Objective:To explore the clinical effects of various special forms of the descending branch of the lateral circumflex femoral artery (DLCFA) perforator flaps in repairing high-voltage electrical burn wounds on the wrist.Methods:This study was a retrospective observational study. From September 2014 to June 2024, 79 male patients with high-voltage electrical burns on the wrist, aged 20 to 62 years and met the inclusion criteria, were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, with wrist high-voltage electrical burn wound (hereinafter referred to as wrist wound) types being classified as type Ⅱ or type Ⅲ. In the early stage after injury, debridement was performed on the patients' wrists. Based on the wound condition and flap indications, the flow-through, lobed, chimeric, flow-through-lobed, lobed-chimeric, flow-through-chimeric, or flow-through-lobed-chimeric DLCFA perforator flap was employed individually, and the flow-through-chimeric DLCFA perforator flap and tensor fascia lata myocutaneous flap were employed in combination to repair the wounds. The donor site wounds were repaired using direct sutures or skin grafting. The number of various DLCFA perforator flaps resected during surgery and the number of various types of wrist wounds repaired were recorded, as well as the closure status of the donor site wound. The postoperative flap survival, occurrence of vascular crisis, wound or suture site healing, and patency of the reconstructed artery in flow-through flaps were recorded. During follow-up, the appearance of the flap, scar formation, and the presence of thigh muscle herniation were observed.Results:Intraoperatively, 11 flow-through DLCFA perforator flaps were resected to repair 11 type Ⅱ wrist wounds, 13 lobed DLCFA perforator flaps were resected to repair 9 type Ⅱ and 4 type Ⅲ wrist wounds, 16 chimeric DLCFA perforator flaps were resected to repair 16 type Ⅱ wrist wounds, 11 flow-through-lobed DLCFA perforator flaps were resected to repair 5 type Ⅱ and 6 type Ⅲ wrist wounds, 10 lobed-chimeric DLCFA perforator flaps were resected to repair 5 type Ⅱ and 5 type Ⅲ wrist wounds, 6 flow-through-chimeric DLCFA perforator flaps were resected to repair 6 type Ⅱ wrist wounds, 7 flow-through-lobed-chimeric DLCFA perforator flaps were resected to repair 7 type Ⅲ wrist wounds, and 5 flow-through-chimeric DLCFA perforator flaps combined with tensor fascia lata myocutaneous flaps were resected to repair 5 type Ⅲ wrist wounds. Seventy-four patients had their donor site wounds closed by direct suturing, while 5 patients had their donor site wounds closed by skin grafting. Postoperatively, the flaps in 3 patients developed vascular crisis, including 1 case of arterial crisis and 2 cases of venous crises but survived after emergency vascular exploration and other treatments; the remaining flaps survived completely. Postoperatively, 3 patients had seepage beneath their flaps, which were closed after dressing changes; the remaining patients' wounds or suture sites all healed. Anteriography showed that all reconstructed arteries in 35 patients who underwent flow-through flap transplantation were patent postoperatively. During the follow-up period of 3 months to 1 year, 20 patients had bloated flap, while the rest had good flap appearance; linear scars were left in the donor sites that underwent direct wound closure, and the skin-grafted areas of the donor site wounds showed no significant patchy hypertrophic scarring; no thigh muscle herniation occurred.Conclusions:Taking the full advantage of perforator flaps, various special forms of the DLCFA perforator flaps are used to repair the three-dimensionally injury wounds caused by high-voltage electrical burns on the wrist, which not only minimizes the damage to the donor site but also allow the recipient site to be well repaired, showing good appearance in the recent follow-up.

