Objective To explore median effective dose(ED50)of 0.375％ropivacaine based on the cross sectional area(CSA)of supraclavicular brachial plexus block(SCBPB)with L-shaped baffle intervention.Methods Patients scheduled for upper limb surgery from September 2023 to May 2024 at Ningbo NO.6 Hospital were enrolled.Patients were randomly divided into two groups:L-shaped baffle compression group(group L)and non-compression group(group C).CSA of supraclavicular brachial plexus was measured by ultrasound,and 0.375％ropivacaine was administered based on the CSA.The ED50 was determined by using the Dixon up-and-down sequential method,with an initial dose of 0.4 ml/mm2 and an incremental difference of 0.04ml/mm2.If the block was effective within 30 minutes,the next patient received a lower dose;If ineffective,a higher dose was administered.The process continued until seven cross-over points(ineffective to effective)were observed.ED50 and its 95％CI were calculated by using the Probit method.Adverse reactions,such as phrenic nerve paralysis,nerve injury,dyspnea were recorded.Results The ED50 of 0.375％ropivacaine for SCBPB in group C was 0.254 ml/mm2(95％CI:0.228-0.278),while in group L,it was 0.239 ml/mm2(95％CI:0.215-0.262),with no statistically significant difference between two groups(P＞0.05).The incidence of phrenic nerve paralysis in group L was significantly lower than that in group C(14.29％vs.41.67％,P＜0.05).No significant nerve injuries,dyspnea,or local anesthetic toxicity were observed in either group.Conclusion The ED50 of 0.375％ropivacaine for SCBPB with L-shaped baffle compression,based on the CSA of the brachial plexus,was 0.239 ml/mm2(95％CI:0.215-0.262).L-shaped baffle compression significantly reduced the incidence of phrenic nerve paralysis without notable side effects.

Objective To explore median effective dose(ED50)of 0.375％ropivacaine based on the cross sectional area(CSA)of supraclavicular brachial plexus block(SCBPB)with L-shaped baffle intervention.Methods Patients scheduled for upper limb surgery from September 2023 to May 2024 at Ningbo NO.6 Hospital were enrolled.Patients were randomly divided into two groups:L-shaped baffle compression group(group L)and non-compression group(group C).CSA of supraclavicular brachial plexus was measured by ultrasound,and 0.375％ropivacaine was administered based on the CSA.The ED50 was determined by using the Dixon up-and-down sequential method,with an initial dose of 0.4 ml/mm2 and an incremental difference of 0.04ml/mm2.If the block was effective within 30 minutes,the next patient received a lower dose;If ineffective,a higher dose was administered.The process continued until seven cross-over points(ineffective to effective)were observed.ED50 and its 95％CI were calculated by using the Probit method.Adverse reactions,such as phrenic nerve paralysis,nerve injury,dyspnea were recorded.Results The ED50 of 0.375％ropivacaine for SCBPB in group C was 0.254 ml/mm2(95％CI:0.228-0.278),while in group L,it was 0.239 ml/mm2(95％CI:0.215-0.262),with no statistically significant difference between two groups(P＞0.05).The incidence of phrenic nerve paralysis in group L was significantly lower than that in group C(14.29％vs.41.67％,P＜0.05).No significant nerve injuries,dyspnea,or local anesthetic toxicity were observed in either group.Conclusion The ED50 of 0.375％ropivacaine for SCBPB with L-shaped baffle compression,based on the CSA of the brachial plexus,was 0.239 ml/mm2(95％CI:0.215-0.262).L-shaped baffle compression significantly reduced the incidence of phrenic nerve paralysis without notable side effects.

