Objective:To investigate the clinical effects of expanded frontal flap and flip scar flap in repairing partial nasal defect.Methods:A retrospective observational study was conducted. From January 2012 to January 2022, 26 patients with partial nasal defects who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 19 males and 7 females, aged 5 to 61 years. The surgery was performed in 4 stages. In the first stage, a rectangular skin and soft tissue expander (hereinafter referred to as expander) with suitable rated capacity was planted in frontal region and expanded by injecting water regularly. In the second stage, flip scar flap was grafted to reconstruct nasal inner lining, whose area was about 10% larger than the area of defect. The expanded frontal flap with pedicle was transferred to repair the nasal defect, whose pedicle was supraorbital vessel or supratrochlear vessel on the contralateral side of the defect, and the area of expanded flap was 20% larger than the nasal defect area after resection and flipping of scar flap. The donor site of expanded flap was sutured directly. After 3 weeks of flap transferring, the flap was delayed in the third stage. After 1 week of delaying operation, the pedicle of flap was cut off in the fourth stage. The number, rated capacity, injection volume, and expansion time of embedded expanders were recorded. The occurrences of complications including infection, hematoma, ulceration of expanded flap after the first stage operation, and blood supply disorder or necrosis of flap after operation in the second and fourth stages were observed. All the patients were followed up for 1 year at least, and the color of flap, scar of frontal donor site, symmetry of bilateral eyebrows, and the nasal appearance and ventilated function of external nasal tract were observed.Results:A total of 26 expanders were embedded in 26 patients. The rated capacity of expanders ranged from 100 to 300 mL. The injection volume was 1.0 to 1.5 times of the rated capacity of expanders. The expansion time ranged from 2.5 to 4.0 months, with an average time of 3 months. There were no complications occurred after each operation. The follow-up showed that the color of flap was similar to the normal nasal skin, the scar of frontal region was not obvious, the bilateral eyebrows were basically symmetrical, the nose had excellent appearance, ventilation function of external nasal tract was not affected, while some of the patients had downward rotation or unapparent tip-defining point of nose.Conclusions:Using the flip scar flap to reconstruct the nasal inner lining and pre-expanded frontal flap to reconstruct the nasal skin, without free cartilage transplantation to repair the partial nasal defects can achieve satisfied nasal appearance post operation, without abnormal external nasal ventilation function.

Objective:To evaluate the efficacy of combined fascia sheath suspension (CFS) and frontalis muscle flap suspension in the treatment of severe congenital blepharoptosis.Methods:We searched PubMed, EMbase, Cochrane Library, web of science and Chinese Hownet, Wanfang, VIP, CBM and other databases to collect randomized and non-randomized controlled trials comparing the efficacy of CFS and frontalis muscle flap suspension in the treatment of severe congenital ptosis, from the establishment of literature retrieval database to March 2020; two researchers used RevMan 5.3 software to select and exclude the literature, extract the data and evaluate the quality, set up appropriate effect index and conduct Meta-analysis.Results:Eleven studies included 661 patients, There were 312 cases in study group and 349 cases in control group. The results of Meta analysis showed that the OR of the two groups was 4.88 with 95% CI (2.69, 8.85); the OR of failure rate was 0.20, with 95% CI (0.11, 0.37); the OR of complications was 0.22, with 95% CI (0.14, 0.34). All three groups of data were statistically significant ( P<0.05). Conclusions:The available evidence shows that the combined fascia sheath suspension (CFS) is effective in the treatment of severe congenital blepharoptosis compared with frontalis muscle flap suspension, but the complications of CFS are lower and the satisfaction is higher; these findings have yet to be validated by more high-quality studies due to limitations in the quality and quantity of studies included.

