Objective:To investigate the effectiveness of autologous nano-fat mixed granule fat transplantation in the treatment of facial soft tissue dysplasia in children with mild hemifacial microsomia (HFM). Methods:A total of 24 children with Pruzansky-Kaban type Ⅰ HFM were admitted between July 2016 and December 2020. Among them, 12 children were treated with autologous nano-fat mixed granule fat (1∶1) transplantation as study group and 12 with autologous granule fat transplantation as control group. There was no significant difference in gender, age, and affected side between groups ( P>0.05). The child's face was divided into region Ⅰ(mental point-mandibular angle-oral angle), region Ⅱ (mandibular angle-earlobe-lateral border of the nasal alar-oral angle), region Ⅲ (earlobe-lateral border of the nasal alar-inner canthus-foot of ear wheel). Based on the preoperative maxillofacial CT scan+three-dimensional reconstruction data, the differences of soft tissue volume between the healthy and affected sides in the 3 regions were calculated by Mimics software to determine the amount of autologous fat extraction or grafting. The distances between mandibular angle and oral angle (mandibular angle-oral angle), between mandibular angle and outer canthus (mandibular angle-outer canthus), and between earlobe and lateral border of the nasal alar (earlobe-lateral border of the nasal alar), and the soft tissue volumes in regions Ⅰ, Ⅱ, and Ⅲ of healthy and affected sides were measured at 1 day before operation and 1 year after operation. The differences between healthy and affected sides of the above indicators were calculated as the evaluation indexes for statistical analysis. At 1 year after operation, the parents, the surgeons, and the nurses in the operation group made a self-assessment of satisfaction according to the frontal photos of the children before and after operation. Results:The study group and the control group were injected with (28.61±8.59) and (29.33±8.08) mL of fat respectively, with no significant difference ( t=0.204, P=0.840). After injection, 1 child in the control group had a little subcutaneous induration, and no related complications occurred in the others. All children in both groups were followed up 1 year to 1 year and 6 months, with an average of 1 year and 4 months in the study group and 1 year and 3 months in the control group. At 1 year after operation, the asymmetry of the healthy and affected sides improved in both groups; the satisfactions of parents, surgeons, and nurses in the study group were all 100% (12/12), while those of the control group were 100% (12/12), 83% (10/12), and 92% (11/12), respectively. The differences between healthy and affected sides in mandibular angle-oral angle, mandibular angle-outer canthus, earlobe-lateral border of the nasal alar, and the soft tissue volume in 3 regions of the two groups after operation were significantly smaller than those before operation ( P<0.05). There was no significant difference in the above indexes between the two groups before operation ( P>0.05). After operation, all indexes were significantly lower in study group than in control group ( P<0.05). Conclusion:Autologous nano-fat mixed granule fat transplantation and autologous granule fat transplantation can both improve the facial soft tissue dysplasia in children with mild HFM, and the former is better than the latter.

BACKGROUND:Because of the various types and complexity of congenital tragal malformation, tragal reconstruction is one of the most challenging objects in otoplasty. This study aimed to introduce a surgical technique of cartilage transposition and anchoring that was used to construct a cartilage framework for natural tragus reconstruction. METHODS:A retrospective study was performed for 49 patients who underwent cartilage transposition and anchoring from January 2020 to August 2022. Gender, age, malformation, complication, operation record, preoperative and postoperative photograph, score of esthetic outcomes (4 = excellent, 3 = good, 2 = fair, 1 = poor), and Vancouver Scar Assessment score were reviewed. RESULTS:Twenty-six boys and 23 girls with an average age of 35.79 ± 32.97 months underwent revision. The follow-up time was 13.87 ± 6.57 months. No complications were noted. The average score of esthetic outcomes and the Vancouver Scar Assessment score were 3.94 and 0.08 in the postoperative period, respectively. The overall effect was satisfactory. CONCLUSIONS:Postoperative results showed that cartilage transposition and anchoring were effective techniques for the reconstruction of congenital tragal malformation. The use of cartilage and fascia tissue around the tragus to fill up the depression and reconstruct the tragus were the emphases. The remolded tragus showed less scars and had the similar appearance like the natural tragus of the patient.

The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (nine patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (p > .05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (p < .05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.

Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.

目的:总结使用静脉注射用人血丙种球蛋白(IVIG)治疗儿童严重烧伤感染的经验.方法:采用回顾性研究方法,收集2013-2017年在我院住院治疗的24例严重烧伤感染患儿的临床资料,根据是否应用IVIG治疗分为IVIG组14例和对照组10例,比较分析两组患儿的血常规、肝肾功能、C反应蛋白(CRP)、降钙素原(PCT)、创面培养及血培养等.结果:两组患儿均为Ⅱ度烧伤,年龄、体质量、烧伤面积比较差异均无统计学意义(P均＞0.05).治疗前,IVIG组患儿的体温及CRP水平均高于对照组(P均＜0.05),WBC、中性粒细胞比例、血小板计数、PCT与对照组比较差异均无统计学意义(P均＞0.05);治疗后,IVIG组的体温、CRP及PCT水平较治疗前降低(P均＜0.05).结论:面积深度相当的烧伤患儿,可能出现对烧伤程度不同的炎症反应;IVIG能有效改善严重烧伤患儿的感染症状,降低炎性指标水平.

Objective To establish a high-precision surgical approach for mandibular distraction osteogenesis (MDO) for treatment of serious Pierre-Robin syndrome (PRS) in infants. Methods Ten infants with serious PRS were enrolled in this study. Before the operation, osteotomy and distraction were simulated using computer software, followed by three-dimensional (3D) printing of the head model for verifying the simulation results. After the verification, the individualized osteotomy template and bended distractor were constructed using a 3D printer to assist in subsequent osteotomy and fixation of the distractor. Five days after the operation, the distraction started at a daily rate of 1.2 mm until mild anterior crossbite occurred. The operative time, blood loss, distracted length, postoperative tracheal intubation time, and improvement of eating behavior after the operation were recorded. After the distraction, all the infants underwent CT examination for measurement of the distance from the tongue root to the posterior pharyngeal wall; they also received polysomnogram (PSG) examination to determine the apnea hyponea index (AHI). The distractors were removed surgically at 3 months after the operation. Results The operations were completed successfully in all the 10 infants. The mean operative time of the first operation was 1.72±0.15 h with a mean blood loss of 16±3 mL; the mandibular distraction distance on 20 sides averaged 11.11±1.18 mm. The postoperative endotracheal intubation time was 6.10±0.74 d. After the extubation, 8 infants started oral feeding, and their daily milk intake reached 374.0±65.2 mL 7 d later while the other 2 infants still required nasal feeding. After the distraction, the mean distance from the tongue root to the posterior pharyngeal wall was 7.17±0.70 mm. PSG showed AHI of 1.5±0.6 in these infants. All the infants had good osteogenesis in the distraction area without symptoms of facial nerve injury and showed significant improvement in the lower part of the face. Conclusion For infants with serious PRS, computer aided simulation combined with 3D printing for guiding osteotomy and distraction not only improves the surgical precision of MDO and shortens the operative time, but also avoids damages to important anatomical structures during the surgery.