Analyzing the correlation among the five indications of the regenerative effectiveness of expanded skin:A retrospective study of 277 expansion cases

Background:Skin expansion is a useful method for harvesting extra tissue.However,the outcome is hardly predictable.Methods:A total of 158 patients with 277 expanded skin cases were reviewed and evaluated via photographs.The review and evaluation were conducted to determine the skin’s regenerative condition.The overall texture of the expanded skin,which was deemed good,fair,or poor,was evaluated.The occurrence of five indications of the limitation of skin regeneration(thinning,color change,stretch marks,varicose vessels,and skin lesions)during expansion was recorded.The correlation between the five indications and the overall texture was statistically analyzed.Results:Among the 277 retrospectively reviewed expansion cases,the occurrence rate of skin deterioration showed significant differences between the expansion sites(P<0.01).Skin deterioration was most commonly seen on the neck and at the back.The occurrence of each indication varied among locations.The odds ratios of color change,stretch marks,varicose vessels,thinning,and skin lesions between good and poor skin conditions were 44.97,5.09,22.26,89.79,and 4.61,respectively(all P<0.001).Conclusion:Skin color,stretch marks,varicose vessels,thickness,and skin lesions are closely correlated with the skin regenerative capacity.An integrated evaluation can help predict the regenerative capacity of expanded skin.

VISCOELASTIC CHARACTERISTICS OF EXPANDED SKIN AFTER GRAFTING

The expanded skin specimens of dogs and their controls atdifferent stages after grafting were studied. The stress-strain,stress-relaxation viscoelastic characteristics and tensile strengthwere measured. The results show that, during the initial stage aftergrafting, the biomechanical properties of expanded speci- mensdeviate from those controls significantly. But the biomechanicalproperties of expanded speci- mens and their controls begin to closegradually in a longer recovering time. And when the recovering timereaches 24 weeks or longer, the experimental specimens exhibit thesame mechanical characteristics as their controls. It is shown thatviscoelasticity of expansive skin varies with time after grafting.

Double Forehead Expanded Flaps for Reconstruction of Total Nasal Defect: A Case Report

Objective To introduce a method for total nasal defect reconstruction with a double forehead expanded flap.Case presentation A 55-year-old man underwent three-stage total nasal reconstruction for a complete nasal defect due to electrical injury.The skin expander was implanted during the 1st stage.Total nasal reconstruction was performed with double expanded forehead flap transfer during the 2nd stage.The unilateral forehead flap was used for lining and the contralateral forehead flap,together with the autologous cartilage and titanium mesh framework,were used for skin replacement.The forehead donor defect was covered with a skin graft.Pedicle division and inset were performed in the 3rd stage.Results There was no flap loss,infection,hematoma,rhinostenosis,or implant exposure over the 2-year follow-up,and satisfactory aesthetic results were achieved.Conclusion The double forehead expanded flap method is useful for the reconstruction of large composite nasal defects in patients who are not suitable for nasolabial flaps and those who may not tolerate free tissue transfer.The operation has fewer complications and is uncomplicated.

Application of Autologous Costal Cartilage Scaffold in Reconstruction of Microtia Ear

Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia reconstruction in our hospital were selected,all of whom were type II or type III pediatric deformities.All patients underwent auricle reconstruction and retroauricular skin expansion and autologous costal cartilage stent.The first stage of the operation is to insert a skin dilator behind the residual ear and inject water to expand.The second stage of the operation is to carve and repair the soft ribs(usually 6 or 7 ribs)from the body,make a three-dimensional auricle support for auricle reconstruction,place a negative pressure drainage tube,and follow up for 3 to 6 months to observe the three-dimensional shape of the reconstructed auricle and the formation of cranioauricular angle.Results 41 patients with microtia had good three-dimensional shape of auricle reconstruction,normal auricle position,moderate cranioauricular angle,good helix and triangular fossa structure,and good bilateral symmetry.Patients and their families were satisfied with the effect of auricle reconstruction.Conclusion Autologous costal cartilage is a good scaffold for auricle reconstruction.It is through efficient and elaborate carving and splicing that a good three-dimensional auricle structure can be formed.Combined with early flap expansion,a good postoperative appearance effect can be obtained,which is the appropriate method for auricle reconstruction at present.

Fat grafting in autologous breast reconstruction:applications,outcomes,safety,and complications

Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability;it can be used independently to replace more invasive flap procedures or implants,or as an adjunct for smaller volume supplementation.The breadth of applications in the breast necessitates diversity in technique and approach,and while there is no universally agreed-upon protocol,basic principles have guided the evolution of some commonly adopted tenets.Broadly,fat grafting outcomes are highly favorable but dependent on patient and procedure factors,requiring learned patient selection and expertise in recipient site assessment.Common complications from fat grafting,such as fat necrosis and the development of nodules,are particularly troublesome for post-oncologic patients,requiring considerable pre-surgical consultation for patient education and managing expectations.In addition to volume and contour augmentation,fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or postmastectomy pain syndrome,improved skin quality and reduced fibrosis following radiation,and possible anti-tumorigenic effects.New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma.Preclinically,research towards safe and effective regenerative medicine approaches is actively underway,with the ultimate goal of achieving predictable and increased graft retention,reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.