[Show abstract][Hide abstract] ABSTRACT: We herein report a successful preconstruction of the pars pendulans urethrae with the ileum mucosa for phalloplasty in a one-arm patient using a prefabricated anterolateral thigh flap. After a 2-stage operation and an 18-month follow-up, the patient achieved a good postoperative appearance and an excellent function of neophallus. We believe the use of digestive mucosa for urethral reconstruction enlightens us and deserves further comprehensive clinical studies.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of Reading man flap for the closure of round or elliptical-shaped defect.
Based on the asymmetric Z flaps, F1 (triangular flap) and F2 (rectangular flap) flaps were designed to cover the round or elliptical-shaped defects. The flaps size ranged from 0.8 cm x 0.8 cm to 9.0 cm x 8.0 cm.
From 2008 to 2011, 32 cases were treated without infection or dog-ear deformity. Less than 5% of local necrosis happened in one flap, which healed spontaneously after dressing. Delayed healing happened in 5 cases. The scar after operation was inconspicuous.
Reading man flap can be designed flexibly. It is a good option for the closure of round or elliptical-shaped defects.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 03/2013; 29(2):94-6.
[Show abstract][Hide abstract] ABSTRACT: In 1990, Jiang Hua introduced a new method using one-stage reconstruction with free abductor hallucis muscle transfer for dynamic reanimation of established unilateral facial paralysis. The authors present their experience with this procedure and analyze the postoperative complications and long-term functional and aesthetic outcomes.
From March of 1990 to March of 2010, 45 patients underwent the free abductor hallucis muscle transfer procedure in the authors' department. Forty-one were followed up for 54.6 months (range, 28 months to 17 years). The Toronto Facial Grading System and Facial Nerve Function Index were used to evaluate facial nerve function at 2 years after surgery and last follow-up. Complications and function of the donor foot were analyzed.
No postoperative mortality was found. Complications occurred in four of 41 patients, including muscle loss, infection, hematoma, and hypertrophic scar. The others obtained satisfactory symmetric faces in the static state and in voluntary contraction of the transferred muscles. Mean values for the Toronto Facial Grading System (50.6±7.8) and the Facial Nerve Function Index (65.7±11.4 percent) were significantly higher at 2 years postoperatively in comparison with preoperative status (21.2±5.3 and 19.5±3.6 percent, respectively) (p<0.05). Long-term outcomes (Toronto Facial Grading System, 54.8±6.9; Facial Nerve Function Index, 79.4±9.6 percent) were awarded higher values than early outcomes shown at 2 years postoperatively (p<0.05).
Free abductor hallucis muscle transfer is safe and effective in dynamic reanimation of longstanding unilateral facial paralysis. Favorable long-term results demonstrate that the authors' technique is an alternative method for facial reanimation.
Plastic and Reconstructive Surgery 08/2012; 130(2):325-35. DOI:10.1097/PRS.0b013e3182589d27 · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To present our experience of vaginal reconstruction with the use of a pedicled ileum segment and laparoscope assistance, and to analyze its complications and long-term anatomic and functional results.
The abdominal and perineal approaches were performed simultaneously with the patient in a special position. Under the guidance of laparoscopy, the target ileal segment was harvested and transposed down to the perineum through an artificial tunnel between the bladder and the rectum. A silicon vaginal tutor was introduced into the vaginal cavity and maintained all day long for 2-3 months. The complications and the anatomical and functional results were summarized and analyzed.
From February 2002 to June 2010, 82 patients underwent laparoscope-assisted total vaginal reconstruction with a pedicled ileum segment at our department. Complications developed in 16 of 82 patients, including rectum and/or bladder injury during operation, acute renal failure, delayed healing of the ileocutaneous anastomosis, introital stenosis, and partial or complete intestinal obstruction. The abdominal cutaneous scar was acceptable after the surgery. The vulva was not altered, which was especially significant for patients with congenital vaginal atresia. The neovagina was patent, soft, moist, and flexible. The mean width and depth of the neovagina at the latest postoperative visit measured 3.2 and 15 cm, respectively.
The favorable long-term anatomical and functional results demonstrate that our technique is ideal for patients with congenital vaginal atresia or patients who need secondary vaginal reconstruction. For the primary male-to-female transsexuals or hermaphrodites, it can be an alternative method for vaginal construction.
World Journal of Surgery 07/2011; 35(10):2315-22. DOI:10.1007/s00268-011-1187-3 · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the course and distribution of buccal and marginal mandibular branches of facial nerve, and its relevance to the treatment of facial paralysis and the protection of facial nerve during surgery.
