Objective:To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle.Methods:From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair.Conclusion:A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Purpose: Neoadjuvant therapy modality can increase the operability rate and mitigate pathological risks in locally advanced cervical cancer, but treatment response varies widely. It remains unclear whether genetic alterations correlate with the response to neoadjuvant therapy and disease-free survival (DFS) in locally advanced cervical cancer. Materials and Methods: A total of 62 locally advanced cervical cancer (stage IB-IIA) patients who received neoadjuvant chemoradiation plus radical hysterectomy were retrospectively analyzed. Patients’ tumor biopsy samples were comprehensively profiled using targeted next generation sequencing. Pathologic response to neoadjuvant treatment and DFS were evaluated against the association with genomic traits. Results: Genetic alterations of PIK3CA were most frequent (37%), comparable to that of Caucasian populations from The Cancer Genome Atlas. The mutation frequency of genes including TERT, POLD1, NOS2, and FGFR3 was significantly higher in Chinese patients whereas RPTOR, EGFR, and TP53 were underrepresented in comparison to Caucasians. Germline mutations were identified in 21% (13/62) of the cohort and more than half (57%) had mutations in DNA damage repair genes, including BRCA1/2, TP53 and PALB2. Importantly, high tumor mutation burden, TP53 polymorphism (rs1042522), and KEAP1 mutations were found to be associated with poor pathologic response to neoadjuvant chemoradiation treatment. KEAP1 mutations, PIK3CA-SOX2 co-amplification, TERC copy number gain, and TYMS polymorphism correlated with an increased risk of disease relapse. Conclusion We report the genomic profile of locally advanced cervical cancer patients and the distinction between Asian and Caucasian cohorts. Our findings highlight genomic traits associated with unfavorable neoadjuvant chemoradiation response and a higher risk of early disease recurrence.

Objective:To evaluate the feasibility and clinical effect of resection and repairing the neurofibromatosis type 1 (NF1).Methods:Retrospective analysis was performed with the data of patients diagnosed with NF1 in the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from January 2000 to December 2020. All of these patients underwent resection and repair procedures with flap-transferringor skin-grafting.Results:A total of 34 patients with NF1 were included (16 patients with macrosomia NF1, including two patients with cephalic and facial macrosomia NF1 and 14 patients with extremities and somatic macrosomia NF1). There were 14 males and 20 females, aged from 16 to 46 years, with an average age of 30.4 years. The size of the tumor was 65-2 080 cm 2, with an average of 252 cm 2. Nine patients underwent preoperative interventional embolization of the main blood supply artery after consultation with the interventional department. All patients successfully resected the labeled tumor according to the preoperative plan, among which 33 patients underwent one-stage resection and repair. One female patient with large facial neurofibroma experienced uncontrollable bleeding after partial resection of the tumor during the first surgical resection, and the resection and repair were performed by staged surgery after pressurized bandaging for hemostasis. The bleeding during the operation of other patients was controllable. Fourteen cases were sutured directly after tumor resection. Among which, two cases appeared wound dehiscence within one week after the surgery but recovered well after resutured under local anesthesia. Sixteen cases were repaired by transferring skin flaps, of which five patients suffered from insufficient blood supply of the distal end of the flap and underwent debridement and suturing. Four patients were repaired by skin grafting, of which one patient underwent second skin grafting due to poor survival of part of the grafted skin and recovered well. All patients were followed up for 6 to 36 months (mean 22.6 months). Except for one patient with malignant change and one patient with evident tumor recurrence, no recurrence or malignant change occurred in the other patients, and the surgical effect was satisfactory. Conclusions:The resection and repair of NF1, especially giant NF1, should be based on the location and size of the tumor so as to achieve the one-stage resection and repair as far as possible under the premise of controlling bleeding. Different types of repair methods can be applied according to the location, size, and morphology of the lesion to achieve the purpose of removing the lesion and protecting the morphology and function.

Objective:To explore and summarize the feasibility and effect of repairing Achilles tendon exposure after repair of Achilles tendon rupture with retrograde sural neurovascular flap.Methods:The clinical data of patients with Achilles tendon exposure after repair of Achilles tendon rupture admitted to the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2016 to February 2019 were analyzed retrospectively. Under epidural anesthesia, the necrotic skin and soft tissue were removed entirely, and only the liquefied and necrotic surface of the Achilles tendon was removed. The previous surgical suture of the Achilles tendon was retained. After debridement, the wound surface was covered with a retrograde sural nerve flap. The blood supply and shape of the flap, foot sensation, and ankle function were observed after the operation.Results:The present study included seven patients (four males and three females, aged from 24 to 69 years old, with an average of 45.7 years old). The size of the skin and soft tissue defect at the exposed Achilles tendon was about 2.0 cm × 5.0 cm-5.0 cm × 7.0 cm, and the area of the flap was about 4.0 cm × 7.0 cm-6.5 cm × 9.0 cm. The wounds in the flap donor site of seven patients in this group were closed directly, while one patient whose blood supply of about distal 1 cm of the flap was unsatisfactory ten days after the operation. The patient received a dressing change for 21 days and the wound healed with scar. The other flaps transferred from other patients had a good blood supply, and all wounds in the flap donor site and the defect site healed well. All patients were followed up for 10 to 14 months. The color and texture of the flap were good without obvious bloating. The scar in the operation area was mild, and the heel movement was good. Mild numbness was still felt in the lateral part of the foot in four patients, but no paresthesia was noticed in other patients. The Kofoed ankle score was 78-97, with an average score of 88.3. There were six excellent cases and one good case.Conclusions:The sural neurovascular flap is adjacent to the defect area of Achilles tendon exposure. Although the open repair of Achilles tendon rupture has a certain influence on the skin soft tissue and blood circulation around the Achilles tendon area, it can still form a retrograde sural neurovascular flap with a slightly higher pedicle to repair the Achilles tendon exposure. The donor site can be closed directly with minor trauma. The technique is simple and effective as well.