abstract ( 120 )   PDF (590KB) ( 92 )   Objective　To explore the efficiency of quality control circle activities in reducing the loss rate of dressing change devices in Department of Plastic and Reconstructive Surgery. Methods　From March 2020 to August 2020, in view of the serious loss of dressing change devices, a quality control circle team was established to determine “reducing the loss rate of dressing change devices in Department of Plastic and Reconstructive Surgery” as the theme of the activity, and conducted a status survey and cause analysis by using quality control circle techniques, formulated and implemented corresponding countermeasures, and evaluated and reviewed the effects. Results　After 6 months of quality control circle activities, the loss rate of dressing change devices in the department decreased from 2.86% to 0.32%, with statistical significance (P<0.001). Through the quality control circle activities, the borrowing process of dressing change equipment was standardized, which improved the nursing staff's ability to find and solve problems, and increased their confidence, responsibility and teamwork ability. Conclusion　Quality control circle can effectively reduce the loss rate of surgical dressing change devices, improve medical safety factor, and improve the quality of medical care. Related Articles | Metrics

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The effect of p53 in the occurrence, development and treatment of heart diseases　 LU Tingting, FU Wei 2022, 18 (3):  261.  Abstract ( 240 )   PDF (410KB) ( 133 )   Heart disease is one of the top ten fatal diseases, which threats human health seriously. However, the most useful therapy for heart disease is palliative care. So, we need to search new treatments for heart disease. Recent years, more and more researches are focus on the role of p53 in heart disease. p53, a kind of transcription factor, plays an important role during the occurrence, development and treatment of heart disease via anti-angiogenesis, pro-programmed cell death, autophagy regulation, cell cycle arrest regulation and metabolism regulation. p53 can also promote the differentiation of stem cell and the maturation of cardiomyocytes derived from stem cells in vitro, which can help the stem cells to treat heart disease. Therefore, p53 may become a new target for the treatment of heart diseases in the future. In this paper, the effect of p53 in the occurrence, development and treatment of heart diseases was reviewed. Related Articles | Metrics

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Pre-operation evaluations in vascularized composite tissue allotransplantation　 ZHU Hainan, GU Bin, XIE Feng, et al 2022, 18 (3):  265.  Abstract ( 97 )   PDF (430KB) ( 52 )   With the development of immuno suppressive therapy and the change of people opinion to allotransplantation, more and more vascularized composite tissue allotransplantations (VCA), represented by hand and face allotransplantation, have been carried out in many countries. The successful rate of transplantation varies greatly among different regions. There are many factors that affect the success of surgery. Among them, a comprehensive evaluation before operation is an important point. Preoperative evaluation mainly includes surgical indication evaluation, psychological evaluation, cognitive ability evaluation, social support system evaluation, third-party agency audit, etc. In this paper, the content and importance of the above assessment were reviewed. And it is suggested that VCA teams around the world establish preoperative assessment criteria as soon as possible, and legislate third-party review mechanism to improve the success rate of surgery. Related Articles | Metrics

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Research progress on secondary breast reduction　 ZHANG Xiaoyu, MU Dali 2022, 18 (3):  268.  Abstract ( 113 )   PDF (482KB) ( 94 )   Patients with macromastia tend to have a high level of satisfaction after bilateral breast reduction surgery. However, some patients still seek secondary breast reduction because of inadequate symptom relief or unsatisfactory aesthetic results. To date, there is no international consensus on the safest and most effective surgical technique for secondary breast reduction. This article provided a review of recent algorithms and strategies for secondary breast reduction mammaplasty with the aim of providing a clinical reference for this relatively uncommon revision procedure. Related Articles | Metrics

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Progress in the use of autologous fat grafting and fat derivatives for scar treatment　 HUANG Zonglin, ZHU Congxiao, LIU Anna, et al 2022, 18 (3):  272.  Abstract ( 123 )   PDF (582KB) ( 126 )   Scars result from abnormal regeneration after skin injuries, causing disfigurement and functional impairment. However, current treatments for scars are unsatisfactory to a certain extent. In recent years, numerous researches indicate that autologous fat grafting and the application of fat derivatives (nanofat, SVF-gel) could effectively improve the appearance, texture, and local symptoms of scars. The curative effect of the adipose tissue might be attributed to the wide range of cells it comprises and the secretome thereof, which could interfere in scar formation and reconstruct the scar tissue through a variety of pathways and mechanisms. In this paper, the progress in the application of autologous fat grafting and fat derivatives for scar treatment and the possible mechanisms therein were reviewed. Related Articles | Metrics

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Process in the clinical application of autologous platelet-rich plasma in tissue defect repair　 DING Yi, LIU Fei, YANG Jun 2022, 18 (3):  277.  Abstract ( 177 )   PDF (446KB) ( 121 )   Autologous platelet-rich plasma (PRP) is an autologous platelet concentrate containing large amounts of platelets and growth factors, which has the advantage of being derived from one's own blood, simple to preparate and no immune rejection. It has been used in animal models and in clinical stages to demonstrate its healing and repair effects. The clinical applications of PRP in tissue defect repair were reviewed in this article, in order to provide a more comprehensive reference for future applications and research in this field. Related Articles | Metrics

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Research progress of the mechanism of senile ptosis ZHOU Rong, GAO Weicheng 2022, 18 (3):  281.  Abstract ( 126 )   PDF (369KB) ( 61 )   Senile ptosis is one of the common diseases among the elderly, which not only affects the appearance, but also limits the eyesight, resulting in dysfunction. Currently, concrete pathological mechanism of senile ptosis is not clear. Major scholars suggest that levator aponeurosis injury and the rupture of the upper edge of the tarsal plate may cause senile ptosis. Recently, many studies show that fibrosis and fatty infiltration of Müller's muscle, decrease and fatty infiltration of levator fibers and oxidative stress may lead to and aggravate senile ptosis. The possible causes and pathogenesis of senile ptosis were reviewed in this paper, providing theoretical evidence for clinical therapies.  Related Articles | Metrics

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Progress in retracted nostril alar rim　 GE Chengwang, LIN Weiyi, TANG Xiaowei, et al 2022, 18 (3):  284.  Abstract ( 93 )   PDF (292KB) ( 109 )   Retracted nostril alar rim is a common clinical alar deformity, which has a serious impact on the facial appearance of patients and is difficult to correct. The causes and treatment of nasal alar retraction are varied. In this paper, the definition, pathogenesis and treatment of nasal alar retraction were reviewed, so as to provide some help to clinical work. Related Articles | Metrics

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Discussion on the cultivation of humanistic care consciousness of medical students from the perspective of sequential treatment of cleft lip and palate　 NIE Ping, YE Qicheng, WANG Yuezhi, et al 2022, 18 (3):  286.  Abstract ( 124 )   PDF (378KB) ( 71 )   　With the change of modern medical model, integrating humanistic care spirit into clinical medical education and cultivating medical talents with both scientific literacy and humanistic spirit have become the development trend of modern medical education. Cleft lip and palate teaching has always been the key point and difficulty in the course of oral and craniomaxillofacial deformities. From the perspective of sequential treatment of cleft lip and palate, this paper has explored how to strengthen the cultivation of humanistic care consciousness of medical students through clinical practice, so as to improve the effect of clinical teaching. Related Articles | Metrics