Objective:To explore the clinical effects of various special forms of the descending branch of the lateral circumflex femoral artery (DLCFA) perforator flaps in repairing high-voltage electrical burn wounds on the wrist.Methods:This study was a retrospective observational study. From September 2014 to June 2024, 79 male patients with high-voltage electrical burns on the wrist, aged 20 to 62 years and met the inclusion criteria, were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, with wrist high-voltage electrical burn wound (hereinafter referred to as wrist wound) types being classified as type Ⅱ or type Ⅲ. In the early stage after injury, debridement was performed on the patients' wrists. Based on the wound condition and flap indications, the flow-through, lobed, chimeric, flow-through-lobed, lobed-chimeric, flow-through-chimeric, or flow-through-lobed-chimeric DLCFA perforator flap was employed individually, and the flow-through-chimeric DLCFA perforator flap and tensor fascia lata myocutaneous flap were employed in combination to repair the wounds. The donor site wounds were repaired using direct sutures or skin grafting. The number of various DLCFA perforator flaps resected during surgery and the number of various types of wrist wounds repaired were recorded, as well as the closure status of the donor site wound. The postoperative flap survival, occurrence of vascular crisis, wound or suture site healing, and patency of the reconstructed artery in flow-through flaps were recorded. During follow-up, the appearance of the flap, scar formation, and the presence of thigh muscle herniation were observed.Results:Intraoperatively, 11 flow-through DLCFA perforator flaps were resected to repair 11 type Ⅱ wrist wounds, 13 lobed DLCFA perforator flaps were resected to repair 9 type Ⅱ and 4 type Ⅲ wrist wounds, 16 chimeric DLCFA perforator flaps were resected to repair 16 type Ⅱ wrist wounds, 11 flow-through-lobed DLCFA perforator flaps were resected to repair 5 type Ⅱ and 6 type Ⅲ wrist wounds, 10 lobed-chimeric DLCFA perforator flaps were resected to repair 5 type Ⅱ and 5 type Ⅲ wrist wounds, 6 flow-through-chimeric DLCFA perforator flaps were resected to repair 6 type Ⅱ wrist wounds, 7 flow-through-lobed-chimeric DLCFA perforator flaps were resected to repair 7 type Ⅲ wrist wounds, and 5 flow-through-chimeric DLCFA perforator flaps combined with tensor fascia lata myocutaneous flaps were resected to repair 5 type Ⅲ wrist wounds. Seventy-four patients had their donor site wounds closed by direct suturing, while 5 patients had their donor site wounds closed by skin grafting. Postoperatively, the flaps in 3 patients developed vascular crisis, including 1 case of arterial crisis and 2 cases of venous crises but survived after emergency vascular exploration and other treatments; the remaining flaps survived completely. Postoperatively, 3 patients had seepage beneath their flaps, which were closed after dressing changes; the remaining patients' wounds or suture sites all healed. Anteriography showed that all reconstructed arteries in 35 patients who underwent flow-through flap transplantation were patent postoperatively. During the follow-up period of 3 months to 1 year, 20 patients had bloated flap, while the rest had good flap appearance; linear scars were left in the donor sites that underwent direct wound closure, and the skin-grafted areas of the donor site wounds showed no significant patchy hypertrophic scarring; no thigh muscle herniation occurred.Conclusions:Taking the full advantage of perforator flaps, various special forms of the DLCFA perforator flaps are used to repair the three-dimensionally injury wounds caused by high-voltage electrical burns on the wrist, which not only minimizes the damage to the donor site but also allow the recipient site to be well repaired, showing good appearance in the recent follow-up.

