Search

To describe a modified anchored suture technique combined with varied flaps for the repair of paranasal skin defect secondary to melanocytic nevus excision. The feasibility and effectiveness of the technique were discussed. A total of 26 patients (10 male and 16 female) with an average age of 11.1 years were included in this retrospective study. All patients underwent the anchored suture technique. The subcutaneous tissue of the free margin of the cheek flap was sutured to the deep pyriform ligament. The local flaps were designed according to the size and shape of the defect. The diameter of the nevi ranged from 2.8 to 7.5 cm, with most being 3 to 5 cm (50%). Among the 26 patients, 17 patients underwent the anchored suture technique and nonadvancement flap, whereas the other 9 patients underwent the anchored suture technology and advancement flap with auxiliary incisions. Twenty-five patients had a symmetric nasal alar and unapparent scar and were satisfied with postoperative aesthetic outcomes. Thus, the anchored suture method combined with different flaps to repair paranasal defect is an effective and affordable technique to reconstruct paranasal tissue connections.

Summary Blepharoptosis is a symptom that is commonly observed in clinics. It presents with drooping of the upper eyelid and an asymmetric appearance of the eye. It can occur because of various causes. If left untreated, severe congenital blepharoptosis may impair visual function. The surgical approach largely depends on the severity of blepharoptosis, Bell's phenomenon, and surgical history. However, it is intricate and difficult to achieve satisfactory symmetry and avoid complications. Owing to the complexity involved and discrepancies in treatment, we planned to arrive at a consensus on the diagnosis and correction of blepharoptosis among Chinese plastic surgeons and ophthalmologists, aiming to establish more standardized treatments and cause less harm to patients.

Double-eyelid blepharoplasty, the procedure to create supratarsal crease, has been one of the most popular cosmetic operations in Asia for many years. This study aimed to assess the effectiveness and safety of a surgical procedure using a composite tissue flap for double-eyelid blepharoplasty. A surgical technique was introduced and patients having blepharoplasty with this technique from January 2017 to August 2019 were retrospectively studied. In this technique, a composite tissue flap consisted of the posterior septum and levator aponeurosis was formed and fixed with orbicularis oculi muscle and tarsus. The cosmetic outcomes, patient satisfaction, and complications from the documented medical records were analyzed. Eighty female and 1 male patients had blepharoplasty with the proposed technique and were followed up from 6 months to 42 months. Six patients were found to have mild blepharoptosis. As for cosmetic outcomes, 71patients were graded as good, 7 patients were graded as fair, and only 1 patient was graded as poor. Those patients who were not graded as good had visible scarring, shallow eyelid crease, or asymmetry. The overall patient satisfaction was as high as 95.1%. Mild hematoma formation occurred in 3 patients and no infection or blepharoptosis was observed. One patient complained of asymmetry and 2 patients complained of unilateral crease fading as the complications. The technique is effective to develop durable and natural-looking double eyelids with minimal complications. It could also be an option for mild ptotic patients who ask for double-eyelid blepharoplasty.

Background The transconjunctival technique is an effective approach to mild to moderate blepharoptosis repair that does not involve skin incision. However, accurate surgical manipulation of this method is greatly restricted by poor intraoperative evaluation. Objectives The aim of this study was to introduce a modified transconjunctival approach with flexible intraoperative adjustments in order to achieve more accurate ptosis correction. Methods Taking a transconjunctival approach, the levator aponeurosis and Müller’s muscle were folded with a square-like mattress suture for flexible adjustment and accurate correction. Results In 18 mild ptosis eyelids, 94.5% (17 eyelids) achieved adequate or normal correction. In 9 eyelids with moderate ptosis, 88.9% (8 eyelids) achieved adequate or normal correction. Of 24 ptosis patients, 23 (95.8%) achieved a good or fair symmetry result. Conclusions This study presents a modified transconjunctival technique for repair of mild to moderate ptosis, which is characterized by flexible intraoperative adjustments that produce satisfying functional and aesthetic outcomes. Level of Evidence: 4

Unit commitment is an intractable issue aiming to reduce the overall economic cost of power system operation while maintaining the system constraints. Due to the emerging scenario of global warming, many countries are vigorously developing renewable energy to replace the traditional fossil power plant, in order to reduce the environmental and carbon emission. The increasing penetration of renewable generation significantly challenge the economic and security of power system operation. In this paper, a low carbon multi-objective objective unit commitment model considering economic cost, environmental cost and, more importantly, the carbon emission is established, integrating wind and solar power and therefore generating a multi-objective, high-dimensional, strong non-linear, multi-constraint and mixed integer optimization problem. The non-dominated sorting genetic algorithm-III is tailored and adopted for solving the proposed challenging task, where the decision-making scheme is designed according to the normalization method and weighted sum function. Numerical results show that the proposed complex many-objective low carbon unit commitment model can be successfully solved by the proposed algorithm and the carbon emission is effectively reduced by the integration of renewable generations.

Recessive dystrophic epidermolysis bullosa (RDEB) is a congenital disease caused by a mutation in the COL7A1 gene and frequently results in hand contractures and pseudosyndactyly. Although multiple...

The promotion of integrated energy systems is able to reduce pollutant emissions by using clean energy sources, to promote the replacement of traditional fossil energy with green electricity, and to improve human life quality. In order to popularize integrated energy systems, it is imperative to study its economic applicability. In this paper, according to the cold and thermal electricity load demand, energy prices, equipment technology, the optimization model of the energy system by using the nonlinear integer programming method is firstly established. Then the evaluation index values of different systems are obtained. Secondly, the entropy weight method and analytic hierarchy process (AHP) are applied to obtain the weights respectively. Finally multi-index evaluation model is set up by using the expert evaluation method to determine the important index weight. The simulation results based on the actual data in a certain place show that the evaluation results obtained by the subjective and objective weights are basically consistent, which verifies the accuracy and effectiveness of the proposed method for economic applicability of the typical integrated energy systems.

