A keloid is a benign growth caused by an overabundance of collagen deposits, and tissue expansion is one of the available surgical approaches used in their treatment. 1 Roeder J.A. White S.K. Tissue expansion for the treatment of keloids. Plast Surg Nurs. 1990; 10: 114-117 Crossref PubMed Google Scholar In this article, we report two cases of the recurrence of large keloids in the neck following tissue expansion.

Objective To observe the clinical effectiveness of pixel Er ∶YAG laser in the treatment of facial superficial scars.Methods A total of 40 patients,with facial superficial scar were treated by fractional Er ∶YAG laser(2 940 nm) combined with pixel technology.The spot size 7×7 dots(pixels),long pulse width,2 Hz frequency and pulse energy 1 000～1 400 mJ were used.Three to five stacked laser passes were performed.Treatment was given at 3-4 week intervals and continued 3-6 times.The improvement was assessed according to the degree of scar flatness and appearance 90 days after treatment.Results The results were rated excellent by 30 patients(75%) and good by 10 patients(25%).Wound healed completely 7-12 days after treatment.There was no complications such as pigmentation and so on.Conclusions Pixel Er ∶YAG laser is an effective method for superficial scar.

Background Restylane, a hyaluronic acid gel, has been widely used as a dermal filler in USA and European countries. This study was designed to study the safety and efficacy of Restylane as a non-permanent dermal filler for facial augmentation therapy in China for the correction of nasolabial folds during a follow-up period of 6 months. Methods The study consisted of a screening visit, a baseline visit during which injection with Restylane was given, and follow-up visits after four weeks, three months and six months. The efficacy was subjectively assessed by comparing the treatment results between pre-treatment and post-treatment. Adverse events were analyzed by severity and duration. Results At six months post-baseline, the subjects and the investigators' independent assessment score of Wrinkle Severity Rating Scale was decreased. Global Aesthetic Improvement Scale was considered to have improved by over 90% in some cases. Adverse events related to product and injection was reported in 21.5% of the injections. A vast majority of the post-treatment reactions were mild. Conclusions The efficacy of Restylane for nasolabial fold in a Chinese population was excellent. Restylane was well tolerated and no systemic reactions or other safety concerns were raised.

OBJECTIVE:To assess the safety and efficacy of hyaluronic acid-based gel of non-animal origin (NASHA gel [Restylane]; Q-Med AB, Uppsala, Sweden)for correcting nasolabial folds in Chinese.METHODS:Patients with moderate or severe nasolabial fold (Wrinkle Severity Rating Scale, WSRS) were recruited to receive NASHA gel injection ( < 1.5 ml). The patients were followed up for 6 months. The efficacy was assessed by physicians and patients, respectively. Adverse events (AEs) were recorded and laboratory tests were performed before and after operation.RESULTS:86 patients were treated. 6 months after injection, improved esthetic results was assessed by patients and physicians independently. 52 AEs happened in 32 cases (37.2%). Most of them were local injection reaction and minor, which were recovered spontaneously. No systemic reaction was found.CONCLUSIONS:NASHA gel can improve the nasolabial folds. It is very safe and tolerated.

