Objective:To investigate the validity and the outcome of a new surgery method that utilizes lateral great toe flap to decoratively reconstruct the thumb pulp loss.Methods:From Jan.2009 to Jan. 2014 , 22 cases with unilateral thumb pulp defect were included, for whom, lateral great toe flap was de-ployed to reconstruct the thumb.Blood circulation was re-established by the anastomosis of the digital vessels of toes and fingers in 18 cases, the other 4 cases were conducted by a dorsal metatarsal artery and vein anastomosed to the deep branch of the radial artery and the dorsal metacarpal vein respectively; as for the nerve repair, toe-to-finger digital nerve anastomosis was performed.The donor sites were covered by full-thickness inguinal skin grafts.Results:All the 22 flaps survived without complications.With 6 to 12 months follow-up, the surviving fingers all presented aesthetically pleasant appearance with vivid loops and whorls.Normal functions like sweating were restored as well, and the two-point-discrimination ranged 3.0 to 6.0 mm (4.2 mm in average).The skin grafts to the donor sites healed uneventfully, the appearance and functions of the feet were unaffected.Conclusion: Lateral toe flap should be the first-line choice for reconstructing thumb defect, as it conveniently restores both functions and outlook.

OBJECTIVETo explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.

METHODSSix patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps. Afterwards, a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.

RESULTSAll six free scapular flaps survived without signs of infection. Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex, which resolved after six weeks with only conservative therapy. All the incisions healed without other complications. At six-month follow-up, the patients regained full shoulder function.

CONCLUSIONWith the assistance of an adjacent pedicled flap, the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar. It can achieve positive outcomes in both reconstructive and aesthetic aspects.

Adult ; Arm Injuries ; surgery ; Debridement ; Drainage ; Female ; Hand Injuries ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Scapula ; blood supply ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome

Objective: To investigate the clinical effect of modified three minimally invasive blepharoplasty of double-fixation method. Methods: From April 2015 to December 2016, 82 patients were included, all received minimally invasive blepharoplasty. Three 3 mm-long small incision (at medial, middle and lateral) were designed, then part of the orbicularis oculi muscle and pretarsal fat were removed. Pretarsal fascia was then sutured with orbicularis oculi muscle and skin with two-layer-suture to form double eyelid respectively. Results: With up to 18 months follow-up, all patients had short period of detumescence within 7-12 days, high satisfaction rate with long lasting and natural double eyelid shape were achieved, no obvious scarring was noted. Conclusions Modified three minimally invasive blepharoplasty of double-fixation method has presented the merits of accurate presentation, natural shape, quicker recovery and less trauma, which makes it worthy of clinical presentation.

The concept of depressor orbicularis lateralis arises through anatomy of brow ptosis and innovations of its correction. This vertical muscle band is usually found running inferiorly from the lateral brow down along the lateral orbital rim, adjacent to the orbicularis oculi. The muscle segment is a powerful depressor of the brow and may lead to recurrent lateral eyebrow ptosis, if it is not addressed at the time of the facelift. In this review, the anatomical evidence, basic functions of depressor orbicularis lateralis, as well as its clinical relevance and the proper measures in handling this structure as part of brow ptosis and crow′s feet surgery will be discussed.

Objective:To introduce a method of combining autologous rib graft and a silicone plate as a composite graft for augmentation rhinoplasty.Methods:Twenty-two female patients were included in this series. Eleven cases had unsatisfactory nasal appearance Nine cases were admitted for postoperative graft warping, and refused to harvest a second costal cartilage, thirteen cases had limited amount of rib graft for harvest. When cartilage was insufficient for a full dorsal onlay graft, a L-shaped silicone nasal implant would be used and carved into a plate-like, so as to make into a composite graft with the cartilage on top of the silicone plate.Results:Up to 12-month follow-up was conducted, averaged 6.2 months. One case exhibited temporary ischemic signs at the incisions, resolved by compressive taping at day 5.For all other 21 cases aesthetic outcomes were satisfactory with no graft infection, extrusion or other complications. The dorsal only graft did not significantly transilluminate.Conclusions:Rib-silicone composite dorsal graft is an applicable and safe method in augmentation rhinoplasty surgeries, particularly when there is limited amount of cartilage available.