The objective of the study is to examine the influence of high sustained loads and longitudinal reinforcement on the long-term deformation of concrete beams. First, the influence of high sustained loads on the creep of reinforced concrete beams was investigated using five beams with load levels (ratio of sustained load to failure load) of 0.3, 0.4, 0.5, 0.6, and 0.7. A load level of 0.3 is the service load for a comparative analysis, and load levels of higher than 0.3 are considered high loads. The influence of the longitudinal reinforcement on the creep of the reinforced concrete beams was then studied using four beams with a ratio of longitudinal reinforcement of 0.81%, 1.55%, 2.14%, and 2.72%, respectively. Furthermore, the influences of the load levels and longitudinal reinforcement on the curvature creep, creep of the concrete at the edge of the compressive zone, and the mid-span deflection creep were analysed. Moreover, a comparison between the test data and the existing calculation model of the deformation of a beam was conducted, and the existing model used to predict the long-term deflection of reinforced concrete beams with high sustained loads within a wide range of longitudinal reinforcement ratios was modified. Finally, post-creep tests of the beams were conducted and the calculated formulas of the total strain (the sum of the initial strain, creep strain, and increased strain after creep) of the concrete at the compression edge of the beams was obtained through a regression analysis.

Background Conventional blepharoptosis repair methods distort the normal anatomy of levator aponeurosis and often cause a visible depressed scar in the upper eyelid. Methods The levator aponeurosis was dissected as a flap from the pretarsal tissue in mono-eyelid Asian patients who had mild to moderate congenital blepharoptosis. The flap base was advanced and repositioned on the tarsus. The margin of the distal flap was interposed and fused with orbicularis oculi muscles. Postoperative evaluation included ptosis correction, symmetry, and overall cosmetic outcomes. Results A total of 162 eyes on 97 patients were corrected using our method. Follow-up time ranged from 8 to 24 months (mean 12.4). In mild ptosis eyelids, out of 58 eyelids, 36.2% (21 eyelids), 56.9% (33), and 6.9% (4) required adequate correction, normal correction, and undercorrection, respectively, whereas in moderate ptosis, the results were 34.6% (36 eyelids), 53.9% (56), and 11.5% (12), respectively. For symmetry, 58.8% (57 cases), 32.0% (31), and 9.2% (9) resulted in good, fair, and poor outcomes, respectively. For cosmetic outcomes, 82.8% (48 eyelids), 15.5% (9), and 1.7% (1) of mild ptosis cases achieved good, moderate, and poor results in mild ptosis cases, whereas the results were 77.9% (81 eyes), 20.2% (21), and 1.9% (2), respectively, in moderate ptosis cases. The only complication among all cases was postoperative swelling. Conclusions We presented a new blepharoplasty for ptosis repair that allows both satisfactory ptosis correction and cosmetic outcomes in mild to moderate congenital blepharoptosis.

Temporary ectopic implantation has been performed in clinical practice to salvage devascularized amputated tissues for delayed replantation purpose. In this study, we established a series of segmental forelimb ectopic implantation models in rats, including forelimb, forearm, forepaw, digit, and double forelimbs, to mimic the clinical context. Time of amputated limbs harvesting in donors and ectopic implantation process in recipients were recorded. Survival time and mortalities of recipients were also recorded. Sixty days after ectopic implantation, a full-field laser perfusion imager (FLPI) was used to detect the blood flow of amputated limbs and micro-CT imaging was used to examine bone morphological changes. Histological sections of amputated limbs were stained with hematoxylin and eosin to evaluate pathological changes. Implanted amputated limbs in all models achieved long term survival and there were no obvious morphological and histological changes were found according to results of micro-CT and histology study. Thus, a series of rat segmental forelimb temporary ectopic implantation models have been well established. To our knowledge, this is the first rodent animal model related to forelimb temporary ectopic implantation. These models might facilitate further research related to salvage, reconstruction and better aesthetic and functional outcome of upper extremity/digit in temporary ectopic implantation scenario.

Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible.

Epicanthal fold, which is unique to Asian population, forms a web across and covering the medial canthus. It often impairs the beauty of the eyelids and the outcome of double-eyelid blepharoplasty that is popular in Asians. Although many surgical procedures have been reported, most of them were only description of a single technique. Comparison among techniques will help form universally accepted algorithm or consensus in epicanthus treatment. We want to present our experience of three kinds of epicanthoplasties: horizontal incision method, Z-plasty and V-W plasty and a detailed comparison among these surgical techniques. From 2005 to 2011, the authors had performed epicanthoplasties in 252 cases, in which 220 cases simultaneously underwent a double-eyelid surgery. The choice of technique was based on presurgical evaluation of severity of epicanthal fold. Horizontal incision method was used for majority of mild epicanthal fold. Z-plasty mainly applied to moderate cases and V-W plasty was chosen for severe ones. In addition to skin rearrangement in medial canthic region, underlying orbicularis oculi muscle and thick subcutaneous tissue also needed treatment for effective release. The degree of postoperative scarring and epicanthal fold correction were reviewed. All these three methods produced satisfactory long-term results with alleviation of the skinfold and formation of vivid upper eyelid crease. No complete recurrence was observed. Horizontal incision method left an inconspicuous scar and V-W plasty might cause a relatively obvious scar. Persistent hypertrophic scars were observed in 12 patients and gradually faded after injection of diprospan. In conclusion, preoperative evaluation of skinfold severity, making a rational choice and careful implementation of surgical technique available are important in effective correction of epicanthal fold.

Introduction Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy. Methods The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction. Results 24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour. Conclusions Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.