Background:This study explored the value of integrating problem-based learning(PBL)and team-based learning(TBL)methods into plastic and reconstructive surgery clinical practice.By addressing the challenges faced in tr...Background:This study explored the value of integrating problem-based learning(PBL)and team-based learning(TBL)methods into plastic and reconstructive surgery clinical practice.By addressing the challenges faced in traditional teachings,this study aimed to enhance educational outcomes and prepare students for real-world surgical scenarios,thereby improving patient care in this specialized field.Methods:Fifty undergraduate students majoring in clinical medicine at the Shanghai Jiao Tong University School of Medicine were selected as research subjects.They were randomly divided into experimental and control groups.The experimental group received the combined PBL-TBL teaching method,whereas the control group received the traditional teaching.The teaching effect was evaluated based on student satisfaction and academic performance.Results:The student satisfaction in the experimental group was higher than that of the control group(P<0.05).Subjective scoring for academic performance by instructors was higher in the experimental group than in the control group(P<0.05).Conclusion:The PBL and TBL combination had a significant effect when applied in plastic and reconstructive surgery clinical practice.展开更多
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 multidiscipli...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.展开更多
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...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.展开更多
Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits...Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.展开更多
The treatment of a 40-year-old woman with a giant fibroadenoma in her left breast is presented. The fibroadenoma measured 14 × 5 × 3 cm and weighed 170 g. We demonstrate that the surgical strategy and the re...The treatment of a 40-year-old woman with a giant fibroadenoma in her left breast is presented. The fibroadenoma measured 14 × 5 × 3 cm and weighed 170 g. We demonstrate that the surgical strategy and the reconstructive techniques in oncoplastic breast cancer surgery successfully can be applied to the treatment of these rare benign tumours improving the cosmetic and functional outcome.展开更多
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 diff...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。展开更多
<em>Aloe vera</em> has been used for centuries for medicinal purposes. Clinical and experimental evidence indicates usefulness for skin moisturization, promoting wound healing, thermal skin injury, frostbi...<em>Aloe vera</em> 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. <em>Aloe vera</em> 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 <em>Aloe vera</em> finds substantial evidence for the reported and also likely clinical usefulness for <em>Aloe vera</em> 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.展开更多
Objectives:The eukaryotic initiation factor 4F(eIF4F)translation initiation complex inhibitors(eIF4Fi)were recently found to hyperactivate extracellular signal-regulated kinases 1/2(ERK1/2)signals,which contribute to ...Objectives:The eukaryotic initiation factor 4F(eIF4F)translation initiation complex inhibitors(eIF4Fi)were recently found to hyperactivate extracellular signal-regulated kinases 1/2(ERK1/2)signals,which contribute to acquired resistance to BRAF(B-Raf proto-oncogene,serine/threonine kinase)inhibitors in melanoma.This present study aims to elucidate how to overcome the resistance of the eIF4Fi in BRAFV600E mutant melanoma cells and explore the underlying mechanisms.Methods:Melanoma A375(vemurafenib[VEM]-sensitive)and A375R(VEM-resistant)cells were exposed to eIF4Fi RocA at varying doses and durations in vitro.We investigated the impact of RocA on the activity of ERK1/2,AKT serine/threonine kinase 1(AKT1),eIF4E,and enhancer of zeste homolog 2(EZH2).We then examined the impact of RocA on pro-apoptotic BH3-only proteins and proliferative proteins.We subsequently determined the effect of combined eIF4Fi,AKT1 inhibitor,EZH2 inhibitor or VEM on tumor growth in vitro and in vivo.Results:RocA inhibited proliferation and induced apoptosis in A375 cells,but inhibited proliferation in A375R cells.RocA rapidly reactivated ERK1/2 at 3 h and returned to baseline levels at 48 h.However,eIF4E and AKT1 activation began at 12 h and peaked at 48 h.ERK1/2 positively regulated EZH2 and EZH2-dependent expression of c-Fos and EGR1,while AKT1 negatively regulated c-Myc,c-Jun,and BMF,but positively regulated eIF4E.RocA downregulated ERK1/2(or EZH2,AKT1,and eIF4E)independent bcl-2 and Mcl-1 expression.AKT1i enhanced RocA-induced cell apoptosis,while EZH2i reduced RocA-induced cell proliferation.Combined CR-1-31-B,EZH2i,and AKT1i effectively overcame resistance to RocA and VEM resistance both in vitro and in vivo.Conclusion:The eIF4F complex inhibitor reactivates ERK1/2-EZH2 and AKT1 signaling pathways,resulting in resistance to both eIF4Fi and VEM.Combined administration of an eIF4Fi with EZH2 and AKT1 inhibitors effectively enhances sensitivity to both eIF4F complex and BRAF inhibitors.展开更多
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 An...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.展开更多
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 ...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.展开更多
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, Emb...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.展开更多