Objective:To explore the repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect.Methods:The study was a retrospective observational study. From September 2020 to September 2023, 27 female patients (aged 37-83 years) with chest radiation ulcers after radical mastectomy for breast cancer who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, of which 7 patients developed significant pain in the chest region. Various examinations were completed to accurately assess the presence of tumors and depth of radiation ulcers. After tumor recurrence was ruled out, the ulcer wounds were thoroughly debrided (the wound size after debridement was 8 cm×7 cm to 18 cm×18 cm). At the same time, pathological examination of the wound tissue and bacterial culture of the wound tissue/exudate samples were performed. The wound repair surgery was performed at the same time after debridement or one week after vacuum sealing drainage (VSD) treatment. Based on the location and size of the wound, the age and overall condition of the patient, as well as the principle of minimizing damage to the donor site, the most suitable tissue flap was selected to repair the wound. The donor site wound was transplanted with a split-thickness skin graft or sutured together. The level and tissue structure of radiation injury, and the type and size of transplanted tissue flap were recorded. The results of postoperative pathological examination of wound tissue and bacterial culture of wound tissue/exudate samples, pain relief, survival of tissue flap, and wound healing were recorded. During the follow-up, the shape of the tissue flap, whether the ulcer recurred, the wound healing of the donor site, and whether the abdominal wall hernia occurred in the donor site of the rectus abdominis myocutaneous flap were observed.Results:Radiation injury involved ribs and costal cartilage in 21 cases, ribs, sternum, and clavicle in 4 cases, and clavicle and subclavian artery in 2 cases. Twelve patients were transplanted with rectus abdominis myocutaneous flap, eight patients with latissimus dorsi myocutaneous flap, three patients with internal thoracic artery perforator flap, three patients with superior epigastric artery perforator flap, and one patient with free deep inferior epigastric perforator flap. The size of tissue flap was 14 cm×8 cm to 20 cm×20 cm. After surgery, no tumor component was found in the pathological examination of wound tissue; 25 patients were positive and 2 patients were negative in bacterial culture results of wound tissue/exudate samples; the pain of 7 patients was completely relieved. The tissue flaps of 25 patients survived completely after surgery, and the wounds healed. Two patients had partial necrosis at the tip of the rectus abdominis myocutaneous flap, which healed after debridement and tissue flap repair. The patients were followed up for 6 months to 2 years. The appearance of the tissue flaps was good, and no ulcer recurred. The linear scar was left on the donor site, and no abdominal wall hernia occurred in the donor site of the rectus abdominis myocutaneous flap.Conclusions:Thorough debridement and VSD treatment after accurate assessment of the extent of damage, and the selection of appropriate tissue flap to repair the wound based on the patient's general condition, the wound characteristics, and the principle of minimizing damage to the donor site are good repair strategies for the chest radiation ulcers after radical mastectomy for breast cancer. By using the strategies, the wounds could be closed as soon as possible, preventing ulcer recurrence and having a good prognosis.

Objective:To explore the clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis.Methods:This study was a retrospective observational study. From January 2018 to December 2022, 20 patients with wounds with bone or internal fixation exposure and wounds with osteomyelitis who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, including 19 males and 1 female, aged from 21 to 73 years. Among the 21 wounds, there were 5 wounds with bone exposure, 12 wounds with osteomyelitis, and 4 wounds with internal fixation exposure. After the debridement in the first stage, the wound area was 6 cm×3 cm to 22 cm×10 cm. Then vacuum sealing drainage was carried out for 5 to 7 days. In the second stage, the wounds were covered with pedicled chimeric medial sural artery perforator flap, pedicled chimeric posterior tibialis artery perforator flap, free chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery, free chimeric medial sural artery perforator flap or free chimeric deep circumflex iliac artery perforator flap with incision area of 7 cm×5 cm to 25 cm×12 cm. The chimeric muscle flap was used to fill and cover irregular deep cavities. The wounds in the flap donor sites were sutured directly or repaired with medium-thickness skin grafts from the thigh. The survival of flap and the healing of wound in flap donor site were observed after operation. The recurrence of infection was followed up.Results:Among the 18 free chimeric perforator flaps, 16 flaps survived successfully; one flap experienced a venous crisis on the day of surgery and survived completely after emergency exploration and re-anastomosis; another one flap had partial distal necrosis, which healed after dressing changes. All the wounds in the flap donor sites healed evenly. All 3 pedicled chimeric perforator flaps survived; one of them developed sub-flap infection but healed after debridement and bone cement placement. The wound in the donor site of 1 flap developed incision dehiscence, which healed successfully after redebridement and suturing. The donor site wounds of the rest 2 flaps healed well. During 3 to 12 months of follow-up, the patients with wounds with bone or internal fixation exposure showed no signs of abnormal exudation or infection, and no infection recurrence was observed in patients with wounds with osteomyelitis.Conclusions:The application of chimeric perforator flaps is effective in covering wounds, filling dead spaces, and controlling infection in wounds with bone or internal fixation exposure and wounds with osteomyelitis. Moreover, this method minimizes the damage to the donor site.

