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Background Repairing the defects of face and neck remains a big challenge for plastic surgeons. Here we present a case series of pre-expanded cervico-acromial flaps in the repair of soft tissue defects. Method This is a retrospective study that a total of 126 patients between 2001 and 2019 were included. One patient was excluded since he did not complete the treatment. All patients were followed for at least 0.5 years (range: 0.5-4 years, mean 2.50 years) after surgery. Results All patients are satisfied with the appearance. The color and texture of expanded flaps were similar to surroundings. One patient (0.8%) had complete necrosis and received skin grafts. The size of cervico-acromial was 26-10 × 14-6 cm (mean, 15.389 ± 2.701× 8.341 ± 1.075 cm). The time of operation during stage 1 was 59.254 ± 9.895 minutes, 96.912 ± 18.936 minutes during stage 2, and 38.146 ± 9.478 minutes during stage 3. Surgical complication rate was 14.3%, given that 18 patients had complications following the surgery. Conclusions The cercico-acromial flap is a reliable and multifunctional method for face, neck, and chest reconstruction.

Introduction The aim of this study is to report our experience with modified staged buccal mucosa graft urethroplasty for the repair of proximal hypospadias in children and adolescents. Materials and Methods A total of 183 patients were treated at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2010 and 2019. The patients were grouped according to age: (1) within 1.5-year-old group, (2) prepuberty group (Tanner stage 1), and (3) puberty group. Results In total, 153 patients were included in this study. Thirty-six patients had complications: seven after stage one; 29 after stage two; one patient had two complications. Maximum flow rates were 11.80 ± 1.46 mL/s in the 1.5-year-old group, 13.24 ± 2.61 mL/s in the prepuberty group, and 13.60 ± 2.20 mL/s in the puberty group (p = 0.199). Average flow rates were 6.86 ± 1.37, 7.94 ± 1.74, and 7.88 ± 1.22 mL/s, respectively (p = 0.203). The optimal hypospadias objective scoring evaluation score of 16 was seen in 117 patients (76%), the score of 15 in 23 patients (15%), 14 in 10 (7%), and 13 in 3 patients (2%). Patients with an uncomplicated treatment (no complication) had a higher clinical outcome than patients with a complication (15.8 ± 0.53 vs. 15.3 ± 0.97, with or without complication, p = 0.000). Multivariable analyses showed that previous treatment was closely related to the complication rate (p = 0.016). Conclusion The modified procedure allows for two-stage repair of proximal hypospadias with good results with a low complication rate and good functional results. Delaying operation did not increase complication rates in our research.

Background Flap prefabrication is to turn a random flap into an axial flap by transferring a vascular pedicle. Methods In the past 13 years, we have prefabricated 20 flaps in 20 patients by the superficial temporal artery and its concomitant veins. Typically, a 50- to 800-mL tissue expander was implanted in the donor site. After flap maturation, the prefabricated flap was raised and transferred locally to cover the large defect on the face. All the cases were followed up regularly. Results The patients' age were between 3 and 27 years, the size of the flaps were between 3.5 × 5.5 cm and 13 × 15 cm, the superficial temporal artery length was between 10 and 15 cm. All flaps were transferred successfully: 10 of the flaps had venous congestion, partial epidermis exfoliation and flap necrosis occurred in 4 flaps. All cases were followed up for at least 1 year, the longest follow-up period was 9 years. Long-term follow-up results showed the prefabricated flap survived in good condition and had a satisfactory outcome. Conclusions Because flap prefabrication is practical, and long-term follow-ups have proved its preferable characters and stability, it is a fine method for large area facial reconstructions.

Background Port wine stain (PWS) is a congenital benign vascular malformation. Laser treatment is the main therapy for PWS. But some patients are not sensitive to it, and failed laser treatment will leave scars on face. Hence in this study, the authors used prefabricated flap carried by superficial temporal artery to treat PWS. Methods Nine patients diagnosed with large-scaled PWS (occupying more than half of the cheek) from January 2008 to December 2017 were selected in the study. One of them did not finish the treatment. Eight patients completed all scheduled treatments. In the first stage, superficial temporal vessels were transferred to the donor site and then an expander was implanted. About 80 to 150 days later, PWS was removed and the prefabricated flap was used to repair the wound. All the 8 patients were followed-up for 10 months to 36 months. Results Prefabricated flap survived well. All patients are satisfied with the appearance. The color and texture of prefabricated flap is similar to the surroundings. Conclusion The combination of prefabricated flap and skin soft tissue expander not only extends the scale of flap but also enhances the efficacy of surgical treatment. It is a good candidate to treat PWS.

Manganese oxide octahedral molecular sieves (OMS-2) synthesized from hydrothermal (H-OMS-2), reflux (R-OMS-2), co-precipitation (C-OMS-2), and solid phase (S-OMS-2) methods were impregnated with palladium and used for CO catalytic oxidation. Preparation methods presented an obvious effect on the morphology and catalytic activity of Pd/OMS-2 catalysts for CO oxidation. The hydrothermal synthesized OMS-2 (Pd/H-OMS-2) exhibited more ordered nanorod structure and higher crystallinity than Pd/R-OMS-2, Pd/C-OMS-2, and Pd/S-OMS-2. Further surface analysis indicated that different preparation methods of synthesizing OMS-2 and the impregnation process followed have a significant effect on the chemical states of Mn and O over the final Pd/OMS-2 products. The kinetics studies showed the trend of apparent activation energy (E a) over different catalysts: Pd/H-OMS-2 (18.19 kJ/mol)

The Cu/ZSM-5 catalysts prepared by different copper precursors were used for the selective catalytic reduction (SCR) of NO x with NH3. The Cu/ZSM-5 catalyst prepared by the copper nitrate (Cu/ZSM-5-N) presented the best performance among the Cu/ZSM-5 catalysts and showed above 90 % NO x conversion at 225–405 °C. The average particle size of CuO was 5.82, 9.20, and 11.01 nm over Cu/ZSM-5-N, Cu/ZSM-5-S (prepared by copper sulfate), and Cu/ZSM-5-C (prepared by copper chloride), respectively. The Cu/ZSM-5-N catalyst showed the highly dispersed copper species, the strong surface acidity, and the excellent redox ability compared with the Cu/ZSM-5-C and Cu/ZSM-5-S catalysts. The Cu+ and Cu2+ existed in the Cu/ZSM-5 catalysts and the abundant Cu+ over Cu/ZSM-5-N might be responsible for the superior SCR activity.

To mitigate possible negative impacts of cascade dams on spawning of rare and endemic fish species in the national nature reserve downstream of these dams, spawning flow velocity demand for fish need to be considered in the cascade dams operation. Based on the cascade dams constructed in the upper Yangtze River, Coreius Heterodon was selected as the representative fish species. According to the drifting distance of fish eggs, the flow velocity characteristics at the spawning location of Coreius Heterodon were analysed with the unsteady flow mathematical model. The results show that a large flow velocity increase process is good for Coreius Heterodon spawning, and the process of velocity fluctuation is similar before spawning. The cumulative velocity amplitude, the cumulative number of fluctuations and the maximum velocity amplitude are closely correlation with the spawning number. The velocity in spawning period is affected by the dams operation, and the suitable range of velocity is changed from [0.8m/s, 1.2m/s] to [1.1m/s, 1.4m/s]. The results can provide the basis for future ecological operation based on flow velocity index of the cascade dams.

Objective The purpose of this study was to investigate the effects of TGF-β 1/Smad3 signaling pathway and its downstream factor CTGF in collagen deposition and its molecular mechanism. And then it explored further the effect of exercise on the TGF-β1/Smad3 signaling pathway and collagen deposition in skeletal muscle. Therefore, it is expected to provide alternative exercise intervention approaches for skeletal muscle diseases, which are caused by age-related changes of collagen, and to provide new research perspectives for skeletal muscle satellite cell activation and skeletal muscle regeneration. Methods 21 male BALB/c mice were normally raised from 4 weeks to 36 weeks under standard conditions. The mice was divided randomly into three groups, including: group C, the quiet control group; Group A, the aerobics training group, received nine weeks of treadmill training without loading; And the group R, the resistance training group, received nine weeks of climbing training with loading. The body weight and limb grip of the mice were measured on regularly during the experiment. After 24 hours of the last intervention experiment, the mice were weighed and then executed by dislocating the cervical spine. The quadriceps were taken. Real-time PCR technology was used to detect the mRNA levels of TGF-β1, TβR I, Smad 3, CTGF, Pax7, COL1 and COL3. Western blotting technique was used to detect the protein levels of TGF-β1, Smad3, P-Smad3 , CTGF, COL1, COL3, Pax7 and MyoD . The deposition of collagen in the quadriceps muscle tissue of mice was detected by Sirius red staining. And the localization and expressions of COL1 and Pax7 in the quadriceps of mice were demonstrated by immunohistochemistry and immunofluorescence technology respectively. Results (1) Compared with group C, the weight of mice in group A was significantly increased (P

Objective To investigate the therapeuctic effect of one-stage reconstruction of distal urethra with free graft of tublar oral mucosa. .Two strips of oral mucosa graft(0.4-0.6 cm in width),were harvested and sutured around an oiled silk roll to form mucosa tube. The mucosa tube was used to reconstruct distal urethra. Postoperative pressure dressing and earlier urination were recommendedFrom May 2007 to October 2015,16 cases with distal urethra defect or stenosis were treated with this method. The urethra defect was 2-4 cm in length. Urethral fistula happened in 3 patients. All the other 13 cases healed primarily.10 cases were followed up for 1-5 years by telephone with normal function.One-stage reconstruction with free graft of bulbar oral mucosa is suitable and reliable for distal urethra defect less than 4 cm in length.

To investigate the plasty method for penoscrotal transposition and its efficacy.The adhesion between penis tunica albuginea and scrotum sheath capsule was separated to return the testis and their sheath capsule to the abdomen side of penis. Also, the scrotum skin was also transferred to the abdomen side of penis. The normal anatomic position of penis and scrotum was returned.Between Jan 2004 to Oct 2015,34 cases were treated.5 scrotum fascia skin flaps underwent ischemia at the flap tip with delayed healing. All the other flaps survived with primary healing and good appearance.Adhesion between penis tunica albuginea and scrotum sheath capsule should be separated to return the testis and their sheath capsule, as well as scrotum skin to the abdomen side of penis. It' s an optional method for penoscrotal transposition.

Mesoporous nano Pd/CeO2, Pd/CeO2–ZrO2 and Pd/CeO2–ZrO2–Al2O3 catalysts were prepared via a soft template-assisted hydrothermal method and employed in low-temperature catalytic CO oxidation. Almost 100% of CO conversion could be obtained by the optimal Pd/CeO2–ZrO2–Al2O3 catalyst at 60 °C. Addition of Zr and Al into Pd/CeO2 lead to an increase of the pore volume, average size of mesopores, the surface Ce3+/Ce4+ atomic ratios and Oadsorbed/Olattice, while the activation energy (Ea) decreased in the order Pd/CeO2 (50.4 kJ mol−1) > Pd/CeO2–ZrO2 (40.7 kJ mol−1) > Pd/CeO2–ZrO2–Al2O3 (32.4 kJ mol−1). The low-temperature CO catalytic conversion increased with the decreased activation energy (Ea).

Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety. From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18–24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement–ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale. With 6 months’ follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients’ perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54. This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Extensive scarring and giant nevi on the mid and lower faces places further demands on scar resurfacing in terms of match, size, and thickness. The area of supraclavicular cervical flap is rather limited, but the expansion could expand its utility in facial resurfacing.Rectangular expanders were inserted via the incisions at the upper fringes of clavicles, and implanted under supraclavicular flap areas. After full expansion, the flap based on supraclavicular artery was elevated to cover the defects left by surgical removal of scar or tumor. Pedicle division was performed on the 10 to 14 days postoperatively.A total of 17 patients were treated with the described technique between 2005 and 2015. The dimensions of the flap ranged from 17 cm × 8.5 cm to 22 cm × 12 cm. The average size was 197 cm. Twenty-one flaps (with 4 patients in bilateral fashion) survived completely. Epidermolysis occurred to 2 flaps, which healed by conservative management. These flaps matched well with the face in terms of the color, thickness, and texture. No obvious flap shrinkage occurred in the follow-up. The donor sites were closed primarily without loss of function or breast deformity.It is an efficient and safe method to obtain preexpanded supraclavicular flap, applying to patients with extensive scarring on mid and lower faces, especially female ones. Excellent aesthetics can be achieved without compromising function and aesthetics of donor sites.

