Background Large unilateral facial hemangiomas, particularly those involving the parotid gland, are significant due to their potential to cause severe facial asymmetry. No universally accepted classification exists for assessing the severity or determining appropriate surgical interventions. This study proposes an algorithm for managing involuting or involuted hemangiomas with facial asymmetry, based on magnetic resonance imaging (MRI) findings. Methods Sixteen patients presenting with facial asymmetry who underwent surgical procedures for involuting or involuted hemangiomas were included in this study. Patients were categorized into four types based on the association between MRI findings of hemangiomas and surgical procedures. Those without facial asymmetry who did not require surgery were classified as Type I and were therefore excluded from analysis. Results Ten patients who received liposuction were classified as Type II, three patients who underwent lipectomy with a minimal access cranial suspension lift were classified as Type III, and three patients who underwent lipectomy with formal facial nerve dissection were classified as Type IV. All 16 patients showed improvement in facial asymmetry and deformity. The mean postoperative follow-up period was 7.8 months. No major complications were observed in any of the types. Conclusion Surgical interventions of hemangiomas associated with facial asymmetry are typically performed during the involuting or involuted phase, offering a less invasive approach with lower morbidity. Preoperative MRI findings can effectively delineate the extent and depth of fibrofatty tissue, assisting surgeons in selecting the optimal therapeutic strategy. Our classification system may serve as a practical guide for surgical planning.

Objectives: This study assesses the efficacy of tracheotomy-primed sclerotherapy in craniofacial venous malformations (VMs), establishes evidence-based airway intervention criteria, and develops site-specific safety protocols to optimize treatment timing and safety in cases with upper airway compromise. Methods: We retrospectively collected the clinical data of 35 patients treated by our center between January 2008 and November 2024, who were diagnosed with cervicofacial VMs involving the upper respiratory tract. All patients underwent direct tracheotomy or tracheotomy after sclerotherapy for lesions located in the anterior cervical area. Sclerotherapy was performed under fluoroscopy or laryngoscopy after tracheotomy. Results: 35 patients underwent 225 sclerotherapy sessions. Nineteen patients underwent tracheotomy directly, and sixteen patients received sclerotherapy at the anterior cervical area before tracheotomy. All patients presented improvement according to magnetic resonance imaging (MRI) findings, and 94.29% (33/35) of patients reported improvement in clinical presentations. All patients experienced improvement in quality of life (QoL). No major complications occurred. Decannulation was successfully performed in all 35 patients after finishing sclerotherapy. Conclusions: Tracheotomy followed by sclerotherapy is safe and effective for VMs involving the upper respiratory tract. This is necessary for patients with lesions involving the laryngopharyngeal region, tongue base, and bilateral pharyngeal walls. In high-risk prophylactic tracheostomy candidates, anterior cervical sclerotherapy-tracheostomy-sclerotherapy (ACSTS) is an effective strategy for managing airway obstruction.

BACKGROUND:Capillary malformation-arteriovenous malformation (CM-AVM) is a rare genetic disorder characterized by multiple small capillary malformations (CMs) and arteriovenous malformations (AVMs), which has been linked with pathogenic variants in RASA1 and EPHB4. However, more data are needed to explore the phenotypic characteristics and the association between genotypes and clinical phenotypes. OBJECTIVES:Our aim was to investigate the phenotypic and genetic characteristics of CM-AVM in East Asians, identify potential unique phenotypes, and conduct genotype-phenotype association analyses. METHODS:This is a single-center study prospectively collecting CM-AVM patients' clinical data, with genetic data from blood or tissue samples. RESULTS:A total of 59 patients were enrolled. Thirty-two individuals had a leading CM greater than Schobinger stage II. The trigeminal nerve branches and greater auricular, transverse cervical, and lesser occipital nerves' somatosensory innervation zones divided head and neck CMs into six zones: V1, V2, V3, GA, TC, and LO zones. GA, TC, and LO zones had a positive correlation with one another but a negative correlation with V2 zone involvement. The RASA1 and EPHB4 pathogenic variants were detected in 41 out of 59, which showed two types of variant allele frequency (VAF) distributions. VAF above 30% made RASA1 pathogenic variants more susceptible to multifocal CMs than those below 30%. CONCLUSIONS:Leading CMs in the head and neck exhibit two segmentation patterns, anterior and lateral, which may differ in ear involvement and progression. Germline RASA1 pathogenic variants increased multifocal CM risk more than the somatic variants.

Background Both reconstructive outcomes and donor site deformities should be considered in forehead expander selection for resurfacing facial skin defects. Cranial bone deformity as well as bone resorption always cannot be completely normalized after tissue expander extraction. This study aimed to investigate the correlation between the degree of frontal deformity, the reconstruction outcomes, and the expander size. Patients and Methods Cases of forehead tissue expansion performed from 2011 to 2020 with 50/80 mL sized expanders and 150/200 mL expanders were retrospectively reviewed and separated into 2 groups. Demographic and clinical data were collected. Two plastic surgeons (Y.Z. and L.L.) who were not involved in the operation process compared the patient's preoperative photos with their final follow-up photos. The Fisher exact, 2-sample t tests, and the Wilcoxon rank-sum test were performed in this study. Results Ultimately, 51 patients were included in the 50/80ml sized expander group, and 28 patients were included in the 150/200 mL expander group. Demographic data were collected and had no statistically significant differences between the 2 groups. There was no statistical difference in the frontal deformation rate between the 2 groups. The degree of frontal deformation was significantly different, and a large expander could significantly reduce the frontal deformation degree (P < 0.05) and acquire a higher evaluation of the whole reconstruction outcomes (P = 0.007). Conclusions The large-sized (150/200 mL) expander sited on the forehead was shown to have a slighter postoperative forehead change and better reconstruction effect. It is advisable to choose expanders with relatively larger sizes in the application of the forehead expand flap.

Large involuted infantile hemangioma remains a challenge in facial reconstruction. The characteristic fibrofatty residuum and multiple subunits/tissues involvement contribute significantly to the difficulty of surgical management. Tissue expander plays an important role in facial reconstruction, allowing plastic surgeons to repair skin damaged by both congenital and acquired defects. Between 2009 and 2021, 30 patients who underwent tissue expansion surgery were reviewed in a single hospital. The demographic data, lesion characteristics, surgical approaches, complication rate, and aesthetic outcomes were analyzed. Thirty patients (5 men and 25 women) with a mean age of 14.03 ± 7.25 years (range, 4–33 years) were included. The mean follow-up is 35.92 months, ranging from 9 to 75 months. Tissue expansion-related complications include closed infection, 2/30 (6.67 www.springer.com/00266 .

Arteriovenous malformations (AVMs) are aggressive congenital high-flow vascular anomalies, in which the feeding artery and draining vein are connected through fistulas without normal capillary networks. In severe cases, the condition may cause swelling, ulceration, bleeding, and even heart failure. Various treatment options are available for AVMs, including laser, surgical resection, embolization, and targeted drug therapy. With the development of endovascular treatment technology, absolute ethanol embolization of AVMs has become one of the first-line therapies owing to its sustained efficacy and low recurrence rate. However, administration of this therapy is challenging and may lead to serious complications if inappropriately managed. In this article, we reviewed and summarized previous clinical articles, literature reviews, and clinical trial data to comprehensively describe clinical manifestations of AVMs, the mechanism of ethanol embolotherapy, key points in treatment and management of complications, and issues that need to be addressed. We expect to provide a reliable information reference source for clinical physicians and researchers.

Arteriovenous malformations (AVMs) are serious congenital vascular anomalies in which the arteries connect directly with veins without capillaries. This condition will continue to worsen without proper intervention and cause ulcers, repeated hemorrhages, and even cardiac insufficiency. Primary treatment options for AVMs include surgery and interventional treatment; however, they are associated with high risk and recurrence rates. Recent studies revealed that excessive activation of the Ras/MAPK pathway can induce the formation and development of peripheral AVM, whereas MEK inhibitors can effectively control nidus progression, making them a potential novel treatment for AVM. This review provides an up-to-date overview of correlated laboratory and clinical research to provide information for further research and clinical practice.

以面部年轻化为目的的下睑成形术理念因眶周精细的解剖学进展而不断革新，根据各种解剖特点设计的手术方案正在广泛应用，迫切需要可靠的术后效果评估体系，来准确评估与比较不同手术方式的效果。近年出现了一些更加客观、数字化的指标，以及基于3D成像技术的评估。本文概述各种下睑成形术效果评估方法并进行分析，提出未来的发展方向，为临床提供思路。

BACKGROUND Cutaneous erythema is one of the most common signs of arteriovenous malformations (AVMs) in the head and neck region, influencing aesthetic appearance. Surgical resection of AVMs may lead to cicatrization of the skin or aggravation of the lesion. Laser treatment, although effective in improving superficial vascular lesions, cannot prevent deep AVMs from further development. OBJECTIVE The authors propose an absolute ethanol embolization therapy that can effectively and safely eradicate the nidus with a favorable aesthetic outcome. METHODS The authors conducted a retrospective observational study of 14 AVM patients with distinct cutaneous erythema in the head and neck region undergoing embolotherapy in a single primary care center. Symptoms before and after treatment, complications, and degree of devascularization were recorded and assessed. Changes in cutaneous redness were evaluated using a previously reported quantitative measurement. RESULTS Complete symptomatic relief was observed in 5 patients, and major improvement was observed in 9 patients. The mean Δa* value of the color change had a significant reduction of 6.50 ± 4.04, p < .001, indicating a remarkable remission of cutaneous erythema. CONCLUSION Ethanol embolization is an effective and safe treatment for head and neck AVMs with excellent aesthetic outcomes and might become a potential treatment method for other superficial vascular anomalies.

Thanks to the development of computer science, display technology and tracking technology in recent years, virtual reality and augmented reality catch more and more people’s eyes. At the same time, this new technology has been applied to many different industries, and it has huge practical value and broad prospect in healthcare, especially in plastic surgery. In this article we review the basic concept of virtual reality and augmented reality and introduce their practical applications in plastic surgery (preoperative planning, intraoperative guiding and surgical training), providing an outlook for further development in this field.

Hyperreflexia develops after spinal cord injury (SCI) in the human and in the spinal cord transected animal, and can be measured by the loss of low frequency-dependent depression of the H-reflex. Previous studies demonstrated normalization of low frequency-dependent depression of the H-reflex using passive exercise when initiated prior to the development of hyperreflexia. We examined the effects of passive exercise prior to compared to after the development of hyperreflexia in the transected rat. Adult female rats underwent complete transection (Tx) at T10. Frequency-dependence of the H-reflex was tested following passive exercise for 30 days, initiated prior to hyperreflexia in one group compared to initiation after hyperreflexia became established, and compared to intact and untreated Tx groups. An additional Tx group completed 60 days of exercise initiated after hyperreflexia was established. Lumbar enlargement tissue was harvested for western blot to compare Connexin-36 protein levels in control vs Tx animals vs Tx animals that were passively exercised. No differences in whole tissue were evident, although regional differences may still be present in Connexin-36 levels. Statistically significant decreases in low frequency-dependent depression of the H-reflex were observed following 30 days of exercise initiated prior to the onset of hyperreflexia, and also after 60 days of exercise when initiated after hyperreflexia had been established, compared with Tx only animals. We concluded that modulation of spinal circuitry by passive exercise took place when initiated before and after the onset of hyperreflexia, but different durations of exercise were required.

Abstract Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.

传统的"血管瘤"(Vascular Anomalies)包含了各种血管性肿瘤和血管/淋巴管畸形,在中国有逾2千万病例.疾病谱中既涵盖常见病,如婴幼儿血管瘤,在新生儿中发病率高达1％～ 10％;也涵盖罕见疑难病,如颅外动静脉畸形,发病率约为1/20万,却是国际公认的疑难疾病.这些疾病可发生于全身各部位,累及多器官,造成多种多样的临床表现,治疗所涉跨越各学科解剖界限、知识和技术,远非传统单一学科所能胜任.

过去的一年余,手术和非手术面部年轻化领域,无论除皱手术、解剖学、埋线悬吊提升、注射,还是激光光电领域,都取得了不少令人侧目的进展,以下更值得关注,比如:"斜拉桥"除皱术式;氨甲环酸的局部浸润注射和静脉用药可减少出血;利用AI技术评估除皱术后的外貌年龄;除皱术后暂时性的面神经损伤的健侧A型肉毒毒素注射临时调整;透明质酸加速其中PDO缝线的降解;注射透明质酸可诱导下颏骨吸收;钝针注射后血管意外栓塞的发生率比锐针低得多;SVF辅助的脂肪注射的脂肪更为优化;Er:YAG激光全面部剥脱性治疗需要关注的安全参数等,当然,这些新的结论是否正确,还需要在后续的临床前瞻性研究中继续跟进.

Peripheral arteriovenous malformations (AVMs) are a rare type of vascular malformation with direct connections between arteries and veins, which bypass capillary beds. Symptoms such as deformities, pain, ulcerations, hemorrhage, and even cardiac failure may lead to physical and psychosocial disorders and sometimes amputation (1). Surgical eradication of AVMs poses a high risk of massive bleeding even after embolization or ligation of feeding arteries and draining veins, given the complicated vascular communication.

Background: The optimal timing of laser epilation with expanded forehead flaps in facial defect reconstruction remains undetermined. Objective: To compare the efficacy and safety of hair removal during or after flap expansion. Methods: This prospective exploratory study included 15 (11 women and 4 men, 16.47 ± 16.331 years of age) and 26 (19 women and 7 men, 10.69 ± 10.899 years of age) patients who underwent 755 nm long-pulsed alexandrite laser epilation during flap expansion and after surgery, respectively. Facial reconstruction was performed in these patients because of congenital melanin nevus, scar or port-wine stains. Evaluation included hair reduction rate, patient satisfaction, and adverse events. Results: The median number of laser sessions for hair removal during flap expansion was significantly lower than that after surgery (2.00 vs. 3.00, p < 0.01), and the hair reduction rate was also significantly higher during flap expansion (79.5% ± 21.93% vs. 68.3% ± 17.44%, p < 0.05). No severe adverse events were reported. Conclusion: Laser hair removal is safe and efficient when performed both during flap expansion period and after surgery, but its efficacy was significantly higher, and fewer sessions were required when performed during tissue expansion. Clinical trial registration information: ChiCTR1900026090.

Background Oral propranolol can effectively activate and accelerate infantile hemangioma (IH) involution; however, could the final outcome of oral propranolol treatment for IHs commensurate that of spontaneous involution? Objective This study aimed to investigate the long-term therapeutic effect of oral propranolol for IHs. Methods We present an individual matching comparative study with (1) oral propranolol therapy for mixed and deep IHs on the lips, nose, and parotid and (2) lesion type– and lesion location–matched untreated IHs as controls. Patients' follow-up photographs were assessed by 3 surgeons blinded of their treatment. Outcome measures were the quantification of the degree of sequelae ranging from 1 to 4 and the age at which IH achieved involution arrest. Results Ten groups of oral propranolol and untreated patients with matched lesions were assessed. Average age at which lesions stabilized and reached no change in appearance was 1.7 years old and 6.3 years old for propranolol group and untreated group ( t = 5.663, P < 0.001). There was no significant difference in the quantified degree of sequelae for oral propranolol group and untreated group upon follow-up (1.60 vs 1.40, respectively; t = 1.259, P = 0.240). Conclusions Oral propranolol therapy accelerates IH involution but does not have a superior effect than spontaneous involution on the overall outcome of problematic IHs.

