AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Pati...AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Patients with full thickness eyelid carcinoma involving more than 50%margin length who underwent surgical resection were retrospectively reviewed in the study.The defects were reconstructed using conjunctival flap with auricular cartilage grafting,covered with myocutaneous flap above.Followed-up time ranged from 12 to 24 mo.Outcomes were classified as“good”,“fair”,and“poor”by evaluating the margin appearance,eyelid appearance,and complications.RESULTS:A total of 42 patients were enrolled in the study(26 males,16 females,mean age,68.6±7.7 y,range:53 to 82 y).The mean defect widths measured 23.2±2.9 mm(range,17 to 28 mm).The mean posterior lamellar defect height was 5.5±1.3 mm(4 to 8 mm).Thirty-seven patients had a“good”outcome(88.1%),5 patients had a“fair”outcome(11.9%),and no one had a“poor”outcome.CONCLUSION:Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect.It can not only achieve satisfied reconstruction,but also preserve intact tarsal plate of the opposite eyelid,avoiding retraction or entropion.展开更多
The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of th...The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.展开更多
AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.ME...AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.METHODS:Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis.A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect.The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft.Postoperative cosmetic and functional outcomes were evaluated.RESULTS:The mean age of the patients was 46.3±18.1y(20-70y).The defects ranged from 30%-80%of the lid width and resulted from the excision of lid tumors in 11 patients(55%)and from trauma in 9(45%)patients.Postoperative complications included one case of lateral graft ectropion,2 cases of lid retraction and 3 cases of marginal graft necrosis.Most of the patients had an acceptable final cosmetic outcome.CONCLUSION:Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction.Large defects≥50%of the horizontal length are at greater risk of complications.Reconstruction of medial defects by this technique was associated with a greater incidence of complications.展开更多
In this study,the efects of defect,mean stress and lower loading are investigated for high cycle(HCF)and very high cycle fatigue(VHCF)behavior of Ti-6Al-4V alloy.It indicates that the S-N curve of Ti-6Al-4V alloy exhi...In this study,the efects of defect,mean stress and lower loading are investigated for high cycle(HCF)and very high cycle fatigue(VHCF)behavior of Ti-6Al-4V alloy.It indicates that the S-N curve of Ti-6Al-4V alloy exhibits a linear decreasing trend or a plateau characteristic in HCF and VHCF regimes,which depends on the defect size and stress ratio.VHCF strength decreases with increasing the defect size,and it is irrespective of stress ratios.The fatigue crack initiates from specimen surface at R=−1 in both HCF and VHCF regimes.While the fatigue crack initiates from the subsurface or the interior of the specimen at R=0.1 in VHCF regime.A sequence of lower stress amplitude below the fatigue strength at 10^(9) cyc has no or negligible infuence on the fatigue life of 10^(5)-10^(9) cyc.The lower stress amplitude in variable amplitude loadings does not afect the failure mechanism.The residual compressive stress relaxation is not observed after a large number of lower loadings under ultrasonic frequency fatigue test.Gerber formula and Goodman formula give dangerous predictions of VHCF strength for both smooth specimens and specimens with defects.展开更多
Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried o...Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.展开更多
Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we desc...Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.展开更多
AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microsco...AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.展开更多
Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive prcedure. Free tissue transfer remains the standard for the management of these defects. However, there are...Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive prcedure. Free tissue transfer remains the standard for the management of these defects. However, there are some disadvantages like;longer operative times, bulky contour, and the need for highly skilled expertise. The reverse superficial sural artery flap (RSSAF) is a distally based fasciocutaneous or adipo-fascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Methods: Twenty RSSAF flaps were harvested for reconstruction of different traumatic soft tissue defects of the lower third of leg, ankle and foot. Follow up for 6 months postoperative. Results: Twenty Patients;twelve males and eight females underwent reconstruction of different soft tissue defects over the foot and ankle using RSSAF. The overall complications occurred in 6 flaps;4 minor and 2 major complications. The remaining 14 flaps passed an uneventful follow up. Conclusions: The reverse superficial sural artery flap RSSAF can be used as a reliable alternative to free tissue transfer in reconstruction of defects over the lower third of leg, ankle, and foot. Venous congestion is the major threat to the flap but its incidence can be minimized by wide pedicle, less kink of the flap, and keep the venae comitants around the artery.展开更多