Objective:To discuss a surgical method that reduces the notch tension and assists in suspending and lifting the skin after reposition so as to relieve scar and to prevent alopecia and maintain long-term lifting effect.Methods:After forehead or temporal open incision rhytidectomy, 2-0 absorbable sutures were used to pass through the intradermal at the hairline and skin junction in front of the incision. After that, the sewing needle passed through the whole skin flap vertically from the two points of the suture inlet and outlet, and then sutured on the deep temporal fascia or galea aponeurotica, in order to reduce tension of the main anchor point of the incision and to assist suspending the elevated flap. Afterwards, the width of the skin excision was determined according to the skin relaxation, the subcutaneous relaxation suture of scalp incision was conducted and the incision closed with nailing device.Results:From June 2016 to October 2018, this method was applied in 33 cases of rhytidectomy. In the early postoperative period, the skin around the hairline had a slight appearance of accumulation due to the traction of sutures, which gradually disappeared with time. During the long-term follow-up, 2 patients had hair loss near the incision, and the hair density decreased. The remaining patients had no obvious scar hyperplasia and alopecia, and no long-term skin accumulation. The facial rejuvenation effect was good, and the satisfactory rate of patients was high.Conclusions:The technique of intradermal tension reduction combined with suspension suture redistributes the tension and significantly reduces the scar hyperplasia and baldness at the incision. Meanwhile, the suture also plays the role of accessory suspension, which helps to increase the stability and durability of facial tissue; the whole procedure is simple, safe, and long lasting.

Facial rhytidectomy is one of the most complex and unpredictable procedures in the field of cosmetic and plastic surgery, aiming to rejuvenate the face. The facial rejuvenation surgery began in the early 20th century. The purpose of the surgery is to alleviate the aging characteristics of the skin, fascia, fat and other tissues of the face and neck by surgical means. In China, due to historical development and other factors, it started late. From the late 1980s to the early 1990s, Song Yeguang and other pioneers took the lead in venturing into this field. With the significant growth of the economy and the increasing attention from both medical professionals and marketing to cosmetic surgery, surgeons in this era have made substantial contributions to the systematic and standardized advancement of rhytidectomy surgery. However, with the understanding of the aging process of the face and the in-depth study of the changes in the anatomy and tissue structure of the face and neck, surgical techniques have evolved from simple to complex, and gradually improving over time. Through long-term observation of the surgical outcomes, the surgical technique has evolved from complex to simple. The purpose of this paper is to summarize the evolution of rhytidectomy in China by reviewing the literature from previous years.

