The neurofibromatosis type 1 and skin and soft-tissue tumors forum of the 23rd international congress of plastic and reconstructive surgery was successfully held in Shanghai

On March 23,2024,at the 23rd Shanghai International Congress of Plastic and Reconstructive Surgery,a Neurofibromatosis Type 1 and Skin and Soft-Tissue Tumors Forum was unveiled.This forum aimed to foster multidisciplinary cooperation to standardize the diagnosis and treatment of neurofibromatosis and skin and soft-tissue tumors,attracting leading experts and scholars from across the nation.It served as a pivotal platform for sharing advancements in pathology,clinical practices,and surgical techniques related to these conditions,alongside discussions on standardized care and precision medicine,marking a significant step forward in the field.

Association of daily sitting time and leisure-time physical activity with body fat among U.S.adults

Background:Prolonged sitting and reduced physical activity lead to low energy expenditures.However,little is known about the joint impact of daily sitting time and physical activity on body fat distribution.We investigated the independent and joint associations of daily sitting time and physical activity with body fat among adults.Methods:This was a cross-sectional analysis of U.S.nationally representative data from the National Health and Nutrition Examination Survey2011-2018 among adults aged 20 years or older.Daily sitting time and leisure-time physical activity(LTPA)were self-reported using the Global Physical Activity Questionnaire.Body fat(total and trunk fat percentage)was determined via dual X-ray absorptiometry.Results:Among 10,808 adults,about 54.6%spent 6 h/day or more sitting;more than one-half reported no LTPA(inactive)or less than 150 min/week LTPA(insufficiently active)with only 43.3%reported 150 min/week or more LTPA(active)in the past week.After fully adjusting for sociodemographic data,lifestyle behaviors,and chronic conditions,prolonged sitting time and low levels of LTPA were associated with higher total and trunk fat percentages in both sexes.When stratifying by LTPA,the association between daily sitting time and body fat appeared to be stronger in those who were inactive/insuufficiently active.In the joint analyses,inactive/insuufficiently active adults who reported sitting more than 8 h/day had the highest total(female:3.99%(95%confidence interval(95%CI):3.09%-4.88%);male:3.79%(95%CI:2.75%-4.82%))and trunk body fat percentages(female:4.21%(95%CI:3.09%-5.32%);male:4.07%(95%CI:2.95%-5.19%))when compared with those who were active and sitting less than 4 h/day.Conclusion:Prolonged daily sitting time was associated with increased body fat among U.S.adults.The higher body fat associated with 6 h/day sitting may not be offset by achieving recommended levels of physical activity.

Design of Collagen-Based Hemostatic Material for Use in Plastic and Reconstructive Surgery

This study aims to develop collagen-based hemostatic materials. The sheet-shaped collagen sponge was manufactured by freeze-vacuum drying the aqueous solution of collagen (Col) and heat-denatured collagen (Col’) at a composition ratio of 2/1. The both sides or one side of sponge was treated with ultraviolet (UV) irradiation for 15 minutes to introduce intermolecular crosslinks between collagen molecules. The elution behavior of collagen sponge was investigated by immersing the sponge in water for a predetermined time and then by measuring the weight change. The double-sided UV-irradiated sponge showed very slow elution properties. On the other hand, the single-sided UV-irradiated sponge showed initially fast elution and subsequent very slow elution properties. Such initially fast elution of collagen molecules from the surface without UV-irradiation allows an adhesion of collagen sponge to the wound surface and results in hemostatic effect. In addition, the water absorption and retention properties of sponge were investigated by placing the hydrated sponge on a mesh for a predetermined time and then by measuring the weight change. The double-sided UV-irradiated sponge absorbed 81 times more water than own weight and showed a value of 45 times even after 7 days. The single-sided UV-irradiated sponge absorbed 80 times more water than own weight and showed a value of 39 times even after 7 days. The sponge with high water absorption and retention properties allows a wound healing effect because such sponge can absorb large amounts of blood plasma and exudates containing various cell growth factors. The double-sided UV-irradiated sponge is a good candidate for the wound dressing. On the other hand, the single-sided UV-irradiated sponge is a good candidate for the hemostatic material.

Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training.In this situation,virtual reality technology can help the new nurses.Despite its potential benefits,there are studies on patient satisfaction but there is limited information on the usability of virtual reality(VR)technology for new nurses in giving preoperative education to patients.AIM To investigate the impact on satisfaction,usability,and burnout of a system using VR technology in preoperative patient education.METHODS The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019.Each nurse taught four patients:Two using traditional verbal education and two using virtual reality.The System Usability Scale,After-Scenario Questionnaire,and Maslach Burnout Inventory(MBI)were employed to evaluate the impact of these education methods.RESULTS The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups.Among the three subscales of the MBI,emotional exhaustion and personal accomplishment improved statistically significantly.VR was also better in terms of usability.CONCLUSION This study suggests VR enhances usability and reduces burnout in nurses,but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Classification and reconstructive algorithm for nasal alar defect in Asians

Background:The nasal alar defect in Asians remains a challenging issue,as do clear classification and algorithm guidance,despite numerous previously described surgical techniques.The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients.Methods:A retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022.Based on careful analysis and our clinical experience,we proposed a classification system for nasal alar defects and presented a reconstructive algorithm.Patient data,including age,sex,diagnosis,surgical options,and complications,were assessed.The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale.Results:Among the 32 patients,there were 20 males and 12 females with nasal alar defects.The predominant cause of trauma in China was industrial factors.The majority of alar defects were classified as type Ⅰ C(n=8,25%),comprising 18 cases(56.2%);there were 5 cases(15.6%)of type Ⅱ defect,7(21.9%)of type Ⅲ defect,and 2(6.3%)of type Ⅳ defect.The most common surgical option was auricular composite graft(n=8,25%),followed by bilobed flap(n=6,18.8%),free auricular composite flap(n=4,12.5%),and primary closure(n=3,9.4%).Satisfactory improvements were observed postoperatively.Conclusion:Factors contributing to classifications were analyzed and defined,providing a framework for the proposed classification system.The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians.

3D image system improves the learning curve and contributes to medical education of rhinoplasty

Background: Rhinoplasty is a complex surgical procedure that requires critical analysis and precise design before surgery, making it a challenging operation for both the surgical team and medical educators. This study aimed to evaluate the impact of 3D design involvement on learning curves and to establish a more effective method for rhinoplasty education.Methods: Surgeons who participated in an educational program were divided into two groups. The experimental group was involved in the 3D design before the operation, and the control group was asked to review the rhinoplasty atlas. A self-assessment questionnaire was used to evaluate the learning curve of the eight rhinoplasty procedures for each surgeon, and the overall satisfaction rate data were also collected.Results: The self-assessment scores in both groups showed an increasing trend from the first to the eighth operation. The mean scores of the experimental group were significantly higher than those of the control group at the fifth operation(P=0.01). The satisfaction rate of the experimental group(91.7%) was higher than that of the control group(54.5%).Conclusion: The 3D imaging system can improve the learning curve and satisfaction rate of rhinoplasty education,proving that it is an easy and effective tool for medical education.

Characteristics and mechanisms of subcutaneous and visceral adipose tissue aging

Aging is one of the most significant health challenges worldwide and is a primary cause of chronic diseases and physiological decline.Among the myriad changes that occur with aging,alterations in adipose tissue distribution and function have gained considerable attention because of their profound impact on metabolic health and overall well-being.Subcutaneous adipose tissue(SAT)and visceral adipose tissue(VAT)are the two major depots of white adipose tissue,each with distinct roles in metabolism and health.Understanding the characteristics and underlying mechanisms of SAT and VAT is crucial for elucidating the aging process and developing strategies to promote healthy aging.This review focuses on delineating and analyzing the characteristics and intrinsic mechanisms underlying the aging of subcutaneous and visceral adipose tissue during the aging process,which can contribute to a better understanding of the aging process and enhance healthy aging.

A treatment recommendation for trichoepithelioma:Thoughts on selection of treatment timing and method

In this report,we present the case of a 55-year-old woman with a 30-year history of multiple familial trichoe-pithelioma(MFT),with facial surface tumors that progressively worsened,causing ventilation disorders.In order to improve the patient’s appearance and functional impairment,we performed a two-step surgical excision and skin grafting procedure post diagnosis through genetic testing.The 18-month follow-up confirmed that the effect was satisfactory without obvious recurrence.Based on this outcome,we have developed a diagnosis and treat-ment process for patients with MFT,aiming to provide a reference for standardized treatment of this rare disease.

