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Table of Content

    01 October 2022, Volume 18 Issue 5 Previous Issue   
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    Analysis of 50 cases of breast reconstruction with expanded latissimus dorsi musculocutaneous flap immediately after radical mastectomy

    ZHU Fang, XU Zhe, WANG Xianming , et al
    2022, 18 (5):  377. 
    Abstract ( 148 )   PDF (781KB) ( 168 )  
    Objective To investigate the efficacy and cosmetic effect of immediate breast reconstruction with expanded latissimus dorsi myocutaneous flap after modified radical mastectomy with nipple and areola preserved. Methods Clinical data of 50 patients with breast cancer from April 2014 to April 2019 were retrospectively analyzed. The operation was modified radical mastectomy with nipple and areola sparing or skin sparing and breast reconstruction with extended latissimus dorsi myocutaneous flap. The operative related indexes (operative time, operative blood loss and drainage tube indwelling time) and postoperative complications were observed, and the postoperative cosmetic effect was evaluated. Results Modified radical mastectomy and breast reconstruction were successfully completed in 50 patients, and the survival rate of skin flap was 100%. The amount of breast tissue resection was (200±50) g, the operative time was (220±40) min, the operative blood loss was (35±15) mL, the indwelling time of chest drainage tube was (12±4) d, and the indwelling time of back drainage tubewas (20±5) d. Two patients had seroma on the back one month after operation, which disappeared after re-drainage. One patient appeared partial ischemic necrosis of the nipple after operation, which healed after dressing change. One patient had limited upper limb movement, which was relieved after functional exercise. The evaluation of cosmetic effect showed that the excellent and good rate of reconstructed breast was 92%. All patients were followed up for 36-60 months, with a median follow-up of 48 months. No local recurrence or distant metastasis was observed. Conclusion Breast reconstruction with immediate expanded latissimus dorsi musculocutaneous flap after modified radical mastectomy is suitable for small and medium sized breast of Asian women, with strong operability and good cosmetic effect, and is worthy of clinical promotion.
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    Clinical application of the pedicled lateral thoracic artery perforation

    flap in breast reconstruction immediately after breast-conserving surgery

     ZHANG Xiaoli, LI Zan, SONG Dajiang, et al
    2022, 18 (5):  382. 
    Abstract ( 240 )   PDF (911KB) ( 137 )  
    Objective To investigate the clinical application effect of the pedicled lateral thoracic artery perforator flap in breast reconstruction after breast conserving surgery and its tumor safety. Methods A total of 41 breast cancer patients who underwent breast-conserving surgery using pedicled lateral thoracic artery perforator flap from October 2020 to May 2022 were included in the study. Age ranged from 35 to 82 years old, 56.4 years on average. All the paitents were females. The tumors were all unilateral, with 15 cases on the left and 26 cases on the right side. The locations of the masses were the out upper lateral quadrant (n=21), the outer lower quadrant (n=6), the inner upper quadrant (n=9), the inner lower quadrant (n=3), and the posterior nipple (n=2). The diameter ranged from 0.9 cm to 4.0 cm. There were luminal A type (n=14), luminal B type (n=17), HER2 overexpression type (n=7), and triple negative type (n=3); There were 19 cases in stage Ⅰ, 16 cases in stage Ⅱ, and 6 cases in stage Ⅲ. Survival of the flap, the shape of the reconstructed breast and the local recurrence were observed after operation. Results The average mass of tumor and breast tissue resected was about 40 g. All flaps survived. There was no reduction in flap volume after radiotherapy. All 41 patients were followed up for 3 to 24 months (12 months on average) with satisfactory results. No recurrence of breast cancer happened. Conclusion The pedicled lateral thoracic artery perforator flap is a relatively simple and reproducible reconstructive technique, which greatly improves the breast shape after breast conserving, and is worthy of clinical application and promotion.
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    Surgical strategy of huge chest wall defect reconstruction using pedicled rectus abdominis musculocutaneous flap combined with free deep inferior epigastric artery perforator flap

