Objective:To investigate the quantitative characteristics of abdominal wall aesthetics in young East Asian women.Methods:A cross-sectional survey study design was adopted. From June to August 2024, the Department of Plastic Surgery of Zhongshan Hospital, Fudan University disseminated volunteer recruitment announcements via multiple channels. Young female volunteers from East Asia aged 22-35 years were stratified enrolled according to the demographic ratios (30∶2∶1) of young women aged 22-35 years in China, Japan, and Repubic of Korea reported by authoritative organizations. These volunteers were unanimously evaluated to have an aesthetically "GOOD" abdominal wall via observations by four plastic surgery medical staff and four individuals without a medical background with meeting other inclusion and exclusion criteria. Three-dimensional (3D) photography was utilized to capture and reconstruct the 3D images of the abdominal walls. Key aesthetic landmarks of the abdominal wall were observed and measured. The main parameters include linearity, proportionality, angles, and areas of the umbilicus, abdominal wall depression, rectus abdominis protrusion, and abdominal wall contour. Statistical software (SPSS 26.0) was employed to calculate the average level of each parameter. Continuous variables conforming to the normal distribution were expressed as Mean±SD. Continuous variables that do not conform to the normal distribution were expressed as M( Q1,Q3), and compared using Mann-Whitney U test. Categorical variables were presented as frequencies and proportions (%). P<0.05 was considered statistically significant. Results:A total of 63 young East Asian women defined having an aesthetically "GOOD" abdominal wall were enrolled with an age of (26.7±7.4) years and body mass index of (19.6±3.9) kg/m 2. Umbilicus: 52.4%(33/63) umbilicus exhibited a vertical elliptical shape with a vertical diameter of 1.8(1.7, 2.1) cm, transverse diameter of 1.2 (1.0, 1.7) cm, depth of 0.4(0.3, 0.7) cm and projected area of 2.1(1.3, 3.0) cm 2; the presence of a bulge at the base of the umbilicus was relatively rare [6 cases (9.5%)], and no cases were observed protrusion beyond the abdominal wall and most umbilicus were at the lower 3/5 level of abdominal wall. Midline depression: the upper umbilical segment was significantly longer than the lower segment [7.8 (6.7, 8.4) cm vs. 3.6 (2.8, 4.1) cm, P<0.01], with an approximate upper-to-lower ratio of 2∶1; the upper segment was also wider [0.6 (0.5, 0.6) cm vs. 0.4 (0.4, 0.5) cm, P<0.01] and deeper than the lower segment [ 0.4(0.3, 0.6)cm vs. 0.1(0.1, 0.3) cm ( P<0.05)]. Semilunar lines: the left side measured a length of 14.5(10.6, 16.4) cm while right side measured 15.6(14.7, 16.1) cm ( P>0.05). Costal margin depression: the left side measured a depth of 0.3(0.2, 0.4) cm and the right side 0.3(0.2, 0.6) cm ( P>0.05) with infrasternal angle(upper abdominal angle) measuring 72.6°(59.8°, 89.6°). Iliac fossa depression: the depth of left side measured 1.0(0.8, 1.3) cm, while right side 1.0(0.8, 1.1) cm ( P>0.05); the left projected area was 16.4 (14.7, 18.3) cm 2 and right side 15.8(13.6, 17.8) cm 2 ( P>0.05). Rectus abdominis eminence: at costal margin level, the left side measured a width of 4.8 (4.1, 5.1) cm and the right side 4.7(4.1, 4.9) cm ( P>0.05); at umbilical level, the left side width was 4.1(3.7, 4.5) cm and the right side 3.8(3.2, 4.7) cm ( P>0.05); the overall projected area was 36.5(33.7, 38.5) cm 2. Outer contour lines: the length of left side was 33.6(31.5, 35.8) cm and the right side 35.7(31.6, 38.5) cm ( P>0.05); the waistline was located at the 2/5 level of the abdominal wall, approximately 2.4(1.7, 3.6) cm higher than the umbilicus; the outer contour of abdominal wall exhibited a morphology reminiscent of swan-neck vase. Conclusion:Using 3D photography technology, the body surface measurements of the abdominal wall in young East Asian women were conducted to quantify its aesthetic characteristics. The abdominal wall deemed aesthetically pleasing typically exhibits a "swan-neck vase" shape, characterized by relatively fixed landmark points, lines, planes, and proportional relationships. These results reflect the current positive and health-oriented aesthetic preferences prevalent among the general public.

