'Injury but not disability, disability but not useless’ is the guiding principle behind the establishment of plastic and reconstructive surgery, making it a unique specialty in modern medicine. Its development relies not only on the optimized use of donor resources but also on technological advancements and innovations in concepts. However, in the face of severe tissue damage caused by burns, trauma, and congenital deformities, traditional repair method often fall short, necessitating more effective solutions. Against this backdrop, progress in donor sourcing and interdisciplinary innovation will inject new vitality into reconstructive surgery. In this context, we take facial transplantation reconstruction as a starting point, reviewing and organizing the technological development, issues, and challenges of autologous and allogeneic facial transplantation reconstruction from the perspective of donors. This exploration aims to shed light on the future direction of this field and gain a deeper understanding of the present and future of donor-driven reconstructive surgery.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

'Injury but not disability, disability but not useless’ is the guiding principle behind the establishment of plastic and reconstructive surgery, making it a unique specialty in modern medicine. Its development relies not only on the optimized use of donor resources but also on technological advancements and innovations in concepts. However, in the face of severe tissue damage caused by burns, trauma, and congenital deformities, traditional repair method often fall short, necessitating more effective solutions. Against this backdrop, progress in donor sourcing and interdisciplinary innovation will inject new vitality into reconstructive surgery. In this context, we take facial transplantation reconstruction as a starting point, reviewing and organizing the technological development, issues, and challenges of autologous and allogeneic facial transplantation reconstruction from the perspective of donors. This exploration aims to shed light on the future direction of this field and gain a deeper understanding of the present and future of donor-driven reconstructive surgery.

Objective To evaluate the value of three-dimensional scanning technology in the preoperative design of tissue expansion procedures,with the expectation of making objective and accurate judgments regarding the timing of the second-stage expanded flap transfer surgery for patients,in order to avoid insufficient or excessive expanded flap areas.Methods From April 2024 to September 2024,we treated 10 patients who planned to undergo local tissue expansion for head and neck reconstruction.We utilized the Vectra WB360 three-dimensional imaging device to measure the wound defect area,the base area of the expander,and the expanded flap area in these patients,and compared these measurements with intraoperative results to assess the accuracy of this technology in guiding tissue expansion surgery.Results In 10 cases,the surface area of the expander(expansion skin area),the base area of the expander,and the lesion area were measured using the Vectra WB360 3D imaging device,with average measurements of(539.3±268.4)cm2,(157.0±78.13)cm2,and(252.8±141.6)cm2.Intraoperative actual measurements were(470.7±230.4)cm2,(159.9±83.2)cm2,and(241.7±134.1)cm2.Statistical analysis revealed no significant differences between the device-measured base area of the expander and lesion area compared to the intraoperative actual measurements(P＞0.05).The device-measured expanded skin area was greater than the intraoperative flap area(P＜0.05),which is associated with the retraction of the expanded skin after the removal of the expander.During the opearation,the flaps were able to completely cover the wound,and all flaps survived postoperatively.Follow-up at 1 to 6 months indicated good recovery of the surgical site's appearance and function,with a high level of patient satisfaction.Conclusion The Vectra WB360 three-dimensional imaging device significantly improves the accuracy of preoperative flap area estimation,optimizes surgical planning,and thereby enhances the success rate of expanded skin flap surgery.

Objective To evaluate the value of three-dimensional scanning technology in the preoperative design of tissue expansion procedures,with the expectation of making objective and accurate judgments regarding the timing of the second-stage expanded flap transfer surgery for patients,in order to avoid insufficient or excessive expanded flap areas.Methods From April 2024 to September 2024,we treated 10 patients who planned to undergo local tissue expansion for head and neck reconstruction.We utilized the Vectra WB360 three-dimensional imaging device to measure the wound defect area,the base area of the expander,and the expanded flap area in these patients,and compared these measurements with intraoperative results to assess the accuracy of this technology in guiding tissue expansion surgery.Results In 10 cases,the surface area of the expander(expansion skin area),the base area of the expander,and the lesion area were measured using the Vectra WB360 3D imaging device,with average measurements of(539.3±268.4)cm2,(157.0±78.13)cm2,and(252.8±141.6)cm2.Intraoperative actual measurements were(470.7±230.4)cm2,(159.9±83.2)cm2,and(241.7±134.1)cm2.Statistical analysis revealed no significant differences between the device-measured base area of the expander and lesion area compared to the intraoperative actual measurements(P＞0.05).The device-measured expanded skin area was greater than the intraoperative flap area(P＜0.05),which is associated with the retraction of the expanded skin after the removal of the expander.During the opearation,the flaps were able to completely cover the wound,and all flaps survived postoperatively.Follow-up at 1 to 6 months indicated good recovery of the surgical site's appearance and function,with a high level of patient satisfaction.Conclusion The Vectra WB360 three-dimensional imaging device significantly improves the accuracy of preoperative flap area estimation,optimizes surgical planning,and thereby enhances the success rate of expanded skin flap surgery.

