Objective:To investigate the prevention and treatment for deviation of costal cartilage dorsal onlay grafts in rhinoplasty.Methods:From January 2010 to October 2020, a total of 588 patients (83 male cases, 505 female cases, age range from 25 years to 55 years, 32±4 years in average) accepted costal cartilage rhinoplasty in Shenzhen Mylike Medical Plastic Aesthetic Hospital. During the operation, various methods were used in the process of catilage selection, water bath, sculpture, treatment of nasal dorsal, graft fixation and fascial modification to prevent and treat the deformation and displacement of the costal cartilage dorsal onlay grafts.Results:The immediate postoperative photograph of 588 cases showed that costal cartilage dorsal onlay graft was put on the middle of dorsum. After a follow-up period of 396 cases from 6 to 60 months, the average follow-up period was 12.1 months, there were 44 cases happened with the deviation of dorsal onlay grafts, and deviation was managed after the second rhinoplasty surgery. There was no prolonged function sequela such as ventilation dysfunction, abnormal sensation, or hyposmia occured. 362 cases were satisfied with the aesthetic effect.Conclusions:It is particularly important to grasp the principles of managing costal cartilage in rhinoplasty and to learn how to prevent and treat postoperative complications of costal cartilage dorsal onlay graft.

Objective:To explore the surgical method and clinical effect of correcting lateral type alar retraction with intercartilaginous graft and lateral crural strut graft.Methods:A retrospective study was performed on the data of patients with moderate to severe lateral alar retraction treated in Shenzhen Mylike Medical Plastic Aesthetic Hospital from October 2018 to June 2020. During the operation, lower lateral cartilages was totally dissected and strengthened by lateral crural strut graft while scroll area was released and lengthened with intercartilaginous graft to correct lateral type alar retraction. The preoperative and postoperative distance from the nostril’s long axis to the alar rim was measured from the side view, the nasal measurements were expressed as Mean±SD, and paired t-test was used for statistical analysis. Results:A total of 32 patients were enrolled, including 5 males and 27 females, with an average age of 31 years (18-47 years). Twenty-three cases underwent primary rhinoplasty and 9 cases underwent second rhinoplasty. The preoperative data of distance from the nostril’s long axis to the alar rim was (4.1±0.5) mm (3.2-5.0 mm). The postoperative effect of nasal alar retraction defomity correction was obvious. After a follow-up period of 20 cases from 6 to 18 months, the distance from the nostril’s long axis to the alar rim was 1.5-2.8 mm [(2.1±0.3) mm on average]. Comparison of preoperative and postoperative measured values showed statistically significant difference ( P<0.01). There was 1 patient emerged complication alar flaring, and no contracture and deformation of the nasal rim occurred. All of patients were satisfied. Conclusions:The intercartilaginous graft combined with lateral crural strut graft is an effective new method for correction of lateral type alar retraction. It has stable clinical effect and high satisfaction.

Objective:To explore the surgical method and clinical effect of correcting lateral type alar retraction with intercartilaginous graft and lateral crural strut graft.Methods:A retrospective study was performed on the data of patients with moderate to severe lateral alar retraction treated in Shenzhen Mylike Medical Plastic Aesthetic Hospital from October 2018 to June 2020. During the operation, lower lateral cartilages was totally dissected and strengthened by lateral crural strut graft while scroll area was released and lengthened with intercartilaginous graft to correct lateral type alar retraction. The preoperative and postoperative distance from the nostril’s long axis to the alar rim was measured from the side view, the nasal measurements were expressed as Mean±SD, and paired t-test was used for statistical analysis. Results:A total of 32 patients were enrolled, including 5 males and 27 females, with an average age of 31 years (18-47 years). Twenty-three cases underwent primary rhinoplasty and 9 cases underwent second rhinoplasty. The preoperative data of distance from the nostril’s long axis to the alar rim was (4.1±0.5) mm (3.2-5.0 mm). The postoperative effect of nasal alar retraction defomity correction was obvious. After a follow-up period of 20 cases from 6 to 18 months, the distance from the nostril’s long axis to the alar rim was 1.5-2.8 mm [(2.1±0.3) mm on average]. Comparison of preoperative and postoperative measured values showed statistically significant difference ( P<0.01). There was 1 patient emerged complication alar flaring, and no contracture and deformation of the nasal rim occurred. All of patients were satisfied. Conclusions:The intercartilaginous graft combined with lateral crural strut graft is an effective new method for correction of lateral type alar retraction. It has stable clinical effect and high satisfaction.

Objective: To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery. Methods: A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated. Results: The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up. Conclusions The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.