Objective:To construct the risk prediction nomogram model of acute kidney injury (AKI) with R language and traditional statistical methods based on the large sample clinical database, and verify the accuracy of the model.Methods:It was a a retrospective case control study. The patients who met the diagnostic criteria of AKI in Tongji Hospital of Tongji University from January 1 to December 31, 2021 were screened in the clinical database, and the patients with monitored serum creatinine within 48 hours but without AKI were included as the control group. The demographic data, disease history, surgical history, medication history and laboratory test data were collected to screen the risk factors of AKI in clinic.Firstly, based on multivariate logistic regression analysis and forward stepwise logistic regression analysis, the selected risk factors were included to construct the nomogram model. At the same time, cross validation, bootstrap validation and randomly split sample validation were used for internal verification, and clinical data of patients in the sane hospital after one year (January to December, 2022) were collected for external verification. The receiver-operating characteristic curve was used to determine the discrimination of the model, and calibration curve and decision curve analysis were carried out to evaluate the accuracy and clinical net benefit, respectively.Results:A total of 5 671 patients were enrolled in the study, with 1 884 AKI patients (33.2%) and 3 787 non-AKI patients (66.7%). Compared with non-AKI group, age, and proportions of surgical history, renal replacement therapy, hypertension, diabetes, cerebrovascular accident,chronic kidney disease, drug use histories and mortality in AKI group were all higher (all P<0.05). Multivariate logistic regression analysis showed that the independent influencing factors of AKI were surgical history, hypertension, cerebrovascular accident, diabetes, chronic kidney disease, diuretics, nitroglycerin, antidiuretic hormones, body temperature, serum creatinine, C-reactive protein, red blood cells, white blood cells, D-dimer, myoglobin, hemoglobin, blood urea nitrogen, brain natriuretic peptide, aspartate aminotransferase, alanine aminotransferase, triacylglycerol, lactate dehydrogenase, total bilirubin, activated partial thromboplastin time, blood uric acid and potassium ion (all P<0.05). Finally, the predictive factors in the nomogram were determined by forward stepwise logistic regression analysis, including chronic kidney disease, hypertension, myoglobin, serum creatinine and blood urea nitrogen, and the area under the curve of the prediction nomogram model was 0.926 [95% CI 0.918-0.933, P<0.001]. The calibration curve showed that the calibration effect of nomogram was good ( P>0.05). The decision curve showed that when the risk threshold of nomogram model was more than 0.04, the model construction was useful in clinic. In addition, the area under the curve of receiver-operating characteristic curve predicted by nomograph model in external validation set was 0.876 (95% CI 0.865-0.886), which indicated that nomograph model had a high discrimination degree. Conclusion:A nomogram model for predicting the occurrence of AKI is established successfully, which is helpful for clinicians to find high-risk AKI patients early, intervene in time and improve the prognosis.

Objective:To explore the experience and clinical effect of endoscopic assisted resection of septal cartilage and ethmoid bone vertical plate in rhinoplasty.Methods:Twenty women with short noses underwent septal extension graft from February 2018 to September 2019. Endoscopic technique was utilized to harvest the septal cartilage and ethmoid vertical plate. During the operation, the average area of septal cartilage was 22 mm × 15 mm, the average area of ethmoid bone vertical plate was 26mm × 16mm, and the septum retained a 10 mm wide " L" sturt. The septal cartilage and the vertical plate of the ethmoid bone were used as the columella strut and the extension graft respectively to reconstruct the shape of the tip of the nose. Expanded polytetrafluoroethylene was implanted in the nasal dorsum to increase its height.Results:The patients were followed up for 3-12 months at an average of 9 months. 20 patients achieved straight back of nose, symmetrical arch of nose and no deviation of columella. The tip of nose is soft without rigidity. There was no exposure of prosthesis or perforation of nasal septum. There was significant differences in the distance between the root and tip of nose before and after operation ( P<0.05). 2 patients complained of olfactory hypoesthesia and recovered spontaneously after 4 months. 1 patient was not satisfied with the improvement of the nasal projection. There was no obstruction of nasal ventilation and other dysfunction after operation. Conclusions:Endoscopy can assist the operator to harvest the septal cartilage and ethmoid bone vertical plate safely and accurately. The extension of nasal septum prepared by the cartilage of nasal septum combined with the vertical plate of ethmoid bone can effectively increase the length of nose.

Objective:To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods:from December 2016 to October 2019, 42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method. The incision was the classic temporal to peri-auricular incions. After the skin flap and superficial musculoaponeurotic system(SMAS) flap was elevated. The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation. The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results:After 9-12 months of follow-up, the facial aging characteristics were significantly improved, especially sagging mandibular bag and loose perioral skin. The volume of middle face was restored with natural contour. Post-operative complications included local facial depression (2 patients), slight asymmetry (1 patient) and mild tactile abnormalities (1 patient). Satisfaction survey showed that 28 patients were very satisfied, 12 were satisfied and 2 were dissatisfied. The subjective satisfaction rate was 95.2% (40/42). There were no serious complications such as facial nerve injury or flap necrosis.Conclusions:This technique has a good outcome combined with conventional rhytidectomy, as it can achieve good effect of rejuvenationin the middle and lower face.