Objective To investigate the clinical effects of reparing the complicated soft tissue defects of limbs with free thoracodorsal artery perforator (TDAP) flaps.Methods From April,2009 to March,2014,19 limbs (including 8 upper limbs and 11 lower limbs) soft tissue defects with bone and tendon exposure were repaired with free TDAP flaps in the secondary stage.There were 12 thoracodorsal artery perforator flaps,5 polyfoliate perforator flaps,1 chimeric muscle flap,and 1 chimeric muscle polyfoliate flap.The sizes of the flaps ranged from 5.0 cm×6.0cm-20.0 cm×l 1.0 cm.Seventeen wounds of the dornor site were closed directly,and the other 2 were closed with skin grafts.Results Sixteen flaps survived successfully.Two flaps had venous congestion and survived at last after taking the stitches out.One flap had partial necrosis and repaired by skin graft finally.The clinical results were satisfactory after 12-18 months following-up,and the scars of the dornor sites of all but 3 patients were not obvious.All the shoulder function were normal.Conclusion The TDAP flap has dependable blood supply,good texture,less dornor site morbility.The polyfoliate TDAP flap can be used for repairing irregular defect.The chimeric latissimus TDAP flap can be used for the function reconstruction.The free TDAP flap is suited for repairing soft tissue defects of the limbs.

Objective:To introduce the 3-DEEP treatment strategy for Wassel Ⅳ thumb polydactyly and evaluate the clinical efficacy of this treatment strategy.Methods:A retrospective study of Ningbo Sixth Hospital between January 2010 and December 2019 in Wassel Ⅳ thumb polydactyly cases, 153 cases of 155 thumbs, according to the appearance and the X-ray image to be subdivided into type A (balanced type, crab claw shaped), 16 cases; type B (disequilibrium, the thumb joint deviation less than 25 degrees), 97 cases ; and type C (disequilibrium, the thumb joint deviation greater than 25 degrees) , 42 cases. The thumb plastic surgery was divided into three layers: bone and joint, tendon and muscle, and skin-soft-tissue for personalized design (3-DEEP). Postoperative follow-up was conducted to evaluate the efficacy and satisfaction, and complications were observed.Results:153 patients were followed up for 1 to 6 years, and the efficacy evaluation was excellent in 104 cases, good in 46 cases, and poor in 5 cases, with the excellent and good rate of 96.8%. The functional satisfaction and shape satisfaction were 98.1% and 96.8% respectively. Among them, 2 cases showed unsatisfactory postoperatively flexion and extension of the interphalangeal joint and interphalangeal joint deviation deformity, 1 case showed radial hump deformity of the metacarpophalangeal joint 2 years after the operation, and 2 cases showed relatively obvious incision scar.Conclusions:Wassel Ⅳ thumb polydactyly is the most common type of thumb polydactyly, but there are still obvious differences in the same classification group.We further subdivided the classification of cases of Wassel type Ⅳ, and according to the anatomical characteristics of each subtype, we designed 3-DEEP treatment strategies, get better thumb appearance, avoid postoperative joint dysfunction, and less postoperative complications.

The treatment of scar contracture has always been the difficult and key point in clinical research. As a new treatment method, fractional laser has a good effect on the early treatment of scar. After fractional laser thermal stimulation, the texture of scar improved and the traction symptom can be relieved to a certain extent. However, in practical application, the relationship between fractional laser parameters and the improvement degree of scar ductility is not clear, resulting in the blindness and randomness of the treatment. Finite element model analysis is a widely used numerical analysis method with high precision in organization simulation. In this paper, we will review and prospect application of fractional laser in the treatment of scar contracture combining with finite element model analysis method.

