Objective:To evaluate the efficacy and safety of fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition for the treatment of metopic synostosis.Methods:Retrospective analysis was performed on the clinical data of children with metopic synostosis who were treated in the Department of Burns and Plastic Surgery, Children’ s Hospital of Nanjing Medical University from January 2015 to October 2023 with fronto-orbital plasty, which involved premature frontal suture osteotomy with frontoparietal transposition. The frontal and parietal bones were divided into two bones, then the supraorbital bridge was cut off and the premature frontal suture was removed. The parietal bone block was then placed on the upper edge of the orbital bone, followed by the placement of the two pieces of the frontal bone on the upper edge of the parietal bone. Finally, all bone blocks were secured using absorbable plates. Pre-and post-operative CT scans and reconstructions were performed to measure changes in cranial cavity volume, and complications such as cerebrospinal fluid leakage, infection, and recurrence of metopic synostosis were followed up.Results:A total of 5 patients with metopic synostosis were enrolled, 4 males and 1 female, aged 5 to 14 months. The operation time was 4.5 to 5.5 hours, and the intraoperative blood loss was 50 to 150 ml. All patients completed the treatment without serious complications. The cranial cavity volume increased by 48.53 to 172.00 cm 3 after the operation. Follow-up was conducted for 3 to 6 months, and the trigonocephaly was completely improved without any serious complications. Short-term follow-up indicated stable craniofacial morphology. Conclusion:Fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition is an effective and safe treatment for metopic synostosis. The procedure has a low risk of recurrence and complications, and the result are positive. Recurrence was scarce in the short term, and the long-term situation needs to be observed.

Objective:To evaluate the stability of the zygomatic complex in reduction malarplasty (RM) with different fixation method.Methods:The clinical data of patients with zygomatic arch protrusion at the Department of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University from January 2018 to January 2021 were analyzed retrospectively. All patients underwent L-shaped osteotomy reduction malarplasty which were divided into zygomatic body fixation (ZBF) and zygomatic arch fixation (ZAF) according to fixation technique. As for ZBF, there were 4 different groups including two bicortical screws (2LS), an L-shaped plate with one bicortical screw (LPLS), an L-shaped plate with short-wing on the zygoma (LPwZ) and an L-shaped plate with short-wing on the maxilla (LPwM). As for ZAF, there were 3 different groups including mortice-tenon (MT), 3-hole plate (3HP) and short screw (SS). CT imaging data of two postoperative periods (1 week later; 6 months later) were collected. ITK-SNAP and 3D Slicer software were applied to evaluate the difference in the displacement distance of relevant landmarks of the zygomatic complex, so as to compare the postoperative stability of RM under different fixation methods. Statistical analyses were performed using IBM SPSS Statistics, version 25.0, and Kruskal-Wallis method was used to compare the difference of relevant landmarks displacement distance between ZBF group and ZAF group. P<0.05 was considered statistically significant. Results:60 patients (120 zygomatic arches) who were composed of 21 men and 39 women, aged (27.1±4.9) years were included. There were 30 samples in each group of ZBF and 40 samples in each group of ZAF. Compared with the single L-shaped plate (LPwZ, LPwM) group, the displacement distance of zygomatic complex in 2LS and LPLS groups was shorter ( P<0.05). The three fixation method of zygomatic arch (MT, 3HP, SS) had similar effects on the displacement of zygomatic complex ( P>0.05). Conclusion:After RM, the "two-bridge" fixation method (2LS and LPLS) provides better stability than the single L-shaped plate. The stability of all ZAF is similar when combined with 2LS or LPLS.

