中华烧伤与创面修复杂志

Refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery

Hao Dongyue, Song Baoqiang, Dong Liwei, Cang Zhengqiang

, Available online , doi: 10.3760/cma.j.cn501225-20250929-00409

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Objective To summarize the refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery. Methods This study was a retrospective study of case series. From July 2015 to June 2025, 1 136 patients (1 187 ears) with congenital microtia who met the inclusion criteria were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University, including 781 males and 355 females, aged 8-40 years. All the patients underwent total expansion auricular reconstruction surgery, which was performed in 3 stages, including skin and soft tissue expander implantation in the stage Ⅰ surgery, costal cartilage harvesting+expanded flap and residual ear management+cartilage framework fabrication and implantation in the stage Ⅱ surgery, and residual ear revision+earlobe transposition in the stage Ⅲ surgery. The postoperative complications in stages Ⅰ, Ⅱ, and Ⅲ were observed and recorded, and the complication rate was calculated. At the last follow-up, patients' satisfaction with the surgical outcome was surveyed using a self-designed satisfaction scale, and the satisfaction rate was calculated. Results Postoperative hematoma occurred in 33 patients, including 17 cases after the stage Ⅰ surgery, 15 cases after the stage Ⅱ surgery, and 1 case after both the stage Ⅰ and Ⅱ surgeries. Cartilage framework infection occurred in 15 patients after the stage Ⅰ surgery, helix cartilage fracture occurred in 3 patients after the stage Ⅱ surgery, and cartilage framework deformation occurred in 12 patients after the stage Ⅱ surgery. The complication rate of patients was 5.5% (63/1 136). At the last follow-up during 3 months to 4 years after the stage Ⅲ surgery, 957 patients were satisfied with the surgical outcome, 156 patients were basically satisfied, and 23 patients were dissatisfied, with satisfaction rate of 84.2% (1 113/1 136). Conclusions Total expansion auricular reconstruction achieves sufficient skin tissue volume after expansion without skin grafting, a well-formed reconstructed auricle with few complications, and high patient satisfaction with the surgical outcome.

Application of pectoralis major fascia in robotic nipple-sparing mastectomy immediate breast reconstruction with gel implant

Chen Kuo, Lyu Pengwei

, Available online , doi: 10.3760/cma.j.cn501225-20250807-00351

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Objective To preliminarily evaluate the feasibility, safety, and early aesthetic outcomes of using the pectoralis major fascia in robotic nipple-sparing mastectomy immediate breast reconstruction with gel implant (RNSMIBR). Methods This study was an retrospective cohort study. From November 2023 to April 2025, 34 female breast cancer patients who met the inclusion criteria and were treated at the First Affiliated Hospital of Zhengzhou University. Seventeen patients, aged 43±7 years, who underwent posterior subpectoral pocket expansion using a titanium mesh patch in RNSMIBR surgery were included into titanium mesh patch group, and 17 patients, age 46±7 years, who underwent posterior subpectoral pocket expansion using the pectoralis major fascia in RNSMIBR surgery were included into pectoralis major fascia group. Surgery-related complications during postoperative hospitalization and within 30 days after discharge were recorded and graded using the Clavien-Dindo classification. At the follow-up of approximately 3 months postoperatively, the BREAST-Q scale was used to score the patients' satisfaction with breast appearance, their psychosocial well-being, and satisfaction with medical care. Results During hospitalization and within 30 days after discharge, three patients in the titanium mesh patch group experienced grade I complications. In the pectoralis major fascia group, three patients experienced grade I complications and three patients experienced grade Ⅲb complications and the the grade Ⅲb complication in one patient was radiotherapy-related. No other complications occurred in the two groups. There was no statistically significant difference in the Clavien-Dindo classification of surgery-related complications between the two groups of patients (P>0.05). At the follow-up of approximately 3 months postoperatively, the BREAST-Q scale scores were 92±5 in the titanium mesh patch group of patients and 79±28 in the pectoralis major fascia group of patients, respectively, with no statistically significant difference between the two groups (t=1.85, P>0.05). Conclusions The pectoralis major fascia-assisted expansion may serve as an alternative option of expansion in RNSMIBR when titanium mesh patch is unavailable or cost-prohibitive. For patients requiring postoperative radiotherapy, titanium mesh patch or other materials that do not rely on vascular supply are still preferred to balance aesthetic outcomes and complication control.

