OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery

OBJECTIVETo investigate the application of combining mastopexy and triple-plane breast augmentation in correction of breast ptosis and atrophy.

METHODSPeri-areolar incision was performed to finish the fascia and dermal suspension to correct the breast ptosis. The implant was inserted under the pectoralis major muscle through lateral lower border of the gland and a "X" shape full thickness incision was made on the pectoralis major muscle according to the new position of nipple-areolar complex.

RESULTS14 patients received combined mastopexy and triple-plane breast augmentation to correct breast atrophy and mastopexy simultaneously. All the patients were regularly followed for 6-12 months. No patients suffered severe complication and the results were satisfied.

CONCLUSIONS"Triple-plane" breast augmentation could be safely performed with peri-areolar mastopexy with minor injury. The technique could help to ensure the balance between the gland, nipple-areolar complex and the implant.

Atrophy ; surgery ; Breast ; pathology ; surgery ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Pectoralis Muscles ; surgery

OBJECTIVETo investigate the therapeutic effect of alar rotation flap for severe alar retraction.

METHODSPatients with severely retracted alar underwent ala reconstruction using alar rotation flaps and autogenous cartilage batten grafts. First, costal cartilage was used to reshape the nasal tip and nasal dorsum. Then cartilage patch was used to extend and thicken the retracted alar. Then the alar rotation flap was transferred to correct retracted alar.

RESULTSFourteen patients with severe alar retraction underwent alar reconstruction with alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, with improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision healed with acceptable cosmetic results, with obvious scar in only one patient (one side).

CONCLUSIONSThe alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Scar can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.

Cartilage ; transplantation ; Cicatrix ; prevention & control ; Costal Cartilage ; transplantation ; Esthetics ; Humans ; Nose Deformities, Acquired ; surgery ; Rhinoplasty ; methods ; Rotation ; Surgical Flaps

OBJECTIVETo investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.

METHODSFrom May 2009 to October 2013, there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound ( CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA). The perforator with wider caliber, faster flow speed, longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.

RESULTSThere were 37 perforators of SCA detected by CDUS, whose calibers were ranging from 0.5 to 0.8 mm [Mean: (0.6 ± 0.1) mm]. There were 48 perforators of SCA detected by MEUS. Compared to CDUS, the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ± 0.3) mm vs (0.6 ± 0.1) mm, P < 0.05]. According to the results of MEUS and three-dimensional reconstructive techniques, in at least 65.4% (17/26) of the flaps, thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap. The results of the operations confirmed the existences of all the marked vessels. 25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper. The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia. The patient recovered 1 day later without treatment. All the patients have been followed up for 3 to 16 months (Mean: 8 months) with well-survived flaps.

CONCLUSIONSThe perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery. MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.

Arteries ; diagnostic imaging ; Humans ; Mammary Arteries ; Microbubbles ; Neck ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; Ultrasonography ; methods

OBJECTIVETo observe the therapeutic effect of expanded supraclavicular island flaps for facial and cervical scar.

METHODSFrom Oct. 2010 to Nov. 2013, a series of 16 patients with facial and cervical scars were treated by the expanded supraclavicular island flaps, pedicled by the supraclavicular cutaneous branch of transverse cervical artery. In the first stage, the soft tissue expanders (ranging from 400 ml to 600 ml in volume) were implanted in the anterior thoracic region. In the second stage, the facial and cervical scars were removed and the contructures were released, the expanded flap was transferred to cover the defects. The wounds at the donor sites were closed directly.

RESULTSThe flaps size ranged from 12 cm x 7 cm to 22 cm x 11 cm. All flaps survived with no flap necrosis. Hematoma occurred in one case and healed by debridement. 16 patients were followed up for 3-12 months. The color and texture of all flaps matched well with the surrounding skin tissue, no bulky appearance or hypertrophic scar were noticed.

CONCLUSIONSThe expanded supraclavicular island flap is a good choice for repairing facial and cervical scar. The appearance and function can be improved.

Cicatrix ; surgery ; Face ; surgery ; Humans ; Neck ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; transplantation ; Thoracic Wall ; Tissue Expansion Devices

OBJECTIVETo explore a combined application of tissue expansion, perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.