Objective:To assess the effectiveness of robot-assisted mandibular angle osteotomy using the FACE-Q questionnaire.Methods:A randomized controlled clinical study was conducted in the Second Affiliated Hospital of Zhengzhou University from January 2022 to June 2023. Patients with mandibular angle hypertrophy aged 18 to 40 years old were recruited as research objects, and a randomization and supply management system (Clinflash IRT 2.0) was used to randomly assign the experimental group and control groups in a 1∶1 ratio. Before surgery, Mimics 21.0 software was used to plan the surgical approach and determine the osteotomy plane based on the head CT data of the two groups. The experimental group underwent robot-assisted mandibular angle osteotomy according to the preoperative osteotomy plan, while the control group underwent traditional manual mandibular angle osteotomy according to the preoperative design. Six months after surgery, patients filled in the FACE-Q craniofacial module scale to evaluate the surgical effect, covering 12 indicators in four aspects: appearance satisfaction (including face, jaw and smile), health-related quality of life (including appearance anxiety, psychology, social interaction and speech), postoperative function (including breathing, diet, face and pronunciation), and adverse reactions. Each indicator was scored from 0 to 100 points, with higher scores indicating better evaluation. SPSS 27.0 software was used to process the data, and the measurement data of normal distribution were expressed by Mean±SD, and t-test was used for comparison between groups. The measurement data of non-normal distribution were expressed by M ( Q1, Q3), and Mann-Whitney U test was used for the comparison between groups. P<0.05 was considered statistically significant. Results:The experimental group included 20 patients, 3 males and 17 females, with an age of (27.6±4.4) years (19 to 38 years); the control group included 20 patients, 4 males and 16 females, with an age of (27.4±3.9) years (19 to 35 years). Six months postoperatively, all patients in both groups had good wound healing, and the mandibular hypertrophy was improved to varying degrees. There were no complications such as facial paralysis, facial deviation, or pain. The FACE-Q questionnaire results showed that in terms of appearance satisfaction, the scores for the three indicators of face, mandible, and smile in the experimental group were (72.2±11.7), 86(77, 92), and (63.2±9.5) points, respectively, all higher than those in the control group, which were (49.2±9.9), 43(35.5, 50), and (48.0±7.7) points, respectively, with statistically significant differences ( P<0.01 for all); in terms of health-related quality of life, except for speech, the scores for the three indicators of appearance anxiety, psychology, and social interaction in the experimental group were higher than those in the control group [(71.0±11.5) points vs.(49.1±10.3) points, (66.7±11.7) points vs.(45.4±10.5) points, (75.0±9.7)points vs.(56.4±8.5) points], with statistically significant differences ( P<0.01 for all); in terms of postoperative function, the score for eating in the experimental group was higher than that in the control group [(83.4±10.7) points vs.(71.0±14.9) points] ( P<0.01), but there were no statistically significant differences in the other three indicators ( P>0.05 for all); in terms of adverse reaction, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The result of the FACE-Q questionnaire assessment confirmed that robot-assisted mandibular angle osteotomy can significantly improve patients’ postoperative appearance satisfaction, psychological state, social adaptability, and eating function without increasing the incidence of complications.

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

Objective:To discuss the clinical curative effect and feasibility of the combination therapy of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation in the treatment of mallet finger.Methods:A retrospective analysis was performed on patients with tendon zone Ⅰ rupture of tendinous mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from July 2021 to June 2023. During the procedure, firstly, the extensor digitalis tendon in the zone Ⅰ was sutured percutaneous with 3-0 thread monofilament sutures in the "quantitative 8-stitch method " according to the pre-marked number sequence of 1 to 8, and fixed at the base of the distal phalanx via a constructed bone tunnel. Secondly, the distal interphalangeal joint (DIPJ) was fixed elastically with Kirschner wire, without damage to the articular surface. Four to five weeks after the operation, the Kirschner wire was removed, and flexion and extension of the affected finger were gradually increased. At the last follow-up, the range of motion (ROM) and the total action motion (TAM) of the finger were recorded, and the healthy side of the ROM and TAM slightly differed. Finger function was evaluated following the American Association of Hand Surgeons TAM system. It was divided into four grades: excellent, good, fair and poor. SPSS 15.0 software was used for statistical analysis. Measurement data conforming to normal distribution were expressed as Mean±SD, and a paired sample t-test was used for comparison between the affected finger and the corresponding healthy finger. Results:A total of 30 patients (30 digits) were enrolled, including 19 males and 11 females with the age of (38.5±4.3) years (14 to 71 years). All were single closed injuries. Time from injury to operation was (1.1±0.4) d (3 h to 7 d). The distance of tendon break was (8.4±0.5) mm (4 to 12 mm). Mallet finger deformities were all corrected postoperatively. There were no complications such as scar, exposed suture, nail tract infection, or nail removal on the dorsal side of the affected finger. All patients were followed up for (7.5±1.3) months (6-13 months). At the last follow-up, the ROM of DIPJ of the affected finger and the corresponding healthy finger were 43.28°±2.03° and 44.15°±1.12°, respectively, with no statistical significance ( t=1.32, P=0.084). TAM of the affected finger and the corresponding healthy finger were 240.15°±5.13° and 242.13°±3.11°, respectively, with no significant difference ( t=2.12, P=0.135). According to TAM system evaluation criteria, excellent in 27 cases, good in 3 cases, excellent and good rate was 100% (30/30). Conclusion:The combination of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation has a satisfactory treatment outcome in the mallet finger, and there is no damage to the DIPJ surface. It is a simple, safe, effective method with minimal invasion.

