Look at “Physique” before plastic surgery

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.Many people have heard of the term “scar constitution”, and they think that a wound on their body, such as scratches by branches or nails in daily life, when cutting vegetables The knife wound left a scar, which is even a scar constitution. These self-diagnosed people are scared because they are afraid of leaving scars, so they dare not perform cosmetic plastic surgery or even fear all operations. &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. However, not all people who have suffered trauma and left scars are scars. In fact, the process of scar formation is a normal process of tissue repair. When the skin is injured, such as trauma or surgery, the wound edge will become red and hard, and may be accompanied by itching and pain. This situation is most obvious one month to six months after the injury, and then gradually reduces, and eventually the scar will become similar to the surrounding skin. But for people with scars, the repair process is much longer. It is manifested by scars exceeding the wound margin, highlighting the skin, purplish red in color, and accompanied by obvious itching pain. Of course, this proportion of the population is extremely small, and it can also be relieved by treatment. &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.Which conditions are easy to leave scars&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. The formation of scars is affected by many factors. Scars are more likely to be left on the places where the human skin is tight and thick, such as the joints of the front chest, shoulders, and limbs. Relatively speaking, scars are less likely to be left on areas with low skin tension and thin skin, such as eyelids. In addition, during adolescence, due to the strong metabolism and strong body repair ability, scars are prone to proliferation and recovery is slower. With the increase of age, the metabolism speed slows down, the repair ability of tissues is not as strong as when they were young, and scar hyperplasia is not so obvious. Moreover, trauma in daily life is more likely to leave scars than incisions during surgery. The reason is that the cut edges of traumatic wounds in daily life are generally irregular, and the wounds can easily enter the dirt and be contaminated by bacteria. During the operation, the doctor will sterilize the skin, try to ensure that the incision is small, and along the skin lines, the location will be hidden and the skin tension is small. &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.It is important to consider your “physique” before plastic surgery&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.Before performing cosmetic surgery, consider your own “physique” necessary. You can pay attention to whether you have any scars before, especially obvious scars. In addition, if your parents or family members have scarred physiques, you should also pay special attention to your “physique”. If you cannot distinguish “physique” by yourself, you must inform in advance and ask a doctor to help you identify it.

Digital materials: reconstruction of huge anterior chest wall defects

[Summary] Recently, we performed reconstruction surgery for a patient with a huge anterior chest wall defect. The most advanced digital materials were used for repair during the operation, and satisfactory results were obtained. & nbsp. Recently, we performed reconstruction surgery for a patient with a huge anterior chest wall defect. The most advanced digital materials were used for repair during the operation, and satisfactory results were obtained. & nbsp. The patient is a young female, 24 years old, and found that the anterior chest wall is weak since childhood, and there is no bone structure on the surface of the heart, which shows that the heart can beat widely. Upon examination, the diagnosis was a chest wall defect. Because there were no obvious symptoms in the early stage, no treatment was given. With the increase of age, the defect area gradually increased, and the left side breast was found after puberty. There was no discomfort, but he felt ugly and eager for treatment. The patient had been to a number of hospitals for treatment, but no treatment was given because the defect was too large. The patient finally came to our hospital for treatment. After sufficient preoperative preparation, he underwent surgery recently. & nbsp. Preoperative examination: the anterior chest wall is asymmetrical in appearance, the left mammary gland is moved down, there are two nipples, and the right side is basically normal. There is a clear depression in the middle of the chest wall, which shows the heart beating. On palpation, a large area of ​​anterior chest wall osseous structural defect was found, involving the left chest wall and anterior chest wall, and there was no murmur in the heart auscultation. Preoperative imaging examination revealed a large-scale defect of the anterior chest wall bony structure. The defect involved the sternum, multiple left ribs and costal cartilage, and the heart was located deep in the defect. & nbsp. (The central anterior chest wall is recessed, a large-scale beating of the heart can be seen, the left side of the breast) (three-dimensional reconstruction of the chest wall structure, a large area of ​​the anterior chest wall defect, the heart is directly below the defect) & nbsp. Sign. Due to the large area of ​​the bony structure defect, we first reconstruct the patient’s thorax before surgery, simulate the details of the operation, design digital materials, then process them, and finally use this material to complete the reconstruction of the chest wall. & nbsp. (According to the digital material completed by the defect) & nbsp. The surgery is performed under general anesthesia, supine position, median incision, and the chest wall structure is revealed through the incision. During the operation, most of the sternum body was missing, only the right part of the edge remained, and there was no abnormal connection between the right costal cartilage and the sternum. The left costal cartilage was largely missing, and there was no bony structure in the precardiac area. Fully reveal the bony structure of the front chest wall and the left chest wall, put the digital materials into the chest wall, and fix it properly, the surface is lined with fiber membrane for protection. The incision is closed and the operation ends. (The digital material is placed in the chest wall and properly fixed) & nbsp. (The surface of the digital material is covered with fibrous membrane) & nbsp. (The anterior chest wall after surgery, the left side breast has been removed) & nbsp. Chest wall defect is an important disease in chest wall surgery. It exists alone or it can be secondary to other factors. Defect repair generally includes three parts: bone structure repair, soft tissue repair, and skin repair. The defect of this patient is mainly limited to osseous structure, so only osseous structure repair is needed. & nbsp. The decisive factor for the repair of osseous structures lies in the repair materials. There have been many materials used in clinical practice in the past, but it is difficult to obtain satisfactory results. Recently, 3D printing materials have received attention, and cannot be legally used in clinics because of the lack of permission. Digital materials are a new generation of plastic materials, which not only have all the advantages of 3D printing materials, but also discard the related defects, so they are more ideal repair materials. & nbsp. In the past work, we have used digital materials to complete a large number of chest wall repair operations, and achieved satisfactory results. In future work, we will also increase the use of this material to help more patients. & nbsp. (Wang Wenlin, Director of Chest Wall Surgery, Second People ’s Hospital of Guangdong Province, WeChat: wangwenlinzhuren. Public number “Expert of Thoracic Surgery”: wangwenlinyishi)

