OBJECTIVE: To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. METHODS: According to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them ( n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m ² (mean, 23.09 kg/m ²). There was no significant difference in the age and body mass index between groups ( P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. RESULTS: In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant ( P<0.05). There was no significant difference between the groups in the VSS scores and scar widths ( P>0.05). CONCLUSION Moderate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.
Humans ; Male ; Female ; Prospective Studies ; Cicatrix/prevention & control* ; Thigh/surgery* ; Wound Healing ; Surgical Flaps ; Plastic Surgery Procedures/methods* ; Suture Techniques ; Middle Aged ; Transplant Donor Site ; Sutures ; Adult

donor site after skin graft should not be overlooked. Patients continue to complain of dryness, itching sensation. Such discomfort can cause irritation to the patients and lead to delayed healing or secondary infection. Thus, the author predicted Eucalyptus Oil, which acts on Transient Receptor Potential Melastatin 8 would be effective in regulating scar by reducing itching sensation in donor site when combining conventional silicone materials.METHODS: The study was performed on 30 patients who underwent split thickness skin graft with lateral thigh as donor site between January 2017 and August 2018. First, primary evaluation of fully epithelized donor site scar three weeks after surgery was conducted. Control group (n=15) applied silicone gel (Kelo-cote, USA) solely two times a day. study group (n=15) applied Eucalyptus oil, combined with silicone gel. After 3 months of follow up, donor scar was evaluated using Vancouver scar scale and VAS scores of subjective patient reports regarding pain and itching sensation.RESULTS: It was confirmed that both groups showed stable scar improvement comparing scar quality for 3 months. After 3 months, scar quality in study group showed superiority in pigmentation, pliability and pruritus compared to control group.CONCLUSION: Application of Eucalyptus Oil combined with conventional silicone gel is favorable to scar management and may give additional benefit of alleviating pruritis symptoms.]]>
Cicatrix ; Coinfection ; Eucalyptus ; Follow-Up Studies ; Humans ; Pigmentation ; Pliability ; Pruritus ; Sensation ; Silicon ; Silicones ; Skin Transplantation ; Skin ; Thigh ; Tissue Donors ; Transplant Donor Site ; Transplants ; Wound Healing

BACKGROUND: Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery. METHODS: Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20–47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1–4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured. RESULTS: Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C). CONCLUSIONS: Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.
Eyebrows ; Eyelashes ; Female ; Hair Follicle ; Hair* ; Humans ; Male ; Tissue Donors* ; Transplant Donor Site ; Transplantation

OBJECTIVETo investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.

METHODSFrom 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.

RESULTSThe patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.

CONCLUSIONSThe scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.

Breast ; surgery ; Cicatrix ; pathology ; Costal Cartilage ; Dissection ; methods ; Female ; Follow-Up Studies ; Humans ; Nipples ; surgery ; Rhinoplasty ; methods ; Time Factors ; Tissue and Organ Harvesting ; methods ; Transplant Donor Site

OBJECTIVETo investigate the application and therapeutic effect of advanced orbicularis oculi muscle (OOM ) flap for eyelid defect.

METHODSUni-pedicle or bi-pedicle advanced OOM flaps were designed according to the location, depth and size of the eyelid defects. The resulted wounds in the donor sites were closed directly. The flap size ranged from 1.5 cm x 0.5 cm - 6.0 cm x 3.5 cm.

RESULTS120 cases were treated. All the flaps survived except for 3 flaps with epidermis necrosis at the end of flaps, which healed after dressing. The patients were followed up for 3 -36 months with inconspicious scar in donor sites. The flap color, texture had a good match with surrounding skin.

CONCLUSIONSThe OOM flap is ideal for eyelid defect with reliable blood supply, satisfied color and texture. The wound at donor site can be closed directly with less morbidity.

Blepharoplasty ; methods ; Cicatrix ; Eyelids ; surgery ; Facial Muscles ; transplantation ; Humans ; Surgical Flaps ; transplantation ; Transplant Donor Site ; surgery

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.
Counseling ; Fingers ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Humans ; Informed Consent ; Necrosis ; Pain, Postoperative ; Retrospective Studies ; Skin ; Tissue Donors ; Toes* ; Transplant Donor Site ; Wounds and Injuries

BACKGROUND: Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. METHODS: Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. RESULTS: The fat survival rate of the experimental group (75.4%+/-3.9%) was higher than that of the control group (53.1%+/-4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. CONCLUSIONS: Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.
Adipose Tissue ; Autografts ; Ear ; Glycerol ; Graft Survival ; Humans ; Male ; Microvessels ; Negative-Pressure Wound Therapy ; New Zealand ; Perfusion ; Rabbits ; Skin ; Survival Rate ; Transplant Donor Site ; Transplants*

OBJECTIVETo investigate the application of relay flaps pedicled by perforator from digital artery for reconstruction of soft tissue defects at finger tip.

METHODSFrom Mar. 2012 to Jun. 2014, 9 cases with soft tissue defects at finger tip were reconstructed with relay flaps at one side of finger pedicled by perforator from digital artery. The flap size ranged from 1.3 cm x 1.6 cm to 1.6 cm x 2.2 cm. The defects at donor sites were covered by adjacent web perforator V-Y advanced flaps.

RESULTSAll the 18 flaps in 9 cases survived completely with primary healing both in recipient and donor sites. The patients were followed up for 5 months to 2 years ( average, 12 months) with good elasticity and cosmetic results. No pain happened in the treated finger. The 2-point discrimination distance was 7-8 mm in fingertip flaps, and 10-12 mm in web perforator flaps. Hand function was graded as excellent in 7 cases, good in 2 cases, based on ATM assessment. The affected fingers had normal temperature and cold-resistance during winter. The width and depth of web in the donor site were not affected.

CONCLUSIONSThe relay flaps pedicled by perforator from digital artery can be applied for reconstruction of soft tissue defects at finger tip. The procedure is easy with satisfactory results and reservation of main artery. No skin graft is necessary for closure of defects on donor sites.

Arteries ; Elasticity ; Finger Injuries ; surgery ; Fingers ; blood supply ; Follow-Up Studies ; Humans ; Perforator Flap ; transplantation ; Time Factors ; Transplant Donor Site ; Wound Healing

OBJECTIVETo investigate the reconstruction of 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap pedicled at oral commissure.

METHORDSAt the first stage, the lower lip mucosal flap pedicled by inferior labial artery was transposed to reconstruct the defect on upper lip vermilion and tubercle. The defect at the donor site was closed directly. At the second stage, the flap pedicle was cut off and revised.

RESULTS6 patients were treated with satisfactory aesthetic results. All the flaps survived completely. The oral commissure kept normal with no obvious scar at the donor sites.

CONCLUSIONSThe modified crosslip vermilion flap pedicled at oral commissure has the advantages of avoiding inconvenience in feeding, speaking and cleaning. The procedure is simple with available blood supply. Both aesthetic and functional results are satisfactory.

Arteries ; Esthetics ; Humans ; Lip ; surgery ; Mouth Mucosa ; transplantation ; Surgical Flaps ; blood supply ; Transplant Donor Site ; surgery

OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery