Dermatofibrosarcoma protuberans(DFSP) is an uncommon recurrent soft-tumor of skin and is locally highly invasive and aggressive, although it rarely metastasizes. When possible, of the many treatment modalities, the surgical excision is indicated primarily. There are three surgical modalities, which are excision with undefined or conservative surgical margins, excision with wide surgical margins and Mohs micrographic surgery(MMS). And the classical standard surgery was the local wide excision with at least 3cm margin around the primary tumor and through the deep fascia. However recent studies has showed that MMS decreased the recurrent rate of the tumor, conserving the normal uninvolved tissue, and MMS is accepted as the first choice treatment modality of DFSP. Some studies reported that the margin of 2.5cm is necessary to clear the tumor in MMS. We present two cases of recurrent DFSP treated by Mohs micrographic surgery, one through 4-staged resection, the other, 3-staged resection of the tumor.
Dermatofibrosarcoma* ; Fascia ; Mohs Surgery* ; Skin

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.
Humans ; Mesentery/surgery* ; Digestive System Surgical Procedures ; Fascia/anatomy & histology*

The paper summarizes the academic thought and clinical experience of professor LI De-hua in treatment of facial nerve injury after total parotidectomy with blade needle based on jingjin (muscle region of meridian, sinew/fascia) theory. This disease is located at muscle regions of hand-/foot-three yang meridians; and the sinew/fascia adhesion is its basic pathogenesis, manifested by "transversely-distributed collaterals" and "knotted tendons". In treatment, the knotted tendons are taken as the points. Using the relaxation technique of blade needle, the lesions of sinews/fascia are dissected and removed to release the stimulation or compression to the nerves and vessels so that the normal function of sinews/fascia can be restored.
Humans ; Facial Nerve Injuries/surgery* ; Fascia ; Foot ; Hand ; Lower Extremity

PURPOSE: In Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed. MATERIALS AND METHODS: Between May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases. RESULTS: The mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed. CONCLUSION: DTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.
Adult ; Cartilage/surgery ; Fascia/*surgery/*transplantation ; Female ; Humans ; Male ; Nose/surgery ; Prostheses and Implants ; *Rhinoplasty ; Transplantation, Autologous

Total mesorectal excision (TME) is the gold standard of surgical treatment for mid and low rectal cancer. It aims to improve the oncological outcomes as well as preserve anal sphincter, sexual and urinary function. Compared with sympathetic nerve injury alone, pelvic plexus and neurovascular bundle (NVB) injury has significant effect on postoperative sexual dysfunction, especially erectile function. Since the lateral surgical plane of TME is narrow and densely packed, dissecting outside the plane causes pelvic plexus injury, while dissecting inside it results in residual mesorectum. In this commentary, we review the research progress of lateral fascial anatomy of TME, and describe the anatomical characteristics of rectosacral fascia based on our previous research results. The prehypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. In addition, the pelvic plexus fuses with the prehypogastric fascia which is considered as the outer side layer of rectosacral fascia laterally. Thus, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc shape and then enter the superior-levator space. Before dissecting the lateral spaces, the anterior space of the rectum should be dissected first. After an "U" shape cutting of the Denonvilliers' fascia, the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia is transected to ensure the integrity of the mesorectum without damaging the pelvic plexus.
Fascia ; Humans ; Hypogastric Plexus ; Laparoscopy ; Male ; Pelvis/surgery* ; Rectal Neoplasms/surgery* ; Rectum/surgery*

Adult ; Aged ; Aged, 80 and over ; Fascia Lata ; surgery ; Female ; Humans ; Male ; Middle Aged ; Synovial Cyst ; surgery

OBJECTIVETo introduce the application of "tennis racket" flap with fascial pedicle on the healthy chest for radiation ulcer after surgical treatment of breast cancer.

METHODSThe " tennis racket" flap was designed on the healthy chest along the cartilage with fascia pedicle near the sternum. 9 cases were treated. The flaps size ranged from 5.0 cm x 3.5 cm to 13 cm x 11 cm with pedicle size of 2-8 cm in length and 2.0-3.0 cm in width.

RESULTSAll the 9 flaps survived completely with satisfactory appearance. The patients were followed up for 2 months to 3 years without ulcer reoccurrence.

CONCLUSIONSThe "tennis racket" flap has a slender fascial pedicle without major blood vessel. It has the advantages of good flexibility for rotation and large flap size for the reconstruction of the radiation ulcer after surgical treatment of breast cancer.

Breast Neoplasms ; radiotherapy ; Fascia ; Female ; Humans ; Radiodermatitis ; surgery ; Skin Ulcer ; etiology ; surgery ; Sternum ; Surgical Flaps ; Tennis

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery

In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.
China ; Consensus ; Fascia ; Humans ; Neoplasm Recurrence, Local ; Quality of Life ; Rectal Neoplasms/surgery* ; Rectum/surgery*

OBJECTIVE: To explore the technique of "two-flap" in ear reconstruction. METHOD: Quantitative tissue expansions were used in the mastoid area in the first stage. After the final injection, there was 1 month of sustaining time. Expanded skin flap and unexpanded fascia flap were designed in the second stage, so the "two-flap" technique was used in the ear reconstruction. From January 2004 to December 2008, 1427 patients of microtia were treated using "two-flap" technique. RESULT: The expanded skin flap could show the fine structures of the reconstructed ears. The reconstructed ears had vivid cranioauricular angle after using the unexpanded fascia flap. CONCLUSION "Two-flap" method was easily manipulated and the complications were rare. The reconstructed ears had lucid and three-dimensional contour.
Ear ; surgery ; Ear, External ; surgery ; Fascia ; transplantation ; Humans ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps