Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.

Objective:To summarize the effect of Ilizarov technique in the treatment of limb contracture secondary to venous malformation.Methods:From January 2015 to June 2019, nine cases of limb contracture secondary to venous malformation, from Peking University Third Hospital and Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, were treated with Ilizarov technique, including four males and five females, aged 9 to 35 years, with an average age of 19.5 years. There were two cases of flexion of the hip and knee, four cases of flexion of the knee, two cases of flexion of the knee with talipes equinovarus, and one case of flexion of the wrist. Ilizarov technique was used for treatment after the evaluation of the multi-disciplinary treatment team. According to the safe zone of wire fixation and the limbs deformities character, the preassembled external fixator was connected to the relevant deformed limbs, and the tendons were released at the same time. Limbs deformities were corrected gradually by adjusting the external fixator. For patients with severe pain or rapid development of the affected area, it is appropriate to perform ultrasound-guided injection of lauromacrogol and physical therapy to promote the function of joints.Results:During the treatment, there were no neurovascular injury, peripheral blood circulation disorder, infection event of injection channel and incision, or deep vein thrombosis. The follow-up were 6 to 40 months, with an average of 30.5 months. All the contractures of the hip and knee joints, most of the deformities of the wrist and ankle joints were corrected and the pain disappeared.Conclusions:Ilizarov technique is a minimally invasive, safe and effective method for the treatment of limb contracture secondary to venous malformation.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.

Objective:To summarize the effect of Ilizarov technique in the treatment of limb contracture secondary to venous malformation.Methods:From January 2015 to June 2019, nine cases of limb contracture secondary to venous malformation, from Peking University Third Hospital and Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, were treated with Ilizarov technique, including four males and five females, aged 9 to 35 years, with an average age of 19.5 years. There were two cases of flexion of the hip and knee, four cases of flexion of the knee, two cases of flexion of the knee with talipes equinovarus, and one case of flexion of the wrist. Ilizarov technique was used for treatment after the evaluation of the multi-disciplinary treatment team. According to the safe zone of wire fixation and the limbs deformities character, the preassembled external fixator was connected to the relevant deformed limbs, and the tendons were released at the same time. Limbs deformities were corrected gradually by adjusting the external fixator. For patients with severe pain or rapid development of the affected area, it is appropriate to perform ultrasound-guided injection of lauromacrogol and physical therapy to promote the function of joints.Results:During the treatment, there were no neurovascular injury, peripheral blood circulation disorder, infection event of injection channel and incision, or deep vein thrombosis. The follow-up were 6 to 40 months, with an average of 30.5 months. All the contractures of the hip and knee joints, most of the deformities of the wrist and ankle joints were corrected and the pain disappeared.Conclusions:Ilizarov technique is a minimally invasive, safe and effective method for the treatment of limb contracture secondary to venous malformation.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.

Background: Currently, many problems are still controversial on performing out of digestive tract operation through endoscopic submucosal tunnel. Aims: To evaluate the feasibility and safety of endoscopic mediastinal exploration via esophageal submucosal tunnel. Methods: Endoscopic mediastinal exploration was performed via esophageal submucosal tunnel in two healthy swine. A 5 cm submucosal tunnel was created with blunt dissection. The mucosal incision was closed by hemostatic clips, and penicillin was used prophylactically. Two weeks later, after reexamined by gastroscopy, the animals were sacrificed and the esophagus was obtained for macropathology and histopathology. The survival rate, wound healing and complications were observed. Results: The mediastinal organs such as aorta, trachea, and pericardium were identified clearly during exploration. All the animals survived with no obvious complications. Gastroscopy and histopathology showed good wound healing two weeks after operation. Taking autopsy as standard, the anatomical structures were accurately identified under endoscopy. Conclusions: Animal experiment revealed that mediastinal exploration via transesophageal endoscopic submucosal tunnel is feasible and relatively safe.

