Objective:To investigate the feasibility and effect of applying the island pre-expanded supratrochlear artery flap to treat mid-facial giant nevus near the nose in children.Methods:From January 2019 to January 2021, 10 cases of midfacial giant nevus patients were treated with the island pre-expanded supratrochlear artery flap in the Department of Burn and Plastic Surgery of Children’s Hospital of Nanjing Medical University. The process of treatment was divided into three stages. Stage 1: The expander capacity was determined according to the lesion size. The expander was implanted under the frontal muscle, and the flap was regularly expanded postoperatively. Stage 2: The expander was removed, and the lesion was excised. The expanded flap was designed according to the shape and size of the lesion. Stage 3: The transferred flap was trimmed. The postoperative complications and the blood supply after flap transfer were observed. The treatment effect was evaluated during the follow-up after the operation.Results:A total of 10 children were included in this group, including six males and four females, aged 4-12 years, with an average age of 7.8 years. Six patients underwent three-stage surgery, and four patients underwent two-stage surgery. During the first stage, a 100-400 ml renal expander was implanted, and tissue expansion was conducted once or twice a week. The expansion lasted 10 to 12 weeks (average, 11.4 weeks). Complications such as leakage, angle, and blood supply obstruction were not observed during the expansion process. The size of the expanded frontal flap was 7 cm × 6 cm ~ 12 cm ×10cm. Venous congestion occurred at the distal end of the flap in 2 cases, which was treated by partial suture removal and acupuncture bleeding treatment. No flap necrosis occurred. The donor sites were closed directly. No recurrence was observed during the 3-month to 1-year follow-up period. All expanded flaps had no obvious contraction with a good match of color and texture.Conclusions:The island pre-expanded supratrochlear artery flap provides an ideal selection of donor site for a large mid-facial defect with a reliable effect. The scar in the middle face and secondary deformities can be avoided.

Objective:To investigate the treatment of autologous fat grafting (AFG) for breast reconstruction of soft tissue defects in pediatric Poland syndrome (PS) with computer-assisted calculation.Methods:Patients with PS were recruited in Children’s Hospital of Nanjing Medical University from January 2016 to January 2021. The children were divided into two groups: CT-assisted group and control group. CT-assisted group were examined by CT scan before operation. The imaging data were imported to 3D Slicer Software. Three -dimensional (3D) reconstruction of thoracis soft tissue in defected side were created in the software with the healthy side served as controls. The obtained 3D image was divided into six sections and the volume of each section was calculated. The interest 3D model was fabricated by using a 3D resin printer. The autologous fat grafting was made in PS patients under the 3D printing model guidance. Patients in control group for AFG that the volume of fat determined by surgeon experience without CT scan. The following outcomes were studied: postoperative breast contour, local complications and major systemic complications. Patients were reviewed at six months postoperatively. The satisfaction scores were made by physicians and patient’s guardians, respectively. The scores were analyzed by the independent samples t-test. P< 0.05 was considered statistically significant. Results:18 patients is in CT-assisted group, 8 males, 12 females, the age range from 3-12 years, mean age: 8.3 years. 10 cases underwent once injection, 6 cases underwent twice injections and 3 times in 2 cases, the average is 1.5 times. 18 patients are in control group, 4 males, 14 females, the age range from 4-14 years, mean age: 8.1 years. 8 cases underwent once injection, twice in 5 cases, and 3 times in 5 cases, the average is 1.8 times. The follow-up ranged from 1 to 2 years. The chests were essentially symmetrical and upper limb and thoracic functions were unaffected, no serious local and systematic complications were observed in the CT-assisted group. Thoracic deformities were improved to various degrees in control group. There was chest induration in two cases at 6-month follow-up, which disappeared at 1-year follow-up without any treatment. The physician satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 8 and 6 cases, general 3, respectively. The patient’s satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 10 and 6cases, general 1 , respectively. The physician satisfaction scores in the CT-assisted group and control group were 83.56±7.90, 75.67±13.63, respectively, which showing statistically significant differences ( t=2.13, P=0.041). Furthermore, the patient’s guardian satisfaction scores in the CT-assisted group and control group are 84.39±7.77, 78.28±9.82, respectively, which showing statistically significant differences ( t=2.07, P=0.046). Conclusions:AFG under computer guidance is an individualized surgical method based on children’s own characteristics in improving chest deformity of PS patients, following with high postoperative satisfaction.