Objective:To explore the choice of skin flap design and clinical effects of skin soft tissue expansion in the treatment of body surface lesions.Methods:From January 2018 to December 2020, the Department of Plastic Surgery, the First Affiliated Hospital of the Air Force Medical University performed skin and soft tissue expansion in 148 patients with scars and nevus, including 83 males and 65 females. The age ranged from 4 to 52 years. According to the distance of the donor area, the expanded flap was divided into adjacent local flap and distal pedicled axial flap. An appropriate volume expander was embedded under the donor area flap. The expander was expanded regularly for 8-24 weeks, and the displacement of expander and other complications were avoided.Results:A total of 212 dilators were implanted in 148 patients, and the damaged area was completely repaired after 1 or 2 dilation operations. The expanded flaps were effectively used. The flap transfer was consistent with the first-stage design, with fewer auxiliary incisions, hidden and inconspicuous scars, and maximum repaired area was 22 cm×18 cm; the incidence of dilator complications (16 cases with 21 dilators) was 9.90%.Conclusions:Paying attention to the reasonable design and selection of flap in stage Ⅰ operation can make effective use of expanded flap in stage Ⅱ operation, fully repair body surface lesions, reduce auxiliary incision and achieve the best repair effect.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:To establish a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders (hereinafter termed as expanders) and to validate the predictive value of the model.Methods:A retrospective observational study was conducted. Totally 2 934 patients who underwent skin and soft tissue dilatation surgery in the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University from January 2009 to December 2018 and met the selection criteria were included. There were 1 867 males and 1 067 females, with a median age of 18 years. Totally 3 053 skin and soft tissue expansion procedures were performed with 4 266 expanders implanted. The following indexes were selected as predictor variables, including patients' age, gender, marital status, ethnicity, hospital admission, surgical indication, disease duration, with/without history of smoking, history of drinking, history of blood transfusion, history of underlying diseases, and inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, water injection rate of expander in the first time, placement site of expander, anesthesia method, duration of operation, and with/without postoperative hematoma evacuation, and infection at the placement site of expander as the outcome variable. Univariate analysis of the data was performed using least absolute shrinkage and selection operator (LASSO) regression to screen the potential risk factors affecting infection at the placement sites of expanders, the factors selected by the univariate analysis were subjected to binary multivariate logistic regression analysis to screen the independent risk factors affecting infection at the placement sites of expanders, and a nomogram prediction model for the occurrence of infection at the placement sites of expanders was established. The C index and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and accuracy of the model, respectively, and the bootstrap resampling was used for internal verification.Results:The results of LASSO regression showed that age, gender, hospital admission, surgical indication, disease duration, history of drinking, history of heart disease, history of viral hepatitis, history of hypertension, inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, placement site of expander, postoperative hematoma evacuation were the potential risk factors for infection at the placement sites of expanders (regression coefficient=-0.005, 0.170, 0.999, 0.054, 0.510, -0.003, 0.395, -0.218, 0.029, 0.848, -0.116, 0.175, 0.085, 0.202). Binary multivariate logistic regression analysis showed that male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volumes of expanders ≥200 mL and <400 mL or ≥400 mL, and expanders placed in the trunk or the limbs were the independent risks factors for infection at the placement sites of expanders (odds ratio=1.37, 3.21, 2.00, 2.47, 1.70, 1.73, 1.67, 2.16, 95% confidence interval=1.04-1.82, 1.09-8.34, 1.38-2.86, 1.29-4.41, 1.07-2.73, 1.02-2.94, 1.09-2.58, 1.07-4.10, P<0.05 or P<0.01). The C index for evaluating the discriminative degree of the model was 0.63, the Hosmer-Lemeshow goodness of fit test for evaluating the accuracy of the model showed P=0.685, and the C index for internal validation by the bootstrap resampling was 0.60. Conclusions:Male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volume of expander ≥200 mL, and expanders placed in the trunk or the limbs are the independent risk factors for infection at the placement sites of expanders. The clinical prediction model for infection risk at the placement sites of expanders was successfully established based on these factors and showed a certain predictive effect.

