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Background Liposuction is one of the most commonly performed aesthetic procedures. Toxic shock syndrome(TSS) is a rare, life-threatening complication. The incidence rate of TSS is very low in the plastic surgery field, especially after liposuction and fat transfer. Case presentation A 23-year-old female patient was transferred to our emergency department from an aesthetic clinic with sepsis shock features after received liposuction and fat transfer. The patient underwent TSS, disseminated intravascular coagulation(DIC), multiple organ dysfunction syndrome (MODS), symmetrical peripheral gangrene (SPG), and necrotizing soft tissue infection of the buttocks in the next 10 days. Authors used a series of debridement and reconstructive surgery including vacuum sealing drainage (VSD) treatment, artificial dermis grafts,split-thickness skin grafts, amputation surgeries when her vital signs were stable. The patient experienced desquamation of the hand on the 26th day. The skin grafts survived and the function of both fingers and toes recovered. She was discharged 2 months after admission and was in good health. Conclusion TSS is extremely rare in the field of liposuction and autologous fat transfer. The mortality rate of TSS is very high. Early diagnosis and operative treatment, as well as correction of systemic abnormalities, are the important keys to save a patient's life.

Background Cross-leg flaps are a good choice for reconstructing traumatized lower extremities, especially when free flaps cannot be used. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using cross-leg flaps. Study Design A total of 56 patients suffering traumatic lower extremities were treated with cross-leg flaps. Patients with diabetes mellitus and those who were heavy smokers were also included in this study. Results Most flaps survived without complications. Flap necrosis occurred in 2 cases. The hospital stay was 20.0 ± 6.2 days and the flaps were divided at 13.3 ± 2.8 days. The diabetes patients were mostly elderly, and they had longer hospital stays and duration for flap division. Follow-up was an average of 16.2 ± 8.2 months. Conclusions The cross-leg flap is an effective and simple method for treating traumatic lower extremity wounds. It should have priority over microsurgery, not just be an alternative to it.

To present our experience of vaginal reconstruction with the use of a pedicled ileum segment and laparoscope assistance, and to analyze its complications and long-term anatomic and functional results.The abdominal and perineal approaches were performed simultaneously with the patient in a special position. Under the guidance of laparoscopy, the target ileal segment was harvested and transposed down to the perineum through an artificial tunnel between the bladder and the rectum. A silicon vaginal tutor was introduced into the vaginal cavity and maintained all day long for 2-3 months. The complications and the anatomical and functional results were summarized and analyzed.From February 2002 to June 2010, 82 patients underwent laparoscope-assisted total vaginal reconstruction with a pedicled ileum segment at our department. Complications developed in 16 of 82 patients, including rectum and/or bladder injury during operation, acute renal failure, delayed healing of the ileocutaneous anastomosis, introital stenosis, and partial or complete intestinal obstruction. The abdominal cutaneous scar was acceptable after the surgery. The vulva was not altered, which was especially significant for patients with congenital vaginal atresia. The neovagina was patent, soft, moist, and flexible. The mean width and depth of the neovagina at the latest postoperative visit measured 3.2 and 15 cm, respectively.The favorable long-term anatomical and functional results demonstrate that our technique is ideal for patients with congenital vaginal atresia or patients who need secondary vaginal reconstruction. For the primary male-to-female transsexuals or hermaphrodites, it can be an alternative method for vaginal construction.

Keloids represent a dysregulated response to cutaneous wounding that result in an excessive deposition of extracellular matrix (ECM), especially types I and III collagen. In keloid scars, the ratio of 'type I to type III collagen' varies compared to normal skin. Transforming growth factor beta (TGF-beta) plays a central role in the pathogenesis of fibrosis by inducing and sustaining activation of keloid fibroblasts. However, the underlying mechanisms are poorly understood. RNA interference (RNAi) is an evolutionally conserved mechanism for repressing targeted gene expression. In mammalian cells, RNAi is mediated by small interfering RNA (siRNA). In this paper, we examined the function of Sma and Drosophila mothers against decapentaplegic homolog 3 (Smad3), recently characterized as intracellular effector of TGF-beta signalling, in keloid fibroblasts using siRNA.Dermal fibroblasts obtained from one female patient aged 21 years were maintained in Dulbecco's modified Eagle's medium. Cells (6 passages) were treated with or without Smad3 siRNA and the expression levels of related genes were examined by Reverse Transcription Polymerase Chain Reaction (RT-PCR) and Western Blot. Statistical analysis was performed using one-way ANOVA (Dunnett correction) and the Excel 7.0 software, with significance set at p0.05.The knockdown of Smad3 expression in mRNA and protein levels was confirmed using RT-PCR and Western Blot. Compared to blank, the mRNA levels of types I and III procollagen were also significantly and uniquely decreased following the reduction of Smad3 by siRNA (p0.05). The results indicate that Smad3 plays an important role in the TGF-beta induced fibrosis in keloid. Downregulation of Smad3 expression in keloid fibroblasts can significantly decrease procollagen gene expression. SiRNA targeting Smad3 was an efficient reagent to reduce ECM deposition and attenuate process of fibrosis. It could be a new promising therapeutic approach to improve skin wound healing and inhibit progression of fibrotic conditions by interrupting the TGF-beta signal pathway.

Construction of a neourethra is always considered to be a difficult part in phalloplasty, especially for the female-to-male (FTM) transsexual patients. We report our experience with prefabricated pars pendulans urethrae using vaginal mucosal graft for phalloplasty in FTM transsexuals. We retrospectively reviewed notes on the 22 FTM patients treated with pedicled-flap phalloplasty with prefabricated pars pendulans urethrae using vaginal mucosal graft between January 2008 and December 2012. Surgical outcome, urological function, and complications were recorded. Histological difference between normal mucosa and skin, and pathological changes of vaginal mucosal graft were also observed. All the reconstructive penis survived, and patients could void in a standing position finally at a median follow-up of 25.4 ± 6.0 months. Urethral fistula and urethral stricture rates were 31.8 % (7/22 patients) and 4.5 % (1/22 patients), respectively. The occurrence of the urethral stricture was remarkably low compared with previous reports. Our histological results also showed a pronounced similarity between vaginal and buccal mucosa. Morphologically, they resembled urethral epithelium more closely than the forearm skin. Following the free transfer, the vaginal mucosal graft also showed a good revascularization and the inflammatory reaction and the extent of fibrosis of the mucosa decreased to the normal level after a 6-month prefabrication. With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. According to its histological similarities and source character, the vaginal mucosa is the excellent substitute material for promising urethral reconstruction in FTM transsexuals.

In search of a simpler and safer technique for auricular reconstruction with good appearance.Medpor implant was used as auricular framework, and covered by temporal fascia flap and skin graft.Ear reconstruction was successfully achieved in 19 cases, the newly formed ears all had good appearance after edema disappeared 1 or 2 months postoperatively.Medpor is a kind of good implant material because it is steady in nature, easy to be sculptured. Temporal fascia flap is rich in blood supply, tough and tensile in biomechanics. So the combination of Medpor implant framework with temporal fascia flap is preferable in auricular reconstruction.