| With the high development of industry, energy and urban traffic in China, theincidence of post-traumatic severe facial deformities has been increaseddramatically.Face is irreplaceable for the representation of one’s identity, The anatomy ofhuman’s face is unique and its function is very complicated. It remains a main challengeto make reasonable treatment decisions and provide effective treatment to this patients.However, no consensus exists on the optimal use of diverse reconstructive techniques toimprove treatment outcome.This study (1)proposed a classification and scoring system for postburn facialdeformities that will aid in the selection of reconstructive techniques;(2)established analgorithmic approach based on the regionally predominant vessels of the anterior chestarea and the defect characteristics of the face and neck;(3)established a local skinwarming procedure, and performed this before color duplex imaging to improvepreoperative perforator mapping and enable precise flap design.Study1Objective: To propose a classification for facial deformities through a retroresprctivestudyMethods:The authors reviewed the clinical cases of pre-expanded local flaps,perforator flaps, and prefabricated flaps between January of2005and September of2012in their unit. Deformities were categorized according to their size and location, inaccordance with the concept of facial aesthetic units. The findings were assessed todevelop a classification system. Results: Thestudy included174patients with facial deformities ranging from apartial unit to total face defects. The authors classified postburn facial skin and soft-tissuedeformities as follows: type I, single partial unit defect; type II, total unit defect ordeformities that partially involved two adjacent units; type III, multiunit defects; and typeIV, total/subtotal defects.Conclusions: The authors have proposed a classification system for postburn facialdeformities that will aid in the selection of reconstructive techniques. The proposedsystems may facilitate multicenter studies with high-level evidence and improve theoutcomes of postburn patients.Study2Objective: To establish a treatment strategy for different anterior chest flaptechniques.Methods: A retrospective study was performed to propose a treatment algorithm.69cases were reviewed from May of2005to July of2011, in which different types ofanterior chest flaps were performed for face and neck reconstruction. The reconstructiveprocedures, the aesthetic and functional outcomes and the complications were analyzed.Results: The applications of six types of pre-expanded anterior chest flaps weredescribed in an algorithmic approach based on the regionally predominant vessels of theanterior chest area and the defect characteristics of the face and neck.Conclusions: According to the deformities/defects characteristics and the regionallypredominant vessels of the anterior chest area, the proposed treatment strategy usingdifferent flap techniques may improve the aesthetic and functional outcomes for face andneck reconstruction.Study3Objective: To establish a local skin warming assisted color duplex perforatorimaging.Method: The vaso-dynamic changes in the third, right internal mammary artery perforator (IMAP) before and after local skin warming were examined. To assess theimprovement over conventional imaging, the fourth IMAP and distal third of theposterior interosseous artery (PIA), which are small in diameter and difficult to traceaccurately, were performed.Results:The mean diameter and mean PSFV before warming were0.78±0.04mm(mean±SD) and15.77±2.14cm/s, respectively. After30min of warming at44°C, themean diameter was significantly increased (1.22±0.08mm, p <0.01), and the meanPSFV value was more than doubled (39.41±7.30cm/s, p <0.01)After warming, thesource vessels, the emerging point of its perforator and its subcutaneous courses wereclearly imaged.Conclusion: The established a local skin warming procedure, improve the colorduplex imaging and preoperative perforator mapping, which enable precise flap design. With the high development of industry, energy and urban traffic in China, theincidence of post-traumatic severe facial deformities has been increaseddramatically.Face is irreplaceable for the representation of one’s identity, The anatomy ofhuman’s face is unique and its function is very complicated. It remains a main challengeto make reasonable treatment decisions and provide effective treatment to this patients.However, no consensus exists on the optimal use of diverse reconstructive techniques toimprove treatment outcome.This study (1)proposed a classification and scoring system for postburn facialdeformities that will aid in the selection of reconstructive techniques;(2)established analgorithmic approach based on the regionally predominant vessels of the anterior chestarea and the defect characteristics of the face and neck;(3)established a local skinwarming procedure, and performed this before color duplex imaging to improvepreoperative perforator mapping and enable precise flap design.Study1Objective: To propose a classification for facial deformities through a retroresprctivestudyMethods:The authors reviewed the clinical cases of pre-expanded local flaps,perforator flaps, and prefabricated flaps between January of2005and September of2012in their unit. Deformities were categorized according to their size and location, inaccordance with the concept of facial aesthetic units. The findings were assessed todevelop a classification system. Results: Thestudy included174patients with facial deformities ranging from apartial unit to total face defects. The authors classified postburn facial skin and soft-tissuedeformities as follows: type I, single partial unit defect; type II, total unit defect ordeformities that partially involved two adjacent units; type III, multiunit defects; and typeIV, total/subtotal defects.Conclusions: The authors have proposed a classification system for postburn facialdeformities that will aid in the selection of reconstructive techniques. The proposedsystems may facilitate multicenter studies with high-level evidence and improve theoutcomes of postburn patients.Study2Objective: To establish a treatment strategy for different anterior chest flaptechniques.Methods: A retrospective study was performed to propose a treatment algorithm.69cases were reviewed from May of2005to July of2011, in which different types ofanterior chest flaps were performed for face and neck reconstruction. The reconstructiveprocedures, the aesthetic and functional outcomes and the complications were analyzed.Results: The applications of six types of pre-expanded anterior chest flaps weredescribed in an algorithmic approach based on the regionally predominant vessels of theanterior chest area and the defect characteristics of the face and neck.Conclusions: According to the deformities/defects characteristics and the regionallypredominant vessels of the anterior chest area, the proposed treatment strategy usingdifferent flap techniques may improve the aesthetic and functional outcomes for face andneck reconstruction.Study3Objective: To establish a local skin warming assisted color duplex perforatorimaging.Method: The vaso-dynamic changes in the third, right internal mammary artery perforator (IMAP) before and after local skin warming were examined. To assess theimprovement over conventional imaging, the fourth IMAP and distal third of theposterior interosseous artery (PIA), which are small in diameter and difficult to traceaccurately, were performed.Results:The mean diameter and mean PSFV before warming were0.78±0.04mm(mean±SD) and15.77±2.14cm/s, respectively. After30min of warming at44°C, themean diameter was significantly increased (1.22±0.08mm, p <0.01), and the meanPSFV value was more than doubled (39.41±7.30cm/s, p <0.01)After warming, thesource vessels, the emerging point of its perforator and its subcutaneous courses wereclearly imaged.Conclusion: The established a local skin warming procedure, improve the colorduplex imaging and preoperative perforator mapping, which enable precise flap design. |
PDF Full Text Request