Clinical application value of color Doppler ultrasound in the repair of skin and soft tissue defects in the extremities using the anterolateral thigh perforator flaps pedicled with the oblique branch of the lateral circumflex femoral artery

Sun Fengkun, Wang Limin, Song Xinghua, Zhao Xudong

, Available online , doi: 10.3760/cma.j.cn501225-20240623-00247

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Objective To investigate the clinical application value of color Doppler ultrasound in the repair of skin and soft tissue defects in the extremities using the anterolateral thigh perforator flaps (ALTPF) pedicled with the oblique branch of the lateral circumflex femoral artery. Methods This study was a retrospective cohort study. A total of 30 patients admitted to Dongying Traditional Chinese Medicine Hospital from March 2018 to November 2020 who met the inclusion criteria were selected as the control group. The patients underwent repair of skin and soft tissue defects in the extremities using the ALTPF which pedicled with the oblique branch of the lateral circumflex femoral artery and designed and harvested based on the surgeon's clinical experience. Another 30 patients admitted to the same hospital from December 2020 to May 2023 who met the inclusion criteria were selected as the ultrasound group. The patients underwent repair of skin and soft tissue defects in the extremities using the ALTPF pedicled with the oblique branch of the lateral circumflex femoral artery and designed and harvested according to preoperative color Doppler ultrasound results. Among the patients, there were 49 males and 11 females, aged 19-60 years. After debridement, the wound areas ranged from 6.0 cm×3.0 cm to 13.0 cm×11.0 cm, and the harvested areas of ALTPF ranged from 7.0 cm×4.0 cm to 18.0 cm×8.0 cm. The donor site wounds were directly sutured. For patients in the ultrasound group, the consistency between the classification of the oblique branches of the lateral circumflex femoral artery and the number of its perforating vessels determined by the preoperative color Doppler ultrasound examination and the intraoperative exploration results was analyzed; the diameters of the oblique branches of the lateral circumflex femoral artery at its origin, the diameters of the vessels at the perforation points of its perforating branches, as well as the length of the vascular pedicle were compared between the preoperative color Doppler ultrasound examination and the intraoperative exploration. For patients in the two groups, the blood supply status of the flaps on postoperative days 1, 3, 5, 7, and 14 was scored using a flap blood supply assessment scale; the duration of flap surgery, intraoperative blood loss, and length of hospital stay were recorded; the incidence of tension blisters and venous crisis in the flap recipient areas within one week after surgery and flap necrosis within two weeks after surgery were recorded, and the incidence of incision dehiscence in the flap donor areas within two weeks after surgery and abnormal scar hyperplasia, sensory abnormalities, and decreased motor function within one year after surgery were recorded. One year after surgery, the satisfaction of patients in the two groups with the treatment outcomes was evaluated using a Likert 5-point scale. Results For patients in the ultrasound group, the preoperative color Doppler ultrasound examination revealed that the oblique branch of the lateral circumflex femoral artery was type 1 in 17 cases, type 2 in 5 cases, type 3 in 3 cases, type 4 in 3 cases, and type 5 in 2 cases, which was completely consistent with the intraoperative exploration findings (with Kappa coefficient of 1.00, P<0.05). The number of perforating vessels of the oblique branch of the lateral circumflex femoral artery detected by the preoperative color Doppler ultrasound examination showed a high degree of consistency with the intraoperative exploration results (with Kappa coefficient of 0.80, P<0.05). There were no statistically significant differences in the diameters of the oblique branches of the lateral circumflex femoral artery at its origin, the diameters of the vessels at the perforation points of its perforating branches, as well as the length of the vascular pedicle between the preoperative color Doppler ultrasound examination and the intraoperative exploration (with t values of 0.60, 0.85, and 0.78, respectively, P>0.05). On postoperative days 1, 3, 5, 7, and 14, the scores of flap blood supply status in the ultrasound group of patients were significantly higher than those in the control group (with t values of 8.64, 10.41, 10.84, 8.99, and 6.37, respectively, P<0.05). The duration of flap surgery and length of hospital stay in the ultrasound group of patients were significantly shorter than those in the control group (with t values of 5.34 and 3.73, respectively, P<0.05), and the intraoperative blood loss was significantly less than that in the control group (t=18.37, P<0.05). The incidence of complications in the flap donor and recipient areas in the ultrasound group of patients at different time points after surgery was significantly lower than that in the control group (P<0.05). One year after surgery, the satisfaction rate of patients with the treatment outcomes in the ultrasound group was significantly higher than that in the control group (P<0.05). Conclusions The color Doppler ultrasound was used to clarify the classification and distribution of the oblique branch of the lateral circumflex femoral artery preoperatively. Based on this, the ALTPF pedicled with the oblique branch of the lateral circumflex femoral artery was designed and harvested to repair the skin and soft tissue defects in the extremities, which can significantly improve the postoperative flap blood supply, effectively shorten surgical duration and length of hospital stay, reduce intraoperative blood loss and the incidence of complications, and enhance patients' satisfaction with treatment outcomes.

Reconstruction of superficial organs: the leap from structural restoration to functional rehabilitation

Zan Tao, Gao Yashan

, Available online , doi: 10.3760/cma.j.cn501225-20251110-00467

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The core objective of superficial organ reconstruction is the perfect restoration of both the morphological structure and biological function of the organ. Currently, significant progress has been achieved in structural construction, blood supply assurance, and morphological and functional reconstruction, primarily through surgical techniques, tissue engineering, and regenerative medicine approaches. In the future, with the integration and application of cutting-edge technologies such as gene editing, artificial intelligence, three-dimensional printing, and brain-computer interfaces, superficial organ reconstruction is poised to enter a new historical stage characterized by high intelligence, precision, and comprehensive functional restoration. This article focuses on superficial organ reconstruction, systematically outlines its concept, challenges, and current development status, and proposes future perspectives for this field.