12 cadaver heads were dissected (24 specimens). The course of the buccal and marginal mandibular branch and the interconnections between them were observed. The relationship of buccal branch to parotid duct, marginal mandibular branch to the inferior border of mandible were studied. With modified Sihler's staining technique, the distribution of facial nerve branches in innervated mimetic muscles was displayed. These anatomic relationships mentioned above were further confirmed during the operation of 40 patients with facial paralysis.
Parotid duct had a constant surface landmark. Buccal branch mainly consisted of 2-3 ramifications in 87.5% of the specimens, while marginal mandibular branch was double or single in 95.9% of the specimens. The buccal branch coursed within the distance between 10.7 mm above and 9.3 mm below the parotid duct, and innervated mimetic muscles of midface. The marginal mandibular branch coursed within the distance between 13.4 mm above and 4.8 mm below the lower border of mandible, crossed superiorly the facial artery and innervated mimetic muscles of lower lip.
There is a close relationship of buccal branch to parotid duct and marginal mandibular branch to facial artery and lower border of mandible. With modified Sihler's staining technique, the original 3-dimensional picture of the intramuscular nerve distribution in human mimetic muscles.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 10/2007; 23(5):434-7.
[Show abstract][Hide abstract] ABSTRACT: To investigate the possibility of Laparoscopic reconstruction of vagina using pedicled ileal autograft and provide a new procedure of colpopoiesis.
The abdominal and perineal approaches were performed simultaneously under a sufficiently deep general anaesthesia. Laparoscopically, a 15-18 cm segment of the ileum on its vascular pedicle, ileal branches of the superior mesenteric artery and its concomitant veins, was selected and isolated for transplantation using ultrasonically-powered instruments. The distal of the transferred ileal segment was 15cm apart from the ileocecal junction. The ileum continuity was restored immediately by end-to-end anastomosis and the distal oral of the transplant was closed using a curved intraluminal stapler. Meanwhile, a neovaginal tract was completed to dissect from the perineum into the peritoneum and the tract widened laterally. Then the ileum transplant was reversed to reach the perineum through the peritoneal incision at the top of the neovaginal tract without subjecting the mesenteric neurovascular pedicle to undue tension and subsequent necrosis. The oral edge of the ileum transplant was sutured to the perineal skin.
Followed up for over 1-53 months postoperatively, 36 patients who received laparoscopic vaginoplasty by transferring ileal segment flaps got satisfactory neovaginal function similar to a normal vagina with mucus and moistness.
The advantages of using a laparoscopic ileum colpopoiesis are that (1) satisfactory neovaginal function similar to a normal vagina with mucus and moistness, (2) no disturbance of bowel function, (minimal scarring in abdominal wall and less secondary deformity in perineum and (3) no need for frequent dilation or stent wearing to the reconstructed vagina. And so laparoscopic vaginoplasty was a preferable alternative of vaginoplasty.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 10/2006; 22(5):339-42.
[Show abstract][Hide abstract] ABSTRACT: To study the effect and the key points in the operative procedure of the one-stage reconstruction of postburn whole auricle defect with medpor car scaffold covered with superficial temporoparietal fascia (TPF) flap.
Medpor car scaffold was embedded under the superficial temporal (TFP) fascia. Razor-thin skin was grafted onto the surface of the fascia flap.
Fifteen patients with postburn whole auricle defect were treated by one-stage reconstruction with Medpor ear scaffold during the last four years. It was successful in all the patients with satisfactory appearance of the reconstructed ears.
Medpor possessed friendly biological compatibility. The reconstruction gave satisfactory results, and its advantages consisted of short operational time, easy manipulation, less injury to patients and good auricular contour.
Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 09/2004; 20(4):226-8.
[Show abstract][Hide abstract] ABSTRACT: To introduce a compound external ear framework characterized by few complications, simplicity and very low rate of implant exposure or absorption.
A compound auricular framework, being composed of the ninth autogenous costal cartilage as ear rim and Medpor ear base, was used in one-stage total ear reconstruction. All patients were followed up postoperatively.
Nine cases have been performed clinically using this compound framework and all of them achieved satisfactory efficacies. The reforged ears looked natural and achieved superior cosmesis, and none of them experienced ear rim fracture or implant exposure or distortion.
This compound auricular framework has advantages of practicability, simplicity and minimal complications. It may be an ideal framework for the reconstruction of total external ear at present.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 04/2004; 20(2):121-3.
[Show abstract][Hide abstract] ABSTRACT: To investigate the role of tumor necrosis factor alpha: TNF-alpha in the hypertrophic scar and find a valid way to treat the hypertrophic scars with gene therapy.