    SONG Dajiang, LI Zan, ZHANG Yixin
    2022, 18 (5):  386. 
    Abstract ( 180 )   PDF (2119KB) ( 145 )  
    Objective To explore the strategies of pedicle rectus abdominis myocutaneous flap combined with free inferior epigastric artery perforator flap transplantation for reconstruction of huge chest wall defect after local advanced breast cancer. Methods From August 2007 to October 2018, 89 patients with locally advanced breast cancer who underwent secondary defect reconstruction with lower abdominal flap were selected. The area of secondary soft tissue defect was 25 cm×12 cm to 31 cm×16 cm. All were repaired with pedicled rectus abdominis flap combined with free inferior epigastric artery perforator flap. The flap size was 26 cm×12 cm to 35 cm×15 cm. All of them were large soft tissue defects left after radical mastectomy. The specific forms of combined flap were divided into two types: ① Contralateral pedicled rectus abdominis flap combined with ipsilateral free deep inferior epigastric artery perforator flap; ② Ipsilateral pedicled rectus abdominis flap com bined with contralateral free deep inferior epigastric artery perforator flap. The recipient vessels of free inferior epigastric artery perforator flap included internal mammary vessels, lateral thoracic arteries and veins, thoracoacromial vessels, thoracodorsal vessels, anterior serratus branches of thoracodorsal vessels and transverse jugular arteries and veins. In cases repaired with the second flap form, intrathoracic vessels cannot be selected as recipient vessels. Results There were 57 cases repaired with the first flap form, of which 4 cases had marginal partial necrosis on the side of the pedicled rectus abdominis flap, and 32 cases repaired with the second flap form, of which 2 cases found that the pedicled rectus abdominis flap had no blood supply at all during the harvesting process, so they were replaced by free rectus abdominis flap combined with free deep inferior epigastric artery perforator flap, and 3 cases had marginal partial necrosis on the side of the pedicled rectus abdominis flap, after debridement, local advancement flap was used for repairing. The wounds of all other patients healed by first intention. All patients completed the later treatment smoothly. The postoperative follow-up ranged from 12 to 96 months, with an average of (29.5±0.3) months, and 11 patients lost the contact. Of the 78 patients who completed the follow-up, 4 patients had local tumor recurrence (5.1%), 4 patients had brain metastasis (5.1%), 3 patients had liver metastasis (3.8%), 6 patients had pulmonry metastasis (7.7%), and the rest recovered well with good flap appearance. The functional recovery was satisfactory, and the quality of life of patients was significantly improved. Conclusion Combined abdominal flap transplantation is safe and helpful to control locally advanced breast cancer and improve the quality of life. Among them, the vascular anastomosis choice of the first flap form is more flexible, the blood supply of the flap is more reliable, and the second flap form is more time saving. The specific selection of the two methods needs to be determined according to the actual situation of patients.
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    Repair of abdominal wall donor site defect of TRAM by freeing the anterior rectus sheath of superior rectus abdominis -- An attempt to make patch with autologous tissue

    CHEN Kuo, SONG Dajiang, MU Lan, et al
    2022, 18 (5):  393. 
    Abstract ( 165 )   PDF (1152KB) ( 128 )  
    TRAM皮瓣; 腹直肌前鞘; 自体组织; 补片; 乳房重建; 乳腺癌
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    Meta-analysis of the curative efficacy on the therapy of traditional Chinese medicine on postoperative wound repair in patients with non-puerperal mastitis