Objectives We review our experience in urethrocutaneous fistula (UCF) repair after hypospadias surgery to investigate the risk factors for unsuccessful outcome. Methods Two hundred eleven patients had undergone UCF repair in our department from January 2005 to December 2015. This study included 185 patients who were followed up for more than 6 months. The age of patients, size, site and number of UCFs, number of UCF repairs, urethral complications other than UCF, and postoperative infection were included as potential risk factors. Binary logistic regression analysis was used for multivariate analysis. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. Results Urethrocutaneous fistula repairs failed in 38 patients (20.5%) at first attempt. In the univariate analysis, size of UCFs (P = 0.012), times of UCF repair (P = 0.008), and postoperative infection (P = 0.044) were statistically related with the outcome of surgery. In the multivariate analysis, only the size of UCFs (P = 0.030; adjusted OR, 2.42; 95% CI, 1.09-5.36) and times of repair (P = 0.008; adjusted OR, 3.09; 95% CI, 1.35-7.07) were identified as risk factors for unsuccessful outcome. We had consistent results in the stratified analysis. No additive or multiplicative interaction between the 2 risk factors was found. Conclusions Our study suggested that UCF repairs after hypospadias surgery were easier to fail if one of the UCFs was larger than 2 mm or it had been repaired repeatedly. But when both factors existed, the increase of the risk was not statistically significant. The age of patients, site and number of UCFs, complications other than UCF, and postoperative infection were not significantly related to the success rate of UCF repair.

A series of CuO-CeO2-ZrO2 catalysts were prepared by different methods and applied to the selective catalytic reduction of NO with NH3 reaction at low temperature. The results showed that the SCR activities, morphology, particles dimension, and the surface chemical state of CuO-CeO2-ZrO2 catalysts were obviously influenced by the preparation method. The SCR performance results showed that the CuO-CeO2-ZrO2 catalyst prepared by co-precipitation method presented the best activity in the temperature range of 125–180 °C. The characterization results showed that the Ce4+, Ce3+, Cu2+ and Cu+ species were coexistence in the CuO-CeO2-ZrO2 catalysts, and the Cu species mainly existed as Cu2+. It was also found that the high surface area, the synergistic effect between copper and ceria, enhanced acidity and the highly dispersed copper species were responsible for the high SCR activity of the CuO-CeO2-ZrO2 catalyst.

Objective Post-burn cicatricle contractures of neck pose a challenge for plastic and reconstructive surgeons. To improve functional and cosmetic results, and to minimize the donor-site morbidity, we use pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery as a feasible choice for resurfacing large skin defects of the neck. Methods In this series, from 2008 to 2012, 18 patients with ages ranging between 11 and 42 years (20 flaps with 2 patients in bilateral fashion) suffering from post-burn scar contractures of the neck were treated. In the first stage, an expander was implanted on the deep fascia layer of the cervico-acromial region; 600 to 800 mL of saline was then injected during a 10- to 16-week period. In the second stage after expansion, sufficient skin and tissue was obtained to resurface the defects of the neck after releasing the contractures and excision of post-burn scars. Result All 20 flaps healed primarily with good functional and cosmetic results. The maximum size was 23×16 cm, whereas the minimum was 20×8 cm. After an average follow-up time of 12 months, significant improvement in range of motion with good esthetic outcomes were achieved, and the scars in donor sites seemed acceptable. There ware no significant complications. Conclusions The pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery can provide a large amount of thin tissue with both good color and texture, and without the need for microsurgery, and avoid the disadvantages of donor-site morbidity. This flap is reliable and safe for resurfacing large skin defects of the neck.

To discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.The V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.From January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.Postoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.

Our objective is to report on the efficacy and safety of dermal fat graft in augmentation phalloplasty performed on patients who presented complaining of "small penis," and evaluate the cosmetic and psychological outcomes of it.From April 2010 and January 2015, 23 Chinese adult patients aged 18 to 33 years (average, 23 years) with subjective perception of small penis were included; all who requested an increase in the penile dimension underwent penile elongation (suprapubic skin advancement-ligamentolysis) and girth enhancement by dermal fat graft. Besides objective measurement, Male Genital Image Scale was used to facilitate selection of patients and evaluate the outcome, respectively. The change and shrinkage of the dermal fat strips was evaluated by ultrasound examination and computed tomography.No major complications or erection deficiencies occurred during the postoperative follow-up period. After 6 months, the mean flaccid length was increased by 2.27 ± 0.54 cm, whereas the mean flaccid circumference gain was 1.67 ± 0.46 cm. Significant improvement of genital satisfaction was reported during the follow-up. The shrinkage of dermal fat strips was inconspicuous, and no curvature was observed due to fibrosis.With strict patient selection, this procedure is proved to be a plausible and reasonable option for patients with penile dysmorphophobia. Also, it provides a potential alternative procedure to current dominant methods and promotes the aesthetic results with penile lengthening.