Objective:To summarize the treatment experience of diabetes mellitus combined with necrotizing fasciitis.Methods:A retrospective analysis was conducted on the clinical data of patients diagnosed with diabetes mellitus and necrotizing fasciitis who were admitted to the Department of Burns and Plastic Surgery, Affiliated Hospital of Guizhou Medical University between September 2018 and December 2020. Upon admission, initial treatment involved blood glucose management, the administration of empirical antibiotics to combat infection, and concurrent nutritional support therapy. Surgical interventions, including either dilatation or incision and drainage, were promptly performed within 24 to 72 hours. During these procedures, necrotic tissues and purulent exudates were collected for pathogen culture and antibiotic sensitivity testing to guide appropriate treatment. Post-operatively, a negative pressure closed drainage system was installed to facilitate wound drainage, combined with 1.5% hydrogen peroxide solution to flush the wound or subcutaneous placement of multiple drainage tubes to drain the wound. If post-surgical infection persisted, additional dilatations were deemed necessary. Under the condition of clean wound and fresh granulation tissue, the wound was repaired by medium-thickness skin grafting on the lateral thigh. The laboratory risk indicator for necrotizing fasciitis (LRINEC) was checked and scored, including C-reactive protein, white blood cell count, hemoglobin, blood sodium, blood creatinine, and blood glucose levels. The total score was 0-13 points. When the score was ≥ 6 points, necrotizing fasciitis should be actively suspected. Observation of trauma infection control, statistics on the number of dilatations, trauma repair modalities, hospitalization time, and amputations, and follow-up of trauma healing and recurrence of necrotizing fasciitis were recorded.Results:A total of nine patients were enrolled, consisting of seven males and two females, with an age range of 39 to 81 years. The study population comprised patients with diabetes mellitus, with durations ranging from 0.5 to 10 years. The affected body parts included one upper extremity, six lower extremities, one perineum, and one case involving both a perineum and a lower extremity. LRINEC score ≥ 8 points in 5 cases and 6-7 points in 4 cases. The wound infection was controlled after 1 time dilatations in 4 cases, 2 times in 3 cases and 3 times in 2 cases, the infection of the trauma was controlled and reached a clean and fresh state of granulation tissue.In 7 cases, the trauma was healed after repairing with thick-medium-thick dermal grafting; in 1 case, the trauma was repaired by thin-medium-thick dermal grafting with scattered punctate recurring oozing, which was healed after changing the medication; and in 1 case, the right middle calf leg was amputated. Microbiological culture result: 2 cases of Staphylococcus aureus treated with intravenous drip of ceftazidime 2 000 mg once a day; 1 case of Pseudomonas pseudomallei was treated with intravenous drip of fluconazole 400 mg once a day; 2 cases of Enterococcus faecalis and 2 cases of Enterococcus faecium treated with intravenous drip of piperacillin and tazobactam sodium 4 500 mg 3 times a day, 2 cases of Escherichia coli treated with intravenous drip of levofloxacin 500 mg once a day. The duration of hospitalization of 9 patients ranged from 24 to 56 days. At discharge, LRINEC was significantly improved compared with admission, and LRINEC score was 0-2 points. Follow-up ranged from 3 months to 2 years, relapsed infection happended in the affected limb wound in one case, which healed after anti-infection and dressing change. The other cases healed well without recurrence. Conclusion:In the management of diabetic necrotizing fasciitis, concurrent comprehensive glycemic control and surgical intervention are crucial. The integration of vacuum sealing drainage and the employment of 1.5% hydrogen peroxide for wound cleansing, along with a consistent and prolonged antibiotics reatment course significantly contributes to improved disease control, promote wound healing, leading to reduced mortality and lower rates of amputation.

Objective:To observe the clinical effect of lower eyelid blepharoplasty combined with micro-autologous fat transplantation (MAFT) in the rejuvenation of the infraorbital regions.Method:A retrospective analysis was conducted on the clinical data of patients with lower eyelid pouch and tear trough treated with lower eyelid blepharoplasty combined with MAFT in the Department of Plastic Surgery of Affiliated Hospital of Nanjing University of Chinese Medicine from March 2020 to March 2022. Patients seeked medical attention due to lower eyelid pouch and tear trough, with or without skin laxity, and some patients had varying degrees of midface depression. After preoperative examination and evaluation of the patient’s infraorbital area and midfacial depression, appropriate individualized plans were developed.The patient underwent lower eyelid blepharoplasty by transconjunctival approach combined with tear trough MAFT. For patients with low or depressed midface, midface MAFT was also performed, and for patients with skin laxity, skin removal surgery was performed simultaneously. Complications were recorded after the operation. Preoperative and postoperative photos of more than 6 months were taken with the same postion and delivered to the same doctor to grade the patient’s Barton classification (0-3 grades, with higher grade indicating more obvious tear trough deformity). The improvement of tear trough deformity after surgery was assessed, and the global aesthetic improvement scale (GAIS) score was also assessed. The patients evaluated their improvement using the patients aesthetic improvement scale (PAIS) score (GAIS and PAIS are both 1-5 points, with higher scores indicating more significant postoperative improvement). Normal distribution metric data was represented by Mean±SD, and count data was represented by frequency and/or percentage; skewed distribution metric data was represented by M ( Q1, Q3), and compared by rank sum test. Results:A total of 69 patients were enrolled, including 9 males and 60 females, aged 25-45 years, with an average age of 36.7 years. Among them, 35 patients had midfacial depression, and 11 patients had skin laxity. (0.37±0.07) ml (0.2-0.6 ml) of micro-autologous fat was injected into the orbicularis oculi muscle on each side; (0.18±0.06) ml (0.1-0.2 ml) of micro-autologous fat was injected into the subcutaneous layer on each side; (3.80±0.98) ml (3-5 ml) of micro-autologous fat was injected into the deep medial cheek fat compartment and pyriform aperture fat compartment on each side. No serious complications occurred after the surgery. Postoperative follow-up lasted for 6-13 months, with an average of 8.7 months. The patient’s lower eyelid pouch, tear trough deformity, and depression in the midface have all improved, presenting a youthful and smooth appearance from the infraorbital area to the midface. The skin texture in the lower eyelid area had also improved. At the last follow-up, the Barton classification of the lacrimal groove decreased compared with that before surgery, and the difference was statistically significant [grade 0 (0, 1) vs. grade 2 (1, 2), Z=-7.62, P<0.001]. At the last follow-up, the PAIS score of 69 patients was 5 points in 49 cases (71%) and 4 points in 20 cases (29%); doctor’s GAIS score was 5 points in 38 cases (55%), 4 points in 27 cases (39%), and 3 points in 4 cases (6%) . Conclusion:For those patients with aging status of infraorbital region, like lower eyelid pouch and tear trough deformities, the combination of lower eyelid blepharoplasty through the transconjunctival approach and MAFT can achieve good therapeutic effects. This method is safe with a short recovery time.

Tufted angioma (TA) is a rare vascular endothelial cell tumor that often occurs in infants and early childhood and is rare in adults. There are currently no unified treatment guidelines, and treatment options for children with TA are limited and challenging. This report introduces a case of a child diagnosed with superficial TA in the left popliteal fossa. Topical 0.1% sirolimus cream was given in the early stage and combined with pulsed dye laser treatment in the later stage. The child’s skin lesions recovered well. The author reviews relevant literature reports to summarize the treatment of TA in children and provide relevant ideas and new options for the diagnosis and treatment of the disease.

Tissue engineering has provided wide applications in the field of breast reconstruction for breast cancer patients. A sufficient blood supply is critical to long-term tissue survival, which is also the key to creating large volume tissue-engineered breasts. Compared with traditional three-dimensional(3D) printing, 3D bioprinting uses bioactive bioinks to print tissue or organ structures to bring related biofunctions. It has become a promising developing direction for recreating functional vascular networks in vitro. The article summarized the recent findings of studies on bioprinting in fabricating vascularized tissue-engineered breasts. Moreover, it has highlighted the possible mechanisms of precise bioprinting of vascular networks and angiogenesis.

The maxillofacial orthopedics surgery is aimed to help patients reconstruct three-dimensional structure and restore original function. The anatomical structures involved in this surgery are complicated, which requires higher technical requirements for surgeon. Mixed reality (MR) technology realizes in-depth interaction and feedback between the real world, the virtual world and the users by presenting virtual scene information in the real scene, which has the advantages of virtual-reality fusion, real-time interactivity, three-dimensional registration, rapid alignment, etc. It can be used for pre-operative planning and intra-operative navigation, which can improve the accuracy and safety of surgery, reduce the occurrence of postoperative complications.At the same time, MR technology can reduce the requirements for the surgeon’s surgical experience and skills. As a result, the MR technology has a broader application prospect in the field of maxillofacial orthopedics. The manuscript summarized the characteristics of MR technology, introduced the application of MR technology in the field of maxillofacial orthopedics. It also put forward the urgent problems and future development direction of MR technology in clinical application.