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Objective:To investigate the clinical efficacy of bilateral V-Y advancement island flaps on buttocks in repairing postoperative defects in patients with perianal Paget′s disease.Methods:From January 2009 to January 2021, a retrospective analysis was performed on clinical data collected from 13 patients with perianal Paget′s disease, whose perianal defects resulting from the tumor resection were reconstructed with bilateral V-Y advancement island flaps on the buttocks in the Department of Dermatology, Hangzhou Third People′s Hospital. The postoperative recovery of the buttocks and the effects on the defecation function were evaluated.Results:The areas of perianal defects in 13 cases ranged from 4.8 cm × 5.6 cm to 12.2 cm × 6.4 cm. All defects were successfully repaired by using the bilateral V-Y advancement island flaps, and all surgical wounds healed primarily. One case first received temporary ileostomy, and then received ileostomy closure 3 months later, resulting in the recovery of defecation function; in another 1 case of perianal Paget′s disease comorbid with rectal cancer, the permanent sigmoid colostomy was performed to divert feces, and the defecation function was lost. After the follow-up for 1 - 6 years, the buttocks were symmetrical in shape in all the 13 patients, and 12 with preserved anus had normal defecation function. No tumor recurrence was observed in 12 patients without other malignant tumors after the operation, while 3 patients experienced mild anal stenosis without anal mucosa eversion or wound dehiscence; 1 patient with perianal Paget′s disease complicated by anal canal adenocarcinoma developed bilateral inguinal lymph node and internal iliac lymph node metastasis 1 year after the operation, and died 6 months later.Conclusion:The bilateral V-Y advancement island flaps on the buttocks have the advantages of reliable blood supply and sufficient advancement mobility, and can be used to repair large skin defects around the anus.
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Objective:To analyze the clinical efficacy of electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation in the treatment of vitiligo-associated leukotrichia.Methods:Clinical data were retrospectively collected from 25 patients with stable vitiligo-associated leukotrichia in the Department of Dermatologic Surgery, Hangzhou Third People′s Hospital from January 2019 to January 2021. All the patients received electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation. Outpatient follow-up visits were conducted in the first week, as well as the first, third and sixth months after surgery. The texture and growth status of transplanted hair were observed, and the survival rate of transplanted hair follicles and the proportion of newborn white hair in white hair in the original lesions were recorded.Results:Among the 25 patients with stable vitiligo, there were 14 males and 11 females, and their disease duration ranged from 2 to 15 years, with the average duration being 5.8 years. A total of 30 white patches accompanied by leukotrichia were included, including 9 on the scalp, 7 on the eyebrows and 14 on the eyelashes. One week after surgery, the transplanted hair survived well in all patients, without obvious shedding or local infection. Six months after surgery, repigmentation was observed in most hair in the original lesion area, and only a small amount of white hair grew out, without obvious scarring; the survival rate of transplanted hair follicles was 76.5% ± 10.0%, and the proportion of newborn white hair in white hair in the original lesions was 16.7% ± 7.8%.Conclusion:Electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation was effective in the treatment of vitiligo-associated leukotrichia, with a simple treatment process and few postoperative complications, which provided a reliable choice for the clinical treatment of vitiligo-associated leukotrichia.
