Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective:To explore the clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma (CSCC).Methods:This study was a retrospective observational study. From July 2015 to July 2022, 21 patients with CSCC were treated in the Department of Burns and Plastic Surgery of Guizhou Provincial People's Hospital, including 15 males and 6 females, aged from 27 to 74 years. The area of skin and soft tissue defects after extended resection of CSCC was 7.5 cm×4.0 cm to 23.0 cm×8.5 cm. The wounds in 18 patients were repaired with anterolateral femoral perforator flaps; variations of perforating branch of the descending branch of lateral circumflex femoral artery were observed in 3 patients during the operation, and the wounds were repaired with anteromedial femoral perforator flaps. The flap areas were 8.0 cm×5.0 cm to 25.0 cm×10.0 cm. The wounds in the donor areas were sutured directly in 19 patients, and the wounds in the donor areas were repaired with thin and medium-thickness skin grafts in the contralateral thigh in 2 patients. The postoperative survival of flaps and the occurrence of vascular crisis were observed. The length of operation and the hospitalization day were recorded. The recurrence of tumor, the appearances of the donor and recipient areas of flaps, the function of the flap donor area were followed up. At the last follow-up, the satisfaction degree of patients for the curative effects was evaluated.Results:The flaps survived in 20 patients, while the vascular crisis occurred in 1 patient within 48 hours after operation, and the flap survived after immediate emergency operation. The length of operation was 4 to 5 hours, and the hospitalization day was 15 to 38 days. The patients were followed up for 1 to 6 years after operation, there was no local tumor recurrence, the color and texture of the flaps were with no obvious differences to those of the surrounding tissue, and the elasticity and appearance were good. The skin grafts in the flap donor areas of 2 patients survived well with local pigmentation. There was only linear scar in the flap donor areas of all patients, and there were no significant effects on sensory and motor functions. At the last follow-up, fifteen patients were satisfied with the curative effect, and 6 patients were generally satisfied with the curative effect.Conclusions:For skin and soft tissue defects after CSCC resection, the anterolateral femoral perforator flaps can be used preferentially. In the case of variation of the perforating branch of descending branch of the lateral circumflex femoral artery, the anteromedial femoral perforator flap is selected. The areas of the two flaps are large and can be adjusted according to the amount of defect tissue, thus accurately and effectively repairing skin and soft tissue defects after CSCC resection. The postoperative appearance and function are good.

Objective:To investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.Methods:The clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed. A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement. "septal extension grafts with micropores" were prepared, and the preparation of the remaining grafts was conventional.Results:A total of 30 female patients aged 21-45 years, with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage (at least retention of L-shaped scaffolds larger than 10 mm) were enrolled. All operations were successful, the cartilage scaffold was stable and durable. There were no serious complications such as infection, septal hematoma and cartilage exposure. Postoperative patients were followed up for a duration of 6-24 months. Two out of 30 patients were not satisfied with the postoperative appearance. During the revision surgery, the septal perichondrium was separated, mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling. The other patients were satisfactied with the results.Conclusion:Nasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery, which justifies its application in comprehensive nasal plastic surgery.

Objective:To investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.Methods:The clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed. A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement. "septal extension grafts with micropores" were prepared, and the preparation of the remaining grafts was conventional.Results:A total of 30 female patients aged 21-45 years, with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage (at least retention of L-shaped scaffolds larger than 10 mm) were enrolled. All operations were successful, the cartilage scaffold was stable and durable. There were no serious complications such as infection, septal hematoma and cartilage exposure. Postoperative patients were followed up for a duration of 6-24 months. Two out of 30 patients were not satisfied with the postoperative appearance. During the revision surgery, the septal perichondrium was separated, mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling. The other patients were satisfactied with the results.Conclusion:Nasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery, which justifies its application in comprehensive nasal plastic surgery.

