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Background: Nipple‐areola complex is a naturally hyperpigmented skin area which can be involved in vitiligo. But limited study focused on the treatment of nipple‐areola complex vitiligo, and few methods were proven to be effective. In this study, we aimed to explore the feasibility and efficacy of ReCell® on vitiligo in the nipple‐areola complex area. Methods: Medical records of patients with vitiligo involving nipple‐areola complex and underwent ReCell® treatment from October 2016 to April 2020 were retrospectively reviewed. The repigmentation rate of the nipple‐areola complex and other breast area were calculated under the Wood's light at each follow‐up. The grade of repigmentation and patient‐reported satisfaction rate were also evaluated to prove the effect of ReCell® on vitiligo of breast and especially in the nipple‐areola complex area. Results: A total of 18 patients were included in this study. No surgical complications were reported. The mean postoperative repigmentation rate in the nipple‐areola complex area (3rd‐month, 78.7 ± 5.8%; 6th‐month, 87.6 ± 5.1%; and 12th‐month, 96.1 ± 3.5%) was significantly higher than that in the other breast treatment area (3rd‐month, 70.4 ± 6.9%; 6th‐month, 84.2 ± 5.7%, and 12th‐month, 93.2 ± 3.6%). All patients showed good or excellent grades at the last follow‐up, and 94.4% of them considered the overall treatment results satisfactory. Conclusions: ReCell® is a feasible and efficient treatment strategy in the nipple‐areola complex vitiligo. [ABSTRACT FROM AUTHOR]

Background: Botulinum neurotoxin A injection is a popular noninvasive alternative for the treatment of masseter hypertrophy. This study was conducted to identify a safe injection volume to avoid sunken lateral cheek after botulinum neurotoxin A injection in the masseter muscle. Methods: One milliliter or 0.5 ml of indocyanine green was randomly injected into either side of the masseter muscles of 18 fresh cadaver heads. The bilateral spreads of indocyanine green within the masseter were observed by a fluorescence imager. The masseters were then dissected, and the spreading distance was measured. Results: Dye spreading showed an oval shape parallel to the long axis of the masseter muscle. The lower edges of the masseters were all stained with indocyanine green. The upward spreading exceeded the mouth corner‐tragus line in 94.44% (17/18) of the masseters on the 1‐ml side, and 11.11% (2/18) of the masseters on the 0.5‐ml side. The spreading area and upward spreading distance on the 1‐ml side (9.95 ± 0.48 cm2, 3.18 ± 0.31 cm) were significantly larger than the 0.5‐ml side (7.13 ± 0.80 cm2, 2.08 ± 0.32 cm). Conclusions: The spread of indocyanine green within the masseter occurs in direct proportion to its volume. A bolus of 1 ml easily exceeded the mouth corner‐tragus line and cause sunken cheek. [ABSTRACT FROM AUTHOR]

Background: No reports of the potential areas of surgeons' aesthetics in blepharoplasty. Aims: To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome. Methods: An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome. Results: Fifty‐three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan‐shaped (37.74%) and low‐parallel eyelid (26.42%), and the ideal shapes were obviously fan‐shaped (41.51%) and high‐parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full‐incisional method. 45.28% cared for long‐term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan‐shaped type and 24.53% for high‐parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P <.001), and surgical outcome rank increased by 0.861 points for aesthetics (P <.001). However, their eyelid shape had no direct contribution to surgical outcome (P =.96). Conclusions: The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly. [ABSTRACT FROM AUTHOR]

Objective: We retrospectively evaluated the efficacy and safety of keystone‐designed perforator island flaps for chest keloid reconstruction. Methods: We reviewed consecutive patients who received keystone flap reconstruction after chest keloid resection between January 2017 and February 2018. The patient demographic data, defect size, flap size, complications, and recurrence were recorded. Results: Thirty‐eight patients were evaluated in this retrospective case series. After keloid resection, dimension of wound defects was 5.5‐9.5 cm × 9.5‐12.5 cm, with an average dimension of 7.3 cm × 10.7 cm. The dimension of keystone flaps was between 6‐10 cm × 20‐34.5 cm, with an average dimension of 7.5 cm × 25.5 cm. The flaps healed smoothly without any complication. There was no keloid recurrence with 15 months of follow‐up. 89.4% of the patients had good outcome with no apparent scarring, and 10.6% patients had satisfactory outcome with localized scarring. Conclusions: Keystone‐designed perforator island flap is an effective and reliable method for reconstruction following chest keloid resection. [ABSTRACT FROM AUTHOR]

