ObjectiveTo explore the clinical results of endoscopic resection of the frontal benign tumors.MethodsNineteen cases of benign tumors in the frontal area were rcsected using endo scopic techniques.The tumors were diagnosed as benign according to complaint,history and physical examination.ResultsAll 19 tumors were totally resected.The pathological examination revealed 11cases of lipoma,3 cases of sebaceous cyst,3 cases of sebaceous cyst and 2 cases of dermoid cyst.During 6 months to 2 years of follow-up,no tumor recurred.Local concavity was noticed in all patients but all resolved within 6 months except 2 patients.They received granular fat graft of the concavities 6months late and were satisfied with the results.ConclusionsBenign tumors near eyebrows and in glabella area can be treated by minimally invasive endoscopic technique.Compared with traditional surgery,this technique offers inconspicuous scar and fast recovery.

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 feasibility and technical tips of repairing facial defects with pre-expanded propeller flap based on the perforators of the supratrochlear artery or the supraorbital artery. Methods: In the first-stage operation, a tissue expander was buried underneath the frontalis muscle. The second-stage operation was conducted using pre-expanded supratrochlear artery or the supraorbital artery based propeller flap to repair facial defect. Results: From July 2010 to July 2016, this method was used in 8 patients. 5 flaps were based on the supratrochlear artery, and 3 flaps based on the supraorbital artery. Expander size was ranged from 150 ml to 300 ml. The size of propeller flaps was from 10 cm × 6 cm to 15 cm × 13 cm. All the flaps survived without any major complications. Follow-up period ranged from 3 to 36 months. Eyebrow replacement, flap thinning and scar revision were performed in 6 cases. All patients were satisfied with the final aesthetic result. Conclusions The pre-expanded propeller flap based on the supratrochlear artery or the supraorbital artery is an alternative option to repair the facial defect in appropriate cases.

Objective: To explore the clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures. Methods: From December 2008 to December 2018, 21 patients with axillary burn scar contractures were admitted to our department. There were 12 male patients and 9 female patients, aged 2-48 years, with an average of 17.4 years. According to the characteristics of axillary scar contractures, the patients were divided into type Ⅰ of 5 patients, type Ⅱ of 2 patients, type Ⅲ of 5 patients, and type Ⅳ of 9 patients. The preoperative abduction ranges of shoulder joint were 20-150°, with an average of 68.33°. The wound areas after resection and release of scar contractures ranged from 12 cm×4 cm to 33 cm×11 cm, with an average of 18.13 cm×5.41 cm, and the wounds were repaired with scapular region flaps pedicled with circumflex scapular artery in the areas of 14 cm×5 cm-35 cm×14 cm, with an average of 20.19 cm×7.71 cm. The donor sites of 5 patients were expanded prior to flap repair operation, and the other 16 patients were repaired by direct transfer of flaps. The donor sites were closed directly. The type, number, and transfer way of scapular region flaps were calculated, and the improvement of abduction angle of shoulder joint and condition of the flaps were observed during follow-up after operation. Results: There were 5 ascending scapular flaps, 13 scapular flaps, and 3 parascapular flaps. The flaps were transferred through open wounds in 18 cases, subcutaneous tunnel in 1 case, and trilateral foramia in the remaining 2 cases. All the flaps survived after operation. During follow-up of 3 months to 5 years, with an average of 19.4 months, the abduction angles of shoulder joints were 90-180°, with an average of 137.62°, which showed that the abduction function of shoulder joint improved obviously. The texture of flap was soft, and the color of the flap was close to the surrounding skin. The patients and/or their family members were satisfied with the operation results. Conclusions The scapular region flap pedicled with circumflex scapular artery has a lot of advantages, including a long vascular pedicle, simple technique for flap harvest, a hidden donor site, and flexible and diverse transfer mode of flap. It is an effective option for clinical reconstruction of severe axillary burn scar contracture.

