ObjectiveTo investigate the clinical features, diagnosis, therapeutic methods of Paget's disease involving the scrotum. MethodsThe clinical data of 18 patients with Paget's disease treated in our hospital between 2008 and 2013 involving the scrotum were analyzed retrospectively. The patients' age ranged from 55 to 81 years old with an average of 69. The disease course ranged from 9 months to 18 years, averaging 6 years and 3 months. The main clinical pr was itching (94.4%), followed by exudation (66.7%), pain (11.1%), and desquamation (5.6%). All patients underwent extended resection. ResultsThe patients were followed up for 8 to 52 months averaging 34 months. Four patients' postoperative pathological report found focus on the excision margin, and one of them had local recurrence after 14 months. The remaining 14 cases had no local recurrence. One patient's pathological findings reported Paget's disease combined with invasive adenocarcinoma which invaded subcutaneous fat tissue layer, and this patient developed inguinal lymph node metastasis 20 months after operation. Another patient combined with adenocarcinoma which invaded deep dermis layer developed liver and lung metastasis 18 months after operation. ConclusionPaget's disease involving the scrotum is more commonly seen in older patients, and its main clinical presentation is itching. Paget's disease is usually misdiagnosed, so patients should undergo pathological examination early to clear diagnosis. Surgery is the main treatment. Paget's disease combined with invasive adenocarcinoma has poor prognosis.
ObjectiveTo investigate the effectiveness of double buried suture method for correction of secondary mild unilateral cleft lip nose deformity. MethodsBetween June 2010 and June 2012, 20 patients with secondary mild unilateral cleft lip nose deformity were treated with double buried suture method. Among 20 patients, 12 were male and 8 were female, with an average age of 21 years (range, 14-44 years). All patients had unilateral cleft lip nose deformity after unilateral cleft lip repair, including 9 cases of left deformity and 11 cases of right deformity. The time between first repair and double buried suture was 11-42 years (mean, 19 years). ResultsIncisions healed by first intention, and no related complication occurred. The patients were followed up 6-12 months (mean, 8 months). All patients were satisfied with the nasal contour, symmetrical projection of the alar dome, a central columella, symmetry of nasal floor, and no obvious scar. No recurrence was observed during follow-up. ConclusionDouble buried suture method not only can correct secondary mild unilateral cleft lip nose deformity completely, but also can avoid obvious scarring and recurrence of nose deformity.
Objective To investigate the effectiveness of nasolabial flap and ear cartilage in repairing defects after nasal ala basal cell carcinoma resection. Methods Between January 2012 and August 2014, 8 patients with nasal ala basal cell carcinoma underwent tumor resection and defect repair with nasolabial flap and ear cartilage. Among the 8 patients, 5 were male and 3 were female, with an average age of 65 years (range, 45-76 years). The left side and right side were involved in 3 cases and 5 cases respectively. Carcinoma confirmed by pathological examination in all patients. The time between first biopsy and resection was 7-14 days (mean, 10 days). The defect ranged from 1.5 cm×1.5 cm to 2.0 cm×1.5 cm after tumor resection, and the size of nasolabial flaps ranged from 4.0 cm×1.5 cm to 5.0 cm×2.0 cm. The operations of cutting off the pedicle and thinning skin flap were performed at 6 months after first operation. Results All flaps survived. Incisions healed by first intention, and no related complication occurred. No carcinoma recurred after cutting off the pedicle. All patients were followed up for 6 months. All patients were satisfied with the nasal contour, symmetrical projection of the alar dome, and no obvious scar. Conclusion Nasolabial flap transfer and ear cartilage transplant method not only can repair the nasal ala defects, but also can avoid obvious scar and obtain good nasal ala contour profile. The shortcoming is that patients have to receive two operations.
ObjectiveTo investigate the expression and significance of peroxisome proliferator activated receptor γ(PPAR-γ) in human keloid. MethodsTwenty-three keloid samples were harvested from the patients undergoing keloid and auto-skin grafting operation as the experimental group (keloid group), and the residual normal skin after auto-skin grafting operation was collected as the control group. The expression of PPAR-γ protein was examined by immunohistochemistry staining in both keloid and normal skin. Referring to Shimizu immunohistochemical standard, the result was graded; the positive rate of samples and the rate of positive cells were calculated. ResultsImmunohistochemistry staining showed that PPAR-γ protein was expressed in both keloid and normal skin. In keloid, it located in the pricle cell layer, and granular layer of epidermis, and the dermal vessel; the degree of dyeing was very light. However, in normal skin, it located in the base layer of epidermis, dermal vessel walls, sweat glands and sebaceous glands; the dyeing degree was deeper. Immunohistochemical staining score in the keloid group (2.65±0.78) was significantly lower than that in the control group (3.65±1.19) (t=5.030, P=0.000). The positive rate of samples in the keloid group (52.17%, 12/23) was significantly lower than that in the control group (82.61%, 19/23) (χ2=4.847, P=0.028). The rate of positive cells was 46.04%±8.61% in the keloid group, which was significantly lower than that in the control group (59.39%±11.26%) (t=5.974, P=0.000). ConclusionCompared with normal skin, the expression of PPAR-γ protein in keloid is down-regulated in in human keloid, indicating that PPAR-γ may be related to the formation of keloid.
