A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

Clinical observation of endoscopic skull base reconstruction with an anterolateral thigh free fascia flap

Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is the main treatment for radiation osteonecrosis.The repair after the operation is very important.Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain,aggravating osteonecrosis.This study aimed to verify the feasibility and safety of the ante-rolateral thigh free fascia flap in repairing large skull base defects.Methods:From June 2021 to July 2022,a total of 12 patients with a history of radiotherapy for naso-pharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head&Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects.During the endoscopic operation,a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction.The preoperative and postoperative pain scores were retrospectively analyzed,and the dynamic changes in endoscopic surgery sites were observed.Results:The 12 patients had a median age of 58 y,with 8(66.7%)males and 4(33.3%)females.The median headache score for the patients was 5(4-7)before surgery.The patient's headache was significantly relieved postoperatively,with 11 patients having a score of 0 and one patient having a score of 1.The stench was completely resolved after the operation.There were no serious complications during the perioperative period or 12 months after the operation.Conclusion:The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.

Scalp and Dura Matter Complex Reconstruction Using Free Anterolateral Thigh Flap with Vascularized Fascia

The reconstruction of large scalp and dural defects is difficult. Anterolateral thigh (ALT) flap is now widely used because of its reliable blood supply to the skin paddle. Additionally, ALT can be harvested with a large skin paddle and large, well-vascularized fascia. We have successfully treated eight scalp and dural composite defect cases (five male and three female) using ALT with vascularized fascia. The patients’ mean age was 59.1 ± 20.4 years ranging from 31 to 83 years. The mean dural defect size was 73 ± 21 cm2, ranging from 50 to 120 cm2. There were no postoperative infections, bleeding, cerebrospinal fluid leakage, or meningitis. Further discussion about the usefulness of vascularized fascia may be required and we believe that plastic surgeons, head and neck surgeons, and neurosurgeons should report on the results of dural reconstruction.

Histological Findings of a Local Adipofascial Flap That Was Implanted during Breast Conserving Surgery

We report a patient with breast cancer whose breast was immediately reconstructed using a local adipofascial flap and was then subsequently resected 3 years after the original surgical procedure due to local recurrence. In order to achieve local control of the solitary recurrent lesion, we resected the remnant breast, which gave us a useful opportunity to examine the previously implanted flap histologically. A 33-year-old Japanese female was diagnosed with T2N0M0 breast cancer in the outer area of her left breast and underwent partial mastectomy with immediate reconstruction using a local adipofascial flap. The breast lesion was considered to be invasive ductal carcinoma, scirrhous carcinoma, lymphatic invasion+, venous invasion-, estrogen receptor+, progesterone receptor+, and HER2/neu-. Involvement was noted in three of the twenty-five resected axillary lymph nodes. She received adjuvant hormone therapy, but developed a solitary local recurrence of the skin forty-five months after the initial procedure, for which she received total mastectomy, systemic chemotherapy, and hormone therapy. During the histological examination of the local adipofascial flap that had been implanted into the partial breast defect, normal fatty tissue and the implanted fascia were seen at the implantation site. This is a rare report in which a local flap that was implanted during oncoplastic breast surgery was histologically examined.

Three Reverse Adipofascial Cross Finger Flaps Used for Coverage of Raw Areas on Two Fingers of a Patient with Blast Injury of the Hand—Case Report

We report a case of blast injury to the left hand which resulted in fractures of the fingers with exposure of bones and joints of the phalanges. We used three reverse adipofascial cross finger flaps raised at the same time from 2 fingers to reconstruct adjacent fingers of the patient. The patient recovered well postoperatively and had good range of movement of the fingers. This avoided the complications of the use of regional or distal flaps. To our knowledge, this is the first case reported in which three reverse adipofascial cross fingers flaps are raised at the same time, two of them from an injured finger, to cover three raw areas on two fingers of a patient.

Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

Objective. To study the effects of temporalis myofasdal flap (TMF) transferred to treat the long ankylosis of temporomandibular joint (TMJ). Methods : Seventeen cases with ankylosed condytes received arlhroplasty. The degrees of mouth opening pre- and post-operation were e-vahiated, and the spaces of joints in the X-ray films were also measured. The evaluation of the results of the surgical treatment was based on the TMJ functions. Results .Following up 0. 5-3. 0 years, in 12 of 17 cases the degree of mouth opening improved up to 27 mm. The doctors and the patients were both satisfied with the results. Conclusion:The use of TMF in artkroplasty of temporomandibular joint is a good approach in the treatment of TMJ.

The Combination of Moberg Flap with V-Y Advancement and Reverse Adipofascial Cross Finger Flap for Coverage of Degloving Injury of the Thumb-Case Report

We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.

