The robot surgery system has developed rapidly in recent years. The application of robot surgery systems in plastic and reconstructive surgery is also increasingly wide, but it is still in the initial stage compared to other specialties. This article focuses on the development status of the robot surgery system in the field of plastic and reconstructive surgery, and makes an outlook on the future development of the technology, to promote the application of the robot surgery system in the plastic and reconstructive surgery.
Objective:To explore the clinical application effect of double-eyelid blepharoplasty by continuously buried suture method via double w-shape skin and conjunctiva.Methods:The data of patients operated by double-eyelid blepharoplasty by continuously buried suture method via double w-shape skin and conjunctiva in the Department of Medical Aesthetic Surgery of People’s Hospital of Rizhao, Plastic Surgery of Yimeitiancheng’ s Cosmetic and Plastic Hospital of Rizhao from January 2021 to June 2022 were retrospectively analyzed. Before the operation, the double eyelid line was designed and 5 points were evenly marked, namely points A, B, C, D, and E from the outside to the inside. During the operation, 10 ml needle was used to puncture the 5 points marked on the double eyelid line. Starting from the outermost point A, the needle was inserted obliquely inward on the skin surface, and then the upper eyelid was turned over, and the stitches was stabed-out from the conjunctival surface of the upper margin of tarsus. The stitches was inserted at the original point pierced on the conjunctival surface, and the stitches was stabed- out diagonally inward through the skin surface at the point B. The same method was used to penetrate points C, D and E successively. Then E, D, C, B and A points were penetrated in turn from the inside to the outside. The two suture ends were passed through the 3/ 8 arc round stitches, which was inserted from the point A and stabed-out skin surface of the outer orbital margin above the double eyelid line through the deep. The tightness was adjusted and tied the knotted. After the surgery, the surgical result and complications were observed, and patients’ satisfaction was evaluated before and 6 months after the surgery, which included four factors: eyelid curvature, width, smoothness, and symmetry, with a maximum score of 100. Higher scores indicated greater patients’ satisfaction. Measurement data were expressed as Mean±SD, and paired sample t-test was used to compare the satisfaction of the same patient before and after surgery. P<0. 05 indicated statistically significant difference. Results:A total of 82 patients with 160 eyes were included, including 75 females and 7 males. The age ranged from 18 to 32 years old, with a mean of 25. 4 years old. 78 cases were treated with both eyes and 4 with one eye. In the early postoperative period, 8 patients had local cyanosis and slight swelling of eyelid, which was improved after routine cold compress treatment. Two cases reported a foreign body sensation in the eyeball, which improved with application of levofloxacin for 1 week. The remaining patients had good eyelid morphology with no significant swelling or foreign body sensation. A total of 60 patients were followed up for 6 months, and their eyelid morphology appeared natural and aesthetically pleasing. The eyelid crease was smooth when opened, and there were no obvious surgical scars when closed. Only one patient had a shallow eyelid crease, which was satisfactorily repaired with additional suturing. None of the patients experienced external suture exposure or subcutaneous nodules. The patient satisfaction score was (58. 15±5. 07) before operation and (98. 68±1. 69) 6 months after operation, the difference was statistically significant ( t=-70. 332, P< 0.001) . Conclusions:Double-eyelid blepharoplasty by continuously buried suture method via double w- shape skin and conjunctiva has the advantages of minimally invasive, simple, direct vision operation, which has natural appearance of double eyelid, and high patient satisfaction.
Long non-coding RNA (lncRNA) is a kind of non-coding RNA with a length of more than 200 nucleotides mainly distributed in a variety of eukaryotic cells. It cannot encode proteins itself. With the development of gene sequencing technology, the clinical understanding of venous malformation, molecular pathogenesis of vascular malformation, is getting deeper and deeper. Abnormal expression of lncRNA may be closely related to the occurrence and development of venous malformations. LncRNA can selectively regulate the proliferation, apoptosis and migration of endothelial cells and vascular smooth muscle cells, thus affecting the occurrence and development of venous malformations. Therefore, lncRNA is expected to be a novel diagnostic marker or a new therapeutic target for venous malformations.