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 irrever...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.展开更多
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 ...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.展开更多
BACKGROUND The high prevalence of human papillomavirus(HPV)infection in oropharyngeal squamous cell carcinoma(SCC)is well established,and p16 expression is a strong predictor.HPV-related tumors exhibit unique mechanis...BACKGROUND The high prevalence of human papillomavirus(HPV)infection in oropharyngeal squamous cell carcinoma(SCC)is well established,and p16 expression is a strong predictor.HPV-related tumors exhibit unique mechanisms that target p16 and p53 proteins.However,research on HPV prevalence and the combined predictive value of p16 and p53 expression in head and neck cutaneous SCC(HNCSCC),particularly in Asian populations,remains limited.This retrospective study surveyed 62 patients with HNSCC(2011-2020),excluding those with facial warts or other skin cancer.AIM To explore the prevalence of HPV and the predictive value of p16 and p53 expression in HNCSCC in Asian populations.METHODS All patients underwent wide excision and biopsy.Immunohistochemical staining for HPV,p16,and p53 yielded positive and negative results.The relevance of each marker was investigated by categorizing the tumor locations into high-risk and middle-risk zones based on recurrence frequency.RESULTS Of the 62 patients,20(32.26%)were male,with an average age of 82.27 years(range 26-103 years).High-risk included 19 cases(30.65%),with the eyelid and lip being the most common sites(five cases,8.06%).Middle-risk included 43 cases(69.35%),with the cheek being the most common(29 cases,46.77%).The p16 expression was detected in 24 patients(38.71%),p53 expression in 42 patients(72.58%),and HPV in five patients(8.06%).No significant association was found between p16 expression and the presence of HPV(P>0.99),with a positive predictive value of 8.33%.CONCLUSION This study revealed that p16,a surrogate HPV marker in oropharyngeal SCC,is not reliable in HNCSCC,providing valuable insights for further research in Asian populations.展开更多
This study aims to develop various types of collagen devices for use in oral surgery. The targets are the sheet-shaped sponges to cover mucosal defect wounds (product-1) and gingival defect wounds (product-2) and the ...This study aims to develop various types of collagen devices for use in oral surgery. The targets are the sheet-shaped sponges to cover mucosal defect wounds (product-1) and gingival defect wounds (product-2) and the cylindrical sponge to fill tooth extraction sockets (product-3). The sheet-shaped sponges were manufactured by freeze-vacuum drying the aqueous solution of collagen (Col) and heat-denatured collagen (Col’) at a composition ratio of 2/1, 1/1 or 1/2. Both surfaces of the sheet-shaped sponge were treated by ultraviolet (UV) irradiation for 5, 10 or 15 minutes to introduce intermolecular crosslinks between collagen molecules. The elution behavior of each collagen sponge was investigated by immersing the sponge in water for a predetermined time and then by measuring the weight change. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 15 minutes showed very slow elution properties. This sheet-shaped sponge is the top candidate for product-1. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 5 minutes showed slightly fast elution properties. This sheet-shaped sponge is the top candidate for product-2. Next, the cylindrical sponge was manufactured by freeze-vacuum drying the aqueous solution of Col and Col’ at a composition ratio of 2/1. Both sides of the cylindrical sponge were treated by UV irradiation for 15 minutes. This sponge showed initially fast elution properties and subsequent very slow elution properties. This cylindrical sponge is a good candidate for product-3. As a basic design, the sheet-shaped sponge and the cylindrical sponge should be biodegraded and absorbed by the time new tissue formation is completed.展开更多
Treacher Collins syndrome is caused by the maldevelopment of the first and second branchial arches. It is characterized by mandibulofacial dysostosis and has the following features: outward and downward obliquity of l...Treacher Collins syndrome is caused by the maldevelopment of the first and second branchial arches. It is characterized by mandibulofacial dysostosis and has the following features: outward and downward obliquity of lateral canthi, colobomas of the lateral 1/3 of. the lower eyelids, flattening of malar bone, absence of zygomatic arches, a small and receding chin, sometimes accomapanied with small ears and cleft palate. In 8 cases, the authors reconstructed malar hypoplasia and micrognathia with bone graft and corrected the palpebral fissures. The results of this procedure are satisfactory.展开更多
BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal ...BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.展开更多
Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for ...Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.展开更多
This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. ...This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.展开更多
Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient sa...Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.展开更多
基金supported by grants from the National Natural Science Foundation of China(grant nos.82472554 and 82202449)the Fund for Excellent Young Scholars of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(grant no.JYYQ006).