Objective To evaluate the clinical effect of circumvertical mastopexy with internal shaping using inferior dermal-glandular flap for correction of breast ptosis.Methods From April 2010 to November 2017,33 cases of breast ptosis were treated in our department.The patients required nipple elevation of 3-6 cm and had unpleasing result after circumareolar mastopexy were treated with the technique of circumvertical lift with breast suspension and internal shaping with inferior dermal-glandular flap which pedicle was on the inframammary crease and tack technique for removing excessive skin precisely.Results 33 cases had their drainage tubes removed at the 2～3 days and suture removed at the 12～14 days postoperatively.All had primary healing of incision and no complications such as necrosis of NAC and dehiscence of incision occurred.Elastic bra was asked to wear for three to six months and then stable shape was achieved.Follow-up lasted for 6-60 months.All cases were satisfied with their new breast shape.Conclusions Circumvertical mastopexy with internal shaping using inferior dermal-glandular flap is a simple and effective method with relatively short scar and good shape for correction of the medium grade breast ptosis.

Objective To study the pathological mechanism of aseptic necrosis of breast tissue after long-term breast augmentation injected with polyacrylamide hydrogel (PAHG).Methods We included patients who had no obvious clinical symptoms and underwent surgical removal of the PAHG in our hospital,excluding patients with a history of breast prosthesis implantation.Extracts were collected,and then underwent a careful gross observation and serial sections followed by HE,Mallory,and toluidine blue staining,to observe the histological structure of collagen fibers and inflammatory cells.Immunohistochemistry for CD31 and a-smooth muscle actin (a-SMA) antibody was used to further identify vascular endothelial cells and vascular smooth muscle cells,respectively.Analysis of the correlation between injection time and the incidence of different pathological changes were done.Results We included 22 females (mean age 39.14 years,range 22-55 years) who requested surgical removal of the PAHG.The mean duration of PAHG injection was 9.27 years (range 4-14 years).They had no clinical symptoms or only had induration,deformation and displacement.The basic pathological changes of local tissue included foreign body reaction and chronic inflammation,fibrosis and tissue necrosis;and half of the tissue had also histological changes,such as small vascular smooth muscle layer thickening,lumen stenosis,etc.No significant correlation was found between the pathological changes and the duration of the disease and the clinical symptoms.Conclusions Patients with PAHG injection for augmentation mammoplasty can histopathological changes of local tissues even without experiencing discomfort.The tissue necrosis in some patients may be caused by foreign body reaction and inflammatory reaction.It may also be due to local ischemia caused by small vascular smooth muscle hyperplasia,luminal stenosis etc.

Objective: To investigate the clinical effect and safety of tramadol hydrochloride sustained-release tablets for subcutaneous venous malformation polidocanol sclerotherapy. Methods: The experimentation was designed in block randomization. 106 patients with subcutaneous venous malformations from May 2016 to November 2017, which in line with the inclusion criteria, were randomly divided into experimental group and control group, with 53 cases in each group. Experimental group patients took 100 mg tramadol hydrochloride sustained-release tablet 1 hour before operation, while control group patients took nothing. Both group underwent polidocanol foam injection therapy guided by the color ultrasound, to observe the effect of operative analgesia, postoperative analgesia (VAS grade) and complications. The data was analyzed by SPSS 19.0 software. Comparison between two groups was done with independent sample t test and P<0.05 was considered statistically significant. Results: The pain sensation(VAS grade) in surgery in experimental group(3.02±1.118)were significantly reduced than control group(6.30±1.514) (t=-12.701, P=0.000). 2 hours after operation the pain sensations decreased in both groups, but experimental group(0.23±0.577)were still better than which in control group(0.60±0.987)(t=-2.403, P=0.018). Three patients of experimental group(5.7%) felt mild nausea, and no other severe complications nor adverse effects occured. Conclusions Oral tramadol hydrochloride sustained-release tablets is one of safe, simple and effective way to achieve satisfactory preemptive analgesia for venous malformation polidocanol foam sclerotherapy.

Hemorrhagic anaemia caused by chronic gastrointestinal bleeding is a common complication of BRBNS that has the greatest impact on the patient′s quality of life, even life-threatening. Traditional treatments cannot slow down the overall progress of the disease. The curative effect is limited and has certain limitations. Sirolimus can effectively treat vascular malformations of the soft tissues, and it can control gastrointestinal lesions to correct iron deficiency anemia caused by bleeding, improve quality of life, and can inhibit disease progression and improve prognosis. This new emerging medication may become one of the powerful treatments for BRBNS in the future.