Objective:To investigate the feasibility and effect of applying the island pre-expanded supratrochlear artery flap to treat mid-facial giant nevus near the nose in children.Methods:From January 2019 to January 2021, 10 cases of midfacial giant nevus patients were treated with the island pre-expanded supratrochlear artery flap in the Department of Burn and Plastic Surgery of Children’s Hospital of Nanjing Medical University. The process of treatment was divided into three stages. Stage 1: The expander capacity was determined according to the lesion size. The expander was implanted under the frontal muscle, and the flap was regularly expanded postoperatively. Stage 2: The expander was removed, and the lesion was excised. The expanded flap was designed according to the shape and size of the lesion. Stage 3: The transferred flap was trimmed. The postoperative complications and the blood supply after flap transfer were observed. The treatment effect was evaluated during the follow-up after the operation.Results:A total of 10 children were included in this group, including six males and four females, aged 4-12 years, with an average age of 7.8 years. Six patients underwent three-stage surgery, and four patients underwent two-stage surgery. During the first stage, a 100-400 ml renal expander was implanted, and tissue expansion was conducted once or twice a week. The expansion lasted 10 to 12 weeks (average, 11.4 weeks). Complications such as leakage, angle, and blood supply obstruction were not observed during the expansion process. The size of the expanded frontal flap was 7 cm × 6 cm ~ 12 cm ×10cm. Venous congestion occurred at the distal end of the flap in 2 cases, which was treated by partial suture removal and acupuncture bleeding treatment. No flap necrosis occurred. The donor sites were closed directly. No recurrence was observed during the 3-month to 1-year follow-up period. All expanded flaps had no obvious contraction with a good match of color and texture.Conclusions:The island pre-expanded supratrochlear artery flap provides an ideal selection of donor site for a large mid-facial defect with a reliable effect. The scar in the middle face and secondary deformities can be avoided.

Objective:To investigate the treatment of autologous fat grafting (AFG) for breast reconstruction of soft tissue defects in pediatric Poland syndrome (PS) with computer-assisted calculation.Methods:Patients with PS were recruited in Children’s Hospital of Nanjing Medical University from January 2016 to January 2021. The children were divided into two groups: CT-assisted group and control group. CT-assisted group were examined by CT scan before operation. The imaging data were imported to 3D Slicer Software. Three -dimensional (3D) reconstruction of thoracis soft tissue in defected side were created in the software with the healthy side served as controls. The obtained 3D image was divided into six sections and the volume of each section was calculated. The interest 3D model was fabricated by using a 3D resin printer. The autologous fat grafting was made in PS patients under the 3D printing model guidance. Patients in control group for AFG that the volume of fat determined by surgeon experience without CT scan. The following outcomes were studied: postoperative breast contour, local complications and major systemic complications. Patients were reviewed at six months postoperatively. The satisfaction scores were made by physicians and patient’s guardians, respectively. The scores were analyzed by the independent samples t-test. P< 0.05 was considered statistically significant. Results:18 patients is in CT-assisted group, 8 males, 12 females, the age range from 3-12 years, mean age: 8.3 years. 10 cases underwent once injection, 6 cases underwent twice injections and 3 times in 2 cases, the average is 1.5 times. 18 patients are in control group, 4 males, 14 females, the age range from 4-14 years, mean age: 8.1 years. 8 cases underwent once injection, twice in 5 cases, and 3 times in 5 cases, the average is 1.8 times. The follow-up ranged from 1 to 2 years. The chests were essentially symmetrical and upper limb and thoracic functions were unaffected, no serious local and systematic complications were observed in the CT-assisted group. Thoracic deformities were improved to various degrees in control group. There was chest induration in two cases at 6-month follow-up, which disappeared at 1-year follow-up without any treatment. The physician satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 8 and 6 cases, general 3, respectively. The patient’s satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 10 and 6cases, general 1 , respectively. The physician satisfaction scores in the CT-assisted group and control group were 83.56±7.90, 75.67±13.63, respectively, which showing statistically significant differences ( t=2.13, P=0.041). Furthermore, the patient’s guardian satisfaction scores in the CT-assisted group and control group are 84.39±7.77, 78.28±9.82, respectively, which showing statistically significant differences ( t=2.07, P=0.046). Conclusions:AFG under computer guidance is an individualized surgical method based on children’s own characteristics in improving chest deformity of PS patients, following with high postoperative satisfaction.