Objective:To investigate the validity and the outcome of a new surgery method that utilizes lateral great toe flap to decoratively reconstruct the thumb pulp loss.Methods:From Jan.2009 to Jan. 2014 , 22 cases with unilateral thumb pulp defect were included, for whom, lateral great toe flap was de-ployed to reconstruct the thumb.Blood circulation was re-established by the anastomosis of the digital vessels of toes and fingers in 18 cases, the other 4 cases were conducted by a dorsal metatarsal artery and vein anastomosed to the deep branch of the radial artery and the dorsal metacarpal vein respectively; as for the nerve repair, toe-to-finger digital nerve anastomosis was performed.The donor sites were covered by full-thickness inguinal skin grafts.Results:All the 22 flaps survived without complications.With 6 to 12 months follow-up, the surviving fingers all presented aesthetically pleasant appearance with vivid loops and whorls.Normal functions like sweating were restored as well, and the two-point-discrimination ranged 3.0 to 6.0 mm (4.2 mm in average).The skin grafts to the donor sites healed uneventfully, the appearance and functions of the feet were unaffected.Conclusion: Lateral toe flap should be the first-line choice for reconstructing thumb defect, as it conveniently restores both functions and outlook.

OBJECTIVETo explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.

METHODSSix patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps. Afterwards, a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.

RESULTSAll six free scapular flaps survived without signs of infection. Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex, which resolved after six weeks with only conservative therapy. All the incisions healed without other complications. At six-month follow-up, the patients regained full shoulder function.

CONCLUSIONWith the assistance of an adjacent pedicled flap, the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar. It can achieve positive outcomes in both reconstructive and aesthetic aspects.

Adult ; Arm Injuries ; surgery ; Debridement ; Drainage ; Female ; Hand Injuries ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Scapula ; blood supply ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome

Objective: To investigate the clinical effect of modified three minimally invasive blepharoplasty of double-fixation method. Methods: From April 2015 to December 2016, 82 patients were included, all received minimally invasive blepharoplasty. Three 3 mm-long small incision (at medial, middle and lateral) were designed, then part of the orbicularis oculi muscle and pretarsal fat were removed. Pretarsal fascia was then sutured with orbicularis oculi muscle and skin with two-layer-suture to form double eyelid respectively. Results: With up to 18 months follow-up, all patients had short period of detumescence within 7-12 days, high satisfaction rate with long lasting and natural double eyelid shape were achieved, no obvious scarring was noted. Conclusions Modified three minimally invasive blepharoplasty of double-fixation method has presented the merits of accurate presentation, natural shape, quicker recovery and less trauma, which makes it worthy of clinical presentation.

The concept of depressor orbicularis lateralis arises through anatomy of brow ptosis and innovations of its correction. This vertical muscle band is usually found running inferiorly from the lateral brow down along the lateral orbital rim, adjacent to the orbicularis oculi. The muscle segment is a powerful depressor of the brow and may lead to recurrent lateral eyebrow ptosis, if it is not addressed at the time of the facelift. In this review, the anatomical evidence, basic functions of depressor orbicularis lateralis, as well as its clinical relevance and the proper measures in handling this structure as part of brow ptosis and crow′s feet surgery will be discussed.

Objective:To discuss a surgical method that reduces the notch tension and assists in suspending and lifting the skin after reposition so as to relieve scar and to prevent alopecia and maintain long-term lifting effect.Methods:After forehead or temporal open incision rhytidectomy, 2-0 absorbable sutures were used to pass through the intradermal at the hairline and skin junction in front of the incision. After that, the sewing needle passed through the whole skin flap vertically from the two points of the suture inlet and outlet, and then sutured on the deep temporal fascia or galea aponeurotica, in order to reduce tension of the main anchor point of the incision and to assist suspending the elevated flap. Afterwards, the width of the skin excision was determined according to the skin relaxation, the subcutaneous relaxation suture of scalp incision was conducted and the incision closed with nailing device.Results:From June 2016 to October 2018, this method was applied in 33 cases of rhytidectomy. In the early postoperative period, the skin around the hairline had a slight appearance of accumulation due to the traction of sutures, which gradually disappeared with time. During the long-term follow-up, 2 patients had hair loss near the incision, and the hair density decreased. The remaining patients had no obvious scar hyperplasia and alopecia, and no long-term skin accumulation. The facial rejuvenation effect was good, and the satisfactory rate of patients was high.Conclusions:The technique of intradermal tension reduction combined with suspension suture redistributes the tension and significantly reduces the scar hyperplasia and baldness at the incision. Meanwhile, the suture also plays the role of accessory suspension, which helps to increase the stability and durability of facial tissue; the whole procedure is simple, safe, and long lasting.