Objective:To investigate the application of local free-style perforator flap in repairing gluteal bedsores.Methods:A retrospective study was performed. Date from 35 patients(20 males and 15 females, mean age 46 years old, range from 24-71) with gluteal bedsores between June 2017 and June 2019 were retrieved and reviewed by the Department of Burn and Plastic Surgery, Second Xiangya Hospital of Central South University. Among these cases, 13 were paraplegia after trauma, 6 were paralysis after cerebral hemorrhage, 13 were chronic infection, and 3 were poor wound healing after tumor resection. The average defect size was 5.6 cm×5.0 cm(range from 2.0 cm×3.0 cm to 10.0 cm×5.0 cm). By following the concept of free-style perforator flap, the flap was designed near the wound according to the perforator location detected by Doppler before surgery, and the defects were recovered by the flaps by rotation or other method such as rotation. Or the perforator flap can be modified into dermis-fat flap and flipped 180° to recover the wound. After the surgery, the survival of the flap or the dermis-fat flap, wound healing, as well as the sense and motion function of buttock and lower limbs were observed and recorded.Results:21 cases were repaired by perforator flap and 14 cases were repaired by modified dermis-fat flap. The size of flap range from 3.0 cm×3.0 cm to 10.0 cm×7.0 cm. The follow-up time was 3-22 months(mean, 12 months). All perforator flaps and dermis-fat flaps survived. The appearance of buttock was pleasant and no recurrence of bedsores. The patients without paraplegia had no major sensory loss and pain. The function of gluteus maximus was basically normal, and the motor function of lower limb was also generally satisfactory.Conclusions:The local free-style perforator flap or modified dermis-fat flap has advantages including simple design and operation, reliable blood supply and minimal damage to the donor site. It is a better way to repair gluteal bedsores.

Objective:To introduce a surgical technique applied in autologous costal cartilage rhinoplasty described as the endonasal incision combined with umbrella-like graft.Methods:From February 2018 to May 2019, a total of 52 patients (48 females and 4 males) were enrolled and underwent rhinoplasty operation with bilateral intranasal incision for the construction of umbrellal scaffolds in Department of Burn and Plastic Surgery of the Second Xiangya Hospital. During the operation, bilateral inferior lateral cartilages were fully separated and septal cartilages were exposed. Umbrellal-like scaffolds were built to correct nasal aesthetic defects such as nasal columellar shrinkage and insufficient nasal tip protrusion. During the process of follow-up, all the patients were photographed and were asked to complete the the postoperative satisfaction survey by means of an online link or over the phone.Results:The preoperative nasal aesthetic defection was greatly improved. There is no the temporary complications including infection and bleeding. 30 patients who completed follow-up for 6 months at least and completed postoperative satisfaction survey were included in the case series. The measurements (average): The nasofrontal angle was measured as 141.29°±5.61°preoperation and 137.67°±5.27°postoperation. The nasolabial angle was measured as 89.53°±10.56°preoperation and 94.90°±5.88°postoperation , The nasal tip angle was measured as 86.60°±7.09°preoperation and 80.42°±5.47° postoperation, Columellar-lobular angle was measured as 48.82°±7.32°preoperation and 44.63°±2.51°postoperation , The tip projection-nasal length index was measured as 0.48±0.07 preoperation and 0.54±0.07 postoperation. Columellar-lobular length index was measured as 1.74±0.36 preoperation and 1.22±0.21 postoperation, There were significantly statistical differences between preoperative and postoperative measures. The photograph showed the location and reflection of nasal tip have remained stable, no upward or twist trend occurred. According to questionaire results, postsurgical swelling relieved in all cases within the first 3 to 6 weeks. No prolonged functional sequelae occured, Most of patients were satisfied with the aesthetic and functional results.Conclusions:Endonasal incision combined with umbrella-shape graft facilitates the operation, Bilateral endonasal incision allowed us to evaluate the reestablished nasal tip directly and adjust tip projection with convenience, there’s no columella scar left.

Objective:To investigate the application of local free-style perforator flap in repairing gluteal bedsores.Methods:A retrospective study was performed. Date from 35 patients(20 males and 15 females, mean age 46 years old, range from 24-71) with gluteal bedsores between June 2017 and June 2019 were retrieved and reviewed by the Department of Burn and Plastic Surgery, Second Xiangya Hospital of Central South University. Among these cases, 13 were paraplegia after trauma, 6 were paralysis after cerebral hemorrhage, 13 were chronic infection, and 3 were poor wound healing after tumor resection. The average defect size was 5.6 cm×5.0 cm(range from 2.0 cm×3.0 cm to 10.0 cm×5.0 cm). By following the concept of free-style perforator flap, the flap was designed near the wound according to the perforator location detected by Doppler before surgery, and the defects were recovered by the flaps by rotation or other method such as rotation. Or the perforator flap can be modified into dermis-fat flap and flipped 180° to recover the wound. After the surgery, the survival of the flap or the dermis-fat flap, wound healing, as well as the sense and motion function of buttock and lower limbs were observed and recorded.Results:21 cases were repaired by perforator flap and 14 cases were repaired by modified dermis-fat flap. The size of flap range from 3.0 cm×3.0 cm to 10.0 cm×7.0 cm. The follow-up time was 3-22 months(mean, 12 months). All perforator flaps and dermis-fat flaps survived. The appearance of buttock was pleasant and no recurrence of bedsores. The patients without paraplegia had no major sensory loss and pain. The function of gluteus maximus was basically normal, and the motor function of lower limb was also generally satisfactory.Conclusions:The local free-style perforator flap or modified dermis-fat flap has advantages including simple design and operation, reliable blood supply and minimal damage to the donor site. It is a better way to repair gluteal bedsores.

