Use of a soft tissue expander before surgical treatment of clubfoot in children and adolescents

Primary closure of the skin after surgical correction of severe clubfoot is difficult, sometimes impossible. The authors describe a surgical technique with the use of a soft tissue expander prior to surgical treatment on clubfoot in children and adolescents. They operated on 13 feet (10 patients) with rigid clubfoot, with ages ranging from 3 to 16 years (average 10 years). Satisfactory skin healing with primary closure of the skin was obtained in 10 feet; the remaining 3 had complications such as infection, skin necrosis, and premature exposure of the expander. The authors conclude that soft tissue expansion before surgical correction of clubfoot in selected cases is a good alternative for the management of skin closure. Special attention should be given to surgical technique.     

微粒皮移植治疗大面积深度烧伤后关节瘢痕挛缩的初步体会

目的 探讨大面积深度烧伤病人自体微粒皮与大张异体皮移植术治疗关节部位瘢痕挛缩的方法.方法 选择大面积深度烧伤后期瘢痕严重增生挛缩造成关节畸形而自体皮匮乏的病人11例,共31个关节,在全麻下切除部分瘢痕,彻底松解,矫正关节畸形,用微粒皮加异体皮覆盖创面,术后进行植皮区压迫和早期功能锻炼.随访12个月以上.通过术前、术后的皮肤外观、关节功能、组织学观察等进行效果评价.结果 微粒皮移植者皮肤外观及关节功能明显改善;组织学可见表皮较厚,部分可见表皮脚,真皮层较薄,胶原纤维排列较有规律.结论 微粒皮加大张异体皮移植术可用于治疗大面积深度烧伤病人关节部位瘢痕挛缩.     

医用美容胶原注射的临床疗效观察

目的 评估胶原注射矫治皮肤缺陷的效果。方法 对不同种类的皮肤缺陷注射医用美容胶原。结果 用胶原注射矫治皮肤缺陷共103例,近期效果优良率为85．5％,未见严重并发症。结论 胶原注射矫治皮肤缺陷的方法安全、简便、有效。     

A new approach to pectus deformity in females

One of the most preferred procedures for correction of pectus deformities is the modified Ravitch procedure. The main aim is cosmetic for many patients, especially in females. Two types of skin incisions have been described for this operation in the literature: midsternal and transversal. Both incisions leave a skin scar on the sternum and result in unacceptable cosmetic results. As a way of concealing the ugly skin incision scar under the breasts after puberty, we describe and discuss the use of bilateral inframammarian separated skin incisions. We have used our method for correction of pectus deformity in 12 female cases in our clinic since 1991. Two 4-5 cm incisions were localized as 1/3 medially and 2/3 laterally below both breasts. With this incision we performed the modified Ravitch technique. In spite of technical difficulties of exposure, correction of the deformity was satisfactory in all patients. Only one patient had seroma and one had perioperative pneumothorax. The patients were followed up for from 3 months to 9 years. No recurrence was observed. Breast development and sensitivity was found to benormal at follow-up. The new approach was found to be effective and more cosmetically acceptable than the other approaches for correction of pectus excavatum in female patients.     

Multimodality aesthetic skin rejuvenation

Patients requesting skin correction and rejuvenation are motivated by a number of clinical problems. Photo damage, abnormal pigmentation or vascularity, textural problems, rhytides, and laxity due to chronological aging are the primary complaints of the majority of patients. Advances in new technology in the past decade have provided the skin correction specialist with new options for treatment. Specialists with multiple technology options then face a new dilemma. What is the best treatment plan for individual patients when many options exist? Over the past five years we have developed an approach to our patients based on an individualized treatment plan consisting of a prescribed series of skin correction treatments utilizing the most specific rejuvenation techniques for each clinical problem. Multimodality aesthetic skin rejuvenation (MMASR) emphasizes the corrective process and utilization of the most appropriate technology for the patient's clinical skin problem as evidenced by the clinical examination. MMASR also takes into consideration patient bias, cost concerns, expectations of treatment, and feasibility of combining different technologies in the same treatment session. Combining skin rejuvenation techniques with surgical rejuvenation is also reviewed as an option for patients with both facial laxity and clinical skin problems.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.

