Objective To explore the clinical effectiveness of a locally trained and re-optimized RapidPlan model in lung stereotactic body radiation therapy (SBRT). Methods A total of 132 lung SBRT cases were retrospectively collected as a training group for the establishment of an initial RapidPlan model (RP-1) in the Eclipse 15.5 treatment planning system. RP-1 was then used to optimize the training group plans to generate the first-generation RapidPlans, which were used as a new training group to generate the upgraded RapidPlan model (RP-Plus). Additional 40 lung SBRT cases were selected to verify the quality and efficiency of RP-Plus plans, which were further assessed through clinical quality assurance (QA). Results The RP-Plus reduced the average number of optimization cycles by 2.1 times and 0.3 times compared to manual and RP-1 methods, respectively, and reduced the optimization time by 57.6% and 18.8%. The conformity index met clinical requirements, and the gradient index and Max_2cm(%) were improved compared to RP-1 (both P < 0.05). The RP-Plus plans showed lower dosimetric parameters of organs at risk, including lung V_20Gy, spinal cord D_max, and heart \begin{document}$D_{0.1{\mathrm{cm}}^3} $\end{document} The clinical QA pass rate of the RP-Plus plans was 100%. Conclusion The locally trained and re-optimized lung SBRT RapidPlan model can further improve plan quality and efficiency, and meet clinical QA requirements, showing feasibility for clinical application.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.

Objective:To evaluate the feasibility and clinical effect of resection and repairing the neurofibromatosis type 1 (NF1).Methods:Retrospective analysis was performed with the data of patients diagnosed with NF1 in the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from January 2000 to December 2020. All of these patients underwent resection and repair procedures with flap-transferringor skin-grafting.Results:A total of 34 patients with NF1 were included (16 patients with macrosomia NF1, including two patients with cephalic and facial macrosomia NF1 and 14 patients with extremities and somatic macrosomia NF1). There were 14 males and 20 females, aged from 16 to 46 years, with an average age of 30.4 years. The size of the tumor was 65-2 080 cm 2, with an average of 252 cm 2. Nine patients underwent preoperative interventional embolization of the main blood supply artery after consultation with the interventional department. All patients successfully resected the labeled tumor according to the preoperative plan, among which 33 patients underwent one-stage resection and repair. One female patient with large facial neurofibroma experienced uncontrollable bleeding after partial resection of the tumor during the first surgical resection, and the resection and repair were performed by staged surgery after pressurized bandaging for hemostasis. The bleeding during the operation of other patients was controllable. Fourteen cases were sutured directly after tumor resection. Among which, two cases appeared wound dehiscence within one week after the surgery but recovered well after resutured under local anesthesia. Sixteen cases were repaired by transferring skin flaps, of which five patients suffered from insufficient blood supply of the distal end of the flap and underwent debridement and suturing. Four patients were repaired by skin grafting, of which one patient underwent second skin grafting due to poor survival of part of the grafted skin and recovered well. All patients were followed up for 6 to 36 months (mean 22.6 months). Except for one patient with malignant change and one patient with evident tumor recurrence, no recurrence or malignant change occurred in the other patients, and the surgical effect was satisfactory. Conclusions:The resection and repair of NF1, especially giant NF1, should be based on the location and size of the tumor so as to achieve the one-stage resection and repair as far as possible under the premise of controlling bleeding. Different types of repair methods can be applied according to the location, size, and morphology of the lesion to achieve the purpose of removing the lesion and protecting the morphology and function.

Objective:To evaluate the feasibility and clinical effect of resection and repairing the neurofibromatosis type 1 (NF1).Methods:Retrospective analysis was performed with the data of patients diagnosed with NF1 in the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from January 2000 to December 2020. All of these patients underwent resection and repair procedures with flap-transferringor skin-grafting.Results:A total of 34 patients with NF1 were included (16 patients with macrosomia NF1, including two patients with cephalic and facial macrosomia NF1 and 14 patients with extremities and somatic macrosomia NF1). There were 14 males and 20 females, aged from 16 to 46 years, with an average age of 30.4 years. The size of the tumor was 65-2 080 cm 2, with an average of 252 cm 2. Nine patients underwent preoperative interventional embolization of the main blood supply artery after consultation with the interventional department. All patients successfully resected the labeled tumor according to the preoperative plan, among which 33 patients underwent one-stage resection and repair. One female patient with large facial neurofibroma experienced uncontrollable bleeding after partial resection of the tumor during the first surgical resection, and the resection and repair were performed by staged surgery after pressurized bandaging for hemostasis. The bleeding during the operation of other patients was controllable. Fourteen cases were sutured directly after tumor resection. Among which, two cases appeared wound dehiscence within one week after the surgery but recovered well after resutured under local anesthesia. Sixteen cases were repaired by transferring skin flaps, of which five patients suffered from insufficient blood supply of the distal end of the flap and underwent debridement and suturing. Four patients were repaired by skin grafting, of which one patient underwent second skin grafting due to poor survival of part of the grafted skin and recovered well. All patients were followed up for 6 to 36 months (mean 22.6 months). Except for one patient with malignant change and one patient with evident tumor recurrence, no recurrence or malignant change occurred in the other patients, and the surgical effect was satisfactory. Conclusions:The resection and repair of NF1, especially giant NF1, should be based on the location and size of the tumor so as to achieve the one-stage resection and repair as far as possible under the premise of controlling bleeding. Different types of repair methods can be applied according to the location, size, and morphology of the lesion to achieve the purpose of removing the lesion and protecting the morphology and function.

Objective To investigate the diagnosis and therapy of the sclerosing hemangioma of the lung.Mothods The case history of 15 patients were analyzed retrospectively and summarized the diagnosis and therapy of the Sclerosing hemangioma of the lung.Results There were 2 males and 13 females(1:6.5).No patients were diagnosed this disease before operation for there were no specific imageology features.The tumor cell indicated pantomorphia and there were 3 cases were misdiagnosed during the operation frozen section pathology.The optimization therapy methods was to resect the tumor with the VATS.The prognosis of this disease was well and there were no cases recurrence in these 15 patients.Conclusion The sclerosing hemangioma of the lung was the benign tumor and there were no specific imageology features.The misdiagnosis was frequently before operation.To resect the tumor with the VATS was the optimal therapy method.

Objective To report the experience of lung transplantation with size reduced graft lung.Methods Four cases receiving lung transplantation with size reduced graft lung were analyzed retrospectively.In case 1,left lung transplantation combined with contra-hteral lung volume mduction.In case 2,right lung transplantation Wag individually performed with partially msecfion of upper lobe of graft lung.In case 3.bilateral sequential lung transplantation wag performed using graft lung with partially resection of bilateral upper lobes.In the remained ease,bilateral sequential lung tansplantation was performed using graft lung with resection of right lower lobe.Results All the size reduced graft lungs had good functions during the peri-operation period.Case 1 and case 2 still survived without obvious complication.Case 3 experienced temporary air leak on the 5th day postoperation and cured by water seal drainage but died of abrupt bronchorrhea due to aspergillus infection on the 32th day postoperation.The last cage experienced smoothly recovery excepted fatal virus pneumonia 2 months postopemtion.Conclusion Size reduced graft lungs can be successfully used for transplantation.

Clinical data of 4 patients with chronic obstructive pulmonary disease who underwent allogenic single-lung transplantation were retrospectively analyzed. All cases received corpse donor lungs. One case with diffuse emphysema underwent right lung transplantation. and 3 received left lung transplantation. including one underwent fight lung volume reduction during surgery and 2 cases underwent right lung volume reduction post-transplantation. The inductive treatment with daclizumab or antithymocyte globulin was done and the rejection was prevented with Tacrolimus. mycophenolate and prednisone. The surgery was successfulin 4 cases. One case developed acute rejection on the fifth day post-transplantation. and controlled using methylprednisolone. Two cases discharged successfully, of whom one lived more than 2 years. Two cases died 74 days and 77 days after lung transplantation. respectively.