Because of the versatility of autologous cartilage and proven advantages, it has been widely used in all kinds of rhinoplasty. Autologous cartilage have good biocompatibility with less complications such as infection, extrusion of graft, compared to biological synthetic materials, so it is generally considered the primary graft for nasal surgery especially septal, conchal and costal cartilage. With the popular clinical application of autologous cartilage, problem also arised and considered.The purpose of this paper is to review the application of autologous cartilage and complications in rhinoplasty.

Objective: To study the tissue size, calcification characteristics and the correlation between calcification and age and lateral side of 6, 7 and 8 costal cartilage in women, so as to provide reference for clinical application. Methods: From the radiology storage center of Second Xiangya Hospital, 70 cases of female costal cartilage were treated with dual-source CT three-dimensional reconstruction. The reconstructed images were treated with maximum intensity projection (MIP) and volume reconstruction (VR). The length, width and thickness of bilateral 6, 7 and 8 costal cartilage were measured by VR images, and the correlation between calcification rate, calcification degree, calcification type, calcification location, calcification with age and side was observed and analyzed on VR and MIP images. The data were analyzed by SPSS 20.0 and compared by corresponding statistical method, including independent sample t test, chi-square test, logistic regression analysis and variance analysis. Results: (1) The length of costal cartilage on the left was (98.7 ±12.7) mm, (132.8 ±13.8) mm, (81.5 ±11.6) mm, width (12.6 ±1.5) mm, (11.0 ±1.4) mm, (7.4 ±1.1) mm, thickness (8.1 ±0.5) mm, (7.7 ±0.6) mm, (6.6 ±0.6) mm. On the right side, the length of costal cartilage was (95.8 ±11.3) mm, (133.1 ±12.0) mm, (81.7 ±12.3) mm, width (12.2 ±1.4) mm, (11.11 ±1.5) mm, (7.4 ±1.1) mm, thickness (8.2 ±0.6) mm, (7.7 ±0.5) mm, (6.5 ±0.6) mm. There was no significant difference in the length, width and thickness of the left and right sides of the costal cartilage in the same sequence (P>0.05). There were significant differences in length, width and thickness between unilateral costal cartilage with different ordinal numbers (P<0.01). (2) The total calcification rates of left and right costal cartilage were 61.9% (130/210) and 60.0% (126/210), respectively, and there was no significant difference between the two groups (The chi-square was equal to 0.160. The P value was equal to 0.689), but there was no significant difference in left and right total calcification types, total calcification location and total calcification count (P>0.05). There was no significant difference in the total calcification type between left and right, the total calcification location and the total calcification degree count (P>0.05). There was also no significant difference between the two groups (P>0.05). There was no significant difference in the calcification rate between the left and right sides of the 6th, 7th and 8th costal cartilage, but there was significant difference in the total calcification types of the 6th, 7th and 8th costal cartilage (The chi-square was equal to 61.541, P value was less than 0.001). (3)The relationship between calcification rate and age was analyzed by univariate analysis and logistic regression equation. The higher the age, the higher the calcification rate. The relationship between the calcification degree and age of the 6th, 7th and 8th costal cartilage was tested by variance test, and the regression equation showed that the calcification degree of the 6th, 7th and 8th costal cartilage was higher with the age. Conclusions Preoperative three-dimensional reconstruction and image post-processing of costal cartilage with dual-source CT can accurately measure the amount of cartilage tissue and define the characteristics of calcification, so as to guide the clinical selection of costal cartilage that meets the requirements of operative method. In female patients of different ages undergoing rhinoplasty and external ear reconstruction, the calcification rate of costal cartilage increased with age, but there was no positive correlation. With the increase of calcification with age, artificial materials can be used for cases with severe calcification to avoid the blindness of surgery.

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.

Botulinum toxin A is of extensive application in medical cosmetology, such as wrinkle removal, facial lift, and improving the contour of face, shoulder, calf and so on. Recent studies have found that botulinum toxin A also plays a certain role in improving the blood supply of flaps. This paper reviews the relevant articles published in recent years, summarizes the application of botulinum toxin A in vivo and in vitro. The potential mechanism, for example, improving flap perfusion, reducing thrombogenesis, promoting angiogenesis and inhibiting inflammatory response are also analyzed in the paper. The successful application of botulinum toxin A can provide a more convenient and reliable method to improve the blood supply of the flap for clinical treatment, and that will make efforts to improve the prognosis of patients, shorten the hospitalization time and reduce the hospitalization expenses.

Objective:To evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Chinese rhinoplasty.Methods:A retrospective chart review was conducted for patients who underwent pollybeak correction between January 2021 and December 2022 at the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University. Individualized correction was tailored based on the etiology and severity of the nasal deformity of each patient, involving techniques such as resection of the anterior part of the nasal septum, reconstruction of nasal tip support, reconstruction of the middle part of the nasal vault, and excision of skin in the upper region of the nasal tip. A modified classification system for pollybeak deformity, the supratip fullness rating scale (SFRS), was developed to evaluate supratip fullness (0-3 points, with higher scores indicating more apparent deformity). The patients aesthetic outcomes were assessed by surgeons using the visual analogue scale (VAS) (0-10 points, with higher scores indicating more apparent deformity), and patient self-assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (0-100 points, with higher scores indicating higher satisfaction). The measurement data of normal distribution was expressed as Mean±SD and analyzed by paired t-test; the measurement data of non-normal distribution was expressed as M( Q1, Q3) and analyzed by Wilcoxon signed rank test. Results:In a cohort study of 53 rhinoplasty patients (7 male, 46 female; age range 19-45 years, mean 29 years), comprising 15 primary and 38 secondary surgeries, nasal tip deformities were evaluated. Deformities were classified as mild (5 cases), moderate (25 cases), and severe (23 cases). Over a follow-up period of 6-17 months (mean 9.5 months), significant aesthetic improvements in the nasal tip region were observed. The SFRS scores decreased from 2(2, 3) preoperatively to 0(0, 0) postoperatively ( Z = -6.58, P < 0.001), and VAS scores decreased from 7.47±1.73 to 1.79±1.67 ( t = -25.61, P < 0.001). High patient satisfaction was indicated by a mean ROE score of 82.45±11.55. No significant complications, such as nasal tip ptosis, skin necrosis, or scar hyperplasia, were reported. Conclusion:Selecting an appropriate surgical method based on the severity and cause of pollybeak deformity can achieve satisfactory outcomes. Post-operative patients exhibit significant aesthetic improvement in the upper nasal tip area, resulting in high patient satisfaction.