Objective:To introduce a method of combining autologous rib graft and a silicone plate as a composite graft for augmentation rhinoplasty.Methods:Twenty-two female patients were included in this series. Eleven cases had unsatisfactory nasal appearance Nine cases were admitted for postoperative graft warping, and refused to harvest a second costal cartilage, thirteen cases had limited amount of rib graft for harvest. When cartilage was insufficient for a full dorsal onlay graft, a L-shaped silicone nasal implant would be used and carved into a plate-like, so as to make into a composite graft with the cartilage on top of the silicone plate.Results:Up to 12-month follow-up was conducted, averaged 6.2 months. One case exhibited temporary ischemic signs at the incisions, resolved by compressive taping at day 5.For all other 21 cases aesthetic outcomes were satisfactory with no graft infection, extrusion or other complications. The dorsal only graft did not significantly transilluminate.Conclusions:Rib-silicone composite dorsal graft is an applicable and safe method in augmentation rhinoplasty surgeries, particularly when there is limited amount of cartilage available.

Objective:To construct the risk prediction nomogram model of acute kidney injury (AKI) with R language and traditional statistical methods based on the large sample clinical database, and verify the accuracy of the model.Methods:It was a a retrospective case control study. The patients who met the diagnostic criteria of AKI in Tongji Hospital of Tongji University from January 1 to December 31, 2021 were screened in the clinical database, and the patients with monitored serum creatinine within 48 hours but without AKI were included as the control group. The demographic data, disease history, surgical history, medication history and laboratory test data were collected to screen the risk factors of AKI in clinic.Firstly, based on multivariate logistic regression analysis and forward stepwise logistic regression analysis, the selected risk factors were included to construct the nomogram model. At the same time, cross validation, bootstrap validation and randomly split sample validation were used for internal verification, and clinical data of patients in the sane hospital after one year (January to December, 2022) were collected for external verification. The receiver-operating characteristic curve was used to determine the discrimination of the model, and calibration curve and decision curve analysis were carried out to evaluate the accuracy and clinical net benefit, respectively.Results:A total of 5 671 patients were enrolled in the study, with 1 884 AKI patients (33.2%) and 3 787 non-AKI patients (66.7%). Compared with non-AKI group, age, and proportions of surgical history, renal replacement therapy, hypertension, diabetes, cerebrovascular accident,chronic kidney disease, drug use histories and mortality in AKI group were all higher (all P<0.05). Multivariate logistic regression analysis showed that the independent influencing factors of AKI were surgical history, hypertension, cerebrovascular accident, diabetes, chronic kidney disease, diuretics, nitroglycerin, antidiuretic hormones, body temperature, serum creatinine, C-reactive protein, red blood cells, white blood cells, D-dimer, myoglobin, hemoglobin, blood urea nitrogen, brain natriuretic peptide, aspartate aminotransferase, alanine aminotransferase, triacylglycerol, lactate dehydrogenase, total bilirubin, activated partial thromboplastin time, blood uric acid and potassium ion (all P<0.05). Finally, the predictive factors in the nomogram were determined by forward stepwise logistic regression analysis, including chronic kidney disease, hypertension, myoglobin, serum creatinine and blood urea nitrogen, and the area under the curve of the prediction nomogram model was 0.926 [95% CI 0.918-0.933, P<0.001]. The calibration curve showed that the calibration effect of nomogram was good ( P>0.05). The decision curve showed that when the risk threshold of nomogram model was more than 0.04, the model construction was useful in clinic. In addition, the area under the curve of receiver-operating characteristic curve predicted by nomograph model in external validation set was 0.876 (95% CI 0.865-0.886), which indicated that nomograph model had a high discrimination degree. Conclusion:A nomogram model for predicting the occurrence of AKI is established successfully, which is helpful for clinicians to find high-risk AKI patients early, intervene in time and improve the prognosis.