Objective:To understand the relevant situation of people seeking tattoo removal in laser cosmetic clinics.Methods:A face-to-face questionnaire survey was conducted among respondents seeking tattoo removal who visited the Laser Cosmetic Clinic of the Provincial Hospital affiliated to Shandong First Medical University from June 2021 to May 2022. The survey content mainly included: basic information of the tattoo respondents, tattoo-related situations, respondents’ cognition of tattoos, and 30 questions on tattoo removal needs. The questionnaire responses were statistically analyzed, and differences were analyzed according to the gender, age of the tattoo respondents, and educational level at the time of tattooing. Descriptive statistical analysis was conducted on the general information of the questionnaire; Mantel-Haenszel chi-square test or Pearson’ s chi-squared test were used for the analysis of the difference in the composition ratio of each data.Results:A total of 150 questionnaires were distributed and 142 valid questionnaires were collected. There were 81 male and 61 female tattoo respondents, and (21.8±4.9) years (13- 41 years) . The result of the survey showed that 52.8% (75/142) of the respondents were minors (<18 years old) at the time of tattooing, and 97.2% (138/142) were <24 years old at the time of tattooing; 67.6% (96/142) regretted the act of tattooing; 73.2% (104/142) of the respondents themselves asked for the removal of tattoos; who removed their tattoos for personal development (joining the army, working, studying) was 68.3% (97/142) ; only 23.2% (33/142) of the respondents understood the harms of tattoos; and 21.8% (31/142) of the respondents suffered from adverse reactions after getting tattoos. The percentage of respondents who hid their tattoos from their family members was 82.4% (117/142) ; the percentage of respondents whose family members approved of the tattoos was only 25.4% (36/142) . Analysis of variance showed that there was no correlation between the education level of the respondents and their knowledge of the dangers of tattooing ( P>0.05) ; the reasons for removing tattoos were correlated with the age and gender of the respondents at the time of consultation ( P<0.01) ; the size of tattoos was correlated with the gender of the respondents ( P<0.01) and the female respondents were more inclined to choose a small tattoo; the age of tattooing of the respondents was correlated with the level of education of the respondents when they had tattooed themselves ( P<0.01) , the proportion of tattoos aged <18 years old was highest among respondents with junior high school education at the time of tattooing [76.2% (32/42) ] , and this proportion tended to decrease significantly as the education level at the time of tattooing increased. Conclusions:The respondents seeking tattoo removal in the laser cosmetic clinic are mainly teenagers. About half of the respondents were minors at the time of tattooing, and most of them were not aware of the dangers of tattoos. There is a certain correlation between the age of the respondents and their educational background at the time of tattooing. There are certain differences in the reasons for removing tattoos among respondents depending on gender and age. There is no correlation between the educational background of the respondents and their understanding of the dangers of tattoos.
In the past decades, great progress has been made in cartilage regeneration. The traditional techniques for constructing tissue engineering cartilage scaffold mainly include pore agent method (or template method ) , phase separation method, gas foaming method, freeze-drying method , electrospinning method, etc. Cartilage is heterogeneous, and it is difficult for traditional scaffolds to simulate the high anisotropy of cartilage. Therefore, functional regeneration of cartilage is challenging. With the progress of three-dimensional (3D) printing technology, it is possible to prepare functional bionic scaffolds with fine structure and gradient changes through co deposition of biomaterials, cells and active biomolecules, so as to achieve functional cartilage regeneration. This article reviews 3D printing technology of cartilage tissue engineering, and the application of 3D printing technology in cartilage regeneration at different anatomical positions (articular cartilage, auricle cartilage, nasal cartilage) . In addition, the importance of preparing bionic constructs with regional structure gradient and regional composition gradient was discussed. 3D bioprinting technology, 4 D printing techniques, smart biomaterials brought hope for the construction of bionic tissues and organs.
Objective:To investigate the surgical method of preoperative computed tomography angiography (CTA) combined with color Doppler ultrasonography (CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage in deceased patients. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow up was conducted using outpatient and telephone method . The degree of wrist pain was evaluated using Visual Analog Scale (VAS) , wrist function was evaluated using the improved Mayo scoring method , degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data is represented as Mean±SD, and paired sample t-tests are used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were included, including 9 males and 3 females; age range from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [ (1.7±0.5 ) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [ (11.9±2.1) cm vs. (12.1±1.9) cm]. Statistical significance ( P>0.05) . All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1) , Mayo scores (46.1±3.8 vs. 86.2±6.1) , scapholunar angle [ (65.3±4.1) ° vs. (47.9±3.5) °] , scaphoid angle were compared before and after surgery[ (37.1±3.9) ° vs. (22.8±2.3) °] , wrist flexion and extension range of motion [ (79.0± 11.7) ° vs. (118.5±15.8) °] , grip strength [ (6.7±4.6) kg vs. (26.1±5.3) kg] , the differences were statistically significant (all P <0.05 ) . Conclusions:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.
Craniosynostosis is a common congenital craniofacial deformity in which bony fusion time of cranial sutures is earlier than normal age. It is of great social significance for the study and prevention of the genetic mechanism of craniosynostosis. The identification of human mutant genes such as FGFR1, FGFR2, FGFR3, TWIST1, MSX2, RAB, ERF related to craniosynostosis has stimulated the generation of a large number of recombinant animal models with similar functional acquisition or loss mutations to simulate various manifestations of craniosynostosis. The similarity of craniofacial development and molecular pathways between mice and humans makes them a good animal model for studying craniosynostosis. This article reviews the research progress of mouse models related to syndromic, non- syndromic craniosynostosis and craniosynostosis with non-human gene mutations, in order to provide a more comprehensive and systematic understanding of the genetic pathogenesis and treatment of this disease.
Vascular malformationss (VMs) are resulted from localized vascular developmental defects. Most sporadic cases are associated with genetically heterozygous mutations, whereas some stem from autosomal dominant disorders caused by germline mutations. VMs often exhibit dinstinct gene mutations with diverse phenotypes for the same genes. Conversely, similar phenotypes may be resulted from mutations in different genes, making the differential diagnosis of VMs challenging. This article provide a comprehensive review of recent addition to the new International Society for Study of Vascular Anomalies classification, including causative genes for vasculogenic lesions. There are four primary signaling pathways involved in specific mutations, namely, PIK3CA/mTOR, RAS/MAPK, G-protein-coupled receptor signaling pathway, and transforming growth factor-β. The author also explore the factors affecting the genotype-phenotype correlations, including the time of mutation occurrence, cell types, mutation types, allele variants frequency and epigenetic abnormalities. Furthermore, it discusses the diagnostic method for VMs, encompassing clinical screening, diagnostic imaging, and genetic diagnosis, with a focus on facilitaing clinical application of targeted drug therapy.
2023年10月27至28日，"整形外科相关期刊发展论坛"在北京首钢会展中心成功举办。本次论坛由中国医学科学院整形外科医院《中华整形外科杂志》编辑部主办，邀请了中华医学会杂志社领导以及整形外科相关领域主要期刊的总编和编辑部主任参加，共同探讨新时期期刊行业的发展趋势、挑战和机遇。
Objective:To construct a system HE-01 for the treatment of microtia based on HoloLens and verify the feasibility the application of HE-01 in ear reconstruction.Methods:Six volunteers and six patients with microtia were recruited from Plastic Surgery Hospital of Chinese Academy of Medical Sciences from August to September 2021. Mimics Research and 3-matic research software were used to construct a virtual three-dimensional auricle model. Based on HoloLens and occlusal splint navigation marker device, the virtual-real interactive system HE-01 for the treatment of microtia was constructed. The registration accuracy, tracking delay and display effect of HE-01 were evaluated through repeated experiments of volunteers. The operation process was defined through repeated experiments of patients and the feasibility of applying HE-01 in auricular reconstruction was verified.Results:HE-01 was built successfully and the operation flow was clear. The experiment of volunteers showed that under different angles, the registration accuracy was high (less than 2.7% of the bilateral auricle size difference of normal people), the tracking delay was low (less than 0.1s), and the green and red display effect of virtual auricle guide was the best. Experiments of patients with microtia showed that HE-01 could be applied to auricular reconstruction, and there were no obvious complications in wearing the navigation marker device, which had repeatability and stability.Conclusion:This study has completed the conceptual design of augmented-reality assisted auricular reconstruction based on navigation device, CT data and HoloLens. HE-01 has good registration accuracy, tracking speed and display effect, laying a good foundation for further software development and clinical transformation.