ObjectiveTo investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors. MethodBetween March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years (range, 18-72 years). There were 17 cases of squamous carcinoma and 1 case of dermato-fibril sarcoma protuberans. The defect size ranged from 15 cm×12 cm to 22 cm×17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimusdorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm×14 cm to 24 cm×19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured. ResultsOf 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months (mean, 20 months). Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap. ConclusionsLarge scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.
ObjectiveTo discuss a reliable and aesthetic surgery method for the reconstruction of large defects on the top of nose after giant nevi resection. MethodsBetween January 2011 and June 2015, 46 cases of nasal tip defects caused by giant nevi resection were treated. Of 46 cases, 22 were male and 24 were female, aged 15-59 years (median, 28 years). The right ala nasi was involved in 28 cases, the apex nasi in 8 cases, and the left ala nasi in 10 cases. The diameters of nevi were from 8 to 12 mm (mean, 9.75 mm); no alar cartilage was invaded. Hair growth was seen in 14 cases. The duration of nasal nevi was from 3 years to 49 years (mean, 9.8 years). There were 9 recurrent patients who received laser therapy before surgery. The defects sizes after excision were from 10 mm×10 mm to 14 mm×14 mm. The bilobed flaps were used for one-stage reconstruction, which sizes were from 11 mm×10 mm to 15 mm×14 mm and from 10 mm×10 mm to 15 mm×14 mm. ResultsAll the incisions healed by first intention, and the flaps survived. No complication of intracranial hemorrhage or subdural hemorrhage occurred. The patients were followed up 6 months to 5 years (mean, 18 months). The appearance of nasal tip and nasolabial fold was satisfactory, and no recurrence was found during follow-up. ConclusionOne-stage bilobed flap reconstruction for nasal tip defects after giant nevus resection is one of the effective, safe, and aesthetic surgery methods.
ObjectiveTo evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. MethodsBetween February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. ResultsAll flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. ConclusionSevere palm scar contracture deformity can be effectively repaired by proper application of different flaps.
ObjectiveTo evaluate the effectiveness of an arc-shaped frontalis aponeurosis flap for the treatment of moderate to severe blepharoptosis. MethodBetween January 2011 and December 2014, 80 cases (140 eyes) of moderate to severe blepharoptosis were treated, including 31 males and 49 females with a median age of 16 years (range, 6-45 years). One eye was involved in 20 cases and both eyes in 60 cases. Upper eyelid ptosis degree ranged from 3 to 6 mm (average, 5 mm) when looking at the front horizontally. Fifty-one patients had underwent plastic surgery, and the first operation was performed in others. The arc-shaped frontalis aponeurosis flap was created by incision of upper and middle edge of the eyebrow, then it was retracted to the upper eyelid aponeurosis and was fixed in a slight over-correction position. ResultsThe operation was completed smoothly. The intraoperative blood loss was 5-10 mL (mean, 7 mL). Mild swelling of incision was observed after operation, and disappeared at 3-5 days after operation. Primary healing of incision was obtained, with no complications of infection and flap necrosis. The follow-up duration was 1-3 years (mean, 1.5 years). Seventy-nine cases could close upper eyelid completely and the function of upper eyelid was satisfactory within 3 months. One patient could not close upper eyelid completely after 6 months, and mild keratitis occurred, which was cured by anchyloblepharon. ConclusionsThe arc-shaped frontalis aponeurosis flap can be regarded as a minimally invasive procedure for the treatment of congenital moderate to severe blepharoptosis, it was safe, reliable, and easy-to-grasp.
ObjectiveTo investigate the effectiveness of combined three operations (rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty) for one stage defect repair after resection of xanthelasma palpebrarum with epicanthus. MethodsBetween December 2013 and December 2015, 12 female patients with large xanthelasma palpebrarum and epicanthus underwent rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty for one stage defect repair. The age ranged from 36 to 59 years (mean, 43 years). The course of disease was 3 to 16 years, with an average of 11 years. The initial resection was performed in 6 cases, second resection of residual xanthelasma palpebrarum in 4 cases, and 2 cases had recurrence after resection. The maximum diameter of xanthelasma palpebrarum was 0.5-1.3 cm (mean, 1.0 cm). According to CHE Junmin et al criterion, epicanthus was rated as mild in 7 cases, moderate in 3 cases, and severe in 2 cases. The blood lipid level was in normal range. ResultsPrimary healing of incision was obtained, and the flaps survived in all patients; no complication occurred. Scar hyperplasia was found in 4 cases at 1 month after operation, and the comprehensive treatment of scar was performed. All patients were followed up for 3 months to 2 years, with an average of 1.5 years. Double eyelid effects were good, and no xanthelasma palpebrarum recurred. ConclusionA combination of rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty is an effective operative procedure to repair defect after resection of xanthelasma palpebrarum with epicanthus; and better curve of double eyelid, better shape of endocanthion, and less tension of flap can be got.