Objective To investigate the functional changes of anastomosed vascular or neurovascular mini-muscle transfer and to provide experimental data to clinical application. Methods 32 New Zealand rabbits were operated on by anastomosed neurovascular mini-muscle transfer. In group A, 16 rabbits accepted the anastomosed vascular mini-muscle transfer. In group B, 16 rabbits accepted the anastomosed neurovascular mini-muscle transfer. The electromyography was measured 2 months and 3 months after operation. Results The amplitude of electrical muscle graph (EMG) data in the group A was (2.02±0.41)mV 2 months after operation, and (1.73±0.18) mV 3 months after operation. The EMG data in the group B was (3.90±0.52) mV 2 months after operation and (3.35±0.86) mV 3months after opera-tion. The difference between the two groups was significant (P<0.01). The EMG of anastomosed neu-rovasular mini-muscle transfer was significantly greater than that of anastomosed vasular transfer only.There was no significant difference in latent period of EMG between the two groups (P>0.05). Conclu-sions The muscle functional recovery of anastomosed neurovascular mini-muscle transfer is significant with less demage and no secondary deformity. The results suggest that this technique is worthy to apply for treating facial paralysis.

OBJECTIVETo explore the venous angio-architecture of deep inferior epigastric artery perforator ( DIEP) flap with computed tomography angiography( CTA) and the application of venous angio-architecture in flap thinning of DIEP flap.

METHODSFrom February 2012 to August 2014, preoperative CTA examination of venous system of DIEP flap was performed in 11 patients to study the course, the branch and the anastomosis of the deep inferior epigastric veins, the superficial inferior epigastric veins and the perforator veins. The flap thinning of DIEP flap was based on the finding of the abdominal venous system.

RESULTSThe CTA images were obtained including 22 deep inferior epigastric veins, 22 superficial inferior epigastric veins and 22 perforator veins. The distance between the superficial inferior epigastric vein and abdominal midline was 3.30 cm to 5.77 cm in the zone 3 cm above umbilicus and in the zone 15 cm below umbilicus. The superficial inferior epigastric vein was 0.29 to 0.39 in depth ratio. The superficial inferior epigastric veins were the main drainage vessels of superficial abdominal wall according to the CTA images. They were anastomosed with the deep inferior epigastric veins through perforator veins. The 11 DIEP flaps were thinned based on the structure of the superficial inferior epigastric veins and all flaps had no drainage disturbance.

CONCLUSIONSPreoperative CTA images can display the venous angio-architecture of deep inferior epigastric artery perforator flap. The superficial inferior epigastric vein can be utilized as reference architecture to guide flap thinning of DIEP flap.

Abdomen ; blood supply ; Abdominal Wall ; blood supply ; Angiography ; methods ; Epigastric Arteries ; anatomy & histology ; diagnostic imaging ; Humans ; Perforator Flap ; blood supply ; Phlebography ; methods ; Tomography, X-Ray Computed ; Veins ; anatomy & histology

Objective: To explore flap thinning based on the study of the arterial structure and blood perfusion of the deep inferior epigastric artery perforator (DIEP) flap using computed tomography (CT) angiography. Methods: Clinical imaging study: Preoperative CT angiography was performed in 15 patients with DIEP flap reconstruction to investigate the vascular structure of arterial perforator. Cadaveric imaging study: 10 abdominal specimens harvested from fresh cadavers were cannulated with trocar and injected with contrast medium in the deep inferior epigastric artery perforator. During the perfusion of the contrast medium in the flap, the flap was scanned by three-dimensional CT. The CT data was then sent to CT workstation and the images were processed and reformatted to study the vascular structure of arterial perforators and the blood perfusion. Results: 75 artery perforators in clinical study and 40 artery perforators in cadaveric study were chosen and analyzed. The major deep inferior epigastric artery perforators run directly across the deep layer of adipose tissue without bifurcating beneath the Scarpa′s fascia. Above the Scarpa′s fascia, the artery perforators bifurcate and ultimately terminate in the subdermal vascular plexus. Blood perfusion mode: The subdermal vascular plexus served as the only pathway for blood perfusion between perforasomes. There are two different pathways for blood perfusion in the perforasome: the subdermal plexus and the existing vascular structure of perforator. Conclusions Based on the vascular structure of arterial perforator and blood perfusion of the DIEP flap, thinning of the DIEP flap under the Scarpa′s fascia is safe while thinning above the Scarpa′s fascia should performed according to the blood supply zone of the DIEP flap.