Objective:To compare the clinical effecacy of artificial dermal regeneration matrix (as "artificial dermis" hereafter) and flap transfer in the treatment of soft tissue defects around interphalangeal joint.Methods:Through postoperative follow-up at outpatient clinic, a retrospective study was conducted on the clinical data of 60 patients who had soft tissue defects around the interphalangeal joints and received treatment in the Department of Hand Surgery, the Sixth Hospital of Ningbo from January 2018 to January 2022. According to applied surgical procedures, patients were divided into a flap transfer group (group A, n=30) and an artificial dermis group (group B, n=30). Group A included 19 males and 11 females aged 44.83 years ± 11.56 years including 5 patients with simple soft tissue defects, and 6 with soft tissue defects and fractures, 10 with soft tissue defects with tendon and (or) ligament injuries, 3 with soft tissue defects and vessel and (or) nerve injuries, and 6 with soft tissue defects and over 2 other types of compound injuries. The defect areas ranged from 2.5 cm×1.2 cm to 5.0 cm×1.6 cm. After emergency debridement and treatment for bone and tendon injuries, the patients in group A received transfers of free flap or transfers with adjacent digit flaps or island flaps. Postoperative functional exercise started from 1-6 weeks after surgery. Patients in group B included 17 males and 13 females, aged 44.70 years ± 11.20 years and there were 6 patients with simple soft tissue defects, 6 with soft tissue defects and fractures, 9 with soft tissue defects and tendon and (or) ligament injuries, 5 with soft tissue defects and vessel and (or) nerve injuries, and 4 with soft tissue defects and over 2 other types of compound injuries. The defect area ranged from 3.1 cm ×1.3 cm to 4.5 cm × 1.8 cm. Debridement and treatment of the bone and tendon injury in group B were the same as what in group A, but the patients in group B received artificial dermis coverage other than transfer of flap. After an artificial dermis had completely vascularised, a split-thickness skin graft was performed over the neo-dermis in the second phase surgery. Postoperative functional exercise started from 1-2 weeks after artificial dermis grafting surgery. The interval time of flap transfer or split-thickness skin grafting, survival rate of flap transfer or split-thickness skin grafting, Vancouver Scar Scale(VSS), TPD and total active movement(TAM) were compared between the 2 groups. The count data were analysed by Chi-square test. All measured data were analysed by independent sample t test or Mann-Whitney U test. P<0.05 indicates a statistically significant difference. Results:The interval time of flap transfer in group A and artificial dermis grafting in group B were 2.93 days ± 2.48 days and 19.87 days ± 3.35 days, respectively. There was a statistically significant difference between the 2 groups( P<0.05). All patients were entered in postoperative outpatient follow-up for 11-14 months(12.00 months ± 0.93 months). The appearance of flaps of some patients in group A was bloated with slightly limited digit movement. In group B, the digit movement was normal, without obvious scar hyperplasia in both of the recipient and donor sites. The survival rate of flap transfer or artificial dermis graft, TPD, VSS score and TAM score for group A and group B were 96.00% ± 9.32% and 98.17% ± 3.07%, respectively, 8.67 mm ± 2.01 mm and 9.50 mm ± 1.81 mm, 3.40 ± 1.07 and 3.17 ± 0.91 and 18.30 ± 1.97 and 18.93 ± 1.64, respectively. There were no significant differences between the 2 groups( P>0.05). Conclusion:In comparison with the transfer of flap, an artificial dermis is also effective and satisfactory in the treatment of soft tissue defects around the interphalangeal joint. Further large scale and multi-centre investigations are required.

Objective:To evaluate the effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness.Methods:From November 2017 to April 2022, a retrospective analysis was performed to assess the reserving of pretarsal fullness after the transcutaneous lower blepharoplasty with a skin flap in the Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA. A subciliary incision was made below the ciliary margin and a skin flap was elevated at the surface of pretarsal orbicularis. The muscle was partially split at the position of pretarsal crease, leaving the pretarsal orbicularis oculi muscle and the pretarsal crease intact. Preseptal dissection was proceeded down to the level of arcus marginalis, exposing the orbital fat pads. For patient with tear trough deformity or volume deficiency in the medial cheek, retaining ligament laxity and fat repositioning were routinely performed. The muscle wound was closed edge to edge and the excess skin was excised conservatively. Postoperative complications were recorded. Face-Q scale was used for surgical decision and postoperative satisfaction evaluation. The scores range from 0 to 100, with higher scores indicating less regret the operation or greater satisfaction. The preoperative and postoperative digital photographs were used to evaluate the change of pretarsal fullness.Results:256 patients were included, of whom 233 cases were women and 23 cases were men. The age was (43.0±10.2) years. 24 cases had concomitant lateral canthoplasty due to hypotonia of lower eyelid, 22 had concomitant upper blepharoplasty, and 21 cases had brow lift surgery to correct upper eyelid relaxation. All patients had follow-up for (3.7±4.1) months, most patients were satisfied with the operation results. A total of 211 patients maintained a natural pretarsal fullness postoperatively, with the rate of 82.4%. The Face-Q satisfaction score was (75.8±18.6) and the surgical decision score was (80.3±15.4), indicating that most patients did not regret the operation. Postoperative complications included 8 cases of eyelid bags undercorrection, of whom 4 patients underwent secondary resection. 7 patients experienced infraorbital bulge for the uneven placement of the fat pad, 2 of them required revision surgery. Hematoma occurred in 4 cases and was resolved by hematoma clearance. Other complications included 3 cases of ectropion and 2 cases of minimal tear trough correction. Lower eyelid ectropion was corrected in one case.Conclusion:Reserving the pretarsal fullness in transcutaneous lower eyelid blepharoplasty with a skin flap provides excellent aesthetic results and high patient satisfaction. This technique is simple and effective.

