Objective:To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma.Methods:Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2005 to January 2022 were included. The surgeries were categorized into 4 types. (1) Direct excision and suture. (2) Local skin grafts: covering the defect with split- or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids. (3) Combined skin grafts with orbicularis oculi myocutaneous flap: grafting skin flaps for defects on the upper eyelid and near the lower eyelid, and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects. (4) Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts: the surgery was divided into two stages, the first stage involves the placement of an expander in the temporal area of the affected side, and the second stage involves the removal of the expander, excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle, which was rotated 180° to cover the lower eyelid defect. Defects near the upper and lower eyelid margins were still covered with skin grafts. Follow-up was conducted through outpatient visits, telephone calls, and WeChat messaging to assess facial appearance postoperatively. SPSS 22.0 statistical software was used for analysis, and the measurement data were expressed as Mean±SD, the count data were expressed as percentage, and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities (A&F scores) within the group was performed by paired t-test, the difference was considered statistically significant at P<0.05. Results:A total of 34 patients were included; average age was 17.7±15.3 years. The size of the lesions varied from the smallest nevus measuring 0.3 cm × 0.2 cm and the largest measuring 14.0 cm × 14.0 cm. Direct excision with suturing was performed in 6 cases, among which 2 cases received simultaneous double eyelid surgery, the postoperative A&F score (4.54 ± 1.32) was higher than the preoperative (3.28 ± 0.98) score, the difference was not statistically significant ( P>0.05). The skin graft was performed in 10 cases, the postoperative A&F score (5.13 ± 1.59) was higher than the preoperative (2.25 ± 1.59), the difference was not statistically significant ( P>0.05). The skin graft combined with using orbicularis oculi muscle skin flap was performed in 7 cases, the postoperative A&F score of our patients (5.54 ±1.46) was significantly higher than the preoperative (2.18 ±1.61 ), the difference was statistically significant ( P<0.05). The skin graft combined with the expanded temporal area flap based on the orbicularis oculi muscle was performed in 11 cases, the A&F score of our patients after repair (4.95 ±0.60) was improved compared with the preoperative (2.18±1.48) score, and the difference was not statistically significant ( P>0.05). Twenty-eight patients were followed up for 8 to 81 months while 6 cases lost due to change of contact information, among whom three developed secondary ectropion of the lower eyelid, three experienced recurrence of nevi in the incision and grafting area, two exhibited significant pigmentation in the grafting area, and one developed secondary ptosis of the upper eyelid, while the rest of the patients were satisfied with the repair results. Conclusion:Surgical excision is the only effective treatment for eyelid cleft nevi with different clinical presentations. Covering defects on the upper and lower eyelids with different tissue transplantation method can disperse the entire nevus, resulting in more stable long-term repair effects and a more natural appearance. The combination of an orbicularis muscle flap and a free skin graft provides more stable result in the plastic surgery of medium to large eyelid split nevi. Free skin grafting of the upper and lower lids near the margins, and flap grafting of the lower lids are more consistent with the physiological state of the upper and lower lids, and the combination of different tissue grafting method can make the appearance of the face more reasonable.

Indocyanine green ( ICG ) is a water-soluble biological fluorescent contrast agent with infrared absorption and emission characteristics. Indocyanine green angiography ( ICGA ) takes advantage of this biological property. After ICG is injected into the vascular system, the blood flow dynamic map is captured by high-speed photography or real-time photography, which can realize the visualization of vascular structure and tissue blood supply. Currently, ICGA is the only technique for intraoperative quantitative evaluation of flap blood perfusion, and it is widely used in plastic surgery and microsurgery. According to the relevant literature reports at home and abroad in recent years, this review introduced the working principle and method of ICGA and its research progress in evaluating the blood perfusion of pedicled skin flaps. It is considered that this technique still has some limitations in methodology and accuracy of result, and it is still necessary to combine the clinical experience of doctors in the evaluation of tissue perfusion of pedicled skin flaps.