暮秋至，枫叶丹。由中国医学科学院整形外科医院主办的第十二届北京国际整形美容外科会议暨第二届中国整形外科与再生医学发展大会，于2023年10月27至29日在北京首钢会展中心举行，大会以"拥抱新机遇、启航新征程，共创中国整形外科时代新篇章"为主题，大会分设第十二届宋儒耀整形外科青年医师论坛、第五届整形外科学全国研究生学术论坛、第二届中国整形外科发展联盟论坛暨第三届国家临床重点专科10+X发展论坛和16个专业分论坛。其中，颅颌面外科论坛于2023年10月27日在北京首钢会展中心修理车间2会议室举办。论坛彰显了深厚的学术底蕴、澎湃的合作动能，为我国颅颌面外科发展注入了新的活力。
Objective:To investigate the application effect of the compound flap transfer in tubularized incised plate (TIP) urethroplasty.Methods:Children with hypospadias who received TIP in the Department of Pediatric Urology, the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University from January 2018 to March 2022 were prospectively divided into compound flap transfer group (group A) and traditional TIP group (group B) by random number method. Group A was treated with TIP modified by compound flap transfer, and group B was treated with traditional TIP covered with fascia.The improvement of the compound flap transfer for TIP operation is mainly reflected in the multi-layer cover of the new urethra and the free skin embedded in the incision of the penile head. According to the intention-to-treat (ITT) principle, the final full analysis set (FAS) includes both group A and group B. Some patients were excluded from the analysis of the primary endpoint events due to reasons such as loss to follow-up or treatment group switch. Additionally, the final per-protocol set (PPS) consisting of group A and group B, which adheres to the study protocol, is subjected to statistical analysis.Independent sample t-test or Wilcoxon rank sum test was used for average age, the width of the penile head, degree of chordee, length of neourethra, and operative time. The classification of hypospadias, proportion of dorsal tunica albuginea plication, and incidence of postoperative complications were compared using the Chi-square test or Fisher’s exact test, P < 0.05 was considered statistically significant. Results:According to ITT principles, 50 children were included in FAS group A, ranging in age from 8 months to 15 years and 2 months, with an average age of 4 years. Group B included 50 children, ranging in age from 10 months to 14 years and 9 months, with an average age of 4 years and 1 month. Thirty-seven children in PPS group A were included, ranging in age from 1 year 2 months to 12 years 1 month, with an average age of 4 years. Group B consisted of 41 children, ranging in age from 1 year 2 months to 11 years 9 months, with an average age of 4 years 2 months. Statistical analysis showed that no matter FAS set or PPS, there were no statistically significant differences in the mean age, hypospadias type, average penile head width, average penile subcurvature number, number of dorsal tunica albuginea plication, and the average length of plastic neourethra between group A and group B ( P > 0.05). The average operative time of group A was higher than that of group B. The difference was statistically significant ( P < 0.05). The postoperative follow-up was 3 to 48 months, with an average follow-up of 2 years and 3 months. The complication rate of group A was lower than that of group B [10.81% (4/37) vs 29.27% (12/41)], and the difference was statistically significant ( P< 0.05). Urethral fistula occurred in 3 cases (8.11%), respectively and 6 cases (14.63%) in the two groups, the difference was not statistically significant ( P>0.05); urethral stricture occurred in 1 case (2.70%) and 5 cases (12.20%) respectively, the difference was not statistically significant ( P>0.05), There were 0 case and 1 case (2.44%) of urethral orifice descending or urethral dehiscence respectively, and the difference was not statistically significant ( P> 0.05). Conclusion:TIP with an improved compound flap transfer can reduce the overall postoperative complication rate and is worthy of promotion.