Objective: To propose a classification method and explore the indications and technical tips of the pedicled deep inferior epigastric artery perforator (DIEAP) flap. Methods: From July 2005 to December 2017, 18 patients underwent soft-tissue defect repairment using the pedicled DIEAP flap. The defect locations included abdomen (n=6), iliolumbar region (n=2), perineum (n=4), and proximal thigh (n=6). The flaps were divided into two types. The type Ⅰ flap were further subdivided into two subtypes. The type Ⅰa flap was solely based on the DIEAP. The type Ⅰb flap was also based on the DIEAP, however, the main trunk of the deep inferior epigastric vessels needs to be divided to further improve the pedicle length. The type Ⅱ flap was the traditional pedicled DIEAP flap. Results: Twenty flaps were included in this series. The mean flap size and pedicle length of the 4 flaps in type Ⅰa were 19.0 cm× 6.5 cm and 2.88 cm respectively. The rotation angles were 60 degrees (n=1), 120 degrees (n=1), and 180 degrees (n=2). The 3 flaps of type Ⅰb was 26 cm × 6 cm, 20 cm × 5 cm and 24 cm × 7 cm in size, and the pedicle lengths of them were 6 cm, 7 cm and 7 cm, respectively. All flaps in this subtype were rotated by 180 degrees. The mean flap size and pedicle length of the 13 type Ⅱ flaps were 21.46 cm × 9.38 cm and 11.08 cm. 17 flaps completely survived postoperatively. Small-sized necrosis of the distal portion of the flap occurred in 3 flaps. All patients were followed up for 6 months to 5 years, with the averaged 11 months follow-up time. All patients were satisfied with the final outcomes. Tumor recurrence was not noticed for the oncological patients. Conclusions The pedicled DIEAP flap has remarkable versatility in the defect repairment for the regions including abdomen, iliolumbar region, proximal thigh, and perineal region. Combining with the " propeller flap" concept, the clinical application of pedicled DIEAP flap could be further expanded. The pedicled DIEAP flap is a reliable reconstructive method for defect repairment in abdominal and iliolumbar regions.

Objective: To evaluate the efficacy of indocyanine green SPY imaging in flap surgery. Methods: Between July 2016 and March 2017, forty-five flaps of thirty-five consecutive patients were retrospectively analyzed, among which forty-four were pedicled flaps and one was free flap, measuring from 2.0 cm×1.5 cm to 34.0 cm×17.0 cm. SPY imaging was performed twice for each flap, after the elevation of flap and after flap insertion respectively. The correlation of the flap perfusion detected by SPY and the prognosis of each flap were recorded and analyzed. Results: Twenty-nine flaps demonstrated good perfusion on SPY healed uneventfully. Sixteen flaps were demonstrated poor perfusion in the distal part of flap. Two flaps underwent surgical intervention intraoperatively and totally survived. Fourteen flaps were preserved conservatively and nine suffered partial- or full-thickness necrosis. None of the remaining five flaps sustained necrosis. Secondary healing was achieved through regular dressing change or operative debridement. The sensitivity, specificity and accuracy were 100%(9/9), 85.3%(29/34) and 88.4%(38/43) respectively. Conclusions Intraoperative indocyanine green SPY imaging is a useful adjuvant to evaluate flap perfusion and predict necrosis in plastic surgery, enhancing a surgeon’s clinical judgment of flap viability.

Objective: To explore the feasibility and technical tips of defect reconstruction using the pre-expanded perforator propeller (PEPP) flap. Methods: From July 2009 to December 2017, 56 patients underwent defect reconstruction using the PEPP flap. During the first-stage operation, an expander with appropriate size was buried within a soft-tissue pocket. Three strategies were used for expander placement, including placement of the expander underneath the muscle, at a distance from the emergence point of the perforator when the perforator location is relatively fixed, and following the criteria when a free-style perforator flap is designed. At the second-stage operation, a PEPP flap was raised and rotated a certain number of degrees to reconstruct the defect. Results: 56 flaps were elevated. The expanders were buried according to the strategy Ⅰ in 2 cases, the strategy Ⅱ in 42 cases, and the strategy Ⅲ in 12 cases. The flap size ranged from 7-13 cm to 14-32 cm with the average size of 9.38 cm × 21.22 cm. The pedicle length ranged from 2.5 cm to 10 cm and the mean length was 5.03 cm. The rotation angle was 180 degrees in 44 cases, 150 and 120 degrees in 6 cases respectively. The perforators that were previously explored were all identified during the second-stage operation. 53 flaps survived completely. Venous congestion of the distal portion of the flap was observed after the surgery in two cases. Necrosis of small area of the flap occurred and free skin grafting was used to resurface the defect after debridement. All patients were followed up for 3 months to 4 years and the average follow-up time was 13.4 months. Conclusions The PEPP flap can not only ensure primary closure of the donor site, but also provide more extra tissue for defect reconstruction. For selected patients, it could be an alternative option for soft-tissue defect reconstruction.