A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplas...A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.展开更多
Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applie...Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue展开更多
To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March ...To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.展开更多
Laser and light treatments have recently become popular owing to its efficacy in treating laxity,rhytids,hyperpigmentation of the lower eyelids,and drooping of septum fat.For several decades,our department has explore...Laser and light treatments have recently become popular owing to its efficacy in treating laxity,rhytids,hyperpigmentation of the lower eyelids,and drooping of septum fat.For several decades,our department has explored the application of laser and light treatment for eye rejuvenation.This paper summarizes common treatment methods and analyzes the published literature on the indications and outcomes of multiple laser and light treatments for lower eyelid rejuvenation.An extensive survey of peer-reviewed literature was performed using PubMed,with the search terms“noninvasive treatment”,“infraorbital”,“palpebral bags”,“lower eyelid”,“radiofrequency(RF)”,“laser”,“nonsurgical skin tightening”,and“noninvasive fat reduction”.The results showed that the use of lasers,intense pulsed light(IPL),monopolar RF,bipolar RF,AdipoLASER rejuvenation(ALJ),and fractional RF microneedling are safe and effective treatments for palpebral bags.We conclude that using Qswitched lasers,IPL,RF,ALJ,and fractional RF microneedling is safe and effective for lower eyelid rejuvenation,with minimal complications and quick recovery.Further research and development of optoelectronic therapy may encourage breakthroughs in lower eyelid treatment,such as simplified complex surgery and noninvasive methods.展开更多
Background:Eyelid malignancies often require radical surgical intervention,with a major risk of tissue loss.Reconstructing the eyelid after such procedures is essential to restoring its protective function and aesthet...Background:Eyelid malignancies often require radical surgical intervention,with a major risk of tissue loss.Reconstructing the eyelid after such procedures is essential to restoring its protective function and aesthetic appearance.Traditional reconstruction methods involve using grafts from other sites of the body;however,these methods are limited by factors such as the availability of donor tissue,potential mismatches in tissue characteristics,and associated complications,including graft failure or scarring.Additionally,donor site morbidity and achieving a perfect match in texture and color remain challenging.Recent advances in biomaterials offer new possibilities for improving surgical outcomes by providing more biocompatible and flexible options that can be tailored to meet patient-specific needs,potentially reducing complications and improving functional and cosmetic outcomes.Methods:The study included 61 patients who underwent lower eyelid reconstruction following the radical removal of malignant tumors.The patients were divided into the experimental(31 patients in whom a biodegradable Diplen membrane was used)and control(30 patients in whom the membrane was not used)groups.Patients were followed up for at least 1 year,with clinical outcomes and patient satisfaction carefully evaluated.Results:The experimental group demonstrated significantly better outcomes regarding eyelid position and color,with fewer complications compared to the control group.Patient satisfaction was significantly higher in the experimental group,demonstrating a strong correlation with clinical outcomes.These findings highlight the effectiveness of the biodegradable Diplen membrane in achieving better functional and aesthetic outcomes.Conclusions:Eyelid reconstruction using the biodegradable Diplen membrane offers excellent functional and aesthetic outcomes,significantly enhancing patient satisfaction,which is crucial for postoperative rehabilitation and improved quality of life.展开更多
AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted...AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted among 97 volunteer s including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each par ticipant, including two photographs obtained in a neutral position(NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively;technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively;and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients(ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1;the ICCs of all the measurements obtained in all the positions(NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre-and postoperative clinical evaluation.展开更多
Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retr...Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retraction into three categories:(1)change in the balance of forces associated with the lower eyelid margin;(2)excessive loss of lower eyelid volume;(3)changes in the relative position of the eyeball and lower lid margin.In this review,the corresponding treatment methods are elaborated on individually for the above three forming factors.We also reported,for the first time,a new treatment for lower eyelid retraction.We created a dermal-orbicularis oculi suspension flap on the lateral side of the canthus and suspended it upward and inward on the dense connective tissue over the lateral bony surface of the orbital rim.The longest follow-up time was one year,and the results were satisfactory.展开更多
Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modif...Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modified McGregor flap for reliable soft tissue coverage.Methods:Nine patients with eyelids and malar soft tissue defects were treated over a period of 12 months from July 2013 to June 2014.In this prospective study,a McGregor flap was used for the closure of defects in 9 patients(7 men and 2 women),aged 20-36 years(mean age:27 years).Three sessions of hyperbaric oxygen therapy were administered postoperatively,and patients received subsequent follow-up.Results:Six patients presented with malar and lower eyelid defects,2 patients presented with malar defects,and one patient with upper eyelid,lower eyelid and malar defects following trauma.A McGregor flap was performed in all patients.The preexcision defects varied in size from 3 cm×2 cm to 4 cm×3 cm.No secondary procedures were required in any case.Sutures were removed between 7 and 9 days postoperatively.There were no cases of partial or total flap loss over the course of 10-14 months follow-up.Conclusion:The outcome following use of the McGregor flap procedure was functionally and aesthetically satisfactory in all cases.The McGregor flap is a useful option for the reconstruction of defects following trauma to the upper eyelid,lower eyelid,and malar regions.展开更多
针对复合材料电池包下箱体的树脂传递模塑(Resin Transfer Molding,RTM)成型进行了方案设计,基于PAM-RTM软件对其充模过程进行仿真分析及孔隙缺陷预测。首先,对比了两种方案在三种出胶口状态下充模时间,分析了注胶压力及树脂黏度对RTM...针对复合材料电池包下箱体的树脂传递模塑(Resin Transfer Molding,RTM)成型进行了方案设计,基于PAM-RTM软件对其充模过程进行仿真分析及孔隙缺陷预测。首先,对比了两种方案在三种出胶口状态下充模时间,分析了注胶压力及树脂黏度对RTM成型时间的影响规律;其次,分析了充模过程中注胶口附近位置的压力变化情况;最后,预测了宏观/微观两种尺度孔隙缺陷在构件中分布及注胶压力对孔隙含量的影响规律,并结合流速优化理论控制树脂前沿流速以降低孔隙含量。结果表明,模腔内注胶与出胶口压力差越大,成型用时越少,且受到注胶位置影响。注胶压力与充模时间呈线性关系,压力越低,充模时间缩短效果越明显,且黏度越大,充模时间越长。孔隙含量与前沿流速有关,注胶压力越大导致流速越快,宏观孔隙随之减少,微观孔隙相应增多;且流速优化方式注胶能够显著降低总体孔隙率水平,但会延长成型周期。展开更多
· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved ...· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.·METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized,leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.·RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible.The defects were repaired completely, and the evaluations showed satisfactory function and appearance.·CONCLUSION: This technique is an improved singlestage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.展开更多
基金Supported by Wenzhou Municipal Science and Technology Bureau(No.Y20180719)。
文摘AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Patients with full thickness eyelid carcinoma involving more than 50%margin length who underwent surgical resection were retrospectively reviewed in the study.The defects were reconstructed using conjunctival flap with auricular cartilage grafting,covered with myocutaneous flap above.Followed-up time ranged from 12 to 24 mo.Outcomes were classified as“good”,“fair”,and“poor”by evaluating the margin appearance,eyelid appearance,and complications.RESULTS:A total of 42 patients were enrolled in the study(26 males,16 females,mean age,68.6±7.7 y,range:53 to 82 y).The mean defect widths measured 23.2±2.9 mm(range,17 to 28 mm).The mean posterior lamellar defect height was 5.5±1.3 mm(4 to 8 mm).Thirty-seven patients had a“good”outcome(88.1%),5 patients had a“fair”outcome(11.9%),and no one had a“poor”outcome.CONCLUSION:Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect.It can not only achieve satisfied reconstruction,but also preserve intact tarsal plate of the opposite eyelid,avoiding retraction or entropion.
文摘The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.
文摘AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.METHODS:Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis.A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect.The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft.Postoperative cosmetic and functional outcomes were evaluated.RESULTS:The mean age of the patients was 46.3±18.1y(20-70y).The defects ranged from 30%-80%of the lid width and resulted from the excision of lid tumors in 11 patients(55%)and from trauma in 9(45%)patients.Postoperative complications included one case of lateral graft ectropion,2 cases of lid retraction and 3 cases of marginal graft necrosis.Most of the patients had an acceptable final cosmetic outcome.CONCLUSION:Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction.Large defects≥50%of the horizontal length are at greater risk of complications.Reconstruction of medial defects by this technique was associated with a greater incidence of complications.
基金the support by the Strategic Priority Research Program of Chinese Academy of Sciences(Grant No.XDB0620303)the Natural Science Basic Research Program of Shanxi(Program No.2023-JC-QN-0044).
