Objective To discuss the reduction mammaplasty procedures by reserving the T4 nerve and blood vessels and by repairing the ligament for macromastia patients. Meths Eighteen cases of macromastia were enrolled in this study. The supeior and inferior polar portions on the median line of the breast were dissected to form a central pedicle. Outside deep and fleet branches of the ligament were repaired and the lateral deep and fleet branches of the 4th intercostal nerve reserved in the pedicle. The pedicle was revolved and fixed, the fundus of breast was reduced and the tensile force of the ligament was enhanced. The operation of two-flap rotated flaps reduced the breast volume from inside to the outside. The corium where T4 intercostal nerve distributed skin was reserved to protect the fleet branches of the nerve, and then rotated and fixed to act as a fibrous septum. Results After the operation, the blood vessel and feeling of nipple-areola complex were all satisfactory and the profile of breast was tall and straight. Follow-up from 3 months to 2 years (7 months in average) showed that the scar was unconspicuous, the appearance of the breast was not evidently changed and the patients were satisfactory. Conclusion It is a simple and well-designed procedure of reduction mammaplasty for macromastia with repaired ligment and reserved 4th intercostal nerve. The breast profile is tall and straight after the operation.

Objective To discuss the surgical techniques and efficacy of a new method of breast treatment of hypermastia. Methods From January 2009 to February 2011, a series of 15 patients underwent a new technique for reduction mammaplasty. This technique involved a superomedial pedicle nipple-areolar complex (NAC). Results In our series, the resection weight per breast was (522. 9±218.3) g and the new nipple-to-sternal-notch distance was (21.7± 1.74) cm postoperatively. Mean nipple elevation was 8. 5cm (range, 4-16 cm). There were no hematoma and partial or complete NAC necroses occurred in our series. Minimal wound dehiscence occurred in one case ( 6.7 % ). Thirteen patients were followed up for 6 to 18 months. NAC sensibilities were comparable before and after operation, and good breast shapes were produced in all cases. Conclusion The superomedial pedicle technique provides good results with respect to NAC viability and sensibility, breast contour and last superomedial fullness.

Objective To summarize the clinical characteristics of 15 cases of Poland's syndrome and to explore the suitable treatment strategies. Methods A retrospective study of 15 adult patients with Poland's syndrome was conducted and the related literature was reviewed. According to the development of pectoralis muscles and breast, chest deformities were classified into 2 grades: mild and severe. Mild form was limited to absence of partial pectoralis major muscle, with variable hypoplasia of other minor components (such as the size of breast and the size and position of the nipple-areola complex), leading to a mild chest wall asymmetry. Severe form was characterized by absence or severe hypoplasia of the pectoralis major muscle and mammary gland with an evident chest wall asymmetry. Combined with gender, adult patients were divided into 4 types: female mild, female severe, male mild, and male severe. Each type had its own treatment strategies based on its anatomic features: silicone implant insertion for female mild type;latissimus dorsi muscular flap transposition and silicone implant insertion for female severe type;fat injection for male mild type;latissimus dorsi muscular flap transposition for male severe type of the patients. From 2003 to 2008, 15 adult cases were admitted to our ward, aged from 16 to 34 years.The case number of each type was 6, 6, 2 and 1, respectively. One severe female patients rejected any surgical interventions;the others were all treated as the above. Results Follow-up periods ranged from 6 months to 4 years. This series had got satisfactory results with good breast symmetry and natural texture. All the latissimus dorsi muscular flaps survived well. No postoperative complications, such as implant capsular contracture or implant displacement, were observed. Conclusion The manifestations of Poland's syndrome are extremely varied. This classification method is simple but useful, which could effectively direct the individualized treatment for the complete and adequate rehabilitation. Latissimus dorsi muscular flap, pedicled or free transplanted, pulsing silicone implant in females, are the first choices for severe chest deformations of this syndrome.