文摘Background:This study explored the value of integrating problem-based learning(PBL)and team-based learning(TBL)methods into plastic and reconstructive surgery clinical practice.By addressing the challenges faced in traditional teachings,this study aimed to enhance educational outcomes and prepare students for real-world surgical scenarios,thereby improving patient care in this specialized field.Methods:Fifty undergraduate students majoring in clinical medicine at the Shanghai Jiao Tong University School of Medicine were selected as research subjects.They were randomly divided into experimental and control groups.The experimental group received the combined PBL-TBL teaching method,whereas the control group received the traditional teaching.The teaching effect was evaluated based on student satisfaction and academic performance.Results:The student satisfaction in the experimental group was higher than that of the control group(P<0.05).Subjective scoring for academic performance by instructors was higher in the experimental group than in the control group(P<0.05).Conclusion:The PBL and TBL combination had a significant effect when applied in plastic and reconstructive surgery clinical practice.
文摘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.
文摘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.
文摘Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.
文摘The treatment of a 40-year-old woman with a giant fibroadenoma in her left breast is presented. The fibroadenoma measured 14 × 5 × 3 cm and weighed 170 g. We demonstrate that the surgical strategy and the reconstructive techniques in oncoplastic breast cancer surgery successfully can be applied to the treatment of these rare benign tumours improving the cosmetic and functional outcome.
基金supported by grants from the Youth Doctor Collaborative Innovation Team Project(QC201803)of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicinethe Project of Biobank(NO.YBKA201901)from Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine+1 种基金the Shanghai Youth Top-Notch Talent Program(201809004)“Chenguang Program”supported by Shanghai Education Development Foundation and Shanghai Municipal Education Commission(19CG18)and Science and Technology Commission of Shanghai Municipality(19JC1413),Shanghai Rising-Star Program(20QA1405600).
文摘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。
文摘<em>Aloe vera</em> 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. <em>Aloe vera</em> 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 <em>Aloe vera</em> finds substantial evidence for the reported and also likely clinical usefulness for <em>Aloe vera</em> 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.
文摘Objectives:The eukaryotic initiation factor 4F(eIF4F)translation initiation complex inhibitors(eIF4Fi)were recently found to hyperactivate extracellular signal-regulated kinases 1/2(ERK1/2)signals,which contribute to acquired resistance to BRAF(B-Raf proto-oncogene,serine/threonine kinase)inhibitors in melanoma.This present study aims to elucidate how to overcome the resistance of the eIF4Fi in BRAFV600E mutant melanoma cells and explore the underlying mechanisms.Methods:Melanoma A375(vemurafenib[VEM]-sensitive)and A375R(VEM-resistant)cells were exposed to eIF4Fi RocA at varying doses and durations in vitro.We investigated the impact of RocA on the activity of ERK1/2,AKT serine/threonine kinase 1(AKT1),eIF4E,and enhancer of zeste homolog 2(EZH2).We then examined the impact of RocA on pro-apoptotic BH3-only proteins and proliferative proteins.We subsequently determined the effect of combined eIF4Fi,AKT1 inhibitor,EZH2 inhibitor or VEM on tumor growth in vitro and in vivo.Results:RocA inhibited proliferation and induced apoptosis in A375 cells,but inhibited proliferation in A375R cells.RocA rapidly reactivated ERK1/2 at 3 h and returned to baseline levels at 48 h.However,eIF4E and AKT1 activation began at 12 h and peaked at 48 h.ERK1/2 positively regulated EZH2 and EZH2-dependent expression of c-Fos and EGR1,while AKT1 negatively regulated c-Myc,c-Jun,and BMF,but positively regulated eIF4E.RocA downregulated ERK1/2(or EZH2,AKT1,and eIF4E)independent bcl-2 and Mcl-1 expression.AKT1i enhanced RocA-induced cell apoptosis,while EZH2i reduced RocA-induced cell proliferation.Combined CR-1-31-B,EZH2i,and AKT1i effectively overcame resistance to RocA and VEM resistance both in vitro and in vivo.Conclusion:The eIF4F complex inhibitor reactivates ERK1/2-EZH2 and AKT1 signaling pathways,resulting in resistance to both eIF4Fi and VEM.Combined administration of an eIF4Fi with EZH2 and AKT1 inhibitors effectively enhances sensitivity to both eIF4F complex and BRAF inhibitors.