Objective:To investigate the feasibility of surface-guided hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization.Methods:Nineteen patients treated with hypo- fractionated radiotherapy for intracranial metastasis in our hospital were included. Before the start of treatment, each patient underwent simulation with open face mask immobilization. During the treatment, cone-beam CT(CBCT)images were collected for verification each time. Laser-guided positioning was used for the first time in the treatment, and surface images were captured after six-dimensional position correction as the reference images for subsequent treatment. Subsequent treatment was randomly divided into laser-guided positioning group(LG, 85/F)and optical surface-guided positioning group(SG, 101/F). The six-dimensional error data of patients with two positioning methods were compared and expressed as mean ± standard deviation. Meanwhile, the correlation and consistency between the optical surface error data and the gold standard CBCT error data were compared in the laser-guided fraction. GraphPad Prism 6.0 software was used for data processing and mapping, and SPSS 21.software was used for mean analysis and normality test. Pearson correlation analysis was used to analyze the correlation, and Bland-Altman plot analysis was used to test the coincidence between two methods.Results:Compared with the laser-guided positioning, the 3D error of optical surface-guided positioning was reduced from(0.35±0.16)cm to(0.14±0.07)cm. The Pearson coefficient of correlation along all three directions was less than 0.01,R 2 was 0.91,0.70 and 0.78 on Lat, Lng and Vrt, and R 2 was 0.75,0.85 and 0.77 on Pitch, Roll and Rtn(all P<0.01), respectively. The measurement results of two methods were positively correlated. The Bland-Altman plot analysis showed that the 95% limits of agreement were within preset 3 mm tolerance([-0.29 cm, 0.19 cm], [-0.25 cm, 0.25 cm], [-0.27 cm, 0.19 cm]), and the 95% limits of agreement were within preset 3° tolerance(Pitch[-1.76°,1.76°], Roll[-1.54°,1.60°], ROT[-2.18°,1.69°]), indicating agreement between two methods. Conclusions:The optical surface-guided positioning can reduce the setup errors in the hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization. The optical surface error and CBCT error have good correlation and agreement.

Objective:Based on the current medical environment, to learn about cognition status of doctor-patient relationship among medical students and analyze causes of the tension between doctors and patients.Methods:Using the self-designed questionnaire "Clinical Medical Students' Cognition Survey on Occupational Status and Doctor-Patient Relationship", a cross-sectional survey was conducted on 527 medical students from 5-year and 7-year clinical program in Batch 2014 in a medical university in Heilongjiang Province. The survey mainly analyzed the causes of the tension between doctors and patients from the level of medical staff, patients and their families, hospitals and society. SPSS 22.0 was used for descriptive statistics and chi-square test.Results:The results showed that 93.7% of the medical students believed that the current doctor-patient relationship was not harmonious. There were cognitive differences among medical students in different gender ( P=0.029), first contact clinical grade ( P=0.003) and professional identity ( P<0.001). Conclusion:Medical students have a poor evaluation towards the current doctor-patient relationship. In order to construct harmonious doctor-patient relationship in the future, we can try to take measures such as carrying out relevant courses of doctor-patient communication, improving the medical students' communication skills and enhancing their professional identity.

Objective:To analyze the surgical method and clinical effect of modified anterolateral approach in the treatment of posterolateral tibial plateau fractures.Methods:From January 2014 to December 2017, 21 patients with posterolateral tibial plateau fractures were treated by the modified anterolateral approach in the second people's Hospital of Tangshan, Hebei Province were retrospectively analyzed.The outpatient department conducted regular reexaminations 1, 3, 6 and 12 months after the operation.Rasmussen radiology score, hospital for special surgery (HSS) score of knee function and Lysholm score were used to evaluate the postoperative knee function, and the score results were statistically analyzed.Results:The Rasmussen radiological score of 21 patients immediately after surgerywas (16.96±1.67), ranging from 15.00 to 18.00, with excellent in 15 cases, good in 6 cases, and the excellent and good rate was 100%.Rasmussen radiology score (16.57±1.51) in the last follow-up, ranging from 15.00 to 18.00, showed no significant difference between the last follow-up and the immediate postoperative ( t=0.935, P>0.05). At the last follow-up, the HSS score of knee joint function was (88.55±7.25), ranging from 80.00 to 9.00.At the last follow-up, Lysholm score (86.64±4.34), ranging from 82.00 to 90.00, was excellent in 15 cases, good in 6 cases, and excellent in 100%. Conclusion:The modified anterolateral approach for the treatment of posterolateral tibial plateau fractures is effective and simple, and can achieve good clinical results.

Objective:To investigate the effect of indocyanine green angiography (ICGA) in the design of pre-expanded perforator flaps in the reconstruction of large defects.Methods:From October 2018 to October 2019, there were 22 patients undergoing facial and cervical reconstructive surgeries based on pre-expanded perforator flaps in the back region in Shanghai Ninth Peoples′ Hospital. 12 male and 10 female patients, ranging from 4 to 26 years old with an average age of 19, were all suffered from inferior facial and cervical defects after burns. Single-pedicled or multi-pedicled perforator flaps from back region were designed for treatment. ICGA was conducted after flap dissection intra-operatively to evaluate perfusion areas of perforators, which helped surgeons to determine whether supercharging should be conducted. After flap transplantation, ICGA was conducted again to evaluate the blood supply. Statistics of post-operative complications such as flap necrosis were collected.Results:the average flap size was 27 cm ×17 cm. With the guidance of ICGA, 15 cases remained the design of single pedicle including 5 superficial cervical artery (SCA) flaps and 10 free circumflex scapular artery (CSA) perforator flaps. Supercharging was performed in 7 cases: including 2 SCA flaps supercharged with CSA perforator and 5 free CSA perforator flaps supercharged with thoracodorsal artery (TDA) perforator. Venous thrombus occurred in 1 case but recovered after re-anastomosis of vessels. Except for 2 tip necroses, 20 flaps survived completely one week postoperatively. 2 tip necroses were recovered after dressing changes. All the patients were followed up for 5 to 16 months, with good flap color and texture, and improved function of head and neck.Conclusions:ICGA can be used as a safe and effective intraoperative detection method to guide the selection of appropriate perforators and the decisions on whether to conduct supercharging, which optimizes flap design and improves the success of surgery.