Objective To study the efficacy of radical surgery for the invasion of chest wall by lung cancers and the different methods of chest wall reconstruction. Methods A retrospective analysis of clinical data was conducted in 27 cases of lung cancer with chest wall invasion in this hospital. 24 cases received lobectomy, 3 cases received pneumonectomy, and all cases received wall reconstruction. The size of chest wall defect after resection ranged from 6.5 cm × 5.4 cm × 5.0 cm to 15.5 cm × 12.5 cm ×10.0 cm. The number of rib resection for each patient ranged from 1 to 4. The reconstructive methods were as follows: using polyester fabric to reconstruct costal pleura, using plexiglass, stainless steel wire and grid-like titanium plate to reconstruct bone defect, and using nearby muscle flap and pedunculated muscle flap to reconstruct muscle defect. Results Pathologic diagnosis was non-small cell lung cancer,including 22 cases of squamous cell carcinomas and 5 adenocarcinomas. There were pulmonary infections in 6 cases, chest hemorrhage in 1 case and chest purulence in 1 case. One-year survival was 77. 9 %,3-yearsurvival was 58.3 %, and 5-year survival was 29. 1 %. Conclusion The lung cancer with chest wall invasion is advisable to make active use of radical surgery. The different methods and repair materials are chosen to reconstruct the chest wall defect, supplemented by comprehensive treatments.

Objective To describe an ideal technique to repair full-thickness lower lid marginal defects in a one-stage procedure. Methods The buccal rotation flap and the nasal septal chondromucosal flap were used in one-stage operation to repair full-thickness lower eyelid defect. Results Eleven patients including 6 male patients and 5 female patients underwent lower eyelid reconstruction since January 2000.The age ranged from 29 to 64 years with average 43. Seven patients with full-thickness lower eyelid defect were caused by basal cell carcinoma excision, while four patients were caused by trauma. All the fullthickness lower eyelid defects were reconstructed by using the buccal rotation flap and the nasal septal chondromucosal flap in one-stage operation. All the flaps survived completely after operation. There were no other complications excepting that two patients developed to mild lower eyelid retration after six months. Conclusion The technique consisting of the buccal rotation flap and the nasal septal chondromucosal flap is a simple and useful alternative procedure to close full-thickness defects in the lower eyelid.

Objective To investigate the feasibility, rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the repair of nasal dorsum collapse.Methods The dermal fat composite tissue block (7.0 cm× 1.0 cm × 1.0 cm) was removed from the buttocks or abdoman as filling materials. 13 cases of nasal dorsum and nasal-shaped misfits were treated by using an umbrella graft of the auricular cartilage plus dermal-fat composite tissue graft to reconstruct natual shape of nasal dorsum and tip. Results The nasal dorsum and tip were repaired in 13 patients with collapsed nasal dorsum. The dermal-fat composite tissue survived well, and the incisions were healed in stage Ⅰ and the incision trace was not obvious. After follow-up for one year, the shape of nose was much satisfactory. Conclusion It is a well-accepted and easy-going procedure to repair collapsed nasal dorsum with autologous dermal-fat or a combination of composite ear cartilage tissue graft, with satisfactory effect and no rejection reactions.

Objective To discuss the effect of cheiloplasty we designed an improved Black procedure that with microsurgical technique the tissue from lateral lips on the bilateral cleft lip were used to reconstruct the skin of anterior lip and the vermilion tubercle. Methods 36 cases of congenital bilateral complete cleft lip deformity were repaired through improved Black procedure and microsurgical method, including 19 patients with very short prolabium tissue, repairing insufficient skin and vermilion tubercle tissue by fissure lateral lip tissue. Results Following-up for 3 months to 3 years after treatment showed that 36 patients were with normal and symmetrical high of anterior lips, the chubby vermilion tubercles, the natural morphous of labial archs, the appropriate strength of labrums and the vermilion tubercles and lips without color difference, and the effects were satisfactory. Conclusion The improved Black procedure redeems the shortages of traditional Black procedure for the case with bilateralcomplete cleft lip and smaller anterior lip, such as the deficient height of anterior lips, eclabium and inadequate vermilion tubercles. By applying microsurgical technique, the procedure gives better upper lip function and aesthetic effect, and therefore it is worthy to be recommended in clinic.