文摘In this study,the efects of defect,mean stress and lower loading are investigated for high cycle(HCF)and very high cycle fatigue(VHCF)behavior of Ti-6Al-4V alloy.It indicates that the S-N curve of Ti-6Al-4V alloy exhibits a linear decreasing trend or a plateau characteristic in HCF and VHCF regimes,which depends on the defect size and stress ratio.VHCF strength decreases with increasing the defect size,and it is irrespective of stress ratios.The fatigue crack initiates from specimen surface at R=−1 in both HCF and VHCF regimes.While the fatigue crack initiates from the subsurface or the interior of the specimen at R=0.1 in VHCF regime.A sequence of lower stress amplitude below the fatigue strength at 10^(9) cyc has no or negligible infuence on the fatigue life of 10^(5)-10^(9) cyc.The lower stress amplitude in variable amplitude loadings does not afect the failure mechanism.The residual compressive stress relaxation is not observed after a large number of lower loadings under ultrasonic frequency fatigue test.Gerber formula and Goodman formula give dangerous predictions of VHCF strength for both smooth specimens and specimens with defects.
文摘Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.
文摘Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.
基金Supported by the Young Talent Program of Gusu Health Project(No.GSWS2020014)。
文摘AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.
文摘Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive prcedure. Free tissue transfer remains the standard for the management of these defects. However, there are some disadvantages like;longer operative times, bulky contour, and the need for highly skilled expertise. The reverse superficial sural artery flap (RSSAF) is a distally based fasciocutaneous or adipo-fascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Methods: Twenty RSSAF flaps were harvested for reconstruction of different traumatic soft tissue defects of the lower third of leg, ankle and foot. Follow up for 6 months postoperative. Results: Twenty Patients;twelve males and eight females underwent reconstruction of different soft tissue defects over the foot and ankle using RSSAF. The overall complications occurred in 6 flaps;4 minor and 2 major complications. The remaining 14 flaps passed an uneventful follow up. Conclusions: The reverse superficial sural artery flap RSSAF can be used as a reliable alternative to free tissue transfer in reconstruction of defects over the lower third of leg, ankle, and foot. Venous congestion is the major threat to the flap but its incidence can be minimized by wide pedicle, less kink of the flap, and keep the venae comitants around the artery.
文摘A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.
文摘Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue
文摘To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.
基金supported by the Shanghai Municipal Key Clinical Specialty Project(grant no.shslczdzk00901).
文摘Laser and light treatments have recently become popular owing to its efficacy in treating laxity,rhytids,hyperpigmentation of the lower eyelids,and drooping of septum fat.For several decades,our department has explored the application of laser and light treatment for eye rejuvenation.This paper summarizes common treatment methods and analyzes the published literature on the indications and outcomes of multiple laser and light treatments for lower eyelid rejuvenation.An extensive survey of peer-reviewed literature was performed using PubMed,with the search terms“noninvasive treatment”,“infraorbital”,“palpebral bags”,“lower eyelid”,“radiofrequency(RF)”,“laser”,“nonsurgical skin tightening”,and“noninvasive fat reduction”.The results showed that the use of lasers,intense pulsed light(IPL),monopolar RF,bipolar RF,AdipoLASER rejuvenation(ALJ),and fractional RF microneedling are safe and effective treatments for palpebral bags.We conclude that using Qswitched lasers,IPL,RF,ALJ,and fractional RF microneedling is safe and effective for lower eyelid rejuvenation,with minimal complications and quick recovery.Further research and development of optoelectronic therapy may encourage breakthroughs in lower eyelid treatment,such as simplified complex surgery and noninvasive methods.
文摘Background:Eyelid malignancies often require radical surgical intervention,with a major risk of tissue loss.Reconstructing the eyelid after such procedures is essential to restoring its protective function and aesthetic appearance.Traditional reconstruction methods involve using grafts from other sites of the body;however,these methods are limited by factors such as the availability of donor tissue,potential mismatches in tissue characteristics,and associated complications,including graft failure or scarring.Additionally,donor site morbidity and achieving a perfect match in texture and color remain challenging.Recent advances in biomaterials offer new possibilities for improving surgical outcomes by providing more biocompatible and flexible options that can be tailored to meet patient-specific needs,potentially reducing complications and improving functional and cosmetic outcomes.Methods:The study included 61 patients who underwent lower eyelid reconstruction following the radical removal of malignant tumors.The patients were divided into the experimental(31 patients in whom a biodegradable Diplen membrane was used)and control(30 patients in whom the membrane was not used)groups.Patients were followed up for at least 1 year,with clinical outcomes and patient satisfaction carefully evaluated.Results:The experimental group demonstrated significantly better outcomes regarding eyelid position and color,with fewer complications compared to the control group.Patient satisfaction was significantly higher in the experimental group,demonstrating a strong correlation with clinical outcomes.These findings highlight the effectiveness of the biodegradable Diplen membrane in achieving better functional and aesthetic outcomes.Conclusions:Eyelid reconstruction using the biodegradable Diplen membrane offers excellent functional and aesthetic outcomes,significantly enhancing patient satisfaction,which is crucial for postoperative rehabilitation and improved quality of life.