Abstract：

Objective To investigate a new method for correction of claw hand deformity after burns. Methods From May 2006 to Jul. 2010, 12 patients with claw hands deformities after burns were treated with skin grafts (11 hands) and skin flap(1 hand) with unsatisfactory results. Then elastic traction (skin traction or skeletal traction) were performed with individual functional brace. Results All patients were followed up for 0. 5 to 2 years. Elastic traction was effective in the correction of metacarpophalangeal joint deformity, buttonhole deformity, thumb-in-palm deformity, scar contracture, and palmar arch deformity. Conclusions Elastic traction is a simple and effective way for the correction of claw hand deformity after burns with less morbidity and stable results.     

Blepharoplasty: A Personal Tactical Approach

The author presents his tactical approach and personal instruments for blepharoplasties. To remove the skin excess in the upper eyelid, a special half-moon forceps grasps the excess of skin, and with a very sharp scissors, it is removed in just one cut. Treatment of fat pads uses a special hemostatic forceps, unlike the conventional one that has transverse grooves, with longitudinal grooves to prevent fat sliding after the fat pads are cut, thereby preventing problems with hemostasis. In the lower eyelid, wide undermining and excision of a significant strip of skin and muscle allow an adequate correction. Ectropion is prevented, and the correction done is stabilized with orbicular muscle and skin flap anchorage on the lateral canthal tendon. Fifteen years of experience with this technique has provided excellent results.     

Correction of ectropion of the lower lid by upper eyelid skin transposition

A technique for the correction of ectropion of the lower lid by transposition of a full-thickness skin flap from the ipsilateral upper eyelid to the lower lid has been used in seven patients. The technique allows great flexibility in the extent of the approximation of the lower lid to the eye globe. The pedicle is based medially to obtain close contact between the lower punctum and the eye globe. There were no complications. We believe that the eyelid skin flap transposition technique is a useful operation for the correction of moderate to severe senile and paralytic ectropion.     

Oberlid- und Unterlidblepharoplastik

The article describes the indications and techniques for blepharoplasty of the upper and lower eyelids as well as combinations with other eyelid correction techniques. Upper eyelid blepharoplasty may include skin excision with orbital fat modulation as well as ptosis correction and definition of the superior sulcus palpebralis. The main goal of lower lid blepharoplasty is modulation of intraseptal fat and also often the treatment of a lower lid laxity by canthopexy. It is recommended to avoid excessive skin resection in the lower lid. Furthermore techniques to address an ectropium are reviewed and possible complications of blepharoplasty are presented.     

Adolescent scar contracture scoliosis caused by back scalding during the infantile period

The study design was a retrospective study in adolescent scar contracture scoliosis caused by back scalding during the infantile period. The objective of the study was to investigate the pathogenesis, clinical manifestation and treatment of adolescent scar contracture scoliosis caused by back scalding during the infantile period. This condition seldom occurs and is not reported in current English literature. One patient was first treated with skin expansion, back scar excision and skin flap transfer, followed by anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release. One patient was treated with posterior correction with TSRH instrumentation, and thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at an interval of 3 weeks. The deformities of four patients were well corrected. Trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up. Severe scar contracture caused by back scalding during the infantile period could lead to adolescent scoliosis. Its pathogenesis and clinical manifestation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized. The research was approved by the Ethics Committee of Nanjing University.     

Tissue expansion in reconstructive hand surgery: case report

A 22-year-old musician requested the correction of his digital syndactyly deformity without the use of skin grafts. Failure of the original correction to heal primarily resulted in the formation of dense scar tissue. A small, custom-designed tissue expander was inserted within the web space and was slowly expanded. The additional expanded tissue permitted reconstruction of the web space and the sides of the fingers without the use of skin grafts.     

Treatment of cicatricial lagophthalmos: very small orbicularis oculi muscle pedicled skin flap.

There are many methods for the correction of cicatricial lagophthalmos. Skin and soft tissue should be used to reconstruct the defect after release of tension. We used a very small orbicularis oculi muscle pedicled skin flap for the correction of mild to moderate degrees of cicatricial lagophthalmos in six cases. A small skin island flap from near the skin defect, pedicled on the orbicularis oculi muscle, was transposed to fill the defect. The length of the skin flap ranged from 5 mm to 11 mm. With a follow-up period ranging from 6 months to 18 months (mean: 11 months),we obtained satisfactory functional and aesthetic results. The eyelid closure was much improved and the discomfort was relieved. All the flaps survived without any healing problems. This small orbicularis oculi myocutaneous flap is very reliable and has a wide range of motion. This technique can be applied to eyelid-skin defects of various causes.     