Objective:To summarize the experience of repairing partial areolar necrosis following reduction mammaplasty.Methods:A retrospective analysis was conducted on clinical data from patients who experienced partial areola necrosis after reduction mammaplasty. These patients were treated or consulted at the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, between January 2017 and February 2023. Preoperatively, daily dressing changes were performed on the necrotic areola wounds until the boundaries of necrosis were clearly defined. Debridement and repair were then carried out by resecting bilateral breast glandular tissue through the original incision to reduce breast volume, followed by narrowing the areola radius. If no areola defect remained after narrowing, direct suturing was performed; if defects persisted, the resected normal areola skin was used for grafting. Postoperative follow-up was conducted to observe areola recovery and complications. At the 6-month postoperative mark, patient satisfaction was evaluated using a 5-level scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied). An experienced plastic physician, not involved in the surgery, assessed areolar outcomes based on four criteria: color, softness, shape, and scarring, with each criterion scored from 1 to 4 (higher scores indicating better outcomes).Results:Eight female patients (9 necrotic areolas) were included in the study, with a mean age of (31.8±5.4) years and a mean body mass index of (24.1±1.8) kg/m 2. Among the 9 necrotic areolas, 3 had defect areas greater than 50% of the total areola area, while 6 had defects less than 50%. Direct suturing after areola narrowing was performed in 3 areolas, while free areola skin grafting was used in 6 areolas. Postoperatively, 2 cases exhibited mild epidermal erosion at the graft site, which improved with dressing changes. No complications such as infection, bleeding, hematoma, or seroma occurred. At the 6-month follow-up, all 8 patients demonstrated good wound healing, and all 9 areolas survived. The areolas exhibited consistent shape and color bilaterally, without significant pigmentation changes, depigmentation, or irregular shapes. In the 6 grafted areolas, the grafted skin color closely matched the surrounding native areola tissue, with no obvious demarcation or scar hyperplasia. Patient satisfaction was rated as very satisfied in 3 cases and satisfied in 5 cases. According to the physician’s evaluation, the scores for color, softness, shape, and scarring were (3.7±0.5), (3.8±0.4), (3.3±0.7) and (3.2±0.7) points, respectively. Conclusion:Partial areola necrosis following reduction mammaplasty can be effectively repaired by further reducing breast volume and narrowing the areola for direct suturing or by grafting excess areola skin to the defect site. A satisfactory appearance can be achieved after surgery.

