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Background: Cosmetic injection‐induced nodules are tricky to handle in the clinic. Aims: We reported a case of injection‐induced nodule receiving the experimental treatment of hyperbaric oxygen therapy (HOT). Patient: A woman presented with multiple red solid nodules on the neck after receiving mesotherapy conducted by syringe. Ultrasound examination showed multiple thickened inflammatory skin tissues on the neck. Pathological biopsy results showed epithelioid granulomas in the dermis, within which there were degenerative necrosis and foreign bodies in the center and multinucleated giant cells around. The bacteria tests remained negative. Diagnosed with foreign body granuloma, the patient rejected the resection or steroids, but willingly took the experimental treatment of HOT instead. After one month, the patient's ultrasound examination showed that the lesion's local hardness got significantly reduced, and the local blood flow increased, indicating the condition improved. Results: Although the patient's nodule has not been eliminated, some improvements have been achieved. So far there has no case report on HOT treating injection‐induced nodules in the literature. Conclusion: HOT may be considered as a potential alternative when other treatment options cannot be implemented. More research is needed in this field. [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: 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]

Background: Mandibular osteomyelitis after filler injection is extremely rare. Aims: We reported a case of mandibular osteomyelitis after hyaluronic acid injection. Patients: A 33‐year‐old woman received 1 mL hyaluronic acid injection on her chin 1 year ago, after which her chin kept swelling and painful, and gradually ulcerated with pus flowing out. She received antibiotics, debridement procedures, negative pressure wound therapy, and hyperbaric oxygen therapy without symptoms improved. Cone‐beam computed tomography scan showed local bone destruction, sequestrum formation, and tissue calcification on the right mandible body. The patient was diagnosed with mandibular osteomyelitis and received local curettage for the removal of necrotized bone. Results: Literature search found no case reports on mandibular osteomyelitis after filler injection so far. Conclusion: Minimizing the risk of contamination and infection is strictly required during the filler injection process. Once the patient shows signs of incurable mandibular infection postoperation, clinicians should consider the possibility of osteomyelitis. [ABSTRACT FROM AUTHOR]