TNF-alpha mRNA expression was tested with a semiquantitative reverse polymerase chain reation (RT-PCR) method in the different period of a hypertrophic scar.
There was a significant increase of TNF-alpha mRNA as the hypertrophic scar was getting mature (P < 0.01). However, the ratios of TNF-alpha mRNA was significantly in a lower level than the normal scar.
The results suggest that TNF-alpha may play an important role in normal would healing, but the hypertrophic scar may result from the shortage of the TNF-alpha. This indicates that to increase the TNF-alpha with gene therapy may be a good way to treat the hyphertrophic scar.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 02/2004; 20(1):57-9.
[Show abstract][Hide abstract] ABSTRACT: To explore the expression of hyaluronic acid (HA) and its receptor, Cluster of differentiation 44 (CD44) in proliferative scar and in the process of wound healing of normal human adult skin and fetal skin, and the effect of HA and its receptor on the process of human fetal skin scarless healing.
An incision and then a hypodermic cavity were made on each side of the dorsal median line of 32 female adult BALB/c rats. Skin grafts from 8 human fetuses delivered by natural abortion, full-thickness skin grafts from 8 normal adults undergoing plastic operation, skin wound sample from the donor sites in legs of 8 patients undergoing dermatoplasty with intermediate split thickness skin graft, and proliferative scar from 8 patients of plastic surgery, non-adult and adult, were grafted into the hypodermic cavities. The levels of HA and its receptor were examined by radioimmunoassay, immunohistochemistry and flow cytometry.
The level of HA in normal fetal skin was 143 micro g/g +/- 10 micro g/g, 283 micro g/g +/- 12 micro g/g 12 hours after injury, 315 micro g/g +/- 12 micro g/g one days after injury, reached the peak (321 micro g/g +/- 12 micro g/g) 3 days after injury, and then decrease, became 319 micro g/g +/- 11 micro g/g one week after injury (P > 0.05 in comparison with that 3 days after injury). The level of HA in normal fetal skin was 143 micro g/g +/- 10 micro g/g, significantly higher than that in normal adult skin (51 micro g/g +/- 4 micro g/g), skin wound of normal adult (92 micro g/g +/- 6 micro g/g), and proliferative scar (72 micro g/g +/- 5 micro g/g, all P < 0.01). The level of HA in wounded adult skin was significantly higher than that in the proliferative scar, and even much higher than that in normal skin (P < 0.01). The level of CD44 in normal fetal skin was significantly higher than that in proliferative scar and adult skin (all P < 0.01). The level of CD44 in wounded fetal skin 24 hours after injury decreased, significantly lower than that in normal fetal skin. There was no statistically significant difference between the level of CD44 in fetal skin one week after injury and that 24 hours after injury (P > 0.05). The level of CD44 in wounded adult skin was significantly higher than that in the normal adult skin (P < 0.01). The level of CD44 in the proliferative scar was between the level of CD44 in normal adult skin and that in wounded adult one. In normal fetal skin, CD44, positively stained at a moderate level, was distributed in keratinized cells, basic cells of hair follicle, and fibroblast of dermis. After injury, staining of CD44 became milder, especially by the incision. Immunohistochemistry showed that in normal adult skin, CD44 was distributed mainly in fibroblast of dermis and basic cells of hair follicle, weakly positively stained. After injury, the staning became stronger.
The expression of HA and its receptor during the process of wound healing in human fetal skin is different from that in proliferative scars and adult skin, which might be one of the important causes of scarless healing of wounded fatal skin.
[Show abstract][Hide abstract] ABSTRACT: To explore the differences of PDGF and EGF expression in the wound healing between fatal and adult.
With the established animal model of fetal scarless healing and the adult samples, an immunohistochemical technique was used to evaluate the expression of PDGF and EGF in the normal adult skin, normal fetal skin, and the process of their wound healing.
1. The expression of the PDGF was not found in the fetal skin, but a mild amount of the PDGF was shown in the epidermis and the upper dermal layer 12 hours and 1 day after the wounding process. In the normal adult skin, expression of PDGF was shown in the dermal fibroblasts, macrophagocytes and blood capillaries, and a strong expression was presented during its wound healing process. 2. In the fetal skin, the expression of the EGF was seen in the epidermis, hair follicles, sebaceous glands and sweat glands, but there were no markedly changes during the wound healing. In the adult skin, a positive stain of the EGF was shown in the basal layer of the epidermis while the mild stain in hair follicles and sweat glands. The level of the expression became gradually decreasing with the time going in the wounded adult skin.
The different expression of growth factors between fetal and adult skin in wound healing may be one of the important reasons that the fetal wound could produce scarless healing.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 06/2003; 19(3):199-202.