Objective: To explore the establishment and application of three-dimensional model of deep inferior epigastric artery perforator flap based on computed tomography angiography (CTA). Methods: Six patients with breast absence after modified radical mastectomy because of breast cancer, 5 patients with congenital absence of vagina, and 6 patients with Paget′s disease of penis and scrotum were hospitalized in our unit from January 2012 to April 2017. The size of wounds after excision of the lesion or that of flaps needed for reconstruction ranged from 17 cm×5 cm to 25 cm×9 cm. Abdominal CTA was performed before the surgery, and data of CTA were sent to CT workstation to make three-dimensional model of deep inferior epigastric artery perforator flap according to shape and size of wound. The number, course, and location of deep inferior epigastric artery, vein, and their perforators, and the superficial inferior epigastric vein were observed in the above-mentioned three-dimensional model. The rectangular plane coordinate system with the umbilicus as the origin was established to locate and observe course and type of the largest deep inferior epigastric artery perforator in left and right side. Deep inferior epigastric artery perforator flaps were designed and deep inferior epigastric artery perforators etc. were marked according to three-dimensional models of the flaps before the surgery. The condition observed in three-dimensional model of the flap was compared with the clinical condition in the surgery of free transverse bilateral deep inferior epigastric artery perforator flap transplantation for breast reconstruction and longitudinal pedicled thinned unilateral deep inferior epigastric artery perforator flap transplantation for vagina reconstruction and wound repair of Paget′s disease of penis or scrotum. The size of flap ranged from 17 cm×6 cm to 25 cm×10 cm. Results: Seventeen three-dimensional models of deep inferior epigastric artery perforator flaps were established, including 6 bilateral models and 11 unilateral models. Seventy-two reliable deep inferior epigastric artery perforators were observed in the three-dimensional model with 3.2±0.7 in the right and 3.1±0.8 in the left. The locations of the largest deep inferior epigastric artery perforators in the right and left were [(-3.2±1.4) cm, (-1.0±0.7) cm] and [(4.0±1.2) cm, (-1.2±1.1) cm] respectively. Fourteen largest deep inferior epigastric artery perforators coursed directly and nine coursed tortuously in the rectus muscle. Twenty-three superficial inferior epigastric veins were detected in the three-dimensional models of the flaps. The number, location, and course of deep inferior epigastric artery and vein and superficial inferior epigastric vein observed in the three-dimensional model of deep inferior epigastric artery perforator flap were in accordance with the condition observed in the surgery. Seventy reliable deep inferior epigastric artery perforators were detected in the surgery, and the other 2 perforators were unclear due to bleeding. Course of these perforators were in accordance with the condition observed in the three-dimensional model. Deep inferior epigastric artery perforator flaps of all patients survived well with no complication except that 1 patient suffered from delayed healing of wound in perineum. During follow-up of 1 to 12 months, all flaps survived with good shape and texture. Conclusions The three-dimensional model of deep inferior epigastric artery perforator flap based on CTA can be established easily and can provide information of number, location, and course of deep inferior epigastric artery, vein, and their perforators, and superficial inferior epigastric vein to guide preoperative design and intraoperative dissection of the flap effectively.

Objective:To explore the anatomical levels and injection approaches of the major temporal fat compartments through cadaveric head dissection and to analyze the efficacy of high-volume fat transplantation of the temporal region in a clinical retrospective research.Methods:To clarify the safe and stable levels of high-volume filling of the temporal fat compartment by dissecting the temporal fat compartment of 5 fresh cadaveric heads (10 sides, 25-50 years old, 2 males, 3 females). We retrospectively analyzed the data of patients with temporal fat transplantation admitted to the Second Xiangya Hospital of Central South University and Changsha Mylike Medical Cosmetic Hospital from January 2020 to January 2021. According to the levels and volume of fat filling injection, the patients were divided into large-volume group and conventional group. In the large-volume group the patients were filled with at least three fat compartments with a filling volume of more than 15 ml, while in the conventional group only with 1 to 2 layers, which were the subcutaneous fat and the middle temporal fascia, and the filling volume was generally less than 15 ml. Fat injections were performed with a needle entry within the frontal hairline, targeting the main fat compartments. We compared and studied the mean injection volume per side, postoperative surgeon’s Likert scale score, patient satisfaction and other indicators in the two groups of cases. Stromal vascular fraction-gel(SVF-gel), which was made from surplus fat during the initial operation, was used to locally fine-tune the effect at the 3-month follow-up evaluation.Results:The anatomical study revealed the existence of three main fat compartments in the temporal region: subcutaneous fat layer, superficial and deep temporal fat pad. In the elderly cadavers, the subcutaneous fat was thin, the superficial temporal fat pad and deep temporal fat pad atrophied obviously, and the supporting effect on temporal superficial soft tissue was significantly weakened. The deep temporal fat pad showed obvious atrophy with a certain degree of downward movement. A total of 50 women who underwent bilateral temporal fat transplantation were enrolled in the clinical study, with 25 in the conventional group and 25 in the large-volume group. The age of the patients in the conventional group was (32.7±7.1) years, and the body mass index (BMI) was (20.2±1.9) kg/m 2. In the large-volume group, the age was (32.5±8.3) years, and the BMI was (19.8±2.0) kg/m 2. There were no significant differences in age and BMI between the two groups (all P>0.05). The filling volume was (19.66±4.61) ml/side in the large-volume group, with a Likert scale score of (4.32±0.63) and the patient satisfaction was 92.0%(23/25); the filling volume was (11.06±2.62) ml/side in the conventional group, with a Likert scale score of (3.32±0.80) and the patient satisfaction was 68.0%(17/25). There were statistical differences between the two groups (all P<0.05), suggesting that the large-volume group had better efficacy and patients were more satisfied. No severe complications such as infection, liquefaction, embolism, and nerve injury occurred in all patients during the follow-up period. Conclusion:Anatomical studies have proved that the main three-layer fat compartments filling in the temporal region have a clear approach, especially the feasibility of the puncture approach of the deep temporal fat pad, which provides the basis and feasibility for temporal fat filling with large volume. Compared with the conventional fat filling, multi-level and large-volume filling can significantly improve the surgical effect and patient satisfaction.