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Objective:To summarize and analyze the efficacy of the upper eyelid orbicularis oculi myocutaneous island flap in repairing secondary defects after resection of eyelid and periorbital skin tumors.Methods:A retrospective analysis was carried out on clinical data collected from 28 patients, whose secondary eyelid and periorbital defects were repaired with the upper eyelid orbicularis oculi myocutaneous island flaps in the Department of Dermatology, Hangzhou Third People′s Hospital from August 2019 to June 2021. The survival condition of the flaps was observed after the operation, and the appearance of the upper eyelid and periorbital skin as well as tumor recurrence were evaluated during the follow up.Results:Among the 28 cases, there were 6 males and 22 females; their ages ranged from 47 to 87 years (70.5 ± 10.9 years), 7 patients were aged 80 - 89 years, 8 aged 70 - 79 years, 8 aged 60 - 69 years, 4 aged 50 - 59 years, and 1 patient was aged 40 - 49 years. Skin defects were distributed at the upper eyelid in 1 case, at the lower eyelid in 9 cases, at the inner canthus in 1 case, at the outer canthus in 3 cases, at the upper eyebrow in 1 case, at the dorsum of the nose in 3 cases, and at the junction of the external nose, inner canthus and lower eyelid in 10 cases. The skin defects varied from 1.0 cm × 0.5 cm to 3.1 cm × 2.3 cm in size. The designed upper eyelid orbicularis oculi myocutaneous flap was 0.5 - 1.8 cm in width and 3 - 4 cm in length, and the length of the subcutaneous tunnel was 1.2 - 2.5 cm. During the follow-up of 6 months to 1.5 years, all flaps survived; scars on the upper eyelid donor sites were not obvious; there was no upper eyelid ectropion, no trichiasis, and no eyelid closure abnormality after the operation.Conclusion:The medium- or small-sized defects of the eyelid and periorbital skin can be successfully repaired by the upper eyelid orbicularis oculi myocutaneous island flap, with a favorable cosmetic effect and concealed donor areas.
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Objective:To investigate the application of transverse closure of longitudinal incisions in repairing pentagonal full-thickness defects of the lower eyelid margin.Methods:A retrospective analysis was performed on clinical data collected from 26 patients with melanocytic nevi at the lower eyelid margin in Department of Dermatology, The Third People′s Hospital of Hangzhou from July 2016 to June 2019. Among the 26 patients, 10 were males, and 16 were females. After lesion resection, all the pentagonal full-thickness defects of the lower eyelid margin were repaired via transverse closure of longitudinal incisions.Results:All the pentagonal defects of the 26 cases were successfully repaired. The longitudinal incisions perpendicular to the eyelid were successfully converted into transverse incisions parallel to the eyelid margin and near the eyelash, and all incisions healed primarily. After surgery, mild congestion of the lower eyelid occurred in 3 patients, and temporary blurred vision in 1. During 1 - 2 years of postoperative follow-up, 26 patients all achieved symmetrical appearance of the skin and soft tissues around the eyes, without obvious postoperative scars or lower eyelid ectropion.Conclusions:Horizontal closure of longitudinal incisions can be used to repair the pentagonal full-thickness defects of the lower eyelid margin, because it can convert the incision closure line perpendicular to the lower eyelid margin into a horizontal transverse incision closure line parallel to the lower eyelid margin, so that the incisions and scars of the lower eyelid can be hided with a satisfactory cosmetic effect.
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Objective:To investigate clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects.Methods:Clinical data were collected from 11 patients with basal cell carcinoma of nasal ala in Department of Dermatologic Surgery, the Third People′s Hospital of Hangzhou from August 2019 to September 2020, and analyzed retrospectively. There were 6 females and 5 males, aged 70 years in average (range, 56-87 years) . After tumor resection, full-thickness nasal alar defects were formed, a flap was designed along the inner side of the cheek and turned by 180 degrees to repair the nasal mucosal lining; then, a subcutaneous pedicled flap was designed along the ipsilateral nasolabial fold to repair the outer secondary defects and postoperative defects.Results:The mean diameter of postoperative defects was 1.8 cm (range, 1.5-2.5 cm) , and the mean diameter of the nasal lining was 0.9 cm (range, 0.6-1.5 cm) . Seven days after the operation, stitches were removed, wounds healed without complications, and all flaps survived with a satisfactory appearance. The follow-up period ranged from 1 to 13 months (average, 6 months). After scar maturation, all patients were satisfied with the aesthetic outcome. No tumor recurrence was observed during the follow-up period.Conclusion:The composite subcutaneous pedicled flap is safe and effective for the repair of full-thickness nasal alar defects, and has advantages of a well-hidden donor site, good color match, and stage-I operation for reconstruction.
