Objective:To investigate the feasibility and effect of endoscopic assisted surgery combined with sclerosing agent injection and negative pressure drainage for the treatment of microcystic lymphatic malformation in children.Methods:A retrospective analysis was conducted on clinical data of pediatric patients with microcystic lymphatic malformations between December 2021 and December 2023 in the Department of Burns and Plastic Surgery at Children’s Hospital of Nanjing Medical University. The treatment protocol consisted of endoscope-assisted surgery combined with sclerotherapy and negative pressure drainage. Preoperatively, two-dimensional ultrasound was utilized to demarcate the surface extent of the malformation. Intraoperatively, subcutaneous lymphatic malformation tissues were resected as thoroughly as possible under endoscopic guidance, and cystic cavities were interconnected. Postoperatively, a drainage tube was placed and connected to a negative pressure system. Starting on the third postoperative day, the cystic cavity was irrigated with absolute ethanol every other day. Irrigation was continued until the drainage fluid became light yellow and clear, and the daily drainage volume fell below 5 ml, at which point the drainage tube was removed. Complications were monitored, and treatment efficacy was assessed at the last follow-up using a four-tiered outcome scale: cured, markedly effective, effective, and ineffective. The overall effectiveness rate was calculated as (cured + markedly effective + effective) cases/total number of cases × 100%. Data analysis was performed using descriptive statistics.Results:A total of 20 pediatric patients were enrolled, including 8 males and 12 females. The age range was from 1 month to 13 years, with a mean age of 7 years and 7 months. All lesions were located superficially, distributed as follows: head, face, and neck (8 cases), chest (2 cases), abdomen (3 cases), back (2 cases), and limbs (5 cases). The lesion volumes ranged from 5.8 cm × 4.2 cm × 3.8 cm to 14.5 cm × 10.4 cm × 8.4 cm. No complications such as absolute ethanol intoxication, severe allergic reactions, surgical site infection, neurovascular injury, thrombosis, or pulmonary embolism occurred during the treatment period. All patients had their negative pressure drainage tubes removed on postoperative day 10. After tube removal, one case developed serous drainage from the incision, which resolved after 4 days of wound care and compressive dressing. The remaining 19 cases demonstrated satisfactory incision healing. During a follow-up period of 6 to 12 months, no significant postoperative scarring and recurrence were observed. Treatment outcomes were as follows: 4 cases of cured, 10 cases of markedly effective, 5 cases of effective, and 1 case of ineffective. The overall effective rate was 95%(19/20).Conclusion:The integrated approach of endoscope-assisted surgery combined with sclerotherapy and negative pressure drainage for the treatment of microcystic lymphatic malformations in children yields definite and favorable outcomes. This comprehensive technique is characterized by its minimal invasiveness, stable long-term result as confirmed by follow-up, absence of severe complications, and a low recurrence rate.

Objective:To investigate the feasibility and effect of endoscopic assisted surgery combined with sclerosing agent injection and negative pressure drainage for the treatment of microcystic lymphatic malformation in children.Methods:A retrospective analysis was conducted on clinical data of pediatric patients with microcystic lymphatic malformations between December 2021 and December 2023 in the Department of Burns and Plastic Surgery at Children’s Hospital of Nanjing Medical University. The treatment protocol consisted of endoscope-assisted surgery combined with sclerotherapy and negative pressure drainage. Preoperatively, two-dimensional ultrasound was utilized to demarcate the surface extent of the malformation. Intraoperatively, subcutaneous lymphatic malformation tissues were resected as thoroughly as possible under endoscopic guidance, and cystic cavities were interconnected. Postoperatively, a drainage tube was placed and connected to a negative pressure system. Starting on the third postoperative day, the cystic cavity was irrigated with absolute ethanol every other day. Irrigation was continued until the drainage fluid became light yellow and clear, and the daily drainage volume fell below 5 ml, at which point the drainage tube was removed. Complications were monitored, and treatment efficacy was assessed at the last follow-up using a four-tiered outcome scale: cured, markedly effective, effective, and ineffective. The overall effectiveness rate was calculated as (cured + markedly effective + effective) cases/total number of cases × 100%. Data analysis was performed using descriptive statistics.Results:A total of 20 pediatric patients were enrolled, including 8 males and 12 females. The age range was from 1 month to 13 years, with a mean age of 7 years and 7 months. All lesions were located superficially, distributed as follows: head, face, and neck (8 cases), chest (2 cases), abdomen (3 cases), back (2 cases), and limbs (5 cases). The lesion volumes ranged from 5.8 cm × 4.2 cm × 3.8 cm to 14.5 cm × 10.4 cm × 8.4 cm. No complications such as absolute ethanol intoxication, severe allergic reactions, surgical site infection, neurovascular injury, thrombosis, or pulmonary embolism occurred during the treatment period. All patients had their negative pressure drainage tubes removed on postoperative day 10. After tube removal, one case developed serous drainage from the incision, which resolved after 4 days of wound care and compressive dressing. The remaining 19 cases demonstrated satisfactory incision healing. During a follow-up period of 6 to 12 months, no significant postoperative scarring and recurrence were observed. Treatment outcomes were as follows: 4 cases of cured, 10 cases of markedly effective, 5 cases of effective, and 1 case of ineffective. The overall effective rate was 95%(19/20).Conclusion:The integrated approach of endoscope-assisted surgery combined with sclerotherapy and negative pressure drainage for the treatment of microcystic lymphatic malformations in children yields definite and favorable outcomes. This comprehensive technique is characterized by its minimal invasiveness, stable long-term result as confirmed by follow-up, absence of severe complications, and a low recurrence rate.