To explore the plastic surgical treatment and the way to reduce hemorrhage for scalp and facial plexiform neurofibromas.Between July 2004 and July 2013, 20 patients with scalp and facial plexiform neurofibromas (17 cases of neurofibromatosis type I and 3 cases of plexiform neurofibroma) were treated, and the clinical data were retrospectively analyzed. There were 9 males and 11 females with an average age of 37 years (range, 18-56 years). The disease duration ranged from 8 to 56 years (mean, 19 years). The scalp was involved in 6 cases, the face in 7 cases, and both the scalp and face in 7 cases. The extent of involvement ranged from 4 cm x 3 cm to 15 cm x 13 cm. Obvious pigmentation was seen in 2 cases. Endovascular embolization was performed before surgical intervention in 4 cases. Preliminary sutures around the lesion were carried out in 18 cases having an involved range over 5 cmx5 cm. One-stage excision was performed in 17 cases, and two-stage excision in 3 cases. Wound repair and facial orthopedic treatment were performed after tumor excision.The intraoperative blood loss was 100-500 mL (mean, 300 mL) for patients undergoing single operation. For 3 patients undergoing two-stage excision, the blood loss of the first operation was 500, 600, and 800 mL respectively, and the blood loss of the second operation was all 50 mL. Autologous blood transfusion of 200, 400, and 400 mL was performed in 3 cases respectively. The preliminary sutures were removed at 3-7 days (mean, 5 days) after operation. All the incisions healed primarily without secondary hemorrhage and hematoma, and the flap and skin graft survived totally. Fifteen patients were followed up 1 year to 7 years (mean, 2.5 years). All patients showed significant improvement in appearance. No significant progression, expanding, and sagging were observed.Endovascular embolization and preliminary sutures around the lesion can be used to reduce hemorrhage in resection of plexiform neurofibroma in the scalp and face. Personalized surgical plan of benign neurofibromatosis should be made to reduce the tumor mass, to improve function and appearance.

To compare the effect of three methods for penile reconstruction.From Sept. 2000 to Dec. 2012, penile reconstruction was performed in 48 cases with free scapular flap transplantation, or pedicled superficial circumflex iliac artery skin flap, or anterolateral thigh skin flap pedicled with lateral circumflex femoral artery. The flaps were 12.0-14.5 cm in length, 10-12 cm in width and the urethra perimeter was about 2-3 cm.Free scapular flaps were used in 21 cases, with flap failure in 3 cases due to insufficient blood supply. Malleable penile prosthesis was implanted in 11 cases, which was exposed in 3 cases. Groin skin flaps were used in 21 cases, with flap failure in 8 cases due to insufficient blood supply. Malleable penile prostheses were implanted in 7 cases, which was exposed in 3 cases. Anterolateral thigh skin flaps were used in 6 cases, with flap failure in 2 cases due to necrosis and infection. No prosthesis was implanted in this group. All the failure cases underwent secondary reconstruction with successful results. 37 cases were followed up for 1-6 years, avevage 2.5 years. 26 cases were satisfied with the results of appearance and function.Among these three methods, the free scapular flap is most recommended for its high survival rate, low complication rate and high patient satisfaction.

To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face.From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers.The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting.The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.

Infraorbital and zygomatic reconstruction procedures pose challenges to plastic surgeons because of the close location of the operation to the eyes and nose. Failed flap design can lead to distortion of the adjacent organs and tissue, particularly for larger defects. Flaps based on the orbicularis oculi muscle (OOM) can be easily rotated from the lateral or temporal region to cover the infraorbital and zygomatic area. We use a soft-tissue expander to enlarge the size of this flap for larger defect repair. Out of a total of 12 patients whose infraorbital or zygomatic defects ranged from 2.0 × 3.0 cm to 4.0 × 5.0 cm, 11 experienced a successful repair without complications. The size of the pre-expanded rotation flap ranged from 3.0 × 4.0 cm to 5.0 × 7.0 cm. The pre-expanded rotation flap based on the OOM has the advantages of an excellent colour and thickness match to the infraorbital and zygomatic areas, a reliable blood supply, abundant tissue and negligible donor-site morbidity. It has thus become our favourite technique for infraorbital and zygomatic reconstruction.