Objective:To investigate the method and application experience of nasolabial subcutaneous pedicled flap in the repair of skin defect after resection of nasolabial mass.Methods:From December 2016 to December 2020, a total of 58 patients (43 cases of nevus, 12 cases of seborrheic keratosis and 3 cases of keratinacanthoma) were admitted to the Facial Neck Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 24 males and 34 females. They ranged from 17 to 55 years old, with an average age of 33 years. The minimum facial tumor area was 0.8 cm×0.8 cmand the maximum was 2.2 cm×2.0 cm. A local skin flap with a subcutaneous pedicle was designed preoperatively in the nasolabial groove area, and the subcutaneous pedicle was transferred to the defect area through subcutaneous tunnel or by disconnecting the surrounding tissue. The tumor was removed and the skin defect was closed at one stage. Postoperative complications were summarized and patient＇s satisfaction was investigated.Results:Follow-up period ranged from 6 to 48 months. All the 58 patients had primary healing of the transfer incisions, and all the flaps survived. The blood supply of the flaps was good, and the scar of the operative area was smooth. After resection of peri-lip mass, there was 1 case with obvious scar in the donor area of nasolabial groove, and the overall satisfaction rate was 98.3%.Conclusions:The application of nasolabial subcutaneous pedicled skin flap to repair the skin defect after resection of nasolabial tumor has the advantages of preventing the pulling deformation of the organ, it can be completed in one stage and repair the facial skin defect from a distant position. In addition, the thickness and color of the skin flap are similar to the defect site, and the scar of the donor site is not obvious, and so the appearance and function of the surgery can be satisfied.

The facial artery perforator flap has the advantages of minimal donor site morbidity, acceptable appearance and function at recipent area, which brings its wide application in reconstruction of facial small and medium-sized defects. Nasal defects, as the most important aesthetic unit at face, require three-dimennsional and precise reconstruction. The article reviewed the anatomic study and the current status of the clinical applications of this technique in reconstruction of nasal defects, as well as the existing questions. The prospective application of SPY system in localization of facial artery perforator was also analyzed.

Objective: To investigate the efficacy and the technical details of utilizing a long segment of vein graft to bridge the vascular defect when a free flap is used to repair extensive injuries in lower extremities. Methods: For the reconstruction of extensive leg defect caused by serious composite injury, a local flap is unavailable or cannot fulfill the requirements. The main vessels of the leg could be damaged. It is challenging work to find an ideal recipient vessels for a free flap. The saphenous vein was harvested from the contralateral lower extremities and utilized to bridge the vascular gap between the recipient vessels and flap pedicle vessels. A latissimus dorsi myocutaneous or anterolateral thigh free flap was used to reconstruct the leg defect. The distal end of the grafted vein was anastomosed to the superficial femoral artery in an end-to-side fashion, and the proximal end to the artery of flap pedicle in an end-to-end fashion. When a vein insufficiency was present, the proximal and distal ends of the additional grafted vein were anastomosed to the recipient vein and vein of flap pedicle in an end-to-end fashion. Results: From July 2010 to April 2019, 27 patients underwent reconstruction of leg using the above-mentioned method. There were 20 males and 7 females. The patients′ age ranged from 16 to 54 years with an average of 30.6 years. There were 19 latissimus dorsi myocutaneous flaps and eight anterolateral thigh flaps. The grafted saphenous vein was used to bridge the arterial gap in 21 cases and to bridge both the arterial and venous gaps in 6 cases. The length of the grafted vein for arterial and venous defects was ranged from 14 cm to 43 cm (mean, 24.8 cm) and 5 cm to 12 cm (mean, 8.6 cm), respectively. 26 flaps completely survived after surgery. Venous congestion occurred in the remaining one flap and the flap eventually lost. The patient eventually opted for amputation. All patients were followed up for 3 to 14 months with an average of 9 months. Functional and aesthetic outcomes were obtained in both the recipient and donor sites. No obvious edema of lower extremities was observed. Conclusions For patients with a severe and large soft-tissue defect of the leg, fining an ideal recipient vessels for a free flap is crucial for a successful reconstructive surgery. It is a reliable and an additional option to choose the superficial femoral artery and/ or saphenous vein as the recipient vessels by using the grafted vein to bridge the vascular gaps.