Objective:To systematically describe the characteristics and trends of clinical studies on aesthetic and plastic devices from 2016 to 2020 in China.Methods:Clinical studies on aesthetic and plastic devices conducted in China from 2016 to 2020 were identified through ClinicalTrials.gov and the Chinese Clinical Trial Registry using predetermined search strings. Data on indications, medical device, sponsor type, and study design were collected and analyzed.Results:From 2016 to 2020, 118 registered clinical studies were identified and analyzed, among which 100 trials (84.7%) were initiated by medical institutions and the remaining were initiated by medical device enterprises. The number of studies increased from 12 to 42 from 2016 to 2020 with an average annual growth rate of 39.6%. For indication types, there are 90(76.3%) studies on skin defects, followed by 21(17.8%) on maxillofacial defects, 5(4.2%) on hair defects and 2(1.7%) on breast defects. The top four indications were scars, acne, nasolabial folds, and port-wine stains. For device types, photoelectric devices were involved in 73(61.9%) studies, followed by surgical devices [20(16.9%)] and injection devices [19(16.1%)]. Laser devices were the research focus among all photoelectric device categories. There were 11 clinical studies on scar treatment using laser treatment equipment, of which 6 trials applied parallel controlled study design, and the remaining trials applied self-controlled design. The sample size of these 11 trials ranged from 15 to 110.Conclusions:The number of registered clinical studies on aesthetic and plastic devices kept growing in the last few years. Skin related indications and photoelectric devices have become the hot spot in the field.

Objective:To systematically describe the characteristics and trends of clinical studies on aesthetic and plastic devices from 2016 to 2020 in China.Methods:Clinical studies on aesthetic and plastic devices conducted in China from 2016 to 2020 were identified through ClinicalTrials.gov and the Chinese Clinical Trial Registry using predetermined search strings. Data on indications, medical device, sponsor type, and study design were collected and analyzed.Results:From 2016 to 2020, 118 registered clinical studies were identified and analyzed, among which 100 trials (84.7%) were initiated by medical institutions and the remaining were initiated by medical device enterprises. The number of studies increased from 12 to 42 from 2016 to 2020 with an average annual growth rate of 39.6%. For indication types, there are 90(76.3%) studies on skin defects, followed by 21(17.8%) on maxillofacial defects, 5(4.2%) on hair defects and 2(1.7%) on breast defects. The top four indications were scars, acne, nasolabial folds, and port-wine stains. For device types, photoelectric devices were involved in 73(61.9%) studies, followed by surgical devices [20(16.9%)] and injection devices [19(16.1%)]. Laser devices were the research focus among all photoelectric device categories. There were 11 clinical studies on scar treatment using laser treatment equipment, of which 6 trials applied parallel controlled study design, and the remaining trials applied self-controlled design. The sample size of these 11 trials ranged from 15 to 110.Conclusions:The number of registered clinical studies on aesthetic and plastic devices kept growing in the last few years. Skin related indications and photoelectric devices have become the hot spot in the field.

Objective:To assess the feasibility and effects of the mobile device-based video teaching in plastic surgery education.Methods:In the study, 22 participants were assigned into two groups according to their standardized training area. The intervention group ( n=11) which was outside Beijing had an unlimited access to video-based education; the control group ( n=11) which was in Beijing received traditional teaching. After the end of the first semester of teaching, the two groups of students were tested on theory and clinical operational theory, and the evaluation results were compared. SPSS 18.0 software was applied for t test and chi-square test. Results:After the first semester, the effect of teaching method was evaluated by the scores of written examination and clinical examination. The average scores of the written test in the intervention group were (38.82±3.22) points, while that in the control group were (38.36±2.98) points, without significant differences between the two groups ( P=0.74); the average scores of the clinical examination theory test in the intervention group and the control group were (46.36±3.44) points and (41.00±5.24) points, respectively, with significant differences between the two groups ( P=0.01). In term of total scores, the average scores of the intervention group were (85.18±4.83) points, and those of the control group were (79.36±5.52) points, with statistical differences between the two groups ( P=0.016). Conclusion:Mobile device-based video teaching in plastic surgery education can not only improve students' performance but also facilitate their clinic skills, which is worth popularizing.