Objective:To investigate clinical effects of the three-dimensional(3D) digital technique-assisted distraction osteogenesis in newborns with Pierre Robin sequence(PRS).Methods:The data of neonatal Pierre Robin sequence treated with 3D digital technique-assisted distraction osteogenesis in Children’s Hospital Affiliated to Nanjing Medical University from April 2017 to April 2020 was retrospectively analyzed. 3D digital technique was used to assist the pre-operative design and osteotomy navigation template was made with 3D printing technique to guide in the mandibular osteotomy. CT scans were obtained 3 months postoperatively to follow up the growth of mandible. The rates of recurrence, titanium nail falling, infection, secondary operation and nerve injury were statistically analyzed. The counting data were analyzed using chi-square test. The independent influencing factors of postoperative complications were analyzed by multiple logistic regression, and the difference was statistically significant when P<0.05. Results:Three hundred and forty-five patients were included in the 3D digital technique group consisting of 215 males and 130 females with the ages ranged 3-28 days and the weights 1.8-3.2 kg. Surgical results were satisfied and very close to the preoperative design. Craniofacial CT results showed normal growth of mandible 3 months postoperatively. Three hundred and seventy-seven patients were included in the controlled group consisting of 230 males and 147 females with the ages ranged 6-28 days and the weights 1.6-3.6 kg. The recurrence rate, extender titanium nail off rate, reoperation rate and risk of nerve damage in the 3D digital technique group were 0.29%(1/345), 0.29%(1/345), 0.58% (2/345)and 0.29%(1/345), respectively, while in the control group, the numbers were 1.86%(7/377), 2.92%(11/377), 2.65%(10/377), 2.92% (11/377), respectively, which were significant lower than those in the 3D group. The infection rates were 7.83%(27/345) in the 3D digital technique group and 7.69%(29/377) in the control group, and there was no significant difference between the two groups. The results of multi-logistic regression analysis suggested that the 3D digital technique group could be an independent factor to reduce postoperative complications ( P=0.001). Conclusions:In the newborns with Pierre Robin sequence, 3D digital technique-assisted distraction osteogenesiscan significantly improve the accuracy and success rate of the operation and reduce the complication rate as well.