Objective:To preliminarily evaluate the outcome of fat grafting breast augmentation using filtration-adsorption technique.Methods:Patients undergoing autologous fat grafting (AFG) breast augmentation between July of 2020 and March of 2021 were retrospectively reviewed at Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Patients with complete data who followed up for at least 3 months were included. The lipoaspirates were processed with filtration-adsorption technique and AFG breast augmentation were performed (filtration-adsorption group), and then sedimentation method which was commonly used clinically was set as the control group (sedimentation group). During the follow-up, breast palpation and ultrasound inspection were performed, and the breast volumetric change between preoperative and postoperative was quantitatively compared by three-dimensional scanning technique. Demographic and surgical details were statistically analyzed. Postoperative breast volume retention rates and complication rates were calculated and compared. Normally distributed continuous variables were described in the form Mean±SD, and t-test was used for analysis. Non-normal distributed continuous variables were described in the form of M ( Q1, Q3) and analyzed by Mann-Whitney U test. The classified data were analyzed by Fisher exact probability test. Results:A total of 20 female patients (40 breasts) were included, including 10 patients (20 breasts) aged (31.4±2.5) years in sedimentation group and 10 patients (20 breasts) aged (28.5±4.4) years in the filtration-adsorption group. The fat injection volume in the filtration-adsorption group was 151.1 (125.0, 175.0) ml, and 165.0 (151.3, 196.3) ml in sedimentation group, respectively, with no statistical significance ( P>0.05). The breast volume retention rate in filtration-adsorption group was (62.93±14.06)%, which was significantly higher than that in sedimentation group (24.97±11.02)% ( P<0.01). During postoperative breast ultrasound examination, 2 breasts in sedimentation group had palpable nodules (< 6 mm), 1 breast had ultrasonically detectable but clinically inaccessible nodules (< 4 mm), while only 1 breast in the filtration-adsorption group had an oil cyst (4 mm×2 mm). The complication rate in the filtration-adsorption group was lower than that in sedimentation group[5.0%(1/20) vs. 15.0%(3/20), P>0.05]. Conclusion:The filtration-adsorption technique is an ideal method for fat grafting, which would multiply the volume retention rate in large-volume AFG breast augmentation and reduce the rate of complications.
Patients with breast hypertrophy often have breast and nipple-areolar complex (NAC) skin paresthesia, shoulder or back pain, eczema, reduced mobility, and other problems, which seriously decline the quality of life. With the improvement of patients’ requirements for life quality, researchers have gradually paid attention to the importance of breast and NAC sensation. This paper introduced Semmes-Weinstein monofilaments examination (SWME), pressure-specified sensory device (PSSD), and the hypotheses of breast and NAC sensory change in patients with mammary hypertrophy. The main factors causing sensory change after breast reduction surgery were also summarized. In these patients, the sensory change of the nipple and areola are not necessarily consistent. Pedicle selection could probably affect postoperative breast and NAC sensation. Notably, the superior pedicle and superolateral pedicle could bring some risks to the innervation of NAC, which might cause a significant decrease in postoperative skin sensitivity within a certain period. In addition, patients with larger breasts probably could benefit more from surgery, and the resection volume was not significantly associated with sensory change.