The traditional perforator flap can not meet the need of large-area wound repair because of relatively small area. Therefore, trans-zone flap containing multiple perforasomes is increasingly used in wound repair. However, the high resistance of choke vessels in the trans-zone flap caused the insufficient blood supply at the distal end of the trans-zone flap, which may result in flap necrosis. Therefore, the necrosis at the distal end of trans-zone flap has become a difficult problem in the repair of large-area wound. Studying the hemodynamic changes and vascular remodeling of choke vessels has great significance to improve the distal blood supply of trans-zone flap. This paper reviews the researches on the hemodynamics and vascular remodeling mechanism of choke vessels at home and abroad in recent years, in order to make help for reducing the necrosis at the distal end of trans-zone flap.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, we need to fill in the lacrimal groove and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin’ s improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Objective:To investigate the application of levator palpebrae superioris advancement in correction of wide double eyelid with ptosis after double eyelid operation.Methods:From January 2015 to October 2020, patients with wide double eyelids and ptosis after double eyelid surgery were selected from the Second Xiangya Hospital of Central South University and Changsha Mylike Medical Cosmetic Hospital. In the operation of wide double eyelid correction, all the tissues were given anatomic reduction, and levator palpebrae advancement in correction of wide double eyelid patients with ptosis deformity was applied. After the operation, the patients were followed up, and the doctor, the patients and the third party were asked to compare the photos before and 6 months after the operation. Then, the outcome was evaluated. The result showed that the three parties were satisfied as significantly effective, two parties satisfied as effective, one party satisfied as average, all dissatisfied as poor.Results:A total of 98 patients were included. There were 95 females and 3 males, aged 18-49 years, with an average of 24.5 years. 68 cases were treated with bilateral, 30 cases were treated with unilateral correction. 166 upper eyelid operations were performed, including 102 cases of mild blepharoptosis and 64 cases of moderate blepharoptosis. Postoperative effect evaluation: 90 cases were significantly effective, 5 cases were effective, 3 cases were average, no case was poor, and the satisfaction rate was 96.9% (95/98).Conclusions:In the operation of wide double eyelid repair, levator palpebrae superioris muscle advancement is an important step in wide double eyelid repair, and can effectively correct the ptosis deformity of patients with wide double eyelid.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, it is necessary to increase the volume of the underlying depression and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Objective:To investigate the effectiveness of the firm-suspension technique in Oriental double eyelid blepharoplasty.Methods:From March 2019 to March 2021, the clinical data of patients undergoing incision double eyelid blepharoplasty with firm-suspension technique in the Department of Plastic and Cosmetic (Burn) Surgery of the Second Xiangya Hospital of Central South University and the Department of Plastic Surgery of Changsha Mylike Medical Cosmetic Hospital were retrospectively analyzed. All the internal fixation method in this study were firm-suspension technique: the levator aponeurosis, the remnants of the orbital septum, and the lower lip incision orbicularis oculi muscle were fixed to the upper edge of the tarsal plate. The height, curvature and incision scar of the double eyelid line were observed during the postoperative follow-up. The surgery doctor, patients and a third party surgeon compared photos before and more than 3 months after the operation to evaluate the effect of the operation. Three parties were satisfied as significantly effective, two parties were satisfied as effective, one party was satisfied as normal, and all were dissatisfied as poor.Results:A total of 50 patients (100 eyes) were included, including 47 females and 3 males, ranging in age from 17 to 45 years old, with an average age of 25 years. All the patients had congenital bilateral single eyelid, 43 cases underwent double eyelid surgery for the first time, and 7 patients underwent revision double eyelid surgery. The postoperative follow-up was 3 to 12 months, with an average of 6 months. All incisions were healed by primary intention. Two patients had asymmetric double eyelid folds, and the remaining 48 patients had stable double eyelid folds in shape, natural curvature, appropriate height and width, bilateral symmetry, no obvious scar, postoperative effect evaluation: 42 patients were significantly effective, 6 were effective, 2 were normal, and the satisfaction rate was 96% (48/50).Conclusion:The firm-suspension technique in Oriental blepharoplasty can obtain satisfactory postoperative appearance, and the double eyelid fold was stable.