Objective:To analyze the changes in the epidemiological characteristics of scarlet fever cases in Shanghai City before and after the outbreak of coronavirus disease 2019 (COVID-19), and to provide a reference for scientific prevention and control of scarlet fever.Methods:The information of scarlet fever reported cases in Shanghai City from January 2016 to June 2021 in the information system of Chinese Disease Prevention and Control was collected, and the differences in time trend, regional distribution, age and gender distribution of cases before and after the outbreak of COVID-19 in Shanghai City were analyzed by descriptive epidemiologic method.Results:The incidence rate of scarlet fever reported in 2016-2019 was (0.22-4.02)/100 000 in each month, with a median of 1.13/100 000. During January 2020 (the outbreak began in Shanghai City) and June 2021, the incidence rate of scarlet fever was (0.01-1.64)/100 000, with a median of 0.14/100 000, which was 12.39% of that before the outbreak of COVID-19. During February and June 2020, the monthly reported incidence rate of scarlet fever was (0.18-0.58)/100 000, showing an upward trend compared with the same period in 2020 ((0.01-0.05)/100 000). From 2016 to 2019, the annual reported incidence rate of each district was (0.55-65.48)/100 000, with a median of 9.57/100 000; while in 2020, the annual reported incidence rate of each district was (0.29-9.85)/100 000, with a median of 2.18/100 000, which was 22.78% of that before the outbreak of COVID-19. The incidence of scarlet fever dropped significantly. The incidence rate in Minhang District was still the highest. The cases were mainly four to eight years old, and there was no substantial difference of the proportions before and after COVID-19 pandemic, with the incidence rate of six years old group the highest. The proportion of male was more than female in reported case, while the male ratio in reported cases was not significantly different before and after COVID-19 pandemic.Conclusions:The incidence rate of scarlet fever in Shanghai City has dropped sharply after COVID-19 pandemic. The main epidemiological characteristics of the regional and population distribution of cases remain unchanged.

Objective:To introduce a new method of lateral nasal osteotomy. The key of this method is to fully dissect the tissue around the piriform foramen to achieve nasal osteotomy under direct vision. The osteotomy line in the whole process can be seen, which provides a more reliable control for the degree of osteotomy during the operation, and also makes the postoperative outcome more predictable.Methods:Patients whom were treated with open external osteotomy combined with autologous costal cartilage implantation for augmentation rhinoplasty (with 24 cases of hump nose correction) from October 2018 to October 2020. During the surgery, the whole nasal dorsum was exposed, the superior lateral cartilage was separated from the nasal septum, and the whole process was carried out through the mucosa from the intranasal approach under direct view. The osteotomy line was evaluated at the same time.Results:A total of 33 female patients were retrospectively analyzed. All the operations were successful, and the local swelling occurred after operation. The follow-up time was 3-18 months. After 3 months, the nasal contour and dorsal curves were smooth. Severe infections, major injuries like nasolacrimal duct, lacrimal sac, medial canthus ligament, nerve branches were not noticed in all patients. During the long-term follow-up, two patients exhibited slightly widened nasal bone, but did not require surgical intervention. The shape of nose was greatly improved. Patients were satisfied with the result . The subjective evaluation had "very satisfactory" in 24 cases (72.7%) and "satisfactory" in 9 cases (27.3%). The IGAIS evaluation were also positive: the average score of 33 patients was 1.26±0.34, including 30 cases (90.9%) scoring 1 point and 3 cases (9.1%) scoring 2 points.Conclusions:The open osteotomy technique has better control than that of conventional blind operation. It is more reliable, safer for the surgeons who are new to rhinoplasty and the experienced ones.

Objective:To investigate subalar change after rhinoplasty with costal cartilage.Methods:A retrospective study was performed on patients who received cartilaginous rhinoplasty at the Rhinoplasty Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences from May 2019 to August 2020. The facial three-dimensional(3D) and CT scanning data of young female cases was analyzed. Pre-operative and more than 6 months follow-up data was matched. The 3D facial coordinate system was established. Preoperative and postoperative location of the subnasale and the lateral point of nasal-facial junction, the angle between endocanthion-alare and coronal plane and the nasolabial angle were analyzed with paired samples t-test. The volume of subalar area was analyzed with one-sample t-test. Results:Eighteen female cases aged (27.30±4.41) years were enrolled in the study with (10.61±3.53) months follow-up. One case (5.6%) suffered from nostril asymmetry one month after the surgery. The subnasale moved forward from (74.30±1.97) mm to (77.67±2.37) mm [average difference (3.36±0.96) mm]. The lateral point of nasal-facial junction moved forward from (65.51±2.45) mm to (68.05±2.52) mm [average difference (2.53±1.50) mm]. Nasolabial angle was (88.79±11.21) degree preoperatively and (101.37±5.53) degree postoperatively [average difference (12.57±7.57) degree]. Angle between endocanthion-alare and coronal plane increased from (9.01±3.24) degree to (12.73±3.27) degree [average difference (3.72±2.22) degree]. The differences between pre- and post-operative data were statistically significant ( P<0.01). The volume of subalar area increased by (282.59±103.22) mm 3. The difference was statistically significant ( P<0.01). Conclusions:Rhinoplasty with costal cartilage could make subalar area move forward.

