Objective:To observe the effect of adipose tissue decellularized matrix hydrogel (DAT-gel) on the repair of sciatic nerve defect in rats.Methods:From April, 2019 to April, 2020, aseptic granular adipose tissue was collected from healthy adult women who underwent thigh or abdominal liposuction in the Department of Plastic Surgery, the First Medical Centre of the PLA General Hospital. Decellularisation and enzymatic digestion of adipose tissue were performed to prepare DAT-gel. Scanning electron microscope (SEM) was used to observe the ultrastructure of the hydrogel, and rheology was employed to test the gel dynamics and viscoelasticity of the hydrogel. A rat model of sciatic nerve defect was established and randomly divided into 3 groups: simple chitin catheter group (Chitin group), DAT-gel plus chitin catheter group (DAT-gel group) and autologous nerve reverse connection group (Autograft group) with 10 rats in each group. At the 12th week after surgery, the general view, function and morphology of the regenerated nerve were observed to evaluate the repairing status of the injured nerve. One-way analysis of variance (one-way ANOVA) was used for data analysis. If the difference between the groups was statistically significant, the Turkey method was further used for pairwise comparison. P<0.05 was considered as statistically significant. Results:The results of SEM showed that the DAT-gel had a three-dimensional structure in porous fibre network. The results of rheological test results showed that the complex viscosity of the hydrogel at 4 ℃ and 37 ℃ were 148.91 mPa·s and 801.29 mPa·s, respectively. DAT-gel underwent a sol-gel phase transition when the temperature had been increased. The results showed that DAT-gel had a good temperature-sensitive effect, and its critical point of sol-gel phase transition was similar to the internal temperature of rat. The results of animal experiments showed that the morphology and function of the regenerated nerve in the DAT-gel group were superior to Chitin group at 12 weeks after surgery, according to macroscopic view of the regenerated nerve, electrophysiology of the nerve, the morphology of the new axon and the target muscle, etc.. There was statistically significant between groups ( P<0.05). Conclusion:DAT-gel can significantly promote a repair of sciatic nerve defects in rats.

Objective:To observe the clinical efficiency, duration of action and adverse reactions of lip contour after local injection of type A botulinum toxin into the orbicularis oculi muscle.Methods:From March 2019 to June 2019, a total of 11 patients (6 males and 5 females, mean age 42.2 years) received superficial injection of botulinum toxin A in the orbicular muscle in our hospital. The change of lip thickness was assessed by Medicis lip fullness scale (MLFS) and the 3D structured light camera was used to collect and analyze the facial data. Pre- and post-treatment effects, duration of action and complications were evaluated.Results:Improvement of upper lip thickness was noted in 11 cases (100%). The average onset time after injection was 14.6 days and average effect maintenance time was 124.1 days. The height of the red lips ( Z=-2.940, P<0.05), the distance from the upper lip to the Ricketts line ( Z=-2.137, P<0.05) and nasolabial angle ( Z=-2.137, P<0.05) were significantly changed one month after the injection. No allergic reaction was observed, and the adverse reactions were mild and reversible. Conclusion:Local injection of botulinum toxin type A can achieve mild lip augmentation.

Objective:To compare the results of thinned latissimus dorsi muscle flap combined with skin grafting and dorsal free flaps in repairing traumatic dorsal foot defects.Methods:From January 2005 to December 2019, 41 patients with large soft tissue defects in the dorsum of the foot were admitted to our department. Inclusion criteria: unilateral dorsal foot and ankle soft tissue defects, accompanied by tendon and/or bone exposure, cannot be repaired by simple methods such as skin grafting and local flaps, and the affected area has blood vessels that can be used for anastomosis. Exclusion criteria: primary or secondary vascular diseases, systemic conditions intolerant to prolonged surgery. According to the patient’s choices, the latissimus dorsi flap or the scapular flap were used for repair, namely the traditional flap group. Or latissimus dorsi muscle flap was used to fill and cover the defect, and then the surface of the muscle flap was sealed with split-thickness or full-thickness skin grafting, which is the combined transplantation group. Postoperative follow-up was mainly focused on the recovery of foot function, whether the shoes were worn normally, the appearance of the flap, and the rate of second operation.Results:A total of 41 patients were included in this study. All the flaps survived without infection and tissue necrosis. Twenty three cases, 16 males and 7 females, age from 6 to 52 years with an average of 27.6 years, were repaired with latissimus dorsi flap or scapula flap. The area of soft tissue defects was from 5.5 cm×8.0 cm to 19.5 cm×23.0 cm, with an average areaof 10.1 cm×16.2 cm. The follow-up time was from 6 to 24 months with an average of 9.7 months. All walking function of the foot was basically restored, and the texture of the flap was good. Eighteen patients had bloated flap appearance, 15 of which affected shoe-wearing, and 14 had debulking surgery, 2 had developed hypertrophic scar. Eighteen cases, 14 males and 4 females, age from 19 to 49 years with an average of 30.7 years, were repaired with latissimus dorsimuscle flap combined with split-thickness or full-thickness skin grafts. The area of soft tissue defects was from 4.0 cm×6.5 cm to 20.5 cm×23.0 cm, and the average area was 11.7 cm × 17.3 cm. All donor-site incisions are sutured in one stage without skin grafting. The follow-up time was from 4 to 20 months with an average of 8.3 months. The walking function of all operative feet, with good shape and without bloating, was basically restored. The contour and curve was similar to the healthy side and no skin injury and ulcer was observed. All patients were satisfied with wearing shoes and walking function, and no secondary surgery was required. However, 9 patients had developed hypertrophic scar.Conclusions:Compared with the traditional flap, the free latissimus dorsi muscle flap combined with skin grafting can effectively cover large area of soft tissue defect on the dorsal foot, without bloated flap appearance and secondary surgery. However, the risk of scar hyperplasia after combined transplantation increased.