基金Supported by the Project of National Key Research and Development (No.2018YFC1106103)Chongqing Science and Health Joint Medical Research Project-Youth Project (No.2022QNXM016)The Fundamental Research Funds for the Central Universities (No.2021FZZX005-15)。
文摘AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted among 97 volunteer s including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each par ticipant, including two photographs obtained in a neutral position(NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively;technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively;and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients(ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1;the ICCs of all the measurements obtained in all the positions(NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre-and postoperative clinical evaluation.
基金The study was sponsored by the Natural Science Foundation of Shanghai(grant no.19ZR1430100)the National Natural Science Foundation of China(grant no.81871576).
文摘Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retraction into three categories:(1)change in the balance of forces associated with the lower eyelid margin;(2)excessive loss of lower eyelid volume;(3)changes in the relative position of the eyeball and lower lid margin.In this review,the corresponding treatment methods are elaborated on individually for the above three forming factors.We also reported,for the first time,a new treatment for lower eyelid retraction.We created a dermal-orbicularis oculi suspension flap on the lateral side of the canthus and suspended it upward and inward on the dense connective tissue over the lateral bony surface of the orbital rim.The longest follow-up time was one year,and the results were satisfactory.
文摘Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modified McGregor flap for reliable soft tissue coverage.Methods:Nine patients with eyelids and malar soft tissue defects were treated over a period of 12 months from July 2013 to June 2014.In this prospective study,a McGregor flap was used for the closure of defects in 9 patients(7 men and 2 women),aged 20-36 years(mean age:27 years).Three sessions of hyperbaric oxygen therapy were administered postoperatively,and patients received subsequent follow-up.Results:Six patients presented with malar and lower eyelid defects,2 patients presented with malar defects,and one patient with upper eyelid,lower eyelid and malar defects following trauma.A McGregor flap was performed in all patients.The preexcision defects varied in size from 3 cm×2 cm to 4 cm×3 cm.No secondary procedures were required in any case.Sutures were removed between 7 and 9 days postoperatively.There were no cases of partial or total flap loss over the course of 10-14 months follow-up.Conclusion:The outcome following use of the McGregor flap procedure was functionally and aesthetically satisfactory in all cases.The McGregor flap is a useful option for the reconstruction of defects following trauma to the upper eyelid,lower eyelid,and malar regions.
文摘针对复合材料电池包下箱体的树脂传递模塑(Resin Transfer Molding,RTM)成型进行了方案设计,基于PAM-RTM软件对其充模过程进行仿真分析及孔隙缺陷预测。首先,对比了两种方案在三种出胶口状态下充模时间,分析了注胶压力及树脂黏度对RTM成型时间的影响规律;其次,分析了充模过程中注胶口附近位置的压力变化情况;最后,预测了宏观/微观两种尺度孔隙缺陷在构件中分布及注胶压力对孔隙含量的影响规律,并结合流速优化理论控制树脂前沿流速以降低孔隙含量。结果表明,模腔内注胶与出胶口压力差越大,成型用时越少,且受到注胶位置影响。注胶压力与充模时间呈线性关系,压力越低,充模时间缩短效果越明显,且黏度越大,充模时间越长。孔隙含量与前沿流速有关,注胶压力越大导致流速越快,宏观孔隙随之减少,微观孔隙相应增多;且流速优化方式注胶能够显著降低总体孔隙率水平,但会延长成型周期。
基金Supported by Jilin Province Science and Techology Development Plan Project(No.20150414032GH)
文摘· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.·METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized,leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.·RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible.The defects were repaired completely, and the evaluations showed satisfactory function and appearance.·CONCLUSION: This technique is an improved singlestage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.