Classification and a decade-long follow-up of rat bite injuries in the nasal region

Background:Nasal defects due to rat bites are frequently encountered in rural regions of China.In addition to serving as disease vectors,rats can also inflict bite injuries.In this study,we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period.Methods:We retrospectively reviewed hospital records for patients admitted due to rat bites.This study outlines the demographics,clinical features,and follow-up outcomes supported by comprehensive photo documentation of the patients’progress.Results:Twenty-five patients,with a mean age of 29 years,were admitted due to rat bites.Treatment was provided for three distinct types of injuries:nasal tip defect(type Ⅰ),nasal defect(type Ⅱ),and full-thickness nasal defect with loss of surrounding tissues(type Ⅲ).All patients recovered fully.Conclusions:The treatment for rat bites should be based on the wound type.The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected.We recommend early surgical intervention,along with psychological therapy,to prevent interference with growth and development.

Dermal thickness,rather than drug concentration and injection speed,influences the effective area of botulinum toxin type A in the dermis

Background:Recently,microbotulinum,a new technique that involves injecting botulinum toxin type A(BoNTA)microdroplets into superficial cutaneous tissue,has gained popularity.The precise distribution of BoNTA in the targeted area profoundly affects outcomes.Many factors may influence the effective area of BoNTA in the dermis.This study aimed to determine the dermal distribution properties of BoNTA to guide microbotulinum injection.Methods:Ten healthy males aged 18–65 years without BoNTA treatment in the previous year were recruited to receive intradermal injections in the chest and back.Ultrasound was used to ensure the intradermal delivery of injections and measure the dermal thickness.The minor iodine starch test was performed at baseline and 3 days,7 days,21 days,1 month,and 2 months after treatment.Results:All participants received intradermal injections.The dermis was thinner on the chest(thickness,0.20±0.03 cm)than on the back(thickness,0.39±0.07 cm)(P<0.05).An injection in the thicker dermis had a significantly smaller effective area at every follow-up visit.The drug concentration did not affect the effective area except at 3 days after treatment.Injection speed did not influence the effective area at any follow-up visits.Conclusion:An injection in a thicker dermis leads to a smaller effective area for intradermal injections.When the BoNTA dose is the same,the drug concentration and injection speed do not matter.

Impact of a new teaching model on the fine cosmetic suturing operation and quantitative assessment of the training effect on plastic surgeons

Background Traditional lecture-based teaching(TLT)has long been the primary method of teaching plastic suturing techniques and even surgical education.It has been challenging to adapt this approach to fit the educational objectives of plastic surgery,which is a very practical science.Additionally,it is mainly teacher-led,and the course content is teacher-driven,which has disadvantages such as difficulty in motivating students and disconnection from clinical practice.Therefore,we developed a video point-to-point teaching(VPT)method and teamwork-based teaching(TBT)to study the effect of the new teaching model on fine cosmetic suturing operation(FCSO)and training outcomes for plastic surgeons.Methods We selected 30 junior doctors from the Department of Plastic and Reconstructive Surgery of the Chinese PLA General Hospital.All trainees were randomly assigned to three groups:TLT,VPT,and TBT.All trainees had their performances photographed,and a senior attending physician was appointed as a rater.We rated the process and results of FCSO according to a uniform rubric following the double-blind principle to compare the effects of different teaching modes on the trainees’FCSO and differences in training outcomes.Results There was no significant effect of video recording on trainees’FCSO(P>0.05).The total scores of the first suturing in the three groups were as follows:TLT group(13.18±1.66),VPT group(13.63±1.97),and TBT group(13.50±2.26),with no significant difference among the groups(P>0.05),indicating that the starting level of the trainees in the three groups was basically the same.There was no significant difference(P>0.05)between the VPT(20.30±2.17)and TBT(20.38±2.29)groups,but both of these groups were significantly better than the TLT group(16.43±1.86,P<0.01).Conclusion The TBT and VPT methods are significantly better than TLT.However,the TBT method is more economical and optimal for teachers and better utilizes students’initiative in learning and operation,which improves the teaching level and training efficiency.