Sir: From 2005 to 2006, a study was carried out to determine the efficacy and safety study of Restylane (Medicis Aesthetics, Inc., Scottsdale, Ariz.) on the nasolabial fold in a Chinese population. This was an open-label, multicenter study. Subjects seeking augmentation therapy for nasolabial fold correction were recruited. Intradermal injection with Restylane was made at baseline, and a possible touch-up injection could be given 4 weeks later. The study consisted of a screening visit; a baseline visit; and follow-up visits after 4 weeks, 3 months, and 6 months. Efficacy was assessed subjectively by comparing the treatment results between before treatment and after treatment both by the investigator's evaluation and the subject's self-evaluation with the use of the Wrinkle Severity Rating Scale1 and the Global Aesthetic Improvement Scale. Safety was assessed by evaluation of adverse events following injection and the severity of the reported adverse events. Eighty-six subjects were recruited and treated and 75 subjects completed the 6-month follow-up period. All subjects were injected in both nasolabial folds and 14 subjects received a touch-up treatment in one or both nasolabial folds. After treatment, most subjects' nasolabial folds had improved bilaterally with one or two scores on the Wrinkle Severity Rating Scale. The efficacy analysis showed a very good treatment effect up to 6 months using the Wrinkle Severity Rating Scale. The percentage of responders was above 80 to 85 percent for both nasolabial folds, which is higher than in previous well-controlled randomized clinical studies in Europe and North America.2–4 As for assessments with the Global Aesthetic Improvement Scale, a large proportion of the subjects responded to treatment; 73 percent and 56 percent of subjects were responders at 6 months, according to investigators' and subjects' assessments, respectively. Posttreatment reactions of Restylane are anticipated after intradermal injection. The adverse events included 31 events related to the injection procedure (15.9 percent of the injections) and 11 events related to the study product (5.6 percent of the injections). By comparison with data from previous clinical studies with Restylane, it can be concluded that the frequency of these reactions in this Chinese study was similar to that in the published literature.2–4 A clear majority of the posttreatment reactions were mild and resolved spontaneously. Thus, it was concluded that the efficacy of Restylane for facial tissue augmentation in the Chinese population was excellent, with a high proportion of the subjects responding to treatment using two different scales for evaluation. Response was well sustained, with a significant improvement from baseline at all time points up to 6 months after treatment. Restylane was well tolerated, and no systemic reactions or other safety concerns were raised. Some mild, transient reactions were reported and resolved spontaneously without need of specific treatment. Xiaoqing Yan, M.D. Jun Xu, M.D. Division of Plastic Surgery Chinese People's Liberation Army General Hospital Changsheng Lu, M.D. Plastic Surgery Hospital Chinese Academy of Medical Sciences Yongguang Ma, M.D. Department of Plastic Surgery Peking University 3rd Hospital Wei Li, M.D. Division of Biometrics Clinical Pharmacology Center Fu Wai Hospital Chinese Academy of Medical Sciences Beijing, China

In the correction of aesthetic impairments on the face, dermal, and superficial subcutaneous defects, adequately safe implant material is required. Cultured autologous skin fibroblasts, as a protein repair system, create a living injectable system that has been utilized effectively to treat rhytids, depressed scars, subcutaneous atrophy, acne irregularities, and laser wounds. To evaluate the new method, we have investigated the survival and collagen secretion of autologous transplanted fibroblasts. In this study, rabbit fibroblasts were cultured and expanded. Cells (8 × 107/ml) were injected into the superficial and deep dermal junction of the dorsal ears. Two rabbits were injected independently with labeled [3H]TdR fibroblasts; similarly, eight rabbits were given unlabeled transplanted cells in the right ear and vehicle in the left. Each site was injected three times with the same amount of cells every 2 weeks. The grafts were evaluated for 5 months. After explantation, the samples were collected from the injected sites and stained with autoradiography, H&E, and sirius red, respectively. According to the histological observations, the [3H]TdR-labeled cells survived and large amounts of embryo fibroblasts were found in the experimental subgroup of the labeled cell group. The depth of dermis was significantly different between the experimental subgroup (701.3 ± 31.5 μm) and the control subgroup (638.3 ± 23.9 μm) of the unlabeled group (p < 0.01). There was also a significant difference of collagen III between the experimental subgroup (2.63 ± 1.41 cm2) and the control subgroup (1.05 ± 0.90 cm2) (p < 0.05). There was no significant difference of collagen I between the experimental subgroup (56.25 ± 14.41 cm2) and the control subgroup (55.41 ± 16.59 cm2) (p > 0.05). The results obtained demonstrate that the distinction of the depth of dermis should be interpreted by the increase of collagen III, instead of collagen I, which is produced by the transplanted fibroblasts. The investigation indicated that transplanted autologous skin fibroblasts could provide a potential and effective approach to treat minor facial tissue deficiencies.

Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm X 26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.

OBJECTIVE:To introduce a modified technique of liposuction with excision for gynecomastia.METHODS:From 2003 to 2007, 32 cases of gynecomastia were treated with the modified technique: the operative region was divided into central and periphery parts, liposuction was performed only in the periphery part and the deep layer of the central part, while the breast gland in the superficial layer of the central part underwent sharp dissection, the subcutaneous tissue of the central part was conserved, and blood supply was reserved and saucer deformity was avoided. Follow-up was conducted for 3.0 - 18.5 months.RESULTS:Normal men breast appearance was achieved. No complication happened such as hematoma, seroma, saucer deformity, and necrosis in nipple and areola.CONCLUSION:This modified operative technique for gynecomastia proves to be an excellent and effective technique.

With minimal donor-site morbidity and bulky soft tissue supply, deep inferior epigastric perforator (DIEP) flap is now a preferred free flap in reconstructive surgery. Based on the experiences in free flap procedures, the authors explored a new usage of the DIEP flap to repair groin and scrotal defects. Over the last 2 years, 8 pedicled DIEP island flaps were successfully elevated and transferred in 7 male patients. With intramuscular dissection, the pedicle length could be elongated, with minimal damage to the abdominal fascia-muscular structure. Among these flaps, 5 were used for penoscrotal restore, 3 were raised to repair groin defects. All flaps survived completely. Groin reconstruction with such a flap gave a satisfactory esthetic result. Though somewhat bulky for penoscrotal restoration, it was acceptable for elderly patients. The authors conclude that this flap can be chosen as an alternative option to deal with complex groin and scrotal wounds.

OBJECTIVE To summarize the experiences of the breast reconstruction using the deep inferior epigastric perforator (DIEP) flaps. METHODS From March 2000 to March 2005, 18 cases of breast defects were treated. Defect was caused by mammary cancer in 17 cases and by Poland's syndrome in 1 case. Preoperative radiotherapy was given in 7 patients. The size of the chest wall defects ranged from 25 cm X 20 cm to 12 cm X 8 cm. All the breasts were reconstructed with the DIEP flaps. The flap size ranged from 35 cm X 22 cm to 12 cm X 8 cm (mean 9.58 cm X 26.85 cm). The internal mammary vessels were used as the recipient vessels in 15 patients who underwent delayed breast reconstruction. Among these cases, the bilateral deep inferior epigastric vessels were anastomosed with the proximal and distal ends of the internal mammary vessels separately in 13 cases and only unilateral deep inferior epigastric vessels were harvested and anastomosed to the proximal ends of the internal mammary vessels in 2 cases. The recipient vessels were the thoracodorsal vessels and thoracodorsal vessels plus the circumflex scapular vessels in the patients who underwent immediate breast reconstruction. RESULTS Sixteen flaps survived completely postoperatively and the survival rate was 89%. Flap necrosis occurred in 2 patients; one underwent radiotherapy preoperatively while the other did not. The distal 1/3 portion of the flap necrosed in the patient with Poland's syndrome. Nipple reconstruction and breast remolding were performed in 2 patients. Partial dehiscence of the median abdominal incision occurred in 2 patients at 2 weeks postoperatively and were repaired with resuturing and split-thickness skin grafting separately. CONCLUSION Breast reconstruction using the DIEP flaps not only can preserve the advantages of the traditional method using the transverse rectus abdominis myocutaneous flaps, but also can retain the maximal function of the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal method of the breast reconstruction.

病例患者男,25岁.自12岁起出现关节痛、发热等症状而不规律地使用强的松,体重几年内骤增达90 kg,体形呈向心性肥胖.17岁时,确诊为强直性脊柱炎,开始逐渐减少激素用量,18岁时体重明显降低,腹壁出现类似妊娠纹样的变化,皮肤松弛.现每日仍口服地塞米松0.75 mg.