上睑皮肤松弛患者的睑缘切口重睑术

目的：探讨经上睑缘切口的重睑成形术,同期矫治上睑皮肤松弛的可行性及其设计要点方法：在术前估测拟祛除松弛皮肤的量及重睑线的位置,沿上睑缘上方1-1．5mm刀刃平行睫毛方向斜上切开上睑皮肤,向上分离至睑板上方,切除多余皮肤,在原设计基础上微调重睑线,并适量切除重睑线下方的眼轮匝肌,将提上睑肌腱膜或睑板与真皮层固定缝合3-5点,形成重睑褶皱,最后缝合切口。结果：自2009年1月至2011年6月间,用此术式共行上睑皮肤松弛患者的重睑成形术57例,术后上睑皮肤松弛均得以矫正,重睑形态关观,瘢痕隐蔽,求美者满意率高。结论：睑缘切口的重睑成形术,对上睑皮肤松弛的求美者能有较好的矫正效果,且具有切口痕迹隐蔽的优点。     

超高频皮肤整形仪在眼袋整形中的应用

目的：寻找一种矫治皮肤弹性差,皮下组织松软型眼袋行之有效的方法。方法：选择对26例皮肤弹性性差,皮下组织松软型眼袋用超高频皮肤整形仪治疗。结果：所有病例均获成功,下睑部位皮肤平坦,无瘢痕形成,皮肤颜色在2个月－3个月,左右逐渐恢复正常,结论：超高频皮肤整形仪矫治皮肤弹性差,皮下组织松型眼袋效果良好。     

Soft Tissue Management and Tibialis Posterior Tendon Transfer in Acute Correction for Neglected Drop Foot Deformity

Acute correction of rigid drop foot deformity can be problematic due to the skin defect that may occur in the medial part of the ankle. The purpose of this study is to present an innovative solution for this problem. We hypothesized that acute correction for rigid ankle contractures without arthrosis might be possible if the medial skin defect could be closed. Therefore, we described a surgical technique for acute functional correction of rigid drop foot deformities. The closure of the medial defect was performed by applying a flap and partial-thickness skin graft. We have retrospectively evaluated the results of 18 patients who were treated between 2010 and 2016 with this technique. The mean age of the patients was 37 ± 9.5 (22-56) years. Foot drop etiology was firearm-related nerve injury. Corrections were performed after 14.6 ± 7.9 (8-38) months following the injury. At the end of an average follow-up period of 44.4 ± 6.2 (37-60) months, 14 of 18 patients (78%) recovered without complications, 3 patients experienced partial loss in the medial skin graft region, and 1 patient developed a superficial infection. None of the patients have developed pes planus. We observed that the ankle flexion contracture, which was 34° ± 9.2° (20°-50°) preoperatively, could reach an average of 2.2° ± 2.5° (0°-6°) dorsiflexion after surgery. We suggest that acute correction and tibialis posterior tendon transfer in the treatment of rigid foot drop deformity can be performed with an effective skin closure with low soft tissue complications.     

Penoscrotal transposition with hypospadias: 1-stage repair.

A 1-stage surgical repair of penoscrotal transposition with hypospadias is described. The basic principles are correction of hypospadias with the best vascularized island penile skin flap used for a new urethra and 2 vascularized sliding skin flaps used for reconstruction of the penile skin, and transposition of the penis to the suprascrotal position in the area of the mons pubis, with mobilization plus midline testicular fixation (inter-orchiopexy) and scrotoplasty. This technique was applied in 42 patients 2 to 9 years old between 1986 and 1991. The complications were 2 urethral stenoses on the proximal anastomosis (1 was treated successfully by urethrotomy and 1 by an open operation) and 2 fistulas (successfully treated by surgery), while 2 patients required additional correction of penoscrotal transposition.     

The use of a tissue expander in club-foot surgery. A case report and review

Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method.     

Lower blepharoplasty: Partially joined skin and muscle flaps

As a method of performing a lower blepharoplasty, the author proposes a partially joined skin and muscle flap. This procedure allows one to resect separately different amounts of skin and muscle for appropriate correction of the lower-lid changes that require an aesthetic blepharoplasty. It also promotes muscle raising with consequent skin flap lifting. This technique resects a large amount of skin in order to achieve a smoother lower eyelid.