Objective:To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma.Methods:Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2005 to January 2022 were included. The surgeries were categorized into 4 types. (1) Direct excision and suture. (2) Local skin grafts: covering the defect with split- or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids. (3) Combined skin grafts with orbicularis oculi myocutaneous flap: grafting skin flaps for defects on the upper eyelid and near the lower eyelid, and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects. (4) Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts: the surgery was divided into two stages, the first stage involves the placement of an expander in the temporal area of the affected side, and the second stage involves the removal of the expander, excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle, which was rotated 180° to cover the lower eyelid defect. Defects near the upper and lower eyelid margins were still covered with skin grafts. Follow-up was conducted through outpatient visits, telephone calls, and WeChat messaging to assess facial appearance postoperatively. SPSS 22.0 statistical software was used for analysis, and the measurement data were expressed as Mean±SD, the count data were expressed as percentage, and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities (A&F scores) within the group was performed by paired t-test, the difference was considered statistically significant at P<0.05. Results:A total of 34 patients were included; average age was 17.7±15.3 years. The size of the lesions varied from the smallest nevus measuring 0.3 cm × 0.2 cm and the largest measuring 14.0 cm × 14.0 cm. Direct excision with suturing was performed in 6 cases, among which 2 cases received simultaneous double eyelid surgery, the postoperative A&F score (4.54 ± 1.32) was higher than the preoperative (3.28 ± 0.98) score, the difference was not statistically significant ( P>0.05). The skin graft was performed in 10 cases, the postoperative A&F score (5.13 ± 1.59) was higher than the preoperative (2.25 ± 1.59), the difference was not statistically significant ( P>0.05). The skin graft combined with using orbicularis oculi muscle skin flap was performed in 7 cases, the postoperative A&F score of our patients (5.54 ±1.46) was significantly higher than the preoperative (2.18 ±1.61 ), the difference was statistically significant ( P<0.05). The skin graft combined with the expanded temporal area flap based on the orbicularis oculi muscle was performed in 11 cases, the A&F score of our patients after repair (4.95 ±0.60) was improved compared with the preoperative (2.18±1.48) score, and the difference was not statistically significant ( P>0.05). Twenty-eight patients were followed up for 8 to 81 months while 6 cases lost due to change of contact information, among whom three developed secondary ectropion of the lower eyelid, three experienced recurrence of nevi in the incision and grafting area, two exhibited significant pigmentation in the grafting area, and one developed secondary ptosis of the upper eyelid, while the rest of the patients were satisfied with the repair results. Conclusion:Surgical excision is the only effective treatment for eyelid cleft nevi with different clinical presentations. Covering defects on the upper and lower eyelids with different tissue transplantation method can disperse the entire nevus, resulting in more stable long-term repair effects and a more natural appearance. The combination of an orbicularis muscle flap and a free skin graft provides more stable result in the plastic surgery of medium to large eyelid split nevi. Free skin grafting of the upper and lower lids near the margins, and flap grafting of the lower lids are more consistent with the physiological state of the upper and lower lids, and the combination of different tissue grafting method can make the appearance of the face more reasonable.

Indocyanine green ( ICG ) is a water-soluble biological fluorescent contrast agent with infrared absorption and emission characteristics. Indocyanine green angiography ( ICGA ) takes advantage of this biological property. After ICG is injected into the vascular system, the blood flow dynamic map is captured by high-speed photography or real-time photography, which can realize the visualization of vascular structure and tissue blood supply. Currently, ICGA is the only technique for intraoperative quantitative evaluation of flap blood perfusion, and it is widely used in plastic surgery and microsurgery. According to the relevant literature reports at home and abroad in recent years, this review introduced the working principle and method of ICGA and its research progress in evaluating the blood perfusion of pedicled skin flaps. It is considered that this technique still has some limitations in methodology and accuracy of result, and it is still necessary to combine the clinical experience of doctors in the evaluation of tissue perfusion of pedicled skin flaps.

Objective:To investigate the clinical effect of stage treatment for long-standing facial paralysis with free functional gracilis transfer innervated by cross-face nerve grafting(CFNG).Methods:A retrospective study was carried out focusing on the case data of patients with long-standing facial paralysis who were treated by the free functional gracilis transfer innervated by CFNG in the Second Department of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2014 to December 2020. CFNG was performed in the first stage approach and free functional gracilis transfer in the second stage approach. Auther utilized the modified House-Brackmann grading scale to record the patients’ lip angle movements postoperatively and measured the static and dynamic angle formed between the horizontal line of both lip corners and the vertical midline before and after surgery objectively. Paired t-test was utilized to evaluate the bilateral middle and lower facial symmetry changes, so as to estimate the surgical effect. The significance level was set at 0.05. Results:A total of 26 patients with long-standing facial paralysis were enrolled in this study, including 10 males and 16 females, aged from 16 to 28 years, with an average age of (24.8±3.5) years. The interval of staging operation was 6 to 12 months. The postoperative follow-up was 1-3 years, with an average of (34.9±11.7) months. All grafts survived well. No major complication occurred. 2 patients underwent gracilis muscle debulking due to the paralysis side facial bulking one year after the second stage operation. 1 patient underwent muscle fixation position adjustment due to the poor position of gracilis muscle fixation one year after the second stage operation. 1 patient underwent masseter nerve-CFNG end-to-side anastomosis 2 years after the second stage operation due to insufficient movement of the mouth. The facial symmetry of all patients was improved after the two-staged operations. The movement of lip corners was classified as excellent in 15 cases, good in 9 cases, and fair in 2 cases in terms of the modified House-Brackmann grading scale. According to the objective evaluation of oral angle movement, the static lip angle after surgery was higher than that before surgery (86.4°±3.3° vs. 82.3°±2.7°) and the difference was statistically significant ( t=5.27, P=0.017); the dynamic lip angle after surgery was higher than that before surgery (86.9°±2.8° vs. 80.1°±3.3°), and the difference was statistically significant ( t=7.55, P<0.001). Conclusion:Free functional gracilis transfer innervated by CFNG is an ideal technique for long-standing facial paralysis. It can effectively improve the facial dynamic of the affected side.