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective:To investigate clinical effects of the three-dimensional(3D) digital technique-assisted distraction osteogenesis in newborns with Pierre Robin sequence(PRS).Methods:The data of neonatal Pierre Robin sequence treated with 3D digital technique-assisted distraction osteogenesis in Children’s Hospital Affiliated to Nanjing Medical University from April 2017 to April 2020 was retrospectively analyzed. 3D digital technique was used to assist the pre-operative design and osteotomy navigation template was made with 3D printing technique to guide in the mandibular osteotomy. CT scans were obtained 3 months postoperatively to follow up the growth of mandible. The rates of recurrence, titanium nail falling, infection, secondary operation and nerve injury were statistically analyzed. The counting data were analyzed using chi-square test. The independent influencing factors of postoperative complications were analyzed by multiple logistic regression, and the difference was statistically significant when P<0.05. Results:Three hundred and forty-five patients were included in the 3D digital technique group consisting of 215 males and 130 females with the ages ranged 3-28 days and the weights 1.8-3.2 kg. Surgical results were satisfied and very close to the preoperative design. Craniofacial CT results showed normal growth of mandible 3 months postoperatively. Three hundred and seventy-seven patients were included in the controlled group consisting of 230 males and 147 females with the ages ranged 6-28 days and the weights 1.6-3.6 kg. The recurrence rate, extender titanium nail off rate, reoperation rate and risk of nerve damage in the 3D digital technique group were 0.29%(1/345), 0.29%(1/345), 0.58% (2/345)and 0.29%(1/345), respectively, while in the control group, the numbers were 1.86%(7/377), 2.92%(11/377), 2.65%(10/377), 2.92% (11/377), respectively, which were significant lower than those in the 3D group. The infection rates were 7.83%(27/345) in the 3D digital technique group and 7.69%(29/377) in the control group, and there was no significant difference between the two groups. The results of multi-logistic regression analysis suggested that the 3D digital technique group could be an independent factor to reduce postoperative complications ( P=0.001). Conclusions:In the newborns with Pierre Robin sequence, 3D digital technique-assisted distraction osteogenesiscan significantly improve the accuracy and success rate of the operation and reduce the complication rate as well.

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective: To explore the effect of distraction osteogenesis in the treatment of syndromic craniosynostosis. Methods: The clinical data of 6 children with syndromic craniosynostosis from January 2014 to September 2018 were retrospectively analyzed. There were 5 males and 1 female, aged from 1 month and 21 days to 6 years and 1 month, with an average age of 30 months. There were 3 Crouzon syndrome, 1 Pfeiffer syndrome, 1 Vogt syndrome (ACS Ⅱ) and 1 Clove leaf skull syndrome. The distraction osteogenesis apparatus was used in this procedure. The distraction osteogenesis was prolonged twice a day, 0.4 mm each time, and the prolongation was stopped when the skull shape was significantly improved. Three-dimensional CT scans of the skull were reviewed after 6 months, suggesting that distraction osteogenesis was good, then the lengthener was removed. Complications were recorded, and extended distances were measured. Cranial indices before and after operation were compared to evaluate the efficacy, safety and feasibility of the operation. Results: The procedure of operation and traction was successful in all 6 children. There were no complications such as cranial spinal fluid (CSF) leakage or intracranial infection occurred. The increased distance was (19.1±3.3) mm, ranging from 15.2 to 25.6 mm. The preoperative cranial index was 89.6 ±7.3, while the postoperative cranial index was 74.2 ±3.6. All patients were followed up from 3 to 20 months, with the average of 14 months. The posterior cranial flatness was improved, and the patients were satisfied with the surgical results. Conclusions Distraction osteogenesis is effective and reliable in treating the premature fusion of cranial suture, and it produces excellent result with low rate of CSF leak and infection.

Objective: To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis. Methods: In patients over 6 months old, the nasal bones were wedge-removed without fixation. The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap. Results: Postoperative extended distance of the frontal bone was 28—41 mm (mean, 35.4 mm). After extension, three-dimensional reconstruction of cranial CT was carried out, which showed that CVAI was 0.8—1.2 (mean, 0.98), tending to normal. After discharge, dynamic cranial braces were put on for 1 year. Postoperatively, the children were followed up for 8—36 months (mean, 28 months). The shape and nasal deformity of all children were improved compared with those before surgery. Conclusions Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.

Objective: To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe. Methods: A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level. Results: All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones. Conclusions Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment.

We treated a neonate who was diagnosed as rapidly involuting congenital hemangioma (RICH). With a review on the clinical manifestation, differential diagnosis, and treatment of RICH that associated with thrombocytopenia(TP)and coagulopathy(CP)and received platelet transfusions and embolization therapy including absolute ethanol and polidocanol in our hospital in March of 2015. The platelets and coagulation function soon returned to normal, the tumor involuted significantly. Surgical excision was proceeded subsequently. The platelets returned to normal level after a one-time platelet transfusion, meanwhile, multiple reexaminations of blood coagulation function were normal. Postoperatively, incision wound healed well. There was no recurrence, and the functional recovery of upper limb was satisfactory. RICH is a rare type of vascular tumor which may present with TP and CP similar to KHE-KMP in the neonatal period. More attention should be addressed to identify these two diseases, because the treatment and prognosis of which have significant differences. Consumption of coagulation factors with milder platelet decrease may also be a complication of slow flow venous or venolymphatic malformations.