OBJECTIVE:To investigate the anatomic characteristics of the perforator neurovascular bundles in the anterior abdominal wall for the anatomical basis of the sensate deep inferior epigastric perforator (DIEP) flap.METHODS:Abdominal wall dissection was performed on 9 embalmed female cadavers (18 sides).RESULTS:Most of the deep inferior epigastric perforators emerged at the anterior sheath of the rectus. There were averaged 17.5 perforators on each side, with the diameter equal to or larger than 0.5 mm in 7.8 perforators. The number of skin perforators was the greatest in the supero-medial area. 56.2 percent of vascular perforators traveled with the sensory branches while 80.9 percent of larger perforators (> or = 0.5 mm in diameter) run with the sensory branches.CONCLUSIONS:The lateral perforator neurovascular bundle was the first choice in the design of the sensate DIEP flap.

Objective To verify the ability of distal ends of internal mammary artery and vein used as recipient vessels on breast and chest wall reconstruction. Methods Four bilateral (left 2 and right 2) scent pig buttock island flaps pedicled circle deep iliac artery and vein were used by comparing the different hemodynamic parameters (pressure; flux volume; perfusion unions) between the original pedicl artery (deep iliac artery), proximal and distal ends of internal mammary artery. The free flaps were transplantated by anastomosed end-end to the distal-ends of internal mammary artery and vein after the proximal ends were ligated. Results The pressure of distal end of internal mammary artery was 61%-65% of the pressure with original pedicl artery (deep iliac artery), the immediate volume of anastomasis stoma was a little lower than that of original pedicl artery. The flap, 15 cm×30 cm×2 cm in size, completely survived more than 14 days after operation. Conclusion The slightly decreased distal arterial pressure does not compromise flap survival. Bilateral scent pig buttock island flap pedicled circle deep iliac artery and vein is an ideal animal flap model. This hymodynamic model can be widely used .

OBJECTIVE:To summarize the reasons for the complications after breast reconstruction.METHODS:The reasons for the complications after breast reconstruction were analyzed in flap necrosis, abdominal wall laxity or hernia and seroma.RESULTS:The partial necrosis rate of LDF, TRAM and DIEP was 7.5%, 26% and 14.2% respectively. The total flap necrosis rate in DIEP was 7.1%. In 19 cases using breast prosthesis, the capsular contracture rate was 21%.CONCLUSIONS:The key to reduce the complications is proper selection of an operative method and the indications. The plastic surgeon should be qualified and with better comprehension of the knowledge about breast reconstruction.

OBJECTIVETo reduce the incision scar produced by reduction mammaplasty.METHODSThe periareola incision and the vertical incision below the areola were made when performing breast reduction. The incision in the submammary fold was avoided. The breast was suspended and moulded. The redundant skin and the long skin incision below the areola were sutured utilizing the skin wrinkling suture techniques. The wrinkling skin and incision became flat gradually due to the elasticity of the tissue itself.RESULTS13 cases have been treated with the techniques mentioned above. All incisions healed primarily and there were no complications such as hematoma, infection and necrosis of skin or areola. Of them, 3 patients with very large and ptotic breasts needed small corrective operations to excise the redundant skin that still existed 6 months postoperatively. The shape of the breasts and the vertical incision scars of the other patients were satisfactory.CONCLUSIONSThe vertical mammaplasty using the skin wrinkling suture techniques can be used in breast reduction of various sizes, owing to the advantages of consistent, good and stable result, simplicity to perform and grasp and no scar in the submammary fold.