Comparison of Plastic Surgery Training Programs Between Hong Kong and Shanghai

The field of plastic surgery has developed rapidly in the last couple of decades in Hong Kong and Shanghai,China.Both cities have their own educational system for training plastic surgeons.Their training programs differ in many ways,including the surgical exposure of undergraduate studies,the structure,curriculum,and operative requirements of residency training.In general,Hong Kong has a single pathway of residency training with more early clinical exposure in an undergraduate study.On the contrary,Shanghai has multiple pathways of residency training that are heavily emphasized in academic research.Both Hong Kong and Shanghai should complement each other to modify their plastic surgery training programs that will eventually benefit the field of plastic surgery education。

<i>Aloe vera</i>—Mechanisms of Action, Uses, and Potential Uses in Plastic Surgery and Wound Healing

Aloe vera has been used for centuries for medicinal purposes. Clinical and experimental evidence indicates usefulness for skin moisturization, promoting wound healing, thermal skin injury, frostbite, and ischemic skin insults. Aloe vera has anti-inflammatory, vasodilatory, antimicrobial, and proliferative actions, which have been investigated in various experimental models and in various in vitro studies. This extensive literature review of the properties and actions of Aloe vera finds substantial evidence for the reported and also likely clinical usefulness for Aloe vera in Plastic Surgery and in wound care and wound healing. Though further clinical investigation is warranted, Aloe vera use may likely be indicated in situations where its effects could positively influence outcomes, such as wound healing, flap vascularity, and inflammatory skin pathologies.

Vascular anomalies workshop held successfully at the 21st Shanghai International Conference of Plastic and Aesthetic Surgery

July 20 and 21,2022,witnessed the highlight of the 21st Shanghai International Conference of Plastic and Aesthetic Surgery,a successful vascular anomalies workshop titled“Advancements in the Management of Vascular Anomalies”at Shanghai Ninth People’s Hospital.The conference was graced by many renowned specialists and scholars from China and abroad who presented lectures and panels on cutting-edge debated concepts and technological progress in the field.Amid the coronavirus disease 2019(COVID-19)pandemic,specialists from numerous fields have delivered rich content in person and virtually to participants across China.Prof.Xiaoxi Lin’s team from Shanghai Ninth People’s Hospital,a leading center in the field of infantile hemangioma and vascular malformation in China,collaborated with colleagues on new developments using teaching and discussion.

The 3rd Neurofibromatosis Forum of the 21st Shanghai international conference on plastic and aesthetic surgery was held in Shanghai

Recently,the 11th Shanghai Plastic Surgery Forum and the 21st Shanghai International Plastic and Aesthetic Surgery Conference were successfully held in Shanghai.Among them,the Neurofibromatosis Forum was held on July 23,attracting thousands of experts and scholars,patients and their families,news media,and other stakeholders in China.The conference,hosted by the Ti-Sheng Chang’s Plastic Surgery Development Foundation and co-organized by Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.

Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery:A case report

BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.

Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Successful treatment of a rare subcutaneous emphysema after a blow-out fracture surgery using needle aspiration:A case report

BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.

Treatment of mild and moderate congenital ptosis via the levator imbrication technique

Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s muscle.Meanwhile,both the levator palpebrae superioris and the Müller’s muscle play a synergistic role to elevate the upper eyelid.Thus,to protect the Müller muscle and minimize injury,we developed and applied a levator imbrication technique in patients with mild and moderate congenital ptosis and followed it up to evaluate its clinical efficacy.Methods:This retrospective case series included 53 patients with mild and moderate congenital ptosis,all of whom had undergone ptosis correction using the levator imbrication technique at the Plastic and Aesthetic Department of the Second Affiliated Hospital of Zhengzhou University between June 2018 and June 2020.The outcomes of correction,upper eyelid appearance,and operative complications were observed and analyzed.The postoperative follow-up was 3–12 months.Results:Fifty cases of ptosis were fully corrected,and the bilateral double eyelids were smooth and natural.The eyelids of 20 patients were incompletely closed immediately after the operation but were able to close spontaneously within 2 weeks.No serious complications such as exposure keratitis were reported.Three patients with undercorrection underwent reoperation 3 months after the first operation,and ptosis was corrected.Conclusion:The levator imbrication technique for mild and moderate congenital ptosis is simple to perform and shortens the operation time with less damage,stable postoperative outcomes,and no long-term complications.

Continuous wound infusion of local anaesthetic agents following colorectal surgery:Systematic review and meta-analysis

AIM:To provide a specifi c review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparoto-my for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a sig- nificant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a signifi cant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local an- aesthetic wound infusion was associated with a signifi - cant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no signifi cant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic re- view and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major color- ectal surgery is a promising technique but do not pro- vide conclusive evidence of benefi t. Further research is required including cost-effectiveness analysis.