Ru Zhao

Perineum reconstruction with pedicled anterolateral thigh fasciocutaneous flap

Eighteen pedicled anterolateral thigh perforator island flaps were used for complex perineal reconstructions between May 2003 and May 2005. The patients’ average age was 48.6 years (range, 32 to 64 years), and the average follow-up period was 8 months (range, 2 to 13). In 7 cases, the perforator was septocutaneous and in 11 it was intramuscular. The application of the pedicled anterolateral thigh fasciocutaneous flap is described perineum reconstruction. The size of the perineum defects ranged from 6 × 9 cm to 16 × 17 cm, and the size of the transferred flap ranged from 8 × 11 cm to 18 × 20 cm. All flaps survived. One patient developed minor wound dehiscence in the posterior aspect of the perineal wound because of fecal contamination and skin maceration. The esthetic appearance of the reconstructed perineum was good. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the flap, the authors conclude that this is a safe and reliable flap for perineal reconstruction.

Management for Postoperative Complications of Breast Augmentation by Injected Polyacrylamide Hydrogel

Polyacrylamide hydrogel, a new biomaterial, has been used for injected breast augmentation in China since 1997. A series of 30 patients with various complications after injected polyacrylamide hydrogel visited the author’s department. Most of these patients had undergone injection of both breasts. The average age of the patients was 27.6 years, and the time of consultation for the complications was from 3 to 36 months postopertively. Nearly all the patients had breast lumps and other common complications including breast pain, disfigurement, and infection. Ultrasound examination showed diffuse, irregular, anechoic zones of mammary tissue. Pathologic results indicated inflammatory cell infiltration and fibrous capsular formation. An open suction technique and partial mastectomies via periareolar incisions were performed for the all patients. Most of their symptoms were relieved after removal of the polyacrylamide hydrogel. Only one patient had undergone immediate breast reconstruction with implants, whereas five patients had received breast implants secondarily via an axillary incision. The authors conclude that polyacrylamide hydrogel should be prohibited for injected breast augmentation before more scientific data are available about the long effect of the gel in breast tissue.

A new technique of vaginal reconstruction with the deep inferior epigastric perforator flap: a preliminary report.

Background: Vaginal reconstruction after tumor resection or in congenital vaginal agenesis remains a challenging area in surgery, with many techniques previously described underlining the continued search for an ideal method. In this preliminary report, a series of patients are presented who underwent vaginal reconstruction using a deep inferior epigastric artery perforator (DIEP) flap. Methods: Between May of 2004 and February of 2005, five patients underwent vaginal reconstruction using the pedicled DIEP flap. Four patients had congenital vaginal agenesis and one had a complete vaginal resection because of a tumor. Results: The flaps ranged in size from 9 × 10 cm to 11 × 12 cm. All flaps survived, although one patient developed a posterior space hematoma that required draining. Of the five patients, two were sexually active and enjoyed satisfactory penetrative intercourse after reconstruction. Conclusions: This series demonstrates that a new vagina can be created from the pedicled DIEP flap and that the reconstruction is reliable, with low donor-site morbidity. The major disadvantage of this technique is the conspicuous abdominal scar.

Free anterolateral thigh adipofascial flap for hemifacial atrophy.

Though the etiology of hemifacial atrophy is still unknown, the aim of its reconstruction is cosmetic amelioration of the defect. Among many techniques introduced, microsurgical reconstruction has become the gold standard to restore the symmetry of the face. Seven free anterolateral thigh adipofascial flaps were used to reconstruct hemifacial atrophy between September 1999 and May 2005. There were 1 male and 6 females in the series. All the patients had unilateral disease (6 right and 1 left). The average age of onset of disease was 11.9 years. The average duration of atrophy was 6.7 years. The patients’ average age was 25 years (range, 21 to 32 years), and the average follow-up period was 12.6 months (range, 6 to 36). The size of the transferred flap ranged from 8 × 6 cm to 12 × 13 cm. All adipofascial flaps survived completely. No complications occurred. The result is stable, and no recurrence of facial atrophy was seen in the patients after follow-up. One patient received minor revision because of the bulky reconstructed face. The esthetic appearance of the reconstructed face was acceptable. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the anterolateral thigh adipofascial flap, the authors conclude that this is a safe and reliable adipofascial flap for hemifacial atrophy.

Reduction mammaplasty and correction of ptosis: Dermal bra technique

&NA; A new technique for reduction mammaplasty or mastopexy techniques is presented, which the authors call the dermal bra. The surgical steps are described point by point. A series of 36 patients underwent reduction mammaplasty or mastopexy by means of this technique front January of 1998 to April of 2001. Thirty‐two patients were followed; 28 presented satisfactory results, including a good mammary appearance, invisible scar, good and stable breast projection, and lasting results. Nipple‐areola complex sensitivity was unchanged in all 32 patients. The overall complication rate was 12.5 percent (one patient suffered purse‐string suture exposure, and three had a cutaneous rend). The advantages and disadvantages of this technique are discussed. (Plast. Reconstr. Surg. 111: 1122, 2003.)

Anterolateral thigh flap-based reconstruction for oncologic vulvar defects.