    DAI Qiuying, ZHOU Yue, WU Jingjing, et al
    2022, 18 (5):  397. 
    Abstract ( 191 )   PDF (3824KB) ( 162 )  
     Objective To study the clinical efficacy and related mechanism of traditional Chinese medicine on wound repair after surgery of non-puerperal mastitis(NPM) using systematic review and meta-analysis. Methods All of the clinical randomized controlled trials on traditional Chinese medicine combined with surgery in the treatment of NPM were searched from databases of CNKI, Wanfang, VIP, PubMed, Embase and Cochrane Library from the inception of the databases to March 2022. Literature reading, screening and information extraction were carried out, and the included literature was systematically evaluated. Revman 5.3 software was used for meta-analysis. Results A total of 17 literatures were finally included in the systematic review and meta-analysis. The effective rate was reported in 15 literatures, the recurrence rate in half a year was reported in 5 literatures, the recurrence rate in one year was reported in 5 literatures and the mechanism of clinical efficacy was reported in 7 literatures. The results of meta-analysis showed that the effective rate of traditional Chinese medicine combined with surgery (observed group) was 94.12%, which was significantly higher than 73.39% of simple surgery (control group, P<0.01). The half year recurrence rate in the observed group was 12.00%, which was significantly lower than 42.26% in the control group(P<0.01). The one-year recurrence rate in the observed group was 5.65%, which was significantly lower than 22.52% in the control group(P<0.01). The intervention measures in the observation group can significantly reduce the level of CRP, IL-6, TNF-α, IgA and IgG  in peripheral blood of patients with non-puerperal mastitis. Conclusion The effective rate and recurrence rate of traditional Chinese medicine combined with surgery in the treatment of NPM were better than that of simple therapy of surgery.
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    Effect of different surgical suture on wound healing and aesthetic effect of granulomatous lobular mastitis

    CHEN Ying, TU Yihui, WU Gaosong, et al
    2022, 18 (5):  406. 
    Abstract ( 128 )   PDF (364KB) ( 248 )  
    Objective To explore the effect of different surgical suture on wound healing and aesthetic effect of granulomatous lobular mastitis (GLM). Methods From January 2018 to January 2021, 168 patients with granulomatous lobular mastitis were randomly divided into mousse thread group, absorbable thread group and Songning group according to different types of surgical suture, with 56 patients in each group. The thread knot response at 7 and 14 days after operation, wound healing time, healing grade, wound healing related complications of the three groups were compared, and the satisfaction of the three groups with wound suture aesthetics was compared. Results The rate of Ⅲ degree of thread knot reaction in Songning group (14.28%, 8.9%) was significantly lower than that in absorbable thread group(41.07%, 30.35%) and mousse thread group (35.71%, 26.78%) at 7 and 14 days after operation, and the difference was statistically significant (P=0.005; P=0.014); The healing time of incision in the mousse thread group, absorbable thread group and Songning group was (7.4±1.43) d, (7.3±1.88) d and (6.9±0.88) d, respectively, and there was no significant difference among the three groups (P=0.722). There was no significant difference in wound healing grade among the three groups (P=0.055). The incidence of incision complications in mousse thread group, absorbable thread group and Songning group was 60.71%, 28.57% and 14.28%, respectively. The incidence of postoperative complications in Songning group was lower than that in mousse thread group (P=0.000). The total satisfaction rate of patients in the mousse thread group, absorbable thread group and Songning group was 78.57%, 80.35% and 92.85%, respectively. The total satisfaction rate of Songning group was higher than that of mousse thread group, and the difference was statistically significant (P=0.031). Conclusion Songning used as surgical suture in GLM can obtain better aesthetic effect and wound healing effect, and reduce the rate of wound healing related complications. For the incision with large tension, it is recommended to use three kinds of sutures in combination for layered sutures.
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    Comparative study on blood circulation training methods of the  forehead pedicled flaps before the pedicles division

    WANG Jue, MIN Peiru, XIAO Wentian, et al
    2022, 18 (5):  415. 
    Abstract ( 269 )   PDF (632KB) ( 130 )  
    Objective Blood circulation training of the forehead flap prior to pedicle division helps to improve blood supply to the flap. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. To introduce an innovative method designed for ischemic training and compared its efficacy with the clamped rubber band. Methods The nylon tie blocking method is performed by self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion from the pedicle. The nylon tie and the clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared. Results A total of 40 forehead flaps were included. The cable tie had less incidence of loosening(8.7% vs. 19.6%, P<0.05) and maintained the pressure more effectively. The pain score for the nylon cable tie was significantly lower than the clamped rubber band (3.25±1.12 vs. 7.05±1.02, P<0.05), especially for pediatric patient (3.50±0.88 vs. 8.60±1.23, P<0.01). All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications. Conclusion Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, it is recommend to use the nylon cable tie as the first choice for ischemic preconditioning of the forehead flap before the pedicle is broken.
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    Application of 3D printing personalized nasal stent in the correction of secondary nasal deformities after unilateral cleft lip surgery