METHODSIn the first stage, the position and course of the perforators were confirmed with the multi-detector computed tomography ( MDCT) and color Doppler ultrasound. The expanders were implanted between subdermal vascular plexus and superficial fascia. In the second stage, the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.

RESULTS26 cases with extensive facial and cervical scars were included in this study. Except for one case with necrosis at the distal end, the other 25 flaps survived completely. The maximum flap size was 35 cm x 10 cm with a pedicle of 8 cm x 4 cm. Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap, thus avoiding secondary flap debulking and revisions. All the patients got improvement in contours, facial features and emotional expression.

CONCLUSIONSThe combined application of tissue expansion, perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.

Cicatrix ; surgery ; Face ; surgery ; Humans ; Multidetector Computed Tomography ; Neck ; surgery ; Perforator Flap ; transplantation ; Reconstructive Surgical Procedures ; Tissue Expansion ; methods

Cervicoplasty ; methods ; Face ; surgery ; Humans ; Reconstructive Surgical Procedures

OBJECTIVEA new method for correction of nipple inversion was introduced to improve the surgical result.

METHODSIn this procedure, two opposite rhombus incisions on both sides of the inverted nipple were designed within the range of areola. The rhombus skin was deepithelialized and two subcutaneous pedicle skin flaps were created. Then the shortened lactiferous ducts and fibrous bands beneath the nipple were released. The subcutaneous pedicle skin flaps on both sides of the inverted nipple were advanced through the tunnel beneath the nipple as the supporting tissue. After the operation, continuous traction of the nipple lasted two weeks at least.

RESULTSSince 1999, 16 patients with congenital bilateral nipple inversion have been treated. No complications were found in all the cases. Postoperative follow-up for 2-12 months showed that the appearance of the nipple was satisfactory.

CONCLUSIONSThis method is simple, safe and effective for correction of congenital nipple inversion. The incision scar is indistinct, the natural look and good function of the nipple were reserved.

Adolescent ; Adult ; Female ; Humans ; Nipples ; abnormalities ; surgery ; Surgery, Plastic ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo reduce the incision scar produced by reduction mammaplasty.

METHODSThe periareola incision and the vertical incision below the areola were made when performing breast reduction. The incision in the submammary fold was avoided. The breast was suspended and moulded. The redundant skin and the long skin incision below the areola were sutured utilizing the skin wrinkling suture techniques. The wrinkling skin and incision became flat gradually due to the elasticity of the tissue itself.

RESULTS13 cases have been treated with the techniques mentioned above. All incisions healed primarily and there were no complications such as hematoma, infection and necrosis of skin or areola. Of them, 3 patients with very large and ptotic breasts needed small corrective operations to excise the redundant skin that still existed 6 months postoperatively. The shape of the breasts and the vertical incision scars of the other patients were satisfactory.

CONCLUSIONSThe vertical mammaplasty using the skin wrinkling suture techniques can be used in breast reduction of various sizes, owing to the advantages of consistent, good and stable result, simplicity to perform and grasp and no scar in the submammary fold.

Adult ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Surgery, Plastic ; methods ; Treatment Outcome

OBJECTIVETo introduce a new technique for reduction mammaplasty appropriate to moderate or heavy hypertrophic breast.

METHODSThe superior-lateral dermo-glandular pedicle flap including the nipple-areola complex was created. After the extra glandular tissue was removed, the superior-lateral dermo-glandular pedicle with the nipple-areola complex was rotated, adjusted, sculptured and fixed to the thoracic wall so as to fashion a breast with natural projection and proper shape. This method was used in 4 patients(8 breasts).

RESULTSThe operation results were satisfactory without complications. The breasts maintained nice configuration and good function, with well lactating in one case.

CONCLUSIONThe technique of reduction mammaplasty with the superior-lateral dermo-glandular pedicle is a reasonable method to obtain nice breast configuration and good function.

Adult ; Female ; Humans ; Hypertrophy ; surgery ; Mammaplasty ; methods ; Middle Aged ; Surgery, Plastic ; methods ; Treatment Outcome