Objective:To investigate the quantitative characteristics of abdominal wall aesthetics in young East Asian women.Methods:A cross-sectional survey study design was adopted. From June to August 2024, the Department of Plastic Surgery of Zhongshan Hospital, Fudan University disseminated volunteer recruitment announcements via multiple channels. Young female volunteers from East Asia aged 22-35 years were stratified enrolled according to the demographic ratios (30∶2∶1) of young women aged 22-35 years in China, Japan, and Repubic of Korea reported by authoritative organizations. These volunteers were unanimously evaluated to have an aesthetically "GOOD" abdominal wall via observations by four plastic surgery medical staff and four individuals without a medical background with meeting other inclusion and exclusion criteria. Three-dimensional (3D) photography was utilized to capture and reconstruct the 3D images of the abdominal walls. Key aesthetic landmarks of the abdominal wall were observed and measured. The main parameters include linearity, proportionality, angles, and areas of the umbilicus, abdominal wall depression, rectus abdominis protrusion, and abdominal wall contour. Statistical software (SPSS 26.0) was employed to calculate the average level of each parameter. Continuous variables conforming to the normal distribution were expressed as Mean±SD. Continuous variables that do not conform to the normal distribution were expressed as M( Q1,Q3), and compared using Mann-Whitney U test. Categorical variables were presented as frequencies and proportions (%). P<0.05 was considered statistically significant. Results:A total of 63 young East Asian women defined having an aesthetically "GOOD" abdominal wall were enrolled with an age of (26.7±7.4) years and body mass index of (19.6±3.9) kg/m 2. Umbilicus: 52.4%(33/63) umbilicus exhibited a vertical elliptical shape with a vertical diameter of 1.8(1.7, 2.1) cm, transverse diameter of 1.2 (1.0, 1.7) cm, depth of 0.4(0.3, 0.7) cm and projected area of 2.1(1.3, 3.0) cm 2; the presence of a bulge at the base of the umbilicus was relatively rare [6 cases (9.5%)], and no cases were observed protrusion beyond the abdominal wall and most umbilicus were at the lower 3/5 level of abdominal wall. Midline depression: the upper umbilical segment was significantly longer than the lower segment [7.8 (6.7, 8.4) cm vs. 3.6 (2.8, 4.1) cm, P<0.01], with an approximate upper-to-lower ratio of 2∶1; the upper segment was also wider [0.6 (0.5, 0.6) cm vs. 0.4 (0.4, 0.5) cm, P<0.01] and deeper than the lower segment [ 0.4(0.3, 0.6)cm vs. 0.1(0.1, 0.3) cm ( P<0.05)]. Semilunar lines: the left side measured a length of 14.5(10.6, 16.4) cm while right side measured 15.6(14.7, 16.1) cm ( P>0.05). Costal margin depression: the left side measured a depth of 0.3(0.2, 0.4) cm and the right side 0.3(0.2, 0.6) cm ( P>0.05) with infrasternal angle(upper abdominal angle) measuring 72.6°(59.8°, 89.6°). Iliac fossa depression: the depth of left side measured 1.0(0.8, 1.3) cm, while right side 1.0(0.8, 1.1) cm ( P>0.05); the left projected area was 16.4 (14.7, 18.3) cm 2 and right side 15.8(13.6, 17.8) cm 2 ( P>0.05). Rectus abdominis eminence: at costal margin level, the left side measured a width of 4.8 (4.1, 5.1) cm and the right side 4.7(4.1, 4.9) cm ( P>0.05); at umbilical level, the left side width was 4.1(3.7, 4.5) cm and the right side 3.8(3.2, 4.7) cm ( P>0.05); the overall projected area was 36.5(33.7, 38.5) cm 2. Outer contour lines: the length of left side was 33.6(31.5, 35.8) cm and the right side 35.7(31.6, 38.5) cm ( P>0.05); the waistline was located at the 2/5 level of the abdominal wall, approximately 2.4(1.7, 3.6) cm higher than the umbilicus; the outer contour of abdominal wall exhibited a morphology reminiscent of swan-neck vase. Conclusion:Using 3D photography technology, the body surface measurements of the abdominal wall in young East Asian women were conducted to quantify its aesthetic characteristics. The abdominal wall deemed aesthetically pleasing typically exhibits a "swan-neck vase" shape, characterized by relatively fixed landmark points, lines, planes, and proportional relationships. These results reflect the current positive and health-oriented aesthetic preferences prevalent among the general public.