BACKGROUND:Postsurgical scar management significantly affects patient satisfaction. However, reliable skin support options are limited.OBJECTIVES:The present study aimed to determine the efficacy and safety of using tissue adhesive zippers in postsurgical scar prevention among patients undergoing surgical excision of the face. The primary outcome was a reduction in scar width, which was evaluated 1, 3, 6, and 12 months postoperatively. Scar width at Month 12 was considered the final outcome.METHODS:This was a prospective, randomized, controlled, rater-blinded trial. Sixty-four patients were randomly assigned to 2 groups (the zip group, defined as those using a tissue adhesive zipper for 3 months after surgery, and the control group). Outcomes were evaluated 1, 3, 6, and 12 months postoperatively based on scar width and Patient Observer Scar Assessment Scale score. Skin irritation was monitored during the first 3 months after surgery. The incidence of hypertrophic scar formation was recorded at a 12-month follow-up.RESULTS:Scar width differed significantly between the zip (mean [standard deviation], 1.68 [0.45] mm) and control groups (2.15 [0.64] mm). The scars spread rapidly in the first month after surgery but slowed down and stabilized after 6 months. The Patient Observer Scar Assessment Scale scores of the zip group were significantly lower than those of the control group. Neither group experienced significant complications.CONCLUSIONS:Prolonged use of tissue adhesive zippers immediately after surgery reduced scar width and improved scar appearance without obvious side effects.LEVEL OF EVIDENCE: 2:

BackgroundDespite many advances in the treatment for extracranial arteriovenous malformations (AVMs), they still result in tedious dissection and potential unacceptable complications, particularly in children. Therefore, this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.MethodsA total of 10 children (6 boys and 4 girls) with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017. Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month interval. Therapeutic effectiveness was evaluated and classified into four categories: complete response (CR), partial response (PR), no response, and worsening at 3 months after the last session. Further clinical follow-up outcomes were classified as improved, stable, or aggravated. Adverse events were recorded according to the Society of Interventional Radiology classification.ResultsAll 10 children completed the sessions and follow-ups. CR occurred in 3 (30%) patients, PR in 6 (60%), and no response in 1 (20%). Minor complications (class A) included maculopapular rash, bulla, vomiting, and hyperpigmentation, whereas no major complications occurred.ConclusionIntralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes. This method may be an earlier treatment alternative in children to prevent potential destructive progression, considering the serious complications of currently available therapeutic methods.

目的·评估手术导航系统这一实时立体定向引导技术应用于头颈部危险区域低流量脉管畸形病灶硬化治疗的可行性和安全性.方法·回顾性纳入2017年5月—2019年9月在上海交通大学医学院附属第九人民医院整复外科接受了手术导航系统辅助硬化治疗的头颈部低流量脉管畸形患者.术前将患者计算机断层扫描图像和磁共振图像融合后,进行穿刺路径设计.术中利用导航系统,按预先设计的路径进行穿刺,通过数字减影血管造影验证穿刺结果.统计穿刺成功率和患者术后并发症情况.结果·共纳入10例头颈部低流量脉管畸形患者(6例眼眶内、4例咽部)30处病灶,治疗19次.初次治疗的平均年龄为20.9岁.穿刺成功率达到80.0％(24/30);除1次治疗后患者因硬化剂导致声门溃疡,继而引发肺炎外,未观察到其他并发症.结论·手术导航系统对头颈部危险区域低流量脉管畸形的硬化治疗是可行且安全的辅助技术.