Peripheral nerve injury (PNI) represents a major clinical and public health that often leads to significant functional impairment and permanent disability, resultsing in severe disability with substantial social and personal cost. Despite advanced microsurgical techniques, functional recovery after PNI repair is often unsatisfactory. Therefore, there is an unmet need for adjunctive strategies to promote the functional recovery with a better understanding of the pathophysiology and molecular basis of axon regeneration neurophysiology. Compared with the central nervous system, peripheral nervous system injury can be accompanied with a more active regeneration response, including the intrinsic growth ability and the formation of a suitable regeneration microenvironment. Morphologically, axon regeneration goes through a series of complex physiological processes, such as the establishment of axon regeneration channel, Schwann cells(SCs) dedifferentiate to a progenitor-like state and efficiently guide axons to their original target tissues and the myelination of axon regeneration. Regenerative microenvironment involves complex biomolecule changes at the biomolecule level, such as nerve regeneration signal transduction, microtubule dynamics, expression of genes related to regeneration in neurons and SCs, inflammatory response, neurotrophic factors, changes of extracellular matrix and so on. SCs and distal nerves play a leading role in the process of peripheral nerve chemotaxis regeneration. Local immune response and scar formation after nerve injury are the most important inhibitory factors in the process of axonal regeneration. Following a nerve injury, peripheral neurons have the ability to regrow their axons that remyelinate and reestablish functional connections with targets and recovery of nerve impulse conduct. The ion channel is the basis and premise of nerve electrophysiology. When the axon is locally damaged with sodium channel dissipating, the sodium channel redistributes and forms a new Ranvier node following axon regeneration to keep excitability of regenerated fibers. So that nerve impulses can continue to conduct along the axon, laying the foundation for the recovery of neuroelectrophysiological function. Current experimental researches in peripheral nerve regeneration aim to accelerate the process of regeneration and improve the definition of regenerated axon functions using bioengineering of sophisticated nerve conduits, SCs transplantation and stem cell engineering. Growth factors have been studied to improve and accelerate nerve repair and regeneration by reducing neuronal death and promoting axonal outgrowth. This article reviews the progress in molecular cytology of axonal regeneration and nerve impulse recovery after peripheral nerve injury in order to explore the essence and law of peripheral nerve regeneration.

Objective:To explore the clinical value and effect of the application of a three-dimensional retrograde design method to improve glanuloplasty.Methods:Patients treated with novel glanuloplasty from April 2019 to March 2022 in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Before the operation, a normal penis model was constructed in vitro by a three-dimensional retrograde design method. Copy and rub the shape of the neopenis, which was divided into four parts: head, neck, body, and tail. During the operation, the "arrow" anterolateral thigh (ALT) flap was harvested to construct the neoglans and urethra, the bilateral gracilis muscles and fascia lata were assembled to construct the penile shaft, and free skin graft acted as the foreskin to cover the wound. The appearance and touch of the neoglans, the change in the length and circumference of the neopenis, and the patient’s satisfaction were evaluated.Results:Five patients were enrolled, with an average of 23.4 (20-32) years. Among them, 3 cases were diagnosed as perineal hypospadias, 1 case was congenital micropenis, and 1 case was traumatic penile absence. All the neoglans survived well after the operation, and the meatus of the urethra was located at the top of the neopenis. The donor sites could be sutured primarily without skin grafting. All patients underwent secondary urethral anastomosis 6-9 months after the first stage. Follow-up for 6-12 months after the operation showed that the neoglans had no deformation and the tactile sensation had recovered well. All patients were satisfied with the color, size, and appearance of the neoglans. The neopenis could contract spontaneously about 6 months after the operation, get erection and maintain a certain hardness. The length and circumference of the neopenis decreased to a certain extent within 3 months after the operation, but it was stable at 6 months. The change rate of length was -10.34% to -25.00%, and the change rate of circumference was -5.88% to -13.89%. All patients could urinate in the standing position, and the urine line was normal after the second stage of urethral anastomosis.Conclusion:Based on the concept of retrograde flap design, the "arrow-shaped" ALT flap can construct vivid neoglans and obtain a good prognosis in clinical practice. This technique is easy to operate and can be used for preoperative three-dimensional simulation of body surface organs.