Objective:To explore the applied value of super-selective cervical lymph node dissection in papillary thyroid carcinoma (PTC) patients with clinically suspicious lateral lymph node metastasis (LNM).Methods:We retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the Department of Head and Neck Surgical Oncology, National Cancer Center. Among them, 90 cases received super-selective neck dissection (level Ⅲ and IV) and 142 cases underwent selective neck dissection (level Ⅱ-Ⅳ). The LNM of two groups were analyzed.Results:Postoperative pathological results showed that 173 cases had LNM in the central compartment. The LNM cases of level Ⅱ-Ⅳ were 47, 147 and 130, respectively. Eight patients of super-selective neck dissection and 6 of selective neck dissection had postoperative lymphatic fistulas ( P=0.146). No patients in super-selective neck dissection group while 9 patients in the selective lymph node dissection group had postoperatively permanent impairment of shoulder mobility, the difference was statistically significant ( P=0.015). In the super-selective neck dissection group, 2 patients had long-term postoperative incision discomfort, and 5 cases had obvious cicatrix after surgery. In the patients with selective neck dissection, 27 cases experienced long-term incision discomfort after surgery, and 26 patients had apparent scar tissue, the differences were statistically significant ( P<0.005). There was no recurrence during the follow-up. Conclusions:Super-selective neck dissection is a feasible, safe and effective treatment for cN1b PTC patients. It can improve the quality of postoperative life and avoid the over treatment for patients.

Objective:To explore the applied value of super-selective cervical lymph node dissection in papillary thyroid carcinoma (PTC) patients with clinically suspicious lateral lymph node metastasis (LNM).Methods:We retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the Department of Head and Neck Surgical Oncology, National Cancer Center. Among them, 90 cases received super-selective neck dissection (level Ⅲ and IV) and 142 cases underwent selective neck dissection (level Ⅱ-Ⅳ). The LNM of two groups were analyzed.Results:Postoperative pathological results showed that 173 cases had LNM in the central compartment. The LNM cases of level Ⅱ-Ⅳ were 47, 147 and 130, respectively. Eight patients of super-selective neck dissection and 6 of selective neck dissection had postoperative lymphatic fistulas ( P=0.146). No patients in super-selective neck dissection group while 9 patients in the selective lymph node dissection group had postoperatively permanent impairment of shoulder mobility, the difference was statistically significant ( P=0.015). In the super-selective neck dissection group, 2 patients had long-term postoperative incision discomfort, and 5 cases had obvious cicatrix after surgery. In the patients with selective neck dissection, 27 cases experienced long-term incision discomfort after surgery, and 26 patients had apparent scar tissue, the differences were statistically significant ( P<0.005). There was no recurrence during the follow-up. Conclusions:Super-selective neck dissection is a feasible, safe and effective treatment for cN1b PTC patients. It can improve the quality of postoperative life and avoid the over treatment for patients.

Objective:To compare the results of thinned latissimus dorsi muscle flap combined with skin grafting and dorsal free flaps in repairing traumatic dorsal foot defects.Methods:From January 2005 to December 2019, 41 patients with large soft tissue defects in the dorsum of the foot were admitted to our department. Inclusion criteria: unilateral dorsal foot and ankle soft tissue defects, accompanied by tendon and/or bone exposure, cannot be repaired by simple methods such as skin grafting and local flaps, and the affected area has blood vessels that can be used for anastomosis. Exclusion criteria: primary or secondary vascular diseases, systemic conditions intolerant to prolonged surgery. According to the patient’s choices, the latissimus dorsi flap or the scapular flap were used for repair, namely the traditional flap group. Or latissimus dorsi muscle flap was used to fill and cover the defect, and then the surface of the muscle flap was sealed with split-thickness or full-thickness skin grafting, which is the combined transplantation group. Postoperative follow-up was mainly focused on the recovery of foot function, whether the shoes were worn normally, the appearance of the flap, and the rate of second operation.Results:A total of 41 patients were included in this study. All the flaps survived without infection and tissue necrosis. Twenty three cases, 16 males and 7 females, age from 6 to 52 years with an average of 27.6 years, were repaired with latissimus dorsi flap or scapula flap. The area of soft tissue defects was from 5.5 cm×8.0 cm to 19.5 cm×23.0 cm, with an average areaof 10.1 cm×16.2 cm. The follow-up time was from 6 to 24 months with an average of 9.7 months. All walking function of the foot was basically restored, and the texture of the flap was good. Eighteen patients had bloated flap appearance, 15 of which affected shoe-wearing, and 14 had debulking surgery, 2 had developed hypertrophic scar. Eighteen cases, 14 males and 4 females, age from 19 to 49 years with an average of 30.7 years, were repaired with latissimus dorsimuscle flap combined with split-thickness or full-thickness skin grafts. The area of soft tissue defects was from 4.0 cm×6.5 cm to 20.5 cm×23.0 cm, and the average area was 11.7 cm × 17.3 cm. All donor-site incisions are sutured in one stage without skin grafting. The follow-up time was from 4 to 20 months with an average of 8.3 months. The walking function of all operative feet, with good shape and without bloating, was basically restored. The contour and curve was similar to the healthy side and no skin injury and ulcer was observed. All patients were satisfied with wearing shoes and walking function, and no secondary surgery was required. However, 9 patients had developed hypertrophic scar.Conclusions:Compared with the traditional flap, the free latissimus dorsi muscle flap combined with skin grafting can effectively cover large area of soft tissue defect on the dorsal foot, without bloated flap appearance and secondary surgery. However, the risk of scar hyperplasia after combined transplantation increased.

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h,