Objective:To evaluate the effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness.Methods:From November 2017 to April 2022, a retrospective analysis was performed to assess the reserving of pretarsal fullness after the transcutaneous lower blepharoplasty with a skin flap in the Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA. A subciliary incision was made below the ciliary margin and a skin flap was elevated at the surface of pretarsal orbicularis. The muscle was partially split at the position of pretarsal crease, leaving the pretarsal orbicularis oculi muscle and the pretarsal crease intact. Preseptal dissection was proceeded down to the level of arcus marginalis, exposing the orbital fat pads. For patient with tear trough deformity or volume deficiency in the medial cheek, retaining ligament laxity and fat repositioning were routinely performed. The muscle wound was closed edge to edge and the excess skin was excised conservatively. Postoperative complications were recorded. Face-Q scale was used for surgical decision and postoperative satisfaction evaluation. The scores range from 0 to 100, with higher scores indicating less regret the operation or greater satisfaction. The preoperative and postoperative digital photographs were used to evaluate the change of pretarsal fullness.Results:256 patients were included, of whom 233 cases were women and 23 cases were men. The age was (43.0±10.2) years. 24 cases had concomitant lateral canthoplasty due to hypotonia of lower eyelid, 22 had concomitant upper blepharoplasty, and 21 cases had brow lift surgery to correct upper eyelid relaxation. All patients had follow-up for (3.7±4.1) months, most patients were satisfied with the operation results. A total of 211 patients maintained a natural pretarsal fullness postoperatively, with the rate of 82.4%. The Face-Q satisfaction score was (75.8±18.6) and the surgical decision score was (80.3±15.4), indicating that most patients did not regret the operation. Postoperative complications included 8 cases of eyelid bags undercorrection, of whom 4 patients underwent secondary resection. 7 patients experienced infraorbital bulge for the uneven placement of the fat pad, 2 of them required revision surgery. Hematoma occurred in 4 cases and was resolved by hematoma clearance. Other complications included 3 cases of ectropion and 2 cases of minimal tear trough correction. Lower eyelid ectropion was corrected in one case.Conclusion:Reserving the pretarsal fullness in transcutaneous lower eyelid blepharoplasty with a skin flap provides excellent aesthetic results and high patient satisfaction. This technique is simple and effective.

Objective:To investigate the clinical application and effect of end-to-side anastomosis in personalised free ilioinguinal flap transfer.Methods:From March, 2015 to July, 2020, 88 patients with soft tissue (bone) defect of limbs were treated. Different ilioinguinal flaps were designed according to the wound condition of patients, which were 48 cases of free superficial circumflex iliacartery perforator flap, 7 cases of free superficial epigastric artery perforator flap, 19 cases of composite tissue flap with iliac bone, 8 cases of combined flap of superficial circumflex iliac artery and superficial abdominal wall artery, and 6 cases of superficial circumflex iliac artery and superficial abdominal wall artery lobulated flap. The area of the flap was 4.0 cm×6.0 cm-10.0 cm×30.0 cm. The artery and recipient artery were anastomosed end-to-side: 36 cases to radial artery; 12 cases to ulnar artery; 18 cases to dorsalis pedis artery; 15 cases to anterior tibial artery; 7 cases to posterior tibial artery. Venous anastomosis of skin flap: 42 cases were anastomosed with 2 veins, which were superficial vein of the same name and accompanying vein; 46 cases were anastomosed with 1 superficial vein of the same name. The accompanying vein of the flap was anastomosed end-to-side with the accompanying vein of the main artery of the recipient area, and the superficial vein of the same name was anastomosed end-to-end with the accompanying vein or subcutaneous superficial vein of the recipient artery. Follow-up includes flap blood supply, blood supply to the distal limbs, appearance of both the donor site and the recipient area, and patient satisfaction.Results:There were 83 cases of flaps survived successfully, and 5 cases of crisis. Among them, 2 cases had artery crisis at 48 h after surgery. After exploration, it was found that 1 case caused by arterial thrombosis, and 1 case compressed by the stapler that anastomoses the vein. The other 3 cases had venous crisis at 72 h after surgery: after exploration, it was found that caused by thrombosis at the venous anastomotic site. The average follow-up period was 10 (range, 3-24) months. All flaps survived after re anastomosis or vascular transposition. The donor site and recipient site of the flap healed well. The blood supply of the flap was good and the texture was soft. There was no blood supply disorder in the distal limb.Conclusion:The end-to-side anastomosis technique is suitable for all kinds of free flap transplantation in ilioinguinal region, with high vascular patency rate. It can not only solve the problem of thin vascular pedicle of donor site flap, but also retain the main artery of recipient limb without affecting the distal blood supply.