Objective: To investigate the distribution of the septocutaneous perforators in the medial arm and its clinical applications. Methods: Between March 2014 and August 2018, 39 patients (45 arms) were included in the study. A coordinate system originating at the medial epicondyle was established, with the y-axis running to the axillary apex and expressed in relative value. The y-axis was trisected and each third from proximal to distal were designated as A, B, and C, respectively. Based on this, the medial arm flap was used to reconstruct defects in the head and neck, hand, axilla, elbow and chest wall. Results: An average of 4.6 perforators were identified along the medial intermuscular septum of the arm, located at 0.87±0.08, 0.50±0.09 and 0.20±0.06 on the y-axis, with a prevalence of 95.6%, 100% and 86.7%, respectively. Among the 45 flaps, 30 were used as pedicled distant flaps and 15 as perforator-based propeller flaps, with an average size of 18.7 cm×8.1 cm. The average length of the perforator pedicle was 3.1 cm. One pedicled distant flap developed hematoma after pedicle division but recovered with hematoma removal. One perforator-based propeller flap had partial loss of the distal third, requiring surgical debridement followed by a local flap transfer. Two perforator-based propeller flaps had venous congestion but survived completely with conservative therapy. The remaining flaps healed uneventfully. Donor-site morbidity was minimal. The patients were followed up for 6 months to 3 years (average 12.6 months) with satisfactory aesthetic appearance, greatly improved function and no tumor recurrence. Conclusions The constant perforators could be found in each third of the medial arm. The perforator-based medial arm flap could be used for various soft-tissue defect reconstructions.

Objective To explore the feasibility and technique of reconstruction of extensive softtissue defects at upper extremities using the pre-expanded paraumbilical perforator (PUP) flaps.Methods Pre-expanded PUP flap was used to reconstruct large soft-tissue defect at the upper extremity according to the size,shape,and location of the defect in a multiple-staged procedure.Results From Sept.2009 to Sept.2015,81 patients underwent defect reconstruction using the pre-expanded PUP flaps.93 preexpanded PUP flaps were used.Unilateral flap was used in 70 patients.Bilateral flaps were used to reconstruct the circumferential forearm defects in eight patients (16 flaps).Bilateral flaps were used to reconstruct bilateral forearm defects in three patients (6 flaps).The size of the flaps ranged from 8 cm ×6 cm to 40 cm × 15 cm.Small-sized distal flap necrosis occurred in five patients after division of the proximal pedicle of the flap.The patients were followed up for 1 to 5 years (average 3.5 years) with satisfactory functional and aesthetic outcomes.Dysfunction of the shoulder and elbow joints was not noticed postoperatively.Conclusions The pre-expanded paraumbilical perforator flap provides a valuable option for different defects reconstruction at the upper extremity.

Objective:To establish a standardized burn injury in rat model and to explore effect of the burn injury to choke vessel of dorsal skin flap in the rat model.Methods:114 male Sprague Dawley rats were randomly divided into 3 groups, 38 rats of each group. The dorsal three-perforasome perforator flap of rats in different groups was contacted with 100 ℃ water for 10, 15 or 20 seconds, respectively. Blood perfusion of the injured area was monitored for 7 days using PeriCam PSI system. Lead oxide-gelatine angiogram was performed to observe distribution of skin vessels. Histological analysis was performed to observe depth of burn injury and quantify the microvascular density and diameter. The measurement datas were expressed as Mean±SD, and statistical analysis was performed by t-test, one-way ANOVA and resuable ANOVA. Results:10, 15, 20-s scald resulted in a superficial second-degree burns, a deep second-degree burns, and deep third-degree burns, respectively. At day 7 after burn injury, perfusion was comparable with the pre-burn level in the 10 s-scalding group[speckle flow index (SFI): 143.25±30.40 vs. 140.28±26.35, P=0.828], was slightly lower than pre-burn level in the 15 s-scalding group (106.20±10.30 vs. 119.31±9.66, P=0.072), and significantly decreased in the 20 s-scalding group (67.49±19.93 vs. 136.37±18.96, P=0.001). The density of the blood vessels in the entire three-perforasome area recovered to the pre-burn level within 14 days in the 10 s-scalding group, slightly increased in the 15 s-scalding group, and obviously decreased in the 20 s-scalding group. At day 7 after burn injury, the microvascular density in the choke vessel zone was equal to the pre-burn level in the 10 s-scalding group [(29.16±2.38)/mm 2 vs. (27.74±3.66)/mm 2, P=0.696] and 20 s-scalding group [(30.80±2.27)/mm 2 vs. (27.74±3.66)/mm 2, P=0.407], and significantly increased in the 15 s-scalding group [(36.68±4.65)/mm 2 vs. (27.74±3.66)/mm 2, P=0.027]. At day 7 after burn injury, the microvascular diameter of choke vessels was equal to the pre-burn level in the 10 s-scalding group [(35.61±2.49) μm vs. (41.74±3.31) μm, P=0.938] and 15 s-scalding group [(52.88±4.97) μm vs. (41.74±3.31) μm, P=0.058], and was significantly decreased in the 20 s-scalding group [(37.57±5.33) μm vs. (41.74±3.31) μm, P=0.001]. Conclusions:The superficial second-degree burn injury don’t impact the choke vessels. The deep second-degree burn injury increased the microvascular density in the choke vessel zone and the post-burn blood perfusion can recover to the pre-burn level. The deep third-degree burn injury damage the blood vessels in the dorsal skin and the perfusion can not restore.