Objective To explore the operation of C-type osteotomy for reduction of prominent zygomatic complex. Methods Based on the severity and characteristics of prominent zygomaitc complex, Ctype osteotomy was designed for the malar complex reduction by using oral and minor pre-auricular approaches under general anaesthesia. Two paralleled osteotomic lines of C-type were marked from zygomatic alveola to the conjunction of lateral orbital margin and zygomatic arch through the inferio-lateral edge of orbit. The extension of zygomatic arch reduction was determined the width of two osteotomic lines. The bone which marked lines was removed by reciprocating saw and osteotome. The zygomatic arch root was osteotomiced by pre-auricular approaches. Then, the zygomatic complex could move freely towards superior-medial position. Finally, the zygoma was fixed with titanium mini-plates. Results 12 patients with prominent zygomatic complex had been successfully operated by C-type osteotomy from July 2006 to April 2009. Of them, six cases were symmetrical and six cases were unsymmetrical. Postoperative follow-up for 4-24 months, infection was not occurred, and the scar of pre-auricular incision was not obvious. All the patients obtained positive results. Conclusion C-type osteotomy for correction of prominent zygomtic complex through intra-oral and minor pre-auricular approach is an effective surgical method and gives superior results. It preserves the intactness of maxillary sinus, prevents facial slack, and is especially effective for patients with prominent zygomatic arch.

Objective To explore the effect of infrared ray treatment on improving fat granules survival rate and reducing postoperative complications in autologous fat transplantation. Methods The patients who received autologous fat transplantation were divided into infrared ray group and control group.Each group was further divided into breast group and face group. These cases in infrared ray group were radiated for 30 minutes with infrared ray 24 hours later after surgery, once a day for sequential 5 days.No treatment was given to the control group. The survival status and complication were observed and statistically analyzed. Results Infrared ray treatment could increase fat granules survival rate after autologous fat transplantation, but no significant effect was acheived on reducing complications. Conclusion Infrared ray treatment is an effective way to enhance the survival rate of fat granules.

Objective To investigate the three methods for sun protection factor determination in vivo in Chinese under the same condition, and to evaluate the feasibility and reliability of the three methods. Methods There were 45 healthy volunteers in Guangzhou area were involved in the study. All of them were randomly divided into three groups. Among them 15 volunteers were in the current method group, 5 volunteers in the simplified method group, and 25 volunteers were in the single-exposure method group. Two standard sunscreens of SPF 4 and SPF 15 and one sunscreen labeled as SPF 20 were tested by all the three methods in the study. Two experienced observers read results, respectively, under the same conditions. Results The volunteers in the current method group received the largest dose of UV light.The simple method was next to it and the single-exposure reduced 4-5 folds of UV dose received. The results of the two observers in the current method group and the single-exposure group were very close. But the test results of P3 were not completely coincident between the two observers in the simplified method group. SPFs value of the three sunscreens were 4. 12, 16.09, and 22.60 obtained by the observer 1 and 4. 18, 15.92, and 21.97 obtained by the observer 2, respectively. In the simplified method group, SPFs values of ＜4, ＞15, ＞20 and ＜4, ＜15, ＞20 were obtained by the two observers. In the single-exposure method group, SPFs values of the three sunscreens were 4.04, 15.34, 21.33 by the observer 1 and 3. 96, 15.82, 21.33 by the observer 2, respectively. Conclusion The single-exposure method is convenient and easily to operate and may replace the current method some day. The simple method is not valuable in determination of SPF labeled on the packages of sunscreens, but may be useful in supervision of the market sunscreen products.