Objective:To introduce a new method of lateral nasal osteotomy. The key of this method is to fully dissect the tissue around the piriform foramen to achieve nasal osteotomy under direct vision. The osteotomy line in the whole process can be seen, which provides a more reliable control for the degree of osteotomy during the operation, and also makes the postoperative outcome more predictable.Methods:Patients whom were treated with open external osteotomy combined with autologous costal cartilage implantation for augmentation rhinoplasty (with 24 cases of hump nose correction) from October 2018 to October 2020. During the surgery, the whole nasal dorsum was exposed, the superior lateral cartilage was separated from the nasal septum, and the whole process was carried out through the mucosa from the intranasal approach under direct view. The osteotomy line was evaluated at the same time.Results:A total of 33 female patients were retrospectively analyzed. All the operations were successful, and the local swelling occurred after operation. The follow-up time was 3-18 months. After 3 months, the nasal contour and dorsal curves were smooth. Severe infections, major injuries like nasolacrimal duct, lacrimal sac, medial canthus ligament, nerve branches were not noticed in all patients. During the long-term follow-up, two patients exhibited slightly widened nasal bone, but did not require surgical intervention. The shape of nose was greatly improved. Patients were satisfied with the result . The subjective evaluation had "very satisfactory" in 24 cases (72.7%) and "satisfactory" in 9 cases (27.3%). The IGAIS evaluation were also positive: the average score of 33 patients was 1.26±0.34, including 30 cases (90.9%) scoring 1 point and 3 cases (9.1%) scoring 2 points.Conclusions:The open osteotomy technique has better control than that of conventional blind operation. It is more reliable, safer for the surgeons who are new to rhinoplasty and the experienced ones.

Objective:To investigate subalar change after rhinoplasty with costal cartilage.Methods:A retrospective study was performed on patients who received cartilaginous rhinoplasty at the Rhinoplasty Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences from May 2019 to August 2020. The facial three-dimensional(3D) and CT scanning data of young female cases was analyzed. Pre-operative and more than 6 months follow-up data was matched. The 3D facial coordinate system was established. Preoperative and postoperative location of the subnasale and the lateral point of nasal-facial junction, the angle between endocanthion-alare and coronal plane and the nasolabial angle were analyzed with paired samples t-test. The volume of subalar area was analyzed with one-sample t-test. Results:Eighteen female cases aged (27.30±4.41) years were enrolled in the study with (10.61±3.53) months follow-up. One case (5.6%) suffered from nostril asymmetry one month after the surgery. The subnasale moved forward from (74.30±1.97) mm to (77.67±2.37) mm [average difference (3.36±0.96) mm]. The lateral point of nasal-facial junction moved forward from (65.51±2.45) mm to (68.05±2.52) mm [average difference (2.53±1.50) mm]. Nasolabial angle was (88.79±11.21) degree preoperatively and (101.37±5.53) degree postoperatively [average difference (12.57±7.57) degree]. Angle between endocanthion-alare and coronal plane increased from (9.01±3.24) degree to (12.73±3.27) degree [average difference (3.72±2.22) degree]. The differences between pre- and post-operative data were statistically significant ( P<0.01). The volume of subalar area increased by (282.59±103.22) mm 3. The difference was statistically significant ( P<0.01). Conclusions:Rhinoplasty with costal cartilage could make subalar area move forward.