Objective To present a method for breast reconstruction with the deep inferior epigastric perforator (DIEP) flap and to summarize the operative experiences. Methods DIEP flaps were elevated without carrying rectus abdominis muscle. The breast was shaped after the deep inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2000, we have used the DIEP flaps in 15 cases of breast reconstruction. There were 100 % survival in 10 flaps, distal skin necrosis in 2 flaps, and a full loss in 2 flaps. With the follow-up of 6～12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal heria, bulge and weakness in donor sites. Conclusion DIEP flap is the development and refinement of TRAM flap and possesses of advantages such as rich blood supply, abundant tissue volume, minimal donor site morbidity and easy shaping. It is a new but reliable and safe technique for autologous breast reconstruction.

Objective To supply anatomic foundation for TRAM and DIEP flaps breast reconstruction with both sensory innervation and rectus abdominis muscle function preserved. Methods Dissections of T8～T12 nerves in anterior abdominal wall were performed on 9 embalmed female cadavers (18 sides). By reconstructing DIEP flaps in 15 cases, the natures of the intercostal nerves and the relations with deep inferior epigastric perforators were investigated. Results Most intercostal nerves pierced the rectus abdominis muscle in the lateral one third. There were interconnections between muscular branches of segmental nerves. Sensory branches traveling with vascular perforators were divided into medial branch and lateral branch. The mean length of pure sensory nerve was (27.6±12.2)mm. Conclusion It is possible to preserve sensory innervation by coapting lower intercostal nerves to the 4th thoracic nerve in TRAM and DIEP breast reconstruction. Sparing lateral one third of rectus abdominis muscle does not cause denervated atrophy in the rectus abdominis muscle after TRAM breast reconstruction.

Objectives To modifiy the techniques of harvesting the free inferior epigastric artery transverse rectus abdominis myocutaneous flap as deep inferior epigastric perforator (DIEP) flap based on the anatomic study and to provide ideal methods for breast reconstruction after operation of mastocarcinoma and repair of chest wall ulcer after radiotherapy. [WT5”HZ]Methods DIEP flaps were elevated and transferred to recipient sites in the chest walls. The inferior epigastric artery and vein were anastomosed to the internal thoracic artery and vein. [WT5”HZ]Results[WT5”BZ] During flap dissection, large perforators were found to enter the flap across the fibers of the rectus muscle. So DIEP flaps were elevated with preservation of the continuity of the rectus muscle′s fibers. Four DIEP flaps were used for breast reconstruction and two for repair of chest wall ulcer. The size of the flaps ranged from (10 cm×12 cm) to(12 cm×35 cm). All flaps survived and good results were achieved. [WT5”HZ]Conclusions[WT5”BZ] DIEP flap is technically modified TRAM flap. It not only retains the advantages of TRAM flap such as good blood supply, rich tissue volume and easy to change the flap′s shape, but also preserves the integrity of rectus abdominis muscle and enables to perform simultaneous abdominoplasty.

OBJECTIVE:To provide an ideal method for repairing the circular cicatricial contracture of thigh.METHODS:Deep inferior epigastric perforator (DIEP) island flaps was elevated based only on the deep inferior epigastric artery and vein and transferred to cover the thigh wound after scar had been resected.RESULTS:Four DIEP island flaps was applied clinically and all flaps survived. The size of the flaps ranged from (8 cm x 28 cm) to (11 cm x 32 cm). Venous return and edema had been obviously improved postoperatively. There was no abdominal weakness and hernia in the donor sites.CONCLUSION:DIEP flap not only retains the advantages of TRAM flap such as good blood supply and rich tissue volume, but also preserves the integrity of the rectus abdominis muscle. DIEP island flap is a good material for repair of the circular cicatricial contracture of the thigh.

OBJECTIVETo improve the results of the soft tissue expansion technique.METHODSTwo expanders were buried in the same soft tissue pocket in an overlapping pattern. The inflation process was carried out routinely.RESULTS19 cases of various tissue defects were treated with the overlapping tissue expansion technique since March 1999. Good results have been achieved.CONCLUSIONThe overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique. It is especially suitable for repair of the defects at the facial and cervical region.