Objective:To introduce a surgical technique applied in autologous costal cartilage rhinoplasty described as the endonasal incision combined with umbrella-like graft.Methods:From February 2018 to May 2019, a total of 52 patients (48 females and 4 males) were enrolled and underwent rhinoplasty operation with bilateral intranasal incision for the construction of umbrellal scaffolds in Department of Burn and Plastic Surgery of the Second Xiangya Hospital. During the operation, bilateral inferior lateral cartilages were fully separated and septal cartilages were exposed. Umbrellal-like scaffolds were built to correct nasal aesthetic defects such as nasal columellar shrinkage and insufficient nasal tip protrusion. During the process of follow-up, all the patients were photographed and were asked to complete the the postoperative satisfaction survey by means of an online link or over the phone.Results:The preoperative nasal aesthetic defection was greatly improved. There is no the temporary complications including infection and bleeding. 30 patients who completed follow-up for 6 months at least and completed postoperative satisfaction survey were included in the case series. The measurements (average): The nasofrontal angle was measured as 141.29°±5.61°preoperation and 137.67°±5.27°postoperation. The nasolabial angle was measured as 89.53°±10.56°preoperation and 94.90°±5.88°postoperation , The nasal tip angle was measured as 86.60°±7.09°preoperation and 80.42°±5.47° postoperation, Columellar-lobular angle was measured as 48.82°±7.32°preoperation and 44.63°±2.51°postoperation , The tip projection-nasal length index was measured as 0.48±0.07 preoperation and 0.54±0.07 postoperation. Columellar-lobular length index was measured as 1.74±0.36 preoperation and 1.22±0.21 postoperation, There were significantly statistical differences between preoperative and postoperative measures. The photograph showed the location and reflection of nasal tip have remained stable, no upward or twist trend occurred. According to questionaire results, postsurgical swelling relieved in all cases within the first 3 to 6 weeks. No prolonged functional sequelae occured, Most of patients were satisfied with the aesthetic and functional results.Conclusions:Endonasal incision combined with umbrella-shape graft facilitates the operation, Bilateral endonasal incision allowed us to evaluate the reestablished nasal tip directly and adjust tip projection with convenience, there’s no columella scar left.

Objective:To evaluate the effect of preoperative 3D simulation on the evaluation of rhinoplasty.Methods:From December 2017 to March 2019, patients in the Department of Burn and Plastic Surgery of the Second Xiangya Hospital of Central South University were randomly selected as the research subjects. According to whether they had received 3D simulation before surgery, they were divided into the experimental group (after 3D simulation before comprehensive surgery) and the control group (without 3D simulation before comprehensive surgery). Visual analogue scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE ) questionnaires were used to evaluate the satisfaction of all patients preoperative and one month after surgery.Results:At the beginning of this study, a total of 97 cases were included, 97 cases were given questionnaires, and 60 cases were effectively recovered, 30 cases in each group.There was statistical significance in the improvement of the postoperative VAS scores between the experimental group and the control group ( P<0. 05). The mean improvement in the experimental group was (4. 10±0. 88) points, while the mean improvement in the control group was (2. 53±0. 73) points. There was statistical significance in the improvement of the postoperativeROE satisfaction scores between the two groups. The average preoperative satisfaction score of the experimental group was (29. 5±9. 7) points, which increased to (77. 3±13. 7) points after surgery. In the control group, the average satisfaction score was (30. 4±11. 3) points before surgery and increased to (62. 7±23. 4) points after surgery. Conclusions:3D simulation before nasal synthesis can improve the postoperative satisfaction of patients.VAS and ROE questionnaires are good tools for evaluating the effect of comprehensive rhinoplastic surgery.

Objective:To evaluate the effect of preoperative 3D simulation on the evaluation of rhinoplasty.Methods:From December 2017 to March 2019, patients in the Department of Burn and Plastic Surgery of the Second Xiangya Hospital of Central South University were randomly selected as the research subjects. According to whether they had received 3D simulation before surgery, they were divided into the experimental group (after 3D simulation before comprehensive surgery) and the control group (without 3D simulation before comprehensive surgery). Visual analogue scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) questionnaires were used to evaluate the satisfaction of all patients preoperatively and one month after surgery.Results:At the beginning of this study, a total of 97 cases were included. 97 cases were given questionnaires, and 60 cases were effectively recovered.There were 30 cases in each group. There was statistical significance in the improvement of the postoperative VAS scores between the experimental group and the control group ( P<0.05). The mean improvement in the experimental group was (4.10±0.88) points, while the mean improvement in the control group was (2.53±0.73) points. There was statistical significance in the improvement of the postoperative ROE satisfaction scores between the two groups. The average preoperative satisfaction score of the experimental group was (29.5±9.7) points, which increased to (77.3±13.7) points after surgery.In the control group, the average satisfaction score was (30.4±11.3) points before surgery and increased to (62.7±23.4) points after surgery. Conclusions:3D simulation before nasal synthesis can improve the postoperative satisfaction of patients. VAS and ROE questionnaires are good tools for evaluating the effect of comprehensive rhinoplastic surgery.