    CHEN Chen, CHENG Yusheng, HU Xiaojing, et al
    2022, 18 (5):  419. 
    Abstract ( 198 )   PDF (705KB) ( 157 )  
    Objective To investigate the effect of personalized nasal stent in the correction of secondary nasal deformities after unilateral cleft lip surgery. Methods Forty patients with secondary nasal deformities after unilateral cleft lip surgery from September 2020 to September 2021 were randomly divided into study group and control group, with 20 patients in each group. After surgery, a personalized nasal stent and a finished nasal stent were used respectively. The width and height of the healthy side and the affected side were measured 6 months and 1 week after operation, and the changes of the healthy side and the affected side were compared between the two groups 6 months after operation. Results Six months after surgery, the height and width changes of the affected side of the nostril in the study group were smaller than those in the control group, with statistical significance (P<0.05). Six months after surgery, there was no significant difference in height and width changes of the healthy side nostril between the two groups (P>0.05). The postoperative effect score of the study group was higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion Personalized nasal stent has significant effects on the support of nostrils, the improvement of the nasal columella deviation, the nasal tip shape and the nasal base after nasal deformity reconstruction, which is worthy of clinical application.
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    Application of keystone perforator flap in repairing soft tissue defect in donor site of anterolateral thigh free flap

    CAI Feiyu, LIU Yanshi, LIU Kai, et al
    2022, 18 (5):  426. 
    Abstract ( 255 )   PDF (1029KB) ( 151 )  
    Objective To explore the clinical application and effect of keystone perforator flap in repairing the donor site defect of anterolateral thigh free flap. Methods From February 2018 to December 2020, a total of 12 patients were treated with the keystone flap to repair soft tissue defects in the donor site of the anterolateral thigh free flap. The average defect in the flap donor site was 8.1 cm×14.4 cm (8.0 cm×11.0 cm to 9.0 cm×21.0 cm), and the average area of the designed keystone flap was 9.1 cm×16.4 cm (8.0 cm×13.0 cm to 12.0 cm×19.0 cm). The flap characteristics and postoperative complications were followed up. The flap appearance was analyzed by Vancouver Scar Scale (VSS) score and Scar Cosmesis Assessment and Rating (SCAR) score. Results After an average follow-up of 8.3 months (6-12 months), 2 cases of skin infection around the flap were observed, the infection was controlled by wound dressing change and oral antibiotic treatment. None had osteofascial compartment syndrome (OCS), wound dehiscence, venous return disorder, or skin necrosis. The final follow-up ASS score was 6.8±0.9 and the SCAR score was 7.3±1.0, with satisfactory repair results. Conclusion The keystone perforator flap is an effective repair method for donor site defect of anterolateral thigh free flap, which not only avoids various complications caused by tension suture but also brings good aesthetics.
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    Comparative study on measurement of mandibular movement by electronic facebow and digital caliper