Dermatofibrosarcoma protuberans ( DFSP ) is very rare in clinic, and its diagnosis is not specific. According to the literature domestic and abroad, only 18 cases of patients during gestation period suffered from DFSP have been reported. This paper reported a case from the Department of Plastic Surgery, the First Affiliated Hospital of Bengbu Medical College in April 2022 diagnosed with DFSP during pregnancy.The DFSP showed rapid growth and pain during pregnancy, and stopped rapid growth after delivery. Extensive local resection was performed and the incision margin exceeded 3 cm diameter of the tumor. One-stage skin graft was used to repair the defect. HE staining showed a single spindle cell, arranged in a vortex, with large and dark nuclei. Some nuclei were heteromorphic, and few mitotic figures were observed. Postoperative pathology showed negative margins and basement. Immunohistochemistry showed CD34 (+ + ), Ki-67 (+, 10% ), bcl-2 (-), s-100 (-), SMA (-), CD163 (-), CD68 (-), which were consistent with the diagnosis of DFSP. The pathogenesis of DFSP is not yet clear. As a special population, patients during gestation period need special treatment and diagnosis. Through literature review, this paper summarizes the reports domestic and abroad, and discusses the diagnosis, treatment and prognosis of patients with DFSP during pregnancy.
2023年10月27日，作为第十二届北京国际整形美容外科会议暨第二届中国整形外科与再生医学发展大会的重要组成部分之一——首届八大处整形"血管瘤与脉管畸形MDT论坛"，在来自多地、多中心的各位专家和同道的支持下成功举办！本次论坛汇集了国内整形外科、介入科、儿科、血管外科、影像科、超声科、病理科及内科的多位专家，真正做到以疾病群为中心的多学科诊疗团队（MDT）。针对所有脉管疾患，本论坛分别从血管瘤、脉管畸形、MDT协作等专业方向进行了主题研讨，共同探讨医学领域的最前沿议题。
Objective:To investigate whether the combined injection of micronized acellular dermal matrix(mADM) and granular fat can improve the volume retention rate of the graft and the optimal mixture ratio of these two elements.Methods:From November 2022 to March 2023, the inguinal fat of rats was collected from the Animal Experiment Department of the 940th Hospital of the Joint Logistics Support Force of PLA, and then mixed with mADM in different proportions. Subsequently, different mixtures were injected into both sides of the back in another group of 15 rats: granular fat group (control group, C1), mADM group(control group, C2), granular fat+ mADM(1∶1)group(experimental group, E1), granular fat+ mADM(2∶1) group (experimental group, E2), granular fat+ mADM(4∶1) group(experimental group, E3), granular fat + mADM(6∶1) group (experimental group, E4), and 0.5 ml was injected in each group. At the 4th week, 8th week and 12th week, 5 specimens were randomly selected to detect the volume of grafts, histological analysis and neovascularization of grafts. SPSS 25.0 software was used for statistical analysis. Repeated measures analysis of variance was used to compare the data at multiple time points among multiple groups, and one-way analysis of variance was used to compare the data at each time point among multiple groups. P<0.05 was considered statistically significant. Results:The volume of the grafts in the 6 groups changed significantly with time, and the difference was statistically significant ( P <0.05). At the 4th, 8th and 12th week after injection, the volume of C2 group was larger than that of C1 group. The histological analysis showed that there was no obvious inflammatory cell infiltration in the early stage of C2 group, and the inflammatory reaction gradually occurred after 8 weeks. In the C1 group, vacuolization was observed, and the inflammatory cell infiltration was obvious. The larger the proportion of mADM and granular fat mixed injection, the more collagen fibers arranged regularly. There was a significant difference in the number of neovascularization among the 6 groups at the 4th week after transplantation ( P<0.05), but there was no significant difference at the 8th and 12th week ( P>0.05). Conclusion:mADM combined with granular fat injection can effectively maintain the volume of injection for a long time, and more suitable effect is achieved when the two are mixed at a ratio of 1∶1.