Repair and reconstruction of facial organs injuries: the perfect harmony of structure and function

Song Baoqiang, Pei Jiaomiao

, Available online , doi: 10.3760/cma.j.cn501225-20251111-00468

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The repair of facial organ injuries is a complex field in plastic surgery that involves both functional recovery and morphological reconstruction. The therapeutic goal has evolved from traditional wound closure to the harmonious integration of form and function. To achieve this new objective, surgical plans need to incorporate various flap techniques, autologous and allogeneic tissue transplantation approaches, and integrate emerging methods such as digital design and biomaterials. Although the repair outcomes of facial organ injury have improved compared to the past, challenges such as insufficient nerve function reconstruction, limited scar management, donor site damage, and immune rejection in allogeneic transplantation persist. This article systematically reviews the mainstream repair methods and advancements in domestic and international research on key facial structures, including the nose, eyelids, lips, and ears, focusing on their defect characteristics and repair difficulties. It emphasizes how to achieve both three-dimensional structural reconstruction and dynamic functional restoration while maintaining aesthetic reconstruction. In the future, the integration of technologies such as tissue engineering, three-dimensional bioprinting, supermicrosurgery, and artificial intelligence will drive the development of facial organ injury repair and reconstruction towards precision, personalization, and minimally invasive approaches, ultimately achieving comprehensive rehabilitation of patients' physical, psychological, and social roles.

Efficacy of free lateral arm tissue flap in repairing complex finger wounds

Yang Xi, Liu Wuhua, Duan Jiazhang, Fang Xiang, Xu Yongqing, Shi Yan, Zhang Xing, He Xiaoqing

, Available online , doi: 10.3760/cma.j.cn501225-20240927-00359

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Objective To explore the efficacy of free lateral arm flap in repairing complex finger wounds. Methods This study was a retrospective observational study. From January 2020 to December 2023, 8 patients with complex finger wounds who met the inclusion criteria were admitted to the 920^th Hospital of Joint Logistic Support Force of PLA, including 5 males and 3 females, aged 24 to 56 years. There were 4 cases with multi-finger skin defects; there were 4 cases with single-finger skin combined with bone defects, 3 of whom were complicated with extensor tendon defects. The size of skin defects was 2.5 cm×2.0 cm to 8.0 cm×3.5 cm, and the size of bone defects was 1.5 cm×1.0 cm×1.0 cm to 2.0 cm×1.5 cm×1.0 cm. Five cases were repaired by free lateral arm tissue flap transplantation in the same period of emergency debridement; the remaining 3 patients underwent extended debridement in stage Ⅰ and free lateral arm tissue flap transplantation for repair in stage Ⅱ. Four patients each underwent resection of lobulated flaps and chimeric osteocutaneous flaps, including 4 cases carrying the posterior arm cutaneous nerve and three cases had their extensor tendons being reconstructed with the triceps brachii aponeurosis. The size of skin flaps was 3.0 cm×2.5 cm to 9.0 cm×4.0 cm, and the size of bone flap was consistent with the size of the bone defect. The donor site wounds of skin flaps and bone flaps were closed with interrupted sutures. Postoperatively, the survival status of the tissue flaps was observed, and the pedicle division status of the lobulated flaps was recorded. At the final follow-up, the following parameters were assessed and documented: the appearance and texture of flaps, the sensory recovery of the affected finger transplanted with the posterior arm cutaneous nerve using the British Medical Research Council sensory function assessment criteria, the dorsiflexion of the affected finger transplanted with the triceps brachii aponeurosis, the survival of the bone flaps confirmed via X-ray examination, the scar formation at the donor sites of skin flaps, and the function of the affected fingers evaluated based on the trial standard for functional evaluation of the upper limb of the Hand Surgery Society of the Chinese Medical Association. Results Postoperatively, the tissue flaps survived well. The pedicles of the lobulated flaps were successfully divided under local anesthesia 4 weeks after surgery. The follow-up duration ranged from 10 to 24 months, with an average of 13.5 months. At the final follow-up, the color and texture of the flaps were good, the sensation of the affected fingers transplanted with posterior arm cutaneous nerve recovered to S2-S3 level, the affected fingers transplanted with triceps brachii aponeurosis all achieved limited improvement in dorsiflexion, X-ray examination showed that the bone flaps survived; linear scars formed at the donor sites of skin flaps after wound healing, and the function of the affected fingers was evaluated as excellent in 5 cases and good in 3 cases. Conclusions The lateral arm tissue is rich in perforators and has few anatomical variations, which can be prepared into lobulated flaps and chimeric osteocutaneous flaps for the repair of complex finger wounds. The surgical operation is relatively simple, and the appearance and function of the donor and recipient sites are relatively good after surgery.

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