Temporoparietal Fascia Flaps for Surgical Treatment of Cartilage Exposure After the First-Stage Microtia Reconstruction

Significant improvements have been achieved in microtia reconstruction using an autogenous costal cartilage framework.However,complications such as skin necrosis and cartilage exposure often destroy the final contour of the reconstructed auricle.Local fascia flaps are commonly used in salvage surgery because of their reliability and satisfactory results.Here,we report the case of a 26-year-old woman with multiple skin necroses and cartilage exposure on day 21 after the first-stage microtia reconstruction.The exposure area was covered by a temporoparietal fascia flap as a single-stage procedure.The most essential subunits survived,and the esthetic concours were harmonious and natural at 12 months postoperatively.Temporoparietal fascia flaps are recommended as the surgical treatment for multiple skin necroses and cartilage exposure in microtia reconstruction.The axial-pattern temporoparietal fascia flap is reliable for salvage auricular reconstruction and ensures satisfactory results at long-term follow-up.

AN ANATOMIC STUDY OF ADIPOFASCIAL FLAP OF THE LEG

Objective: To investigate the vascular anatomy of the subcutaneous tissues and fascias of the leg. Methods Four fresh cadaver legs which had been injected with colored latex were dissected under magnification to identify the origin, course an distribution of vessels from the subfascial level to the skin. The adipofascial flap was harvested from the whole medial side of the leg and fascial flap from other leg of the same cadaver. The posterior tibial artery and its first and second supra-malleolus septal arteries were retained in these flaps. Selective injection of China ink through posterior tibial artery was carried out, and dimension of inkstained areas was recorded. Results Three main trunk vessels of the leg gave off branches to deep fascia and subcutaneous tissues, forming a large vascular plexus in the subcutaneous tissues on the deep fascia and a delicate, but dense and well anastomosed vascular plexus beneath the deep fascia. The vascular plexus in the subcutaneous tissues ran deeper than the superficial venous system. The areas stained by selective injection in adipo fascial flaps were larger than those in the fascial flaps. Conclusion Subcutaneous tissues and deep fascia can he considered as an anatomic entity nourished by two very well developed vascular networks which lie on both sides of deep fascia. Incorporation of the deep fascia can not only protect the subcutaneous tissue from being lacerated during raising of the flap, but also enhance vascularity of the adipofascial flap. leaving superficial veins intact while raising the skin flap does not jeopardize the vascular plexus in the subcutaneous tissues and can preserve the superficial lymphatic vessels, so that postoperative edema of the flap or the leg could be avoided.

Influence of Flap Parameters on the Aerodynamic Performance of a Wind-Turbine Airfoil

A numerical method has been used to analyze the flow field related to a NACA 0015 airfoil with and without a flap and assess the influence of the flap height and angle on the surface pressure coefficient,lift coefficient,and drag coefficient.The numerical results demonstrate that the flap can effectively improve the lift coefficient of the airfoil;however,at small attack angles,its influence is significantly reduced.When the angle of attack exceeds the critical stall angle and the flap height is 1.5%of the chord length,the influence of the flap becomes very evident.As the flap height increases,the starting point of the separation vortex gradually moves forward and generates a larger wake vortex.Optimal aerodynamic characteristics are obtained for 1.5%(of the chord length)flap height and a 45°flap angle;in this case,the separation vortex is effectively reduced.

A New Alternative Technique for Preperitoneal Inguinal Hernia Repair: Using Groin Innominate Fascial Island Flap

Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair. Methods: From the February 2010 to December 2010, 15 patients (13 male and 2 female) with inguinal hernia underwent repair with using island groin innominate fascial flap. The follow-up period ranged from 8 to 12 months (mean, 10 months). Results: Seroma developed in one case. Others had not any complications. Conclusion: Because of our technique avoids from the complications and drawbacks of the prosthetic mesh, autograft and abdominal wall flaps, we think that the groin deep fascial flap can be a good alternative to prosthetic meshes for reconstruction of inguinal hernia repair.

两起波音737 MAX空难的致因分析:基于人—自动化交互的FLAP模型

两起波音737 MAX飞机坠毁事故的调查认为,MACS存在致命设计缺陷是导致两起空难的直接原因。MACS的运行逻辑及其行为脱离了机组对波音737系列飞机操控系统的理解,因此两起空难是典型的人—自动化交互失败的案例。FLAP模型有助于研究者以自上而下的、通用化的方法来模拟现今商业运输飞机中与自动化系统相关的问题,利用FLAP模型可以逆向回溯两起空难的成因:除了MACS设计不良之外,波音公司和FAA未遵守航空安全文化是造成两起事故的深层次原因。

Neoadjuvant chemotherapy with capecitabine combined with oxaliplatin for mid-low locally advanced rectal cancer with negative mesorectal fascia:Long-term outcomes of a prospective trial(PKUCH-R03 trial)

Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.