Background: Vulvar defects after tumor extirpation always require immediate reconstruction. Transferring a skin flap from a distant region may be required for large defects. Although the anterolateral thigh flap has gained popularity in other types of oncoplastic surgery, it has rarely been reported for vulvar reconstruction. The aims of this retrospective study were to evaluate the outcome of anterolateral thigh flap–based vulvar reconstruction and to develop an operative strategy. Methods: Eleven patients with vulvar carcinoma underwent resection and immediate reconstruction with the anterolateral thigh flap between 2005 and 2009. Based on defect type and local soft-tissue quality, four types of anterolateral thigh flap–based reconstructions were performed: unilateral anterolateral thigh flap, ipsilateral anterolateral thigh flap combined with contralateral advancement flap or local flap, fenestrated anterolateral thigh flap, and split anterolateral thigh flap. Postoperative complications were recorded and clinical outcomes were evaluated. Results: Partial flap necrosis occurred in one patient with a fenestrated anterolateral thigh flap for bilateral reconstruction. One wound dehiscence occurred in the contralateral local flap. Two patients had prolonged serous drainage. Mean follow-up was 8 months. One patient developed stricture of the urethral meatus and another had regional metastasis. Conclusion: With careful design, the anterolateral thigh flap may provide reliable and durable soft-tissue coverage for various vulvar defects with good outcomes and minimal donor-site morbidity.

Microsurgical correction of progressive facial hemiatrophy using free anterolateral thigh adipofascial flap.

BackgroundThe etiology of progressive facial hemiatrophy is unclear according to resent research. The diseases lack effective treatments. The purpose of this study was to introduce a technique that restores the cosmetic amelioration effectively using free anterolateral thigh adipofascial flap through anastomosis. MethodsFrom September 1999 to June 2011, a total of 14 patients were subjected to correction with revascularized free anterolateral thigh adipofascial flaps at the first stage. Some of them performed additional procedures, such as dermal fat flap filling, lipoinjection, liposuction, and thinning of the flap, were used for secondary minor deformities after the first-stage operation. The donor sites were closed primarily without skin grafting or other flap transplantation. ResultsAll of the flaps survived, and the effect is stable during the follow-ups. Patients were quite satisfied with the symmetry and plumpness of the reconstructed faces. The donor sites were sutured directly and healed at the first stage; there were no obvious morbidities and dysfunctions. ConclusionsThe anterolateral thigh adipofascial flap can provide adequate tissue with reliable blood supply, pliability, ease of revision, and minimal morbidity and dysfunction at the donor site. It is a safe, stable, and effective technique for hemifacial atrophy.

Congenital Infiltrating Lipomatosis of the Face: Case Report and Literature Review

Rationale Congenital infiltrating lipomatosis of the face (CILF) is a rare disorder characterized by collections of nonencapsulated mature lipocytes that infiltrate surrounding tissues. In this article, we would report a new case of CILF, which may be one of the first few cases reported in China. Patient Concerns An 8-year-old boy presented with a hyperplasia of subcutaneous tissue of his left face, which had been gradually progressing since birth, resulting in a marked facial asymmetry. Then he underwent an operation of resection of the subcutaneous mass, and the postoperative pathological analysis reported a mature adipose tissue. Diagnoses and Outcomes The diagnosis of CILF was finally made according to a comprehensive consideration of the patients situation. We then searched different databases for studies that had investigated CILF, reviewed those literatures, and gave our summaries for such a rare disease. Lessons Congenital infiltrating lipomatosis of the face is an extremely rare disease. There is so much unknown about it, and the gradual progress and recurrence make it even harder to cure. Besides, the psychological impact on such patients must be considered. Thus, a proper collection and analysis of the reports of such a disease are very important.

Acute marjolin ulcers: a nebulous diagnosis.

To the Editor: We read with great interest the article of Chang et al entitled ‘‘Acute Marjolin’s Ulcers: A Nebulous Diagnosis.’’ The authors presented 3 cases of acute Marjolin’s ulcer, comprehensively reviewed the published articles, and argued that the types of acute and chronic might be defined without careful deliberation, which might merely add challenge to clinical practice. As plastic and reconstructive surgeons ourselves, we were greatly impressed by the authors’ intelligence and courage on questioning such a deep-rooted conception, which was used as granted for almost a century. In all, 21 cases of Marjolin’s ulcer were treated during our 9-year practice, among which only 1 case was diagnosed as acute. Experiencing a 12-month long of repeated ulceration after the initial injury, oil burn at nasal dorsum while cooking, a 74-year-old woman sought for treatment. Thereafter, the biopsy revealed moderately to well-differentiated squamous cell carcinoma (Fig. 1). A nasolabial flap was carried out after complete tumor removal, and the patient remained recurrence free in a 4-year follow-upperiod. The remarkably rare incidence makes it impossible to compare the characteristics and prognosis of the subtypes of Marjolin’s ulcer in a single center; we do suggest that nonhealing/repeated ulceration needs to be paid particular attention to. According to our practice, the incomplete healing group presented an average latency period of 9.6 T 10.5 years, significantly lower than the completely healed group (37.1 T 15.2 years), which is consistent with the findings of Chang et al that two third of their cases and 70% (7/10) published acute cases with known presentation had a pattern of nonhealing/repeated ulceration. Chronic irritation with repeated attempts at reepithelialization contributes to malignancy, for the persistence of abnormal epithelial cell biological activity, the chronic irritation theory of Marjolin’s ulcer may rationalize this phenomenon. Another noteworthy phenomenon is that 63.6% (7/11) of our patients with chronic intact scars developedMarjolin’s ulcer within a year after the skin broke down spontaneously or accidentally, which endows the importance of postulceration phase in the latency period, then biopsy should be performed on any suspicious ulceration. Thus, instead of subtyping Marjolin’s ulcer arbitrarily, basing on the length of latency period, we would like to propose the necessity of examining the significance of postulceration period, as chronic ulceration may affect the differentiation degree of epithelial cells and, subsequently, the prognosis of Marjolin’s ulcer.

Long-term efficacy and safety of polyacrylamide hydrogel injection in the treatment of human immunodeficiency virus-related facial lipoatrophy.

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