Objective:To explore the clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect.Methods:From July 2004 to August 2018, 355 patients with faciocervical lesion and defect were admitted to the First Affiliated Hospital of Air Force Medical University, including 200 males and 155 females aged 4 to 48 years with major conditions including thermal burn scars, and type Ⅲ and Ⅳ facial-cervical deformities. During the stage Ⅰ skin soft tissue expander implantation surgery, according to the size and location of lesion and defect, expanders with appropriate volume were placed to expand the deltopectoral area. During the stage Ⅱ flap pedicled transposition surgery, after the expander was expanded to the desired volume, the impairment tissue was removed, the flap was designed according to the size of the defect (the unilateral defect area was 7 cm×5 cm to 17 cm×16 cm) and pedicled transposition was carried out. The incision in the chest donor area was directly sutured and closed. After the flap survived, stage Ⅲ flap delay and pedicle division surgery was carried out. The area of one single flap was 8 cm×5 cm to 20 cm×18 cm. The numbers of flaps and expanders, rated volume and expansion of expander, the intervals between surgeries in each stage, flap survival, postoperative complications in surgeries in each stage, and follow-up were recorded and analyzed.Results:A total of 460 pre-expanded deltopectoral flaps were used, including 250 unilateral flaps and 105 bilateral flaps. Totally 460 expanders were used in this group of patients. The rated volume was mostly 500 mL (163 expanders) and 600 mL (142 expanders). The expansion multiple of the expander was (1.14±0.19) times of the rated volume. The flap expansion time of the patients was (96±30) d, the pedicle time was (32±8) d, and the delay time was (7.5±1.6) d. The postoperative complications of patients mainly included infection (29 patients), expander exposure (18 patients), and hematoma (10 patients). During the follow-up of 6 to 120 months, the elasticity, texture, and color of the flaps of patients were similar to the surrounding tissue of the recipient area, and the face and neck were symmetrical, not bloated.Conclusions:The deltopectoral flap obtained by overexpansion has a larger area and a thinner thickness, and the elasticity, texture, and color are similar to the surrounding tissue of the recipient area. After transfer, a stable appearance of the face and neck can be obtained. The main complications are infection and expander exposure, most of which occurred after stage Ⅰ skin soft tissue expander implantation surgery.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.

Objective:To explore the scheme and strategy of four kinds of pre-expanded skin flaps used for reconstruction of the face and neck subunit lesions.Methods:From January 2014 to June 2019, 493 cases of facial and neck lesions were repaired with four types of pre-expanded flaps in Plastic Surgery Department of Xijing Hospital. There were 207 males and 286 females aged from 5 to 42 years, 406 face and neck scars and 87 pigment lesions. The lesion area ranged from 1 cm×1 cm to 22 cm×18 cm. The face and neck were divided into 8 regions: middle facial region, cheek region, neck region, chin region, frontal region, temporal region, periorbital region and perioral region. According to the regional characteristics of the facial and neck subunits, the expandable skin flaps were selected: type Ⅰ expanded forehead midline flap to repair the lesions in middle facial region; and type II expanded thoracic deltoid flap was used to repair the lesions in the cheek, perioral region and chin neck region below the level of eye; type III expanded neck transverse flap was used to repair the lesions in the neck region and chin region; type IV expanded head flap was used to repair the lesions in the frontal region and temporal region, the excess hair of the transferred skin flap were removed by laser.For large cross-subunit lesions, multiple expanded flaps were used in combination to observe the effect of different types of pre-expanded flaps.Results:There were 493 patients with 572 implanted expanders, 486 patients with effective dilatation successfully completed the repair and reconstruction of the facial subunits. The other 7 patients failed due to dilatation due to dilator infection and exposure. There were 43 forehead expanded flaps type I, 238 thoracic deltoid expanded flaps type II, 61 neck transverse expanded flaps type III, 107 head expanded flaps type IV, 6 I + II combined flaps and 31 II + IV combined flaps. The area of expanded flaps ranged from 1 cm×1 cm to 27 cm×18 cm. Among the single flaps, the thoracic deltoid expanded flap had the largest repair area, about 22 cm×12 cm; the combined flap used the thoracic deltoid and head expanded flap to repair the facial and neck lesions with a maximum of about 27 cm×18 cm. After operation, 8 cases had blood supply disorder at the distal end of the flap, which were healed gradually after pressure dressing and dressing change, without obvious scar hyperplasia. The appearance and function of all expanded flaps were significantly improved. After 6 months to 4 years of follow-up, the color, thickness and texture of the flap were similar to the original site, and the scar was not obvious. However, due to the movement and traction of the flap edge, 42 patients had scar contracture when their head was tilted backward, which disappeared when they were under horizontal vision.Conclusions:For the lesions of the facial and neck subunits, the flexible application and combination of 4 kinds of pre-expanded skin flaps on the face and around can be used, which can provide a large area of thin-layer skin flap. It is not only good in blood supply, but also similar in texture and color to the recipient area. It is a good method to repair the lesions of face and neck.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.