Global hotspots and future directions for drugs to improve the skin flap survival: A bibliometric and visualized review

Skin flaps are frequently employed in plastic and reconstructive surgery to address tissue defects.However,their low survival rates remain a challenge,attributed to vascular crisis and necrosis.Despite numerous studies investigating drugs to alleviate flap necrosis,a comprehensive analysis of the research trend in this critical area is lacking.To gain a deeper understanding of the current status,research focal points,and future trends in drugs aimed at enhancing flap survival,a thorough retrospective analysis is imperative.This study aims to employ bibliometric methods to scrutinize the evolution,mechanisms,and forthcoming trends of drugs targeting flap survival improvement.Using VOSviewer software,we quantitatively and visually depict 1)annual temporal trends in the number of documents and citations;2)national/regional publications and their collaborations;3)institutional and authors’contribution;4)journal contribution and relevance;and 5)analysis of research hotspots and directions derived from keywords.Ultimately,we discussed the prospects and challenges of future advances and clinical translation of drugs designed to enhance skin flap survival.In conclusion,the field of pharmacology dedicated to improving skin flap survival is expanding,and this study aims to offer a fresh perspective to promote the advancement and clinical application of such drugs.

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique

AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021.Inclusion criteria included unilateral mild and moderate ptosis,good levator muscle function(>9 mm)and follow-up of at least 6mo.Pre-and post-operative symmetry was graded subjectively for marginal reflex distance 1(MRD1),tarsal platform show(TPS)and eyebrow fat span(BFS).A t-test was used to evaluate MRD1,TPS and BFS asymmetry by calculating delta values.The Bézier curve tool of the Image J software was used to extract the upper eyelid contours,where the symmetry was measured by the percentage of overlapping curvatures(POC).RESULTS:Totally 105 patients(105 eyelids)were included(mild group,n=84;moderate group,n=21).Postoperatively,all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS.The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively,and it decreased to 0.58±0.67 postoperatively in all cases(P=0.0004).In patients with mild ptosis,the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38(P=0.0187).The symmetry of the upper eyelid contour increased in all subgroups of patients,with a POC of 59.39%±13.45%preoperatively and POC of 78.29%±13.80%postoperatively.CONCLUSION:Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1(all subgroups),POC(all subgroups)and TPS(only mild group),whereas BFS is unaffected.

EXPERIMENTAL TREATMENT FOR OBSTRUCTIVE LYMPHEDEMA BY TRANSPLANTATION OF FASCIAL FLAP RICHED IN LYMPH VESSELS

Objective To provide a more effective microsurgical treatment for obstructive lymphedema.Methods Sixty models of rabbits with lymphedema in right hindlimb were devided into three groups: 20 for fascial flap transplantation (group A), 20 for no treatment (group B) and 20 for anastomosis of lymph vessels and vein (group C) as control. For group A, the posterior branch of medial vein in the normal hindlimb was cut down together with the fascial strip (about 3 cm wide) around it and concomitant lymph vessels, then transferred through the block region of the affected limb. The two broken tips of the vein were anastomosed respectively to normal veins beside the block region. Subcutaneous tissue and skin were sutured at last. For group B, no treatment was carried out. But traditional anastomosis of lymph vessels and vein was used for group C. Postoperative variation of volume was observed and lymphoscintigraphy was made. Results The volume curve of the affected limb in group A kept declining after 2 weeks and nearing to that of the normal hindlimb in group B but away from that of the affected limb in group B. The curve of donor limb in group A was similar to that of the normal limb of group B, which meant no secondary lymphedema occurred in donor limb. The volume of the affected limb of group A had significant difference to that of group C at postoperative 24 weeks, which meant the effect of group A was better than C. The lymphatic drainage of the affected limb of group A was obviously better than B and C in lymphoscintigraphic image. Deposit of nuclein was lessened. Conclusion It was verified that the transplantation of vein-lymph vessels-fatty fascial flap had following advantages: decreased technical difficulty, better long-term effect, almost no chronic lymphedema occurred in donor site, extensive adaptation.

Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction

AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

Optimizing Recovery Following Mihata Superior Capsular Reconstruction Surgery with Tensor Fascia Lata Auto Graft: A Comprehensive Rehabilitation Protocol

Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.

When the Combination of a Chinese Flap and Dufourmentel Makes It Possible to Treat a Hopeless Case of Squamous Cell Carcinoma of the Upper Lip

Cancers of the lip are the leading cause of labial defects, and treatment is essentially surgical. The success of a repair is assessed by two essential criteria: The functional character of the lip (restoration of continence allowing feeding) and the aesthetic quality of the repair. However, for many patients from countries whose medical infrastructure does not allow them to undertake complex reconstructions locally, medical transfers represent their only chance of treatment. The aim of this article is to share with you an extreme clinical case of labial reconstruction, the management of which was a real challenge, using two major flaps: the free ante-brachial flap and the DUFOURMENTEL-type bi-pediculated scalp flap.

The Effect of Fascial Pedicled Island Flap of the First Metacarpal Radial Dorsal Artery Skin Branch Chain on the Repair of Thumb Tissue Defect

Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.