Objective:To introduce the 3-DEEP treatment strategy for Wassel Ⅳ thumb polydactyly and evaluate the clinical efficacy of this treatment strategy.Methods:A retrospective study of Ningbo Sixth Hospital between January 2010 and December 2019 in Wassel Ⅳ thumb polydactyly cases, 153 cases of 155 thumbs, according to the appearance and the X-ray image to be subdivided into type A (balanced type, crab claw shaped), 16 cases; type B (disequilibrium, the thumb joint deviation less than 25 degrees), 97 cases ; and type C (disequilibrium, the thumb joint deviation greater than 25 degrees) , 42 cases. The thumb plastic surgery was divided into three layers: bone and joint, tendon and muscle, and skin-soft-tissue for personalized design (3-DEEP). Postoperative follow-up was conducted to evaluate the efficacy and satisfaction, and complications were observed.Results:153 patients were followed up for 1 to 6 years, and the efficacy evaluation was excellent in 104 cases, good in 46 cases, and poor in 5 cases, with the excellent and good rate of 96.8%. The functional satisfaction and shape satisfaction were 98.1% and 96.8% respectively. Among them, 2 cases showed unsatisfactory postoperatively flexion and extension of the interphalangeal joint and interphalangeal joint deviation deformity, 1 case showed radial hump deformity of the metacarpophalangeal joint 2 years after the operation, and 2 cases showed relatively obvious incision scar.Conclusions:Wassel Ⅳ thumb polydactyly is the most common type of thumb polydactyly, but there are still obvious differences in the same classification group.We further subdivided the classification of cases of Wassel type Ⅳ, and according to the anatomical characteristics of each subtype, we designed 3-DEEP treatment strategies, get better thumb appearance, avoid postoperative joint dysfunction, and less postoperative complications.

The treatment of scar contracture has always been the difficult and key point in clinical research. As a new treatment method, fractional laser has a good effect on the early treatment of scar. After fractional laser thermal stimulation, the texture of scar improved and the traction symptom can be relieved to a certain extent. However, in practical application, the relationship between fractional laser parameters and the improvement degree of scar ductility is not clear, resulting in the blindness and randomness of the treatment. Finite element model analysis is a widely used numerical analysis method with high precision in organization simulation. In this paper, we will review and prospect application of fractional laser in the treatment of scar contracture combining with finite element model analysis method.

Objective:To explore the clinical effect of free transplantation of thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit.Methods:From April 2014 to March 2018, 7 patients with large facial scar were admitted to Ningbo NO.6 Hospital, including 3 males and 4 females, aged from 31 to 49 years, 4 with frontal involvement and 3 with chin and neck. Color Doppler ultrasound was used for the positioning of the thoracodorsal artery perforating vessel, and scar resection was performed according to the principle of facial subunit repair. The wound area was 8 cm×6 cm-21 cm×8 cm, and the wound was repaired with the free thoracodorsal artery perforator flap in the area of 9 cm×7 cm-22 cm×9 cm. The donor site was closed directly by suturing. The consistency of the location of the perforating vessel explored during the operation with its preoperative positioning and the flap survival were recorded. The color, texture, and appearance of the flap and the healing condition, scar formation, and function of the donor area were observed during follow-up.Results:The locations of the perforating vessels of 7 patients explored during the operation were consistent with those positioned by color Doppler ultrasound before the operation. All the flaps of the 7 cases survived successfully after operation. Postoperative follow-up of 12-18 months showed that the flap color was similar to the surrounding skin of the recipient area, with soft texture and no obvious contracture. Slight bloated appearance was observed in the flaps of 4 cases. All the 7 patients had postoperative healing of the flap donor site without obvious scar hyperplasia or influence on shoulder joint function.Conclusions:The anatomy of the perforating vessel of the thoracodorsal artery perforator flap is relatively constant and the flap can be cut in large area with soft texture, good appearance, and concealed donor area, which is a good choice for reconstructing large scar on the facial subunit.

Objective:To explore the application of 1 565 nm non-ablative fractional laser in the treatment of enlarged facial pores.Methods:It was a longitudinal cohort study. From September 2020 to September 2021, 68 patients with enlarged facial pores, including 5 male patients and 63 female patients, aged between 20 and 41 (29.3±4.6) years, were treated at the Department of Plastic and Reconstructive Surgery of Ningbo Sixth Hospital. They received 1 565 nm non-ablative fractional laser once every month for a total of 3 times. The number, score and percentile ranking of facial pores before and after treatment were recorded and compared by VISIA, and adverse reactions were observed.Results:The facial pores number before and after treatment were 890.75±312.61 and 834.37±289.94, the facial pores score were 25.76±1.08 and 24.81±8.59, respectively, indicating a statistically significant decrease in facial pores number and score compared to before treatment ( t=4.19, 2.65, P<0.05). The facial pores percentile ranking before and after treatment were 4.00% (2.00%, 7.00%) and 5.00% (2.25%, 8.00%), respectively, indicating a statistically significant increase in facial pores percentile ranking compared to before treatment ( Z=-3.35, P<0.05). Three patients had transient pigmentation, all of which were gradually faded within 1 month after the last treatment. One patient had a few inflammatory papules scattered on the cheek, which faded in 3 days by using erythromycin eye cream. Conclusions:The 1 565 nm non-ablative laser can effectively improve enlarged facial pores with light adverse reactions.