To report a case of phakomatosis pigmentovascularis (PPV) complicated with Klippel-Trenaunay (KT) syndrome and its skin imaging findings in a 2-year-old child. The child was born with red and cyan brown patches on the face, torso, buttocks and limbs, and then gradually developed limb asymmetry. The clinical manifestations, MR and related examinations, pathological biopsy results and skin imaging examination of the child were consistent with the diagnosis of PPV combined with KT syndrome. The case was rare and difficult to treat. Through literature review, the etiology, diagnosis and treatment of PPV complicated with KT syndrome was summarized, and the features of reflection confocal scanning microscope (RCM) and dermoscopy examinations were discussed.
Objective:To explore the diagnosis, staging, and treatment of fibro-adipose vascular anomaly(FAVA).Methods:The data of the patients with FAVA admitted to Xi’an International Medical Center Hospital between October 2019 and February 2023 were retrospectively reviewed. Ultrasound and magnetic resonance imaging (MRI) were routinely performed. X-ray and CT were performed for patients with unequal length of lower limbs, lesions involving joints, and obvious joint deformities. The treatment plan was made according to the stage: stage Ⅰ (pain stage), open or laparoscopi radical resection of the lesion was performed; stage Ⅱ (contracture stage), radical surgery was performed to remove the lesion, sometimes combined with Achilles tendon lengthening or tenolysis, and rehabilitation training was performed 2 weeks after surgery; stage Ⅲ(deformity stage), comprehensive treatment based on surgical resection was adopted, combined with joint capsule release, Achilles tendon lengthening or dissection, tendon transfer and oral sirolimus (each time 0.08 mg/m 2, twice daily ) before and after the operation. For patients with lesions involving multiple anatomical regions, staged surgery was performed, and in principle, only one anatomical region was operated per time. Patients were followed up for pain, joint activity and recurrence. Results:A total of 42 patients were admitted, including 18 males and 24 females. The onset age was (7.3±5.0) years, but the average age of diagnosis was (12.5±6.0) years. The lower limbs were involved in 38 cases, the upper limbs in 4 cases. There were 17 cases of stage Ⅰ, 17 cases of stage Ⅱ and 8 cases of stage Ⅲ. Only 4 cases had no misdiagnosis experience, and the misdiagnosis rate was 90.5%(38/42). Persistent pain, muscle contractures and joint deformities were the main clinical symptoms of the disease. MRI showed heterogeneous high and low signal intensity on T1-weighted images, and the high signal intensity was the same as that of subcutaneous adipose tissue. T2 fat-suppressed sequences showed stronger heterogeneous hyperintensity. The follow-up time was (14.6±10.8) months. Patients who took sirolimus orally before or after surgery experienced significant relief of pain symptoms. Of the 42 patients, the symptoms of 31 patients were completely relieved after the operation, and 11 patients still had residual pain or joint movement disorder or even deformity after the operation. Sixteen of 17 stage Ⅰ patients were cured, the lesion was further expanded and the pain recurred in 1 case after the operation. Of the 17 stage Ⅱ patients, 15 were cured, and 2 had mild limitation of ankle movement after the operation. Eight stage Ⅲ patients had varying degrees of pain or joint movement disorder after surgery, postoperative oral sirolimus significantly relieved symptoms. All 10 patients with stage Ⅰ and Ⅱ who underwent endoscopic resection were cured.Conclusion:FAVA usually occurred in school-age and adolescent children. Pain, muscle contracture and joint deformity were the characteristic clinical features. Combined with MRI features, the diagnosis can be confirmed. FAVA staging system could guide treatment and predict prognosis. For stage Ⅰ and Ⅱ patients, surgery should be performed as soon as possible and the prognosis was good. For stage Ⅲ patients, surgery-based comprehensive treatment could improve symptoms, but it was difficult to cure them radically. Oral sirolimus was also required after surgery.
Sunken upper eyelid is a depression at the inferior orbital border of the upper eyelid, which tends to give the impression of aging and has become an important issue of facial rejuvenation. This article systematically introduces the clinical application and research of different types of adipose tissue in the correction of upper eyelid hollowness, trying to provide theoretical basis and scientific guidance for finding more efficient and reasonable method.