How to treat subclavian artery occlusion?

1. What is the subclavian artery? A large arterial trunk at the base of the neck sends out blood supply to the head and neck, chest wall, upper limbs and other areas. 2. Why does subclavian artery occlusion occur? The vast majority of subclavian artery lesions are caused by atherosclerosis, which is what people often call “plaques in blood vessels.” The longer the plaque is, the more the artery is completely blocked. Other causes include various arteritis, congenital arterial malformations, trauma, and vascular surgery involving the subclavian artery. 3. What are the symptoms of subclavian artery occlusion? 1) More than half of the patients are asymptomatic and found through physical examination; 2) Subclavian artery steal syndrome (SSS): After the blood vessel is blocked, the blood flow of the affected vertebral artery that originally supplies blood to the brain reverses to compensate for the subclavian side of the affected side Arterial blood supply leads to cerebral ischemic attacks. Symptoms include dizziness, limb paralysis, paresthesia, bilateral visual impairment, ataxia, diplopia, syncope, etc. Rarely there are intermittent claudication, dysphonia, dysphagia, tinnitus, convulsions, headache and mental disorders. A small number of patients may have “dumping syndrome”, a sudden onset of lower limb muscle strength and falls, but there is no disturbance of consciousness and can recover quickly. 3) Symptoms of upper limb ischemia: weakness, numbness, coldness, weak pulse or no pulse in the affected limb, severe finger ulcers. The difference in blood pressure between the upper and lower limbs is often very large (the difference in systolic blood pressure is often greater than 20mmHg). 4. How to treat the subclavian artery occlusion? A cerebral ischemic symptom caused by arterial occlusion or an upper limb ischemic symptom requires surgical treatment, but requires a pre-operative evaluation by a specialist. At present, there are two main types of surgical treatment methods: percutaneous transluminal angioplasty (“stent”) and various extra-anatomical bypass reconstruction (“bridging”). Percutaneous transluminal angioplasty (PTA) has become the first choice, with mature technology, small trauma and fast recovery. External anatomical bypass reconstruction: including carotid artery-subclavian artery, subclavian artery-subclavian artery, axillary artery-axillary artery bypass conversion, etc. Due to the high trauma and relatively high complications, it is generally selected after PTA is not suitable or PTA is not successful. Attached to my recent case of subclavian artery occlusion opening surgery: male, went to the hospital due to dizziness and found B-ultrasound to find reverse blood flow of the left vertebral artery, and further CTA showed that the left subclavian artery occlusion. Intraoperative left subclavian artery angiography confirmed that the left subclavian artery was completely occluded: right vertebral artery angiography showed reverse blood flow to the left vertebral artery, and left vertebral artery that originally supplied blood to the brain reversed blood supply to the left upper limb: with a guide wire Through the occlusion artery: the balloon is expanded and placed into a stent to support, and finally successfully opened, the blood vessel is perfectly reconstructed, and the vertebral artery restores positive blood flow: if you have any questions, please contact me on the Sina Aiqi doctor platform. A