    PANG Bo, YAO Jinfeng, LIANG Zhigang
    2022, 18 (5):  428. 
    Abstract ( 220 )   PDF (898KB) ( 247 )  
    Objective To investigate the application effect of electronic facebow and digital caliper in measurement of mandibular movement. Methods Sixteen patients with temporomandibular disorders (TMD) from October 2020 to February 2022 were selected as the research group. Sixteen healthy subjects were selected as the control group. After admission, both groups underwent digital caliper examination and electronic facebow examination respectively. The maximum opening, protrusive boarder movements, lateral left boarder movements and lateral right boarder movements were compared between the two groups, and the measurement accuracy of different examinations were compared. Results There was no significant difference in the maximum opening measured by electronic facebow and digital caliper between the research group and control group (P>0.05). The movement distance of protrusion, left laterality and right laterality were measured by electronic facebow and digital caliper. The distance of the study group was higher than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the maximum opening, protrusive boarder movements, lateral left boarder movements and lateral right boarder movements distance of TMD patients measured by electronic facebow and digital caliper (P>0.05). The data of the maximum opening, protrusive boarder movements, lateral left boarder movements and lateral right boarder movements were measured by electronic facebow and digital caliper respectively, and there was no significant difference (P>0.05). Conclusion TMD patients are often accompanied by TMD movement abnormalities, and both electronic facebow and digital caliper can accurately measure mandibular movement. The former one is more convenient to use and has more comprehensive functions, which can provide a more reliable reference basis for clinical diagnosis and treatment.
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    Application of quality control circle to improve the early postoperative activity implementation rate of the patients with ear reconstructio

    ZHANG Yili, ZHOU Yanchun, BIAN Weiwei, et al
    2022, 18 (5):  433. 
    Abstract ( 152 )   PDF (714KB) ( 105 )  
    Objective To improve the early postoperative activity implementation rate of the patients with ear reconstruction. Methods The quality control circle (QCC) was established and the selected theme was "improving the early implementation rate of postoperative activities in patients with ear reconstruction". A total of 36 patients were examined to analyze the reasons for the low implementation rate, the target value was set and countermeasures were formulated. Results The patient implementation rate increased from 53.29% to 84.68%. Conclusion The QCC activities can effectively improve the early postoperative activity implementation rate of the patients with ear reconstruction, reduce postoperative complications, simultaneously provoke innovation, cooperation and communication within the nursing team, and thus improve the application efficiency of QCC in clinical nursing work.
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    The significance of macrophage-mediated inflammatory responses in the evaluation of material biocompatibility

    LI Shijie, JIANG Aili, LIU Yu, et al
    2022, 18 (5):  436. 
    Abstract ( 367 )   PDF (632KB) ( 347 )  
    With the rapid development of material science and immunology, more and more biomaterials are being used in the field of regenerative medicine. The inflammatory and foreign body reactions caused by materials implanted in tissues are obstacles to tissue repair and regeneration, and are also important elements in the biocompatibility evaluation of products. The intensity and duration of the inflammatory response directly affects the histocompatibility and effectiveness of biomaterials. Macrophages are the key immune cells that dominate the inflammatory response and fibrosis, and the number and behaviour of macrophages can reflect whether the material has good biocompatibility. At present, many researchers aim to modulate and induce macrophages in biomaterials, and similarly, biomaterials compatibility evaluation should also focus on macrophages to optimize and improve existing biological evaluation methods and enhance biocompatibility evaluation. In this paper, the progress of biomaterials compatibility evaluation and the interaction between biomaterials and macrophages were reviewed, focusing on the "double-edged sword" role of macrophages in tissue repair and foreign body reaction, aiming to provide researchers in the biomaterials evaluation industry with optimized evaluation methods, innovative ideas and theoretical basis to advance the development of the medical device industry.
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    Research progress of tissue engineering and 3D broprinting technology in the field of auricular reconstruction

    HE Bei, ZHANG Qingguo
    2022, 18 (5):  441. 
    Abstract ( 234 )   PDF (640KB) ( 282 )  
    Microtia is the second most common congenital craniofacial disease in China, mainly manifested as auricle hypoplasia, partly combined with external auditory canal stenosis or atresia, middle ear malformation. Over the years, auricle reconstruction has been a great challenge for plastic surgeons because of its complexity and precision. In ear reconstruction, autologous costal cartilage transplantation and Medpor stent implantation are the two most commonly used methods, both of which have limitations. In recent years, the auricle construction model with tissue engineering and 3D printing as the core technology has also achieved certain research results, providing new possibilities for the treatment of microtia in the future.
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    Research progress of buccal fat pad-derived stem cells in bone tissue engineering