Objective:To explore the clinical efficacy of modified superomedial pedicle technique using an inverted T-shaped incision for reduction mammaplasty and mastopexy.Methods:A retrospective analysis was conducted on clinical data of patients who underwent modified superomedial pedicle technique for breast reduction surgery with inverted T-shaped incision between March 2021 and March 2023 at the Department of Plastic and Aesthetic (Burn) Surgery, Second Xiangya Hospital of Central South University. Preoperatively, a handheld Doppler ultrasound blood flow detector was used to detect and mark the exit points of the 2nd to 4th perforating vessels of the internal thoracic artery, and a superomedial pedicle containing at least two perforators was designed based on the perforator locations, with a pedicle width generally about 6 cm. Intraoperatively, the pedicle was rotated superolaterally, moving the nipple-areola complex (NAC) upwards to construct a fuller upper pole of the breast and removing excess skin in the lower fold to form a inverted T-shaped incision. Postoperatively, the blood supply of the NAC, breast morphology, and incidence of complications were observed and followed up. Canfield Mirror 7.1.1 software was utilized to measure pre- and post-operative breast morphology data from lateral photographs at 6 months, including total breast area, maximum breast protrusion, upper pole protrusion, lower pole height, and nipple elevation height. The BREAST-Q questionnaire was used to survey patient satisfaction with breast appearance, psychosocial well-being, sexual well-being, and physical health before surgery and 6-12 months after surgery, with each dimension scoring 0-100 points, where higher scores indicate greater satisfaction and health. SPSS 28.0 software was used for data analysis, with normally distributed measurement data expressed as Mean±SD, and paired t-test was applied for comparisons of pre- and post-operative breast morphology data (the first 4 indicators) and BREAST-Q scores, with P<0.05 considered statistically significant. Results:A total of 56 female patients were included, with an age of (32.0±6.7) years and a body mass index of (29.1±5.7) kg/m 2. Preoperative Doppler ultrasound blood flow detection showed that none of the patients had missing or significantly variant perforators of the superomedial pedicle. The volume of breast tissue removed ranged from 890 to 1 800 ml, averaging 1 250 ml, with an average pedicle width of 5.4 cm (4.0-7.0 cm). The follow-up period was (13.3±2.5) months, during which all patients exhibited good blood supply to the NAC and favorable breast morphology, with universal high satisfaction with surgical outcomes. Postoperatively, one case developed incisional seroma, which resolved naturally within 3 months; two cases experienced minor incision dehiscence, which healed well after dressing changes; all other patients recovered well without any complications such as flap necrosis or hematoma. Comparison of breast morphology data showed significant reductions in postoperative left and right total breast area ( P<0.05 for both), and increases in maximum breast protrusion and lower pole height postoperatively ( P<0.05 for both), while the difference in upper pole protrusion was not statistically significant ( P>0.05 for both); postoperative left and right nipple elevation heights were (6.30±1.84) cm and (6.52±1.66) cm, respectively. Among the 44 patients who completed the BREAST-Q survey both before and after surgery, scores showed significant improvements in postoperative breast satisfaction [(50.30±10.30) points vs. (83.20±6.02) points] ( t=5.17, P=0.008) and psychosocial well-being [(56.20±17.20) points vs. (89.70±2.70) points] ( t=5.09, P=0.010), while sexual well-being and physical health scores did not differ significantly from preoperative scores ( P>0.05 for both). Conclusion:Preoperative identification of perforator locations using a handheld Doppler blood vessel detector, followed by the design of a modified superomedial pedicle technique for reduction mammaplasty with inverted T-shaped incision, can not only ensure NAC blood supply, avoiding ischemic necrosis due to vascular anomalies, but also maximally reduce pedicle width and increase pedicle rotation flexibility, achieving desirable breast shaping effects.

The patient was a 29-year-old male with a history of hemophilia for more than 10 years. After 6 hours of botulinum toxin injection into the masseter muscle, the redness and swelling of the right face gradually worsened, accompanied by local pain, and restricted mouth opening, etc. The hematoma was absorbed and the swelling subsided significantly after the infusion of coagulation factor Ⅸ. Such cases of large-scale hematomas after botulinum toxin injection in hemophiliacs is rarely reported. This article summarized the diagnosis and treatment process of this case and combines with literature review to provide clinical experience for diagnosis, treatment and prevention of similar complications.

Dermatofibrosarcoma protuberances is a kind of borderline or potential low-grade fibrocytoma, which usually occurs in trunk and rarely in breast. One case of breast protuberans fibrosarcoma underwent wide resection, followed by immediate reconstruction with perforator flap pedicled by thoracodorsal artery. Satisfactory result was achieved. The whole process was recorded and the related articles were reviewed systemly. The diagnosis and treatment experience of protuberans fibrosarcoma were summarized.

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.