Objective To investigate the application of the three-dimensional reconstruction for the random flap.Methods The bones,muscles,fascia,skin and vessels in eleven patents were reconstructed by the MIMICS 10.01 CT angiography (CTA) scanning,and the single artery and its branches were gained by the subdivision of the vessels.3D-images were shown respectively and jointly.Results Arterial reconstruction images were clearly displayed by 3D workstation CTA and if they were combined with the original cross-sectional images and vessel analysis software,they were able to accurately evaluate the location,range,degree of artery,the distal outflow tract.The vessels and soft tissue displayed in the software could show detailed distribution of the vessels in one region and this could provide the accurate anatomical basis for the random flap and the design of the operation.This method could easily meet the preoperative design demands and also had the guiding significance for postoperative evaluation.Conclusions The method of 3D-reconstruction is very good for studying the random flap and the design of the operation.

Objective To investigate the treatment methods of tissue defects in nose and lower eyelid area.Methods Based on the impaired area,combined pre-expansion of forehead and facial region was adopted.The volume of soft tissue expander was determined.150-170 ml expander was implanted between frontalis muscle and periosteum of forehead,while at the facial region,and the volume of expander should be determined by the normal skin area as large as possible.The excision of impaired tissue was performed after sufficient expansion,and then skin flap or transposition skin flap were advanced at the facial region.At forehead,ortho-position skin flap based on supratrochlear vessels was designed for repairing the nose and palpebra inferior region.Three weeks later division of the ortho-position skin flap was carried out.With the flattened pedicle,the rest part of impaired area was replaced.Results Six cases were performed with this method.For all the cases,the survival rate of flap was 100％.Esthetic appearance and satisfying color-match were achieved,without appearance of lower eyelid ectropion.Conclusions Combined pre-expansion of forehead and facial region is an ideal method in treatment of the defects in nose and lower eyelid area.

Objective To discuss the clinical aesthetic effect of vermilion repair on cleft lips after using double-line reconstruction.Methods 68 children with cleft lip were repaired according to the principle of double-line reconstruction,and two contents including 7 projects,such as shapes of upper lips,vermilion borders of lips,vermilion shapes and lips,etc,were evaluated comprehensively within one month after operation for assessing the postoperative effect.Results 68 cases were followed up,with the follow-up rate of 100％,and 62 cases (91.2％) were satisfied with the vermilion repair.Six cases (8.8％) had a common effect of vermilion shapes after repair.In the 7 contents evaluated,satisfactory results were achieved in the projects except the relatively poor symmetry vermilion borders of lips.Conclusions The double-line reconstruction helps to improve the aesthetic effect of vermilion repair on cleft lips.

Objective To evaluate the curative effect by using transmission straight wire appliance in treatment of adult patients with protruding,to compare with MBT straight wire technique,and to discuss their similarities and differences.Methods Totally 40 protruding patients were assigned into two groups randomly:the transmission straight wire technique group were treated with transmission straight wire appliance,and the MBT straight wire technique group were treated with MBT appliance together with extraoral arch or screw implant anchorage.Cephalometric measurements were compared before and after treatment.Results Average period of treatment was (19 ±4) months for transmission group and (23 ± 4) months for MBT group.The difference was statistically significant (P＜0.05).After treatment,U1/SN,U1/NA,U1-NA,L1/NB,L1-NB,U1-AP,L1-AP,UL-EP,LL-EP were significantly reduced for both patients groups (P＜0.01).U1/L1,nasolabial angle and z angle were increased for both groups (P＜0.05).MP/SN increased by 1.93°(P＜0.05)for transmission group vs.0.81° (P＞0.05) for MBT group.There was no statistically significant difference between the two groups (P＞0.05) except MP/SN (P＜0.05).However,the retraction of anterior teeth in transmission group was greater than that of MBT group,and U1/NA changed (-20.95±8.79)° in transmission group vs.(-16.00 ± 6.52)° in MBT group.Conclusions Both techniques can achieve satisfactory results for protruding cases.The transmission technology can improve soft tissue profile quicker,but anterior teeth have excessive vertical trend,where attention should be paid to control torque on anterior teeth.

Objective To observe the effect of hydrocolloid dressings with instant ice compress on the healing process,postoperative pain and efficacy of patients with acne scar treated by 2940 nm erbium pixel laser.Methods We selected 60 patients with acne scar from November 2012 to June 2014 treated by the erbium pixel laser.They were randomly divided into two groups:hydrocolloid dressings with ice compress after treatment were used in observation group (n=37)and postoperative wound dry were kept in control group (n=23);pain,duration of burning,erythema duration,efficacy,decrustation time,postoperative complications were evaluated and quantitatively analyzed.Results Compared with the control group,the application of hydrocolloid dressings with ice compress group (observation group) received less postoperative paim postoperative VAS pain score was (5.81± 0.64) in observation group and (6.09±0.69) in control group;duration of burning was shorter:(1.86± 0.75) h in observation group and (3.65±0.93) h in control group;duration of erythema was shorter:(2.27±0.73) d in observation group and (3.52 ±0.79) d in control group;decrustation time was shorter:(5.76± 1.06) d in observation group and (8.09±0.95) d in control group;postoperative complications were reduced:(5.4％,2/37) in the observation group and (30.4％,7/23) in the control group,with statistically significant difference (all P＜0.05).The differences were not statistically significant in the intraoperative VAS score and the curative effect.Conclusions The application of hydrocolloid dressing with instant ice compress after erbium pixel laser in the treatment of acne scar can effectively reduce postoperative pain and burning sensation,shorten the duration of erythema and crusting time after operation.It also reduces the incidence of complications.