Objective:To investigate the clinical effect of free superficial circumflex iliac artery flap combined with anterolateral thigh flap in repairing large skin defect of the hand.Methods:A retrospective case series study was conducted to analyze the clinical data of 9 patients with large skin defect of the hand admitted to Ningbo No.6 Hospital from January 2016 to December 2019，including 7 males and 2 females，aged 31-63 years［（45.3±5.6）years］. The area of skin defect reanged from 20 cm×15 cm to 25 cm×20 cm. One side of the superficial circumflex iliac artery flap and the contralateral anterolateral thigh flap were used for repair. Both recipient and donor sites were sutured at the first stage. The ilioinguinal region and thigh donor region were sutured directly. The area of superficial circumflex iliac artery flap was from 19 cm×6 cm to 23 cm ×10 cm and that of anterolateral thigh flap was 19 cm×9 cm to 23 cm×8 cm. The flap survival，healing of donor and recipient area and complications were observed. At 1，6 and 12 months after operation，the function of the flap was evaluated by the late functional evaluation criteria of the flap，hand function by the upper limb functional evaluation criteria of the Chinese Medical Association，and scar condition of the donor site by Vancouver Scar Scale（VVS）. At the last follow-up，the color，elasticity，appearance and scar of the donor site were observed.Results:All patients were followed up for 6-18 months［（12.5±2.3）months］. All flaps survived successfully. All patients achieved donor-site healing at the first stage，except that one patient experienced incision dehiscence in the thigh donor site after operation and healed after the second stage suture. The texture and appearance of the flaps were good. The flap in 5 patients was obviously bloated. Therefore，the secondary skin flap repair was selected，and the appearance was significantly improved after operation. Scores for function of the flap and the hand were improved over time（ P<0.05）. At 12 months after operation，the function of the flap was excellent in 3 patients，good in 4 and fair in 2，with the excellent and good rate of 78%；the result of hand function was excellent in 3 patients，good in 3 and fair in 3，with the excellent and good rate of 67%. The VVS score of the donor site decreased from（9.7±1.3）points at postoperative 1 month to（5.7±0.9）points at postoperative 6 months and（3.4±0.8）points at postoperative 12 months（ P<0.05）. At the latest follow-up，the color and elasticity of the flap was similar to that of the surrounding skin tissue，only with slight bloating；the scar of the donor site was small. Conclusions:The free superficial circumflex iliac artery flap combined with anterolateral thigh flap can cover large skin defect of the hand at one time，with good appearance and texture of the flap. The appearance and function of the wounded hand are good after operation，leaving only linear scar in the donor site.

Objective:To repair the secondary mandibular angle caused by madibular osteotomy by using digital technology and to make quantitative comparative evaluation.Methods:Thirty-nine patients with secondary mandibular angle with unsmooth mandibular margin or bilateral asymmetry after mandibular osteotomy in Southern Theater General Hospital from 1996 to 2017 were included. The three-dimensional model of skull was established by CT skull scan and Mimics 13.0 software. The computer aided design was used to carry out the secondary surgical repair according to the design line, and the mandibular angle was quantitatively measured and evaluated before and after the revision operation. The mandibular angles before, after design and after restoration were measured on the reconstructed images, and the bilateral symmetry and the consistency between the design result and the final result were compared by Paired- t sample test. P< 0.05 indicates statistical difference. Results:All the 39 patients completed the operation successfully, and 1 case developed hematoma 15 days after operation, which was drained and bandaged by oral dressing. Two weeks after operation, the hematoma was resolved. No infection, nerve injury and accidental fracture of mental process were found in all patients. During the 6-month follow-up, the mandibular angle of 39 patients improved from 118.12°±18.08° on the left side and 114.60°±16.01° on the right side to 121.28°±6.96° on the left side and 121.32°±5.88° on the right side. There was significant difference between the left and right sides before operation ( t=1.744, P=0.045), but there was no significant difference between the two sides about 6 months after operation( t=-0.074, P=0.529). The angle of mandibular angle after design was compared with the actual outcomes of patients 6 months after operation and there was no significant difference( t=-0.527, P=0.601). All the patients were satisfied with the improvement of the secondary mandibular angle and facial shape. Conclusions:The application of digital technique to repair the secondary mandibular angle after mandibular osteotomy not only avoids the injury of inferior alveolar neurovascular bundle and mental nerve, but also effectively improves the facial shape of the patients.