Objective:To summarize the experience of repairing partial areolar necrosis following reduction mammaplasty.Methods:A retrospective analysis was conducted on clinical data from patients who experienced partial areola necrosis after reduction mammaplasty. These patients were treated or consulted at the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, between January 2017 and February 2023. Preoperatively, daily dressing changes were performed on the necrotic areola wounds until the boundaries of necrosis were clearly defined. Debridement and repair were then carried out by resecting bilateral breast glandular tissue through the original incision to reduce breast volume, followed by narrowing the areola radius. If no areola defect remained after narrowing, direct suturing was performed; if defects persisted, the resected normal areola skin was used for grafting. Postoperative follow-up was conducted to observe areola recovery and complications. At the 6-month postoperative mark, patient satisfaction was evaluated using a 5-level scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied). An experienced plastic physician, not involved in the surgery, assessed areolar outcomes based on four criteria: color, softness, shape, and scarring, with each criterion scored from 1 to 4 (higher scores indicating better outcomes).Results:Eight female patients (9 necrotic areolas) were included in the study, with a mean age of (31.8±5.4) years and a mean body mass index of (24.1±1.8) kg/m 2. Among the 9 necrotic areolas, 3 had defect areas greater than 50% of the total areola area, while 6 had defects less than 50%. Direct suturing after areola narrowing was performed in 3 areolas, while free areola skin grafting was used in 6 areolas. Postoperatively, 2 cases exhibited mild epidermal erosion at the graft site, which improved with dressing changes. No complications such as infection, bleeding, hematoma, or seroma occurred. At the 6-month follow-up, all 8 patients demonstrated good wound healing, and all 9 areolas survived. The areolas exhibited consistent shape and color bilaterally, without significant pigmentation changes, depigmentation, or irregular shapes. In the 6 grafted areolas, the grafted skin color closely matched the surrounding native areola tissue, with no obvious demarcation or scar hyperplasia. Patient satisfaction was rated as very satisfied in 3 cases and satisfied in 5 cases. According to the physician’s evaluation, the scores for color, softness, shape, and scarring were (3.7±0.5), (3.8±0.4), (3.3±0.7) and (3.2±0.7) points, respectively. Conclusion:Partial areola necrosis following reduction mammaplasty can be effectively repaired by further reducing breast volume and narrowing the areola for direct suturing or by grafting excess areola skin to the defect site. A satisfactory appearance can be achieved after surgery.

Objective To verify the role of aldehyde dehydrogenase 2(ALDH2)in wound healing and to explore the underlying mechanisms.Methods A murine excisional wound model was developed and mice were randomly assigned to control group and Alda-1(ALDH2 agonist)group.Wound healing rate and activity of ALDH2 were measured.Masson staining was used to observe the collagen fiber content,and immunohistochemistry was used to detect the expression of ALDH2 and α-smooth muscle actin(α-SMA).The expression of collagen typeⅠandⅢ(Col-Ⅰ,Col-Ⅲ),and the number of F4/80,inducible nitric oxide synthase(iNOS)and CD206 positive(F4/80+,iNOS+,CD206+)cells were analyzed using immunofluorescences.Furthermore,interleukin(IL)-4-stimulated RAW264.7 cells were treated with Alda-1 or CVT-10216(an ALDH2 inhibitor)in vitro.The proportion of F4/80+CD206+cells were analyzed using flow cytometry.Anti-inflammatory and pro-inflammatory cytokines were examined using ELISA.The expression of protein associated with the AKT/mTOR pathway were detected via western blotting.Results Compared with control group,the wound healing rate of mice in the Alda-1 group was significantly improved,and the expression of Col-Ⅰ,Col-Ⅲ,and α-SMA in the wound surface increased.Although the number of F4/80+cells in wounds did not significantly differ,there was a decrease in iNOS+cells and an increase in CD206+cells.In vitro,compared to IL-4 group,IL-4+Alda-1 group exhibited an increased proportion of F4/80+CD206+macrophages and higher levels of anti-inflammatory factors,alongside a reduction in levels of pro-inflammatory factors.Conversely,IL-4+CVT-10216 group demonstrated a decreased proportion of F4/80+CD206+macrophages,lower levels of anti-inflammatory factors with a concomitant increase in pro-inflammatory factors.Additionally,the protein expressions of p-AKT and p-mTOR were significantly elevated in IL-4+Alda-1 group and diminished in IL-4+CVT-10216 group.Conclusion ALDH2 induces M2 macrophage polarization via AKT/mTOR pathway to promote wound healing in mice.