Objective:To evaluate the clinical application of the new "cigarette core" product for oral mucosa roll in hypospadias patients.Methods:From December 2018 to January 2022, patients who visited the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were selected and underwent staged surgical repair. In the first stage, we used the oral mucosa to form the urethra. The length of the oral mucosa was 5.0-6.0 cm and the width was 1.0-1.2 cm. In the control group, we use the handmade gauze roll; in the experimental group, we use the new "cigarette core" product. In the second-stage operation, the urethra was anastomosed. The operation time was recorded, and the mucosal survival, complications, urination and patients’ satisfaction with the operative effect were followed up. The measurement data of normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 107 male patients were included, including 53 in the control group and 54 in the experimental group, aged from 1 to 28 years, with an average age of 8.5 years. The first-stage operation time of control group was significantly longer than that of experimental group [(61.5±11.5) min vs. (43.8±15.2) min], and the difference was statistically significant ( P<0.01). The patients were followed up for 3 to 20 months. In the first-stage operation, the survival rate of oral mucosa was 98.11%(52/53) in the control group and 100%(54/54) in the experimental group. There were 4 cases of urinary fistula in the control group after the second-stage operation, and the complication rate was 7.55%. There was 1 case of urinary fistula in the experimental group, and the complication rate was 1.85%. All patients had good urination after operation. In the satisfaction survey one year after surgery, the satisfaction rate of the control group was 94.34% (50/53) and that of the experimental group was 100% (54/54). Conclusion:The patented "cigarette core" product is good in consistency. In hypospadias repair, it has a high survival rate of mucosal transplantation and a low incidence of postoperative complications. It can effectively reduce operation time and anesthesia time.

Indocyanine green (ICG) is a water-soluble biological fluorescent contrast agent with infrared absorption and emission characteristics. Indocyanine green angiography (ICGA) takes advantage of this biological property. After ICG is injected into the vascular system, the blood flow dynamic map is captured by high-speed photography or real-time photography, which can realize the visualization of vascular structure and tissue blood supply. Currently, ICGA is the only technique for intraoperative quantitative evaluation of flap blood perfusion, and it is widely used in plastic surgery and microsurgery. This review introduces the working principle and method of ICGA and its application in evaluating pedicled flap perfusion. According to the relevant literature reports at home and abroad in recent years, this review introduces the working principle and method of ICGA and its research progress in evaluating the blood perfusion of pedicled skin flaps. It is considered that this technique still has some limitations in method ology and accuracy of result, and it is still necessary to combine the clinical experience of doctors in the evaluation of tissue perfusion of pedicled skin flaps.

Objective:To investigate the clinical effect of stage treatment for long-standing facial paralysis with free functional gracilis transfer innervated by cross-face nerve grafting(CFNG).Methods:A retrospective study was carried out focusing on the case data of patients with long-standing facial paralysis who were treated by the free functional gracilis transfer innervated by CFNG in the Second Department of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2014 to December 2020. CFNG was performed in the first stage approach and free functional gracilis transfer in the second stage approach. Auther utilized the modified House-Brackmann grading scale to record the patients’ lip angle movements postoperatively and measured the static and dynamic angle formed between the horizontal line of both lip corners and the vertical midline before and after surgery objectively. Paired t-test was utilized to evaluate the bilateral middle and lower facial symmetry changes, so as to estimate the surgical effect. The significance level was set at 0.05. Results:A total of 26 patients with long-standing facial paralysis were enrolled in this study, including 10 males and 16 females, aged from 16 to 28 years, with an average age of (24.8±3.5) years. The interval of staging operation was 6 to 12 months. The postoperative follow-up was 1-3 years, with an average of (34.9±11.7) months. All grafts survived well. No major complication occurred. 2 patients underwent gracilis muscle debulking due to the paralysis side facial bulking one year after the second stage operation. 1 patient underwent muscle fixation position adjustment due to the poor position of gracilis muscle fixation one year after the second stage operation. 1 patient underwent masseter nerve-CFNG end-to-side anastomosis 2 years after the second stage operation due to insufficient movement of the mouth. The facial symmetry of all patients was improved after the two-staged operations. The movement of lip corners was classified as excellent in 15 cases, good in 9 cases, and fair in 2 cases in terms of the modified House-Brackmann grading scale. According to the objective evaluation of oral angle movement, the static lip angle after surgery was higher than that before surgery (86.4°±3.3° vs. 82.3°±2.7°) and the difference was statistically significant ( t=5.27, P=0.017); the dynamic lip angle after surgery was higher than that before surgery (86.9°±2.8° vs. 80.1°±3.3°), and the difference was statistically significant ( t=7.55, P<0.001). Conclusion:Free functional gracilis transfer innervated by CFNG is an ideal technique for long-standing facial paralysis. It can effectively improve the facial dynamic of the affected side.