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Objective:To evaluate performance of O-Z-O flaps in repair of adjacent facial skin defects.Methods:A retrospective analysis was conducted. A total of 60 patients with adjacent facial skin defects receiving O-Z-O flap repair were collected from the Third People′ s Hospital of Hangzhou from 2015 to 2018, including 50 with pigmented nevus, 4 with seborrheic keratosis, 3 with verruca vulgaris, 2 with basal cell carcinoma and 1 with squamous cell carcinoma. Among the 60 patients, 14 were males and 46 were females, with the age being 18 - 75 years. According to the condition of skin lesions, in situ resection was performed, and the optimal incision was designed; the "flap bridge", that is, the normal tissue between adjacent defects, was severed; according to the skin tension line and wrinkle line, residual ends of the two flap bridges were interlaced with each other, sutured and fixed interruptedly, and the wounds were repaired. Results:The skin defects could be completely covered by O-Z-O flaps in the 60 patients. All the patients received primary healing of incisions without scar hyperplasia after operation.Conclusions:The O-Z-O flap has advantages of flexible design and small incisions, and can be used for tension-reducing suture after excision of adjacent skin lesions. It is a good choice for repair of adjacent facial skin defects with satisfactory clinical effect.
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Objective:To evaluate the efficacy of sectioned hair follicle transplantation in the treatment of stable vitiligo in hair-bearing areas.Methods:A total of 10 patients with stable vitiligo aged 19-28 years (including 4 males and 6 females) were enrolled from Department of Dermatology, The Third People′s Hospital of Hangzhou between December 2016 and December 2018. Among the 10 patients, a total of 26 white patches accompanied by leukotrichia received sectioned hair follicle transplantation, including 18 on the scalp and 8 on the eyebrow. Hair follicles were obtained from the occipital and postauricular regions by follicular unit extraction, and divided into the upper and lower portions. Each white patch with leukotrichia was divided into 2 regions, and the 2 portions of the hair follicle were transplanted into the 2 regions of lesions respectively. The patients were followed up once every 4 weeks after grafting, and repigmentation and hair growth were evaluated.Results:At 12 weeks, of the 26 white patches transplanted with the upper hair follicles, 3 were cured, 5 were markedly improved, 12 were improved, and 6 showed no response; the response rate was 30.8% (8/26) , and no hair grew on the transplantation sites. Of the 26 lesions transplanted with the lower hair follicles, 5 were cured, 7 were markedly improved, 11 were improved, and 3 showed no response; the response rate was 46.2% (12/26) , and hair growth was observed on 8 lesions. There was no significant difference in the response rate between the upper hair follicle transplantation group and lower hair follicle transplantation group ( χ2 = 1.30, P = 0.25) . Conclusion:Sectioned hair follicle transplantation is suitable for the treatment of vitiligo complicated by leukotrichia on the scalp and eyebrow.
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Objective:To evaluate clinical efficacy of pedicled fat flaps in the repair of facial defects after skin tumor resection.Methods:Clinical data were collected from 39 patients with facial tumors in Department of Dermatology, The Third People′s Hospital of Hangzhou, and analyzed retrospectively. There were 20 males and 19 females, aged 55 ± 7.3 years (range, 42 - 80 years) , including 15 with basal cell carcinoma, 10 with squamous cell carcinoma, 5 with keratoacanthoma and 9 with solar keratosis. Postoperative skin defects varied from 1.5 cm × 3.0 cm to 8.0 cm × 4.5 cm in size. All patients received skin defect repair with pedicled fat flaps after tumor resection. Twenty-four hours after the surgery, survival condition of the flaps was observed. These patients were followed up at 1, 3 months after the surgery and every 3 months thereafter, and the shape and texture of the flaps and their matching degree with surrounding tissues were evaluated.Results:Twenty-four hours after surgery, the flaps survived well without infection in the 39 patients. Partial necrosis was observed at the distal end of the flaps in 2 cases, whose skin defects were on the lower eyelid, with the ratio of the flap length to pedicle width being greater than 3∶1, and wounds were healed after treatment in both of the 2 cases. One month after surgery, bloated appearance was observed in 3 cases, of which 2 had defects of the upper lip and 1 had defects of the cheek, and the ratios of flap length to pedicle width were less than 2∶1, 2∶1 - 3∶1, and greater than 3∶1 respectively. All patients were followed up for 1 - 12 months, with an average of 7 months. The color and texture of the flaps were good, and favorable function and shape were achieved in both the donor and recipient sites.Conclusion:The pedicled fat flap is markedly effective for the repair of facial skin defects, with high survival rate of flaps, high safety and reliability, and less damage to the donor site.