Objective To report the effect of expanded neck and mastoid region flap in the reparation of facial scars.Methods Total 8 patients were included from January 2007 to May 2011.Tissue expanders were implanted in the neck and mastoid region after we selected suitable expander on the basis of an area of facial scars.Three to six months later,the expanded neck and mastoid region flap was used to repair large area of facial scars.Results From January 2007 to May 2011,we used expanded neck and mastoid region flap to resurface the facial scars in 8 patients.One patient appeared small size of necrosis (0.3 cm× 2.0 cm to 0.5 cm× 2.0 cm) in the distal area and healed after dressing changes.All the other patients healed completely.The period of follow-up was 6 months to 2 years.The flaps matched well to the surrounding skin in terms of color and good texture.Conclusions The method of combined expander neck and mastoid region skin flaps to repair facial scars is suitable.We believe this is a good option of repairing large area of facial scars.

Objective To explore the effect of subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction on moderate and severe inverted nipple.Methods 33 patients with 59 moderate and severe inverted nipples were involved in this study.The bilateral subcutaneous triangular composite tissue flaps pedicled with the base of the nipple were harvested within areola,the two triangular composite tissue flaps were revolved and advanced either horizontally to the opposite pedicle through the tunnel beneath the nipple and fixed as supporting.After the operation,the continuous distraction of the nipple lasted for two to four weeks,clinical effect and complications were analyzed.Results None of these 59 nipples appeared blood circulation disorder after operation.Postoperative follow-up for 6 months to 3 years showed that 54 inverted nipples were corrected completely without complications,such as nipple and areola necrosis,and there were no recurrence.The patients and doctors were satisfied with the appearance of the nipples.Conclusions Correcting the moderate and severe inverted nipple with subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction is simple,microinvasive,effective,and the incision scar is invisible,and it therefore is an ideal method for correcting the inverted nipple.

Objective To observe the surgical effect of nipple retractor to inverted nipples.Methods Between January 2001 and January 2014,this nipple retractor to inverted nipples was used to correct 604 inverted nipples of 322 patients.The follow-up period ranged from 6 to 24 months.The clinical results and complications were evaluated.Results Excellent nipple morphology and patient satisfaction were achieved in 211 cases (93.8 ％),basically normal nipple morphology and patient satisfaction were achieved in 12 cases (5.3％),and recurrent nipple inversion occurred in three cases (1.3％).The latter three patients had experienced failed open correction for their inverted nipples,and some degree of nipple inversion occurred after removal of the frame.In this study,28 patients (12.4 ％) experienced successful pregnancy and breast-feeding.No loss of nipple sensation occurred in 225 cases.Nipple erection was observed after stimulation in 215 cases (95.6％).Conclusions The described technique is minimally invasive,simple,safe,and reliable.Satisfying aesthetic results can be achieved without destroying breast feeding function and nipple sensation.

Objective To study the efficacy of medial plantar island flap for repairing soft tissue defect of the heel after excision of melanoma.Methods Five patients (including 3 males and 2 females) with malignant melanoma were treated.All lesions were located in the heel and were proved by pathological examination.Local extensive resection was performed in all cases.The surgical margin used for excision of melanoma was 2 cm,and the depth used was deep into periosteum of the calcaneus.Plantar medial artery island skin flaps were applied in the reparation according to the size of heel soft tissue defect and anatomic study.The postoperative follow-up was 8 to 14 months.Results The surgical reparation was successful in all 5 cases.The plantar medial artery was very suitable to cover the surgical wound surface and to recover the function and sense.Before 3 months the sense of flaps remained on the donor area and later went to the heel gradually.All patients remained alive and no tumor recurrence was observed.All the patients were walking normally and had protective sensation in the new heel pad comparable to the opposite normal heel.Two patients with more than 10 years follow-up were reported.Conclusions Plantar medial island flap can be used to repair the wound after malignant melanoma resection in the heel,which is an effective method.

Objective To measure the leakage rate in the process of expansion in vivo and in normal saline and the over-expansion property of the expander.Methods We chose 17 cases that were treated with the skin expansion.We recorded total injected saline volume intentionally in these cases before the second surgery,and recorded the remainder of the volume of saline postoperatively.We injected normal saline into 8 expanders,respectively,exceeding 50％ of the volume-rating;and subsequently put these expanders into plastic bucket filled with saline.30 days after,we measured the remaining volume of the normal saline.We injected 100 ml normal saline into 4 expanders,respectively,of which nominal volume was 100 ml,and then left these expanders in saline and measured the remainder volume of the saline 30 days later.In the second time,we injected 150 ml and repeated the abovementioned process.It was repeated 7 times until the injection volume reached 400 ml.We processed the data and depicted a curve of effective expansion.Results The results showed that the leakage rate reached (29.0+12.5) ％ in vivo.Experiments in vitro confirmed that 85.0％ (8.0/9.4) of the saline leaked through the injection port and 14.8％ (1.4/9.4) leaked through the membrane of the expander.In addition,over-expansion performance index test confirmed that the over-expansion property of an expander was about twice the nominal volume.Conclusions The expander is not completely sealed structure.Normal saline can leak through the injection part and the membrane of the expander.The over-expansion property of an expander is limited.When the volume injected into the expander exceeds a certain value,the effective expansion performance is not increased with it.