Objective:To investigate the efficacy of transconjunctival orbital fat repositioning into the premaxillary space for the treatment of eyelid bag and tear trough deformity.Methods:A retrospective review of patients undergoing orbital fat repositioning from April 2018 to June 2019 was performed at the Department of Laser and Plastic Surgery, General Hospital of Southern Theater Command, PLA. 68 patients were included in this series with their age ranging from 19 to 53 (5 males and 63 females). Through a transconjunctival incision, blunt dissection of orbital septum and orbicularis oculi was performed along the preseptal plane to just above the arcus marginalis. Both the orbicularis oculi retaining ligament and the tear trough ligament were sharply released with cutting cautery at its bony origin. Premaxillary space was then entered and separated by blunt dissection between orbicularis oculi and sub-orbicularis oculi fat. Pedicled orbital fat was transposed into the space and secured with percutaneous sutures so as to blend the tear tough. Postoperative result were assessed by self-satisfactory scale and Hirmand classification of tear trough deformity. Scores of self-satisfactory scale were determined as 1 to 5 points according to very satisfied, satisfied, acceptable, not satisfied and very unsatisfied degree respectively.Results:The follow-up was (145.8±82.9) d. The self-satisfactory scale scored 4.47±0.82. Number of the class Ⅰ, Ⅱ, Ⅲ patients reduced from 24, 37, 7 to 7, 0, 0 respectively after the surgery. 20 patients with cheek depression had also been greatly improved. 12 patients had undercorrection of the eyelid bags. 2 patients underwent dry eye that was treated with sodium hyaluronate eye drops and healed within one month. One patient had eyelid numbness which resolved spontaneously. Hematoma developed in one patient who underwent hematoma evacuation surgery. No other complications were seen in any patients.Conclusions:Transconjunctival premaxillary space fat repositioning blepharoplasty is a safe and effective approach for treating eye bags, especially for patients with tear trough deformity and midface depression.

Objective:To repair the secondary mandibular angle caused by madibular osteotomy by using digital technology and to make quantitative comparative evaluation.Methods:Thirty-nine patients with secondary mandibular angle with unsmooth mandibular margin or bilateral asymmetry after mandibular osteotomy in Southern Theater General Hospital from 1996 to 2017 were included. The three-dimensional model of skull was established by CT skull scan and Mimics 13.0 software. The computer aided design was used to carry out the secondary surgical repair according to the design line, and the mandibular angle was quantitatively measured and evaluated before and after the revision operation. The mandibular angles before, after design and after restoration were measured on the reconstructed images, and the bilateral symmetry and the consistency between the design result and the final result were compared by Paired- t sample test. P< 0.05 indicates statistical difference. Results:All the 39 patients completed the operation successfully, and 1 case developed hematoma 15 days after operation, which was drained and bandaged by oral dressing. Two weeks after operation, the hematoma was resolved. No infection, nerve injury and accidental fracture of mental process were found in all patients. During the 6-month follow-up, the mandibular angle of 39 patients improved from 118.12°±18.08° on the left side and 114.60°±16.01° on the right side to 121.28°±6.96° on the left side and 121.32°±5.88° on the right side. There was significant difference between the left and right sides before operation ( t=1.744, P=0.045), but there was no significant difference between the two sides about 6 months after operation( t=-0.074, P=0.529). The angle of mandibular angle after design was compared with the actual outcomes of patients 6 months after operation and there was no significant difference( t=-0.527, P=0.601). All the patients were satisfied with the improvement of the secondary mandibular angle and facial shape. Conclusions:The application of digital technique to repair the secondary mandibular angle after mandibular osteotomy not only avoids the injury of inferior alveolar neurovascular bundle and mental nerve, but also effectively improves the facial shape of the patients.