Objective:To investigate the method of the complex labia minora and clitoris prepuce hypertrophy and summarize the experience.Methods:From January 2016 to October 2019, a total of 432 patients with complex labia minora and clitoris prepuce hypertrophy in the 10th Department of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, were selected by classification. The patients were 18-46 years old (average 28 years old). The redundant prepuce of clitoris was repaired to transform the complex labia minora and clitoris prepuce hypertrophy into simple labia minora hypertrophy, and then labiaplasty was performed by edge or wedge resection.Results:A total of 346 cases were followed up for 3-12 months, 86 cases were lost. Hematoma occurred in 2 cases, bilateral asymmetry in 9 cases, irregular edge in 12 cases, and scar hyperplasia in 1 case. After respective treatment and secondary repair, the patients were satisfied. The overall satisfaction rate was 93.6%(324/346).Conclusions:Our method, through the decomposition operation, will change the complex shape into simple labia minora hyperplasia, reduce the difficulty of operation at the same time, which can achieve more satisfactory appearance.

Objective:To investigate the motivation of patients seeking labiaplasty and the external influencing factors.Methods:From January 2018 to December 2019, 268 patients who sought for operative labiaplasty at the Gynecological Plastic Surgery Center of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences were investigated for their motivation and influencing factors in the questionnaire. The motivation includes four options: aesthetic reasons, functional impairment, both aesthetic and functional reasons, and psychological factors. External influencing factors include two options: a self-requirement, was influenced by others. After collating the data, statistical analysis of the survey result was performed.Results:A total of 216 valid questionnaires were received. Motivation for pursuing operative labiaplasty: 22.2% (48/216) of the patients complained about cosmetic reasons, 38.4% (83/216) of dysfunction, and 35.2% (76/216) had both aesthetic and functional reasons. Psychological factors accounted for 4.2% (9/216). In terms of external influencing factors: all patients motivated by dysfunction were not influenced by others, while 6.3% (3/48) of patients of cosmetic reasons were affected by male partners. In the other two motivations, 7.9% (6/76) and 6/9 respectively indicated that they were affected by male spouse. In addition, there were 2.6% of patients with these 2 motivations (2/76) and 3/9 were affected by the media.Conclusions:Most patients seek labia minora reduction surgery because of functional reasons, and a small number of people are affected by sexual partners and media.

Objective:To explore the surgical methods and effects of different types of pudendal thigh flaps in repairing rectovaginal fistula.Methods:From March 1996 to November 2019, totally 18 cases with rectovaginal fistula admitted to Plastic Surgery Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively. The ages of the patients ranged from 17 months to 39 years with an average of 20.8 years. The bilateral pudendal thigh flap based on the anterior cutaneous branches of obturator artery can be used for larger fistula, which is larger than 1 cm in diameter and covered with serious local scars. Smaller fistula with diameter less than 1 cm can be repaired by the unilateral pudendal thigh flap pedicled with lateral branches of posterior labial artery transferred through subcutaneous tunnel. If the local tissue can be closed directly without tension, pudendal thigh fascial flap is inserted between the vaginal and rectal mucosa to act as a waterproof layer.Results:All flaps used in the 18 patients of this group survived postoperatively with fistula closure and donor site healed primarily. The size of the flaps ranged from 4 cm×2 cm to 7 cm×4 cm. The recipient sites including bilateral pudendal thigh island flaps (4 cases), unilateral pudendal thigh flaps (5 cases) and unilateral facial flaps (9 cases). No recurrence was reported during the follow-up period of 6 to 36 months.Conclusions:The application of pudendal thigh flaps can be considered as a safe and reliable procedure for the management of the middle and lower rectovaginal fistula. According to the anatomical characteristics of fistula, we could design rational flaps to meet the functional, morphological and cosmetic demands from the patients.