    YANG Xiaohua, HE Leren
    2022, 18 (5):  446. 
    Abstract ( 152 )   PDF (520KB) ( 255 )  
     Studies have found that there are stem cells with osteogenic differentiation ability in the buccal fat pad, which can be used as seed cells for bone tissue engineering to induce new bone formation. The buccal fat pad contains two components, mature adipose tissue and stromal vascular fraction, from which can separately obtaine dedifferentiated fat cell and adipose stem cells, both of them have osteogenic differentiation ability. In this paper, the buccal fat pad-derived stem cells, from the discovery of osteogenic ability, comparison with other stem cells, factors influencing osteogenesis, the role of scaffolding, to the clinical trials, were all reviewed, and the research and application progress of buccal fat pad-derived stem cells was summarized to provide a reference of the source of seed cells in bone tissue engineering.
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    Research progress of extracellular vesicles secreted by adipose-derived stem cells in improving the survival rate of fat grafting

    LIU Xuanchen, LI Jie, MA Jiguang
    2022, 18 (5):  450. 
    Abstract ( 204 )   PDF (417KB) ( 109 )  
    Fat grafting has been widely used in the reconstruction of tissue defects, cosmetic filling, or other fields. The improvement of survival rate is of great importance in fat grafting. Extracellular vesicles (EVs) secreted by adipose-derived stem cells improved the survival rate of fat grafting when co-transplanted with granular fat. The definition, extraction, transplantation methods of EVs, and the mechanism of EVs in improving the survival rate of fat grafting were reviewed. The shortcomings of existing studies on EVs were summarized, and the direction for future studies were also provided in this review.
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    Preparation and research progress of adipose decellularized tissue with different properties

    HU Yuling, QI Zuoliang (
    2022, 18 (5):  454. 
    Abstract ( 494 )   PDF (536KB) ( 404 )  
    As a new therapeutic method, the application of tissue engineering in plastic and reconstructive surgery has been paid more and more attention by clinicians and researchers in recent years. However, the common scaffolds have some shortcomings such as low plasticity or poor biocompatibility. It is still a hot spot to find an ideal scaffold material. Decellularized adipose tissue refers to the acellular extract of adipose tissue after a series of operations, which can simulate the characteristics of natural adipose extracellular matrix and has good biocompatibility and adjustability. In the future, it can be used as a new type of biological scaffold in plastic and reconstruction surgery. In t
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    Research progress on clinical applications of platelet-rich fibrin in plastic and reconstructive surgery

    GU Tianyi, TENG Li
    2022, 18 (5):  458. 
    Abstract ( 211 )   PDF (443KB) ( 158 )  
    Platelet-rich fibrin (PRF) is a new generation of platelet concentrates. It is obtained by centrifuging whole blood without any additives. So the production procedure is very simple. It is rich in various growth factors and cytokines, which can accelerate tissue repair and regeneration. PRF has attracted more and more attention. But reported studies are mostly in dentistry and orthopedics. Reports in the plastic and reconstructive field are rare. In order to provide fully understanding for plastic surgeons regarding to PRF, the preparation techniques, derivatives and clinical applications in plastic surgery were reviewed in this paper.
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    Innovation of microsurgery education in the 5G era

    LUO Shenying, GU Shuchen, LIU Yunhan, et al
    2022, 18 (5):  462. 
    Abstract ( 162 )   PDF (453KB) ( 134 )  
    Compared with the previous four generations of mobile communication networks, 5th generation mobile communication technology (5G) possesses characteristics such as high speed, minimal delay and high connection density. As 5G technology is beneficial in realizing human-machine interactions, it has now been gradually promoted in various fields. In this paper, focused on the current shortcomings and dilemmas of microsurgery education, the approaches to enhance the delivery of microsurgery education through combination of 5G technology with ultrahigh resolution imaging, big data storage, extended reality, 3D printing and artificial intelligence were discussed, which are particularly important in remote teaching, live guidance, precise training, as well as improving the accessibility and standardization of education resources. The limitations and challenges of the dissemination of 5G technology, proposing prospects and new thoughts on the delivery of microsurgery education in the 5G era were also discussed.
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