Background: The emergence of COVID‐19 has become a global health emergency. The transmissibility of the disease is of great interest to healthcare workers and scientists alike. The primary route of transmission is via respiratory droplets, but viral RNA has also been found in feces and body fluids such as urine, serum, and semen. So far, there has been no report on whether SARS‐CoV‐2 is present in the exudates of cutaneous lesions. This study was designed to investigate whether SARS‐CoV‐2 can be found in the pressure injury exudates in patients with severe COVID‐19 infections. Methods: 46 critically ill COVID‐19 patients who were admitted to the ICU of the Sino‐French New City Branch of Tongji Hospital in Wuhan between February 4 and April 12 developed pressure injuries. 22 patients with pressure injuries had wound exudates. Wound and pharyngeal swabs of the 22 patients were collected and RT‐PCRs were conducted to detect SARS‐CoV‐2 viral RNA. Results: At the time of pressure injury, 5 patients still tested positive by pharyngeal swabs, the rest of the 17 patients tested negative. However, none of the wound exudate swabs from the participants tested positive for SARS‐CoV‐2 by RT‐PCR. Conclusion: Our study suggests that it is rather unlikely that COVID‐19 can be transmitted via pressure injury exudates, but we still recommend standardized personal protective equipment, face shield and an additional pair of gloves when treating pressure injuries. [ABSTRACT FROM AUTHOR]

Background: Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump. Aims: This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area. Methods: Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared. Results: Patients displayed a larger upper vermillion height (P =.038) and a smaller cutaneous upper lip height (P =.024). There was a trend for a larger upper lip surface area, but not statistically significant (P =.109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients. Conclusion: BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution. [ABSTRACT FROM AUTHOR]

Background: Due to the relatively higher tendency of postsurgery scars, insufficient cartilage support, and low surgical acceptability, nasal defect repair with forehead flap in Asian patients needs further study. Objective: We aim to determine the necessity of tissue expansion, timing of pedicle division, and the importance of cartilage scaffold reinforcement and scar prevention at the donor site during nasal reconstruction in Asian patients with paramedian forehead flap. Methods: A retrospective analysis was performed on patients who underwent nasal reconstruction with forehead flap at our hospital from January 2013 to January 2018. The demographical information, surgery details, and postoperative complications of all patients were recorded. The reconstructed nose, scars, and eyebrow deformities were evaluated by digital photographs, and the overall satisfaction of the patients was documented. Results: The study included 15 patients (7 males and 8 females). All nasal defects involved at least two aesthetic units and included seven full‐thickness defects. Only one patient underwent two revision operations. Complications like hematoma, infection, and necrosis were not detected, except in one patient with partial necrosis of the flap. All patients were satisfied with the reconstructed nose and did not report any respiratory dysfunction. No obvious scars or eyebrow deformities were observed. Conclusion: Three‐stage full‐thickness forehead flap should be used to repair nasal defects in Asian patients, with immediate cartilage scaffold reconstruction at stage one and reinforcement at stage two. Botox injection into the forehead can refine the scar. [ABSTRACT FROM AUTHOR]

Background: The repair and reconstruction of the upper lip defects should focus on the important anatomical landmarks of the upper lip. In this investigation, double V‐Y advancement flaps were used to simultaneously repair the cutaneous and mucosal defects of the upper lip. It was especially suitable for young patients with tight skin and high‐risk scar hyperplasia in the donor sites. Objective: The objective was to examine the surgical outcomes following the simultaneous repairation of upper lip mucocutaneous defects using double V‐Y advancement flaps. Methods: A retrospective review of all patients with defects near the vermilion border who underwent double V‐Y flaps repair from July 2014 to November 2018 was performed. Transverse V‐Y advancement flaps were used to repair the cutaneous defects and longitudinal V‐Y advancement flaps to repair the mucosal defects. Results: Fifteen patients (six males, nine females) were retrospectively reviewed. Defects spanning the vermilion border ranged from 0.8 × 0.5 to 2.5 × 1.5 cm2. Follow‐up was for 3 months or longer. There were no perioperative complications or visible postoperative scars, and major anatomic landmarks were preserved and reconstructed. All patients were satisfied with the aesthetic outcome. Conclusion: Double V‐Y advancement flaps are suitable for the repair of superficial mucocutaneous defects smaller than 50% of the lateral upper lip, especially for younger patients with tight skin. [ABSTRACT FROM AUTHOR]