Objective To explore the underlying mechanism of β2 adrenergic receptor(ADRB2)in fibrogenesis during wound healing.Methods Non-specific ADRB2 gene knockdown adeno-associated virus(AAV-ADRB2 group,6 mice)and control virus(AAV-NC group,6 mice)was injected randomly into the back skin of 12 mice for 21 days,a full-thickness skin defected wound healing murine model was established.Wound healing rates were recorded at the 1st,3rd,5th,and 7th day after operation.Histological examinations by H-E staining,Masson staining,and immunohistochemistry were conducted to observe wounded skin tissue structure,fibrosis,and α-SMA protein expression;quantitative PCR was employed to analyze ADRB2 and matrix metalloproteinase(MMP)mRNA levels;Western blotting was utilized to assess the protein expression levels of COL1A1,COL3A1,TGF-β1,and Smad3.Results On postoperative day 5 and 7,the wound healing rate of the AAV-ADRB2 group significantly decreased(P＜0.05),accompanied by a series pathological changes,including thickened epidermis,exaggerated inflammation,reduced fibroblast count,and inhibited collagen deposition;the α-SMA expression showed a significant decrease(P＜0.05),and the ratio of COL1A1 to COL3A1 decreased(P＜0.05);ADRB2 mRNA levels significantly decreased(P＜0.01),while MMP-1 and MMP-8 mRNA levels increased(P＜0.01);the protein levels of TGF-β1 and Smad3 exhibited a significant decrease(P＜0.05).Conclusions ADRB2 knockdown reduced fibrosis during wound healing and degenerated connective tissue content around the wound bed by inhibiting the TGF-β1/Smad3 signaling pathway,which leads to an increase in MMP mRNA levels and a decrease in the ratio of type Ⅰ to type Ⅲ collagen.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To investigate the surgical treatment of the tumors at cervicothoracic junction.Methods:A retrospective analyses was performed for 63 patients with tumors at the cervicothoracic junction receiving surgery from Mar 2008 to May 2020 in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical data about manifestation, surgical approach, resection degree and pathological types were collected. There were 43 cases of asymptomatic patients and 20 cases of patients with ≥1 clinical manifestations. Twenty two patients receiving radical resection with video-assisted thoracoscopic surgery. Anterior approach was the most popular treatment in open surgery (24 cases, 38.1%), and 8 cases of anterolateral approach(6 cases of Hemiclamshell incisions, 2 cases of trap-door incisions), 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular combined posterolateral approach.Results:Pathological examination suggested 61 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most common pathological type (27 cases, 42.9%), the second common pathological type was tumor originated from fibrous tissues (6 cases, 9.5%). The 3-year overall survival rate of those 63 patients was 88.9%, while the 5-year overall survival rate was 84.1%.Conclusion:Tumors involving the cervicothoracic junction are characterized as special location, complicated anatomy and various histopathological subtypes. Individualized approach and surgery improve safety and normalization of tumors at cervicothoracic junction treatment.

Objective:To investigate the causes and treatment of implant malposition after breast augmentation surgery.Methods:A retrospective study was conducted to investigate the patients with implant malposition after breast augmentation treated or consulted in our department from January 2000 to December 2020. A total of 95 breasts in 74 patients were treated during the period. The age of the patients was from 19-50 years, with the mean of 31.2 years. Causes of these complications were analyzed and the patients were managed in different ways according to the times after primary breast augmentation.Results:Twenty-one malposition breasts occurred within one week after primary surgery, and 17 breasts were successfully treated with manual reduction and fixation. 4 breasts were treated with operation after failed with manual reduction. The patients had good and bilateral symmetric breast morphology during the 6 months follow-up after the second operation. 25 malposition breasts were treated from one week to one month after primary surgery. Reoperation was performed through the original incision, separating the adhesive cavity to reposition the implant. Those patients were successfully treated. No re-occurrence was detected at 6 months follow-up after treatment. 49 malposition breasts were treated more than 3 months after primary surgery. Excessive capsule wrapping the shifted implant was removed to recreate a fresh wound while the adhesive cavity was separated to reset the implant. Bandage fixation was necessary. 7 implants were exchanged. 2 breasts were over corrected and re-operated successfully.Conclusions:The causes of implant malposition at different time after breast augmentation are various. Different methods can be used for effective treatment.