文摘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.
文摘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.
文摘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.
文摘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.
基金Supported by Soonchunhyang research fund,No.2023-0024.
文摘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.
基金Supported by the National Research Foundation of Korea,No.2020R1A2C1100891Soonchunhyang University Research Fund,No.2024-05-014.
文摘BACKGROUND The high prevalence of human papillomavirus(HPV)infection in oropharyngeal squamous cell carcinoma(SCC)is well established,and p16 expression is a strong predictor.HPV-related tumors exhibit unique mechanisms that target p16 and p53 proteins.However,research on HPV prevalence and the combined predictive value of p16 and p53 expression in head and neck cutaneous SCC(HNCSCC),particularly in Asian populations,remains limited.This retrospective study surveyed 62 patients with HNSCC(2011-2020),excluding those with facial warts or other skin cancer.AIM To explore the prevalence of HPV and the predictive value of p16 and p53 expression in HNCSCC in Asian populations.METHODS All patients underwent wide excision and biopsy.Immunohistochemical staining for HPV,p16,and p53 yielded positive and negative results.The relevance of each marker was investigated by categorizing the tumor locations into high-risk and middle-risk zones based on recurrence frequency.RESULTS Of the 62 patients,20(32.26%)were male,with an average age of 82.27 years(range 26-103 years).High-risk included 19 cases(30.65%),with the eyelid and lip being the most common sites(five cases,8.06%).Middle-risk included 43 cases(69.35%),with the cheek being the most common(29 cases,46.77%).The p16 expression was detected in 24 patients(38.71%),p53 expression in 42 patients(72.58%),and HPV in five patients(8.06%).No significant association was found between p16 expression and the presence of HPV(P>0.99),with a positive predictive value of 8.33%.CONCLUSION This study revealed that p16,a surrogate HPV marker in oropharyngeal SCC,is not reliable in HNCSCC,providing valuable insights for further research in Asian populations.
文摘This study aims to develop various types of collagen devices for use in oral surgery. The targets are the sheet-shaped sponges to cover mucosal defect wounds (product-1) and gingival defect wounds (product-2) and the cylindrical sponge to fill tooth extraction sockets (product-3). The sheet-shaped sponges were manufactured by freeze-vacuum drying the aqueous solution of collagen (Col) and heat-denatured collagen (Col’) at a composition ratio of 2/1, 1/1 or 1/2. Both surfaces of the sheet-shaped sponge were treated by ultraviolet (UV) irradiation for 5, 10 or 15 minutes to introduce intermolecular crosslinks between collagen molecules. The elution behavior of each collagen sponge was investigated by immersing the sponge in water for a predetermined time and then by measuring the weight change. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 15 minutes showed very slow elution properties. This sheet-shaped sponge is the top candidate for product-1. The collagen sponge composed of Col and Col’ with a composition ratio of 2/1 that was treated by UV irradiation for 5 minutes showed slightly fast elution properties. This sheet-shaped sponge is the top candidate for product-2. Next, the cylindrical sponge was manufactured by freeze-vacuum drying the aqueous solution of Col and Col’ at a composition ratio of 2/1. Both sides of the cylindrical sponge were treated by UV irradiation for 15 minutes. This sponge showed initially fast elution properties and subsequent very slow elution properties. This cylindrical sponge is a good candidate for product-3. As a basic design, the sheet-shaped sponge and the cylindrical sponge should be biodegraded and absorbed by the time new tissue formation is completed.
文摘Treacher Collins syndrome is caused by the maldevelopment of the first and second branchial arches. It is characterized by mandibulofacial dysostosis and has the following features: outward and downward obliquity of lateral canthi, colobomas of the lateral 1/3 of. the lower eyelids, flattening of malar bone, absence of zygomatic arches, a small and receding chin, sometimes accomapanied with small ears and cleft palate. In 8 cases, the authors reconstructed malar hypoplasia and micrognathia with bone graft and corrected the palpebral fissures. The results of this procedure are satisfactory.
文摘BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.
文摘Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.
文摘This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.
文摘Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.
