Objective To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. Methods From May 1998 to July 2004, 42 patients with oral mucodefects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm×3.0 cm to 6.5 cm×4.0cm.Results Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. Therewere no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. Conclusion The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.
Objective?To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness.?Methods?Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm × 5.5 cm to 10.0 cm × 7.5 cm. According to Brown’s classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance.?Results?All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of seech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions.?Conclusion?According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for repairing defects.
ObjectiveTo investigate the correlation between the anterior talofibular ligament (ATFL) injury and the pathological changes of the anterior tibiotalar fat pad (ATFP) based on MRI. Methods The clinical and imaging data of 217 patients with ankle sprain who met the selection criteria between January 2019 and March 2024 were retrospectively analyzed. There were 113 males and 104 females with an average age of 38.2 years ranging from 18 to 60 years. Patients were divided into mild group (n=106), moderate group (n=63), and severe group (n=48) according to the degree of ATFL injury. There was no significant difference in gender, side, and body mass index among the 3 groups (P>0.05). The age of the mild group was significantly older than that of the moderate and severe groups (P<0.05). The imaging parameters including the longest and shortest sagittal axis, the largest thickness, the longest and shortest transverse axis, the ATFP area, the area of ATFP high-signal region, and the anterior distal tibial angle (ADTA) were measured according to the MRI and X-ray films of patients. According to the morphology of ATFP, the patients were divided into type Ⅰ (n=128), type Ⅱ (n=73), and type Ⅲ (n=16) based on the severity of the lesions. The distribution of ATFP types, ATFP area, area of ATFP high-signal region, and the ratio of area of ATFP high-signal region to ATFP area at the same level were statistically analyzed and compared among different ATFL injury groups. Additionally, radiographic parameters were compared across different ATFP types. Spearman rank correlation analysis was used to assess the relationships between ATFP area, area of ATFP high-signal region, and the ratio of area of ATFP high-signal region to ATFP area at the same level with patient baseline data. Through analysis of the area under curve (AUC) of ROC, optimal variables were selected for quantification to predict ATFL injury. Results There were significant differences in ATFP types among different ATFL injury groups (P<0.05). The mild group had a higher proportion of type Ⅰ, the moderate group had a higher proportion of type Ⅱ, and the severe group had higher proportions of both typeⅡ and type Ⅲ. No significant difference was found in ATFP area among the different ATFL injury groups (P>0.05). However, the area of ATFP high-signal region and the ratio of area of ATFP high-signal region to ATFP area at the same level were significantly lower in the mild group compared to the moderate and severe groups (P<0.05). Except for the longest sagittal axis, maximum thickness, and longest transverse axis, which were significantly smaller in ATFP types Ⅱ and Ⅲ compared to type Ⅰ (P<0.05), there was no significant difference in the remaining radiographic parameters among the different ATFP types (P>0.05). Spearman rank correlation analysis revealed that ATFP area was negatively correlated with patient gender (P<0.05), while area of ATFP high-signal region and the ratio of area of ATFP high-signal region to ATFP area at the same level were negatively correlated with patient age (P<0.05). Through analysis of the AUC for the response variable ATFP injury, the combined diagnostic AUC of ROC for the reciprocal of the maximum thickness and the reciprocal of the area of ATFP high-signal region was 0.839 (asymptotic P<0.001). The corresponding cutoff value when the Youden index reached its maximum was 0.570 3. ConclusionAs the severity of ATFL injury increases, the ATFP undergoes gradual morphological and functional changes. Classification based on ATFP types can assist in assessing the level of ATFL injury, thereby aiding in the prevention of post-traumatic osteoarthritis.
Objective To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. Methods Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. ResultsThe operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. ConclusionFor the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.
ObjectiveTo evaluate the impact of preserving versus resecting the angle of His fat pad at the gastroesophageal junction (abbreviated as “fat pad”) during laparoscopic sleeve gastrectomy (LSG) on the incidence of postoperative gastroesophageal reflux disease (GERD) and weight loss outcomes. MethodsConsecutive obese patients who underwent LSG at the Third People’s Hospital of Chengdu from January 2018 to February 2023 were enrolled. Based on whether the fat pad was resected during surgery, the patients were divided into a group with preservation of the fat pad (preservation group) and group with resection of fat pad (resection group). The primary outcome was the incidence of GERD at 1 year postoperatively. Secondary outcomes were weight loss effects, evaluated by the percentage of excess weight loss (EWL%) and the percentage of total weight loss (TWL%). Furthermore, a subgroup analysis was conducted within the preservation group based on the distance of the stapler from the fat pad (0.5 cm, 1.0 cm, 2.0 cm). After adjusting for confounding factors using multivariate logistic regression and linear regression models, the association between fat pad resection and the incidence of postoperative GERD, as well as EWL% and TWL%, was analyzed. ResultsA total of 560 obese patients were enrolled in this study, with 395 in the preservation group and 165 in the resection group. The incidence of postoperative GERD was significantly lower in the preservation group than in the resection group [25.32% (100/395) vs. 41.82% (69/165), P<0.001]. After adjusting for confounding factors (age, sex, body mass index, cholesterol, fasting blood glucose, and hemoglobin A1c), preservation of the fat pad might be an independent protective factor against postoperative GERD [OR (95%CI)=0.41 (0.25, 0.67), P<0.001]. Regarding weight loss outcomes, preservation of the fat pad had no significant effect on EWL% [β (95%CI)=–4.79 (–16.25, 6.66), P=0.41], but had a significant effect on TWL% [β (95%CI) =–3.27 (–5.45, –1.10), P=0.003]. Within the preservation group, subgroup comparisons (0.5 cm, 1.0 cm, and 2.0 cm) showed no statistically significant differences in the incidence of postoperative GERD (P=0.71), EWL% (P=0.93), or TWL% (P=0.15). ConclusionsFor LSG, resection of the fat pad may increase the risk of postoperative GERD but could be associated with better TWL%. Under the premise of preserving the fat pad, the distance of the stapler from the fat pad (0.5–2.0 cm) has no significant impact on the incidence of postoperative GERD or weight loss outcomes.
Objective To summarize research progress of infrapatellar fat pad derived mesenchymal stem cells (IFP-MSCs) in treatment of osteoarthritis (OA). Methods The recent domestic and international literature on IFP-MSCs was reviewed. The mechanisms and latest research progress of IFP-MSCs in the treatment of OA were summarized and analyzed from aspects such as basic biological characteristics, core therapeutic mechanisms, preclinical research evidence, bioengineering strategies for optimizing therapeutic effects, and the current status of clinical studies and application. ResultsThe main mechanism of IFP-MSCs for OA treatment lies in the significant paracrine effect. By releasing cytokines, exosomes, etc., IFP-MSCs work synergistically to exert anti-inflammatory effects, protect cartilage, and promote repair. Preclinical studies have verified its efficacy and mechanism in vitro and in animal models. To promote clinical translation, researchers have developed a series of bioengineering strategies, including standardized cell preparation and functional preprocessing (such as three-dimensional culture, inflammatory factor stimulation), genetic engineering modification, exosome engineering, and the design of intelligent delivery carriers, aiming to optimize cell functions and achieve precise treatment. Preliminary clinical studies have confirmed its safety and short-term benefits in improving symptoms. ConclusionAlthough there are still challenges such as cell heterogeneity and long-term efficacy verification, by integrating cutting-edge technologies such as three-dimensional organ chips and single-cell omics, IFP-MSCs are expected to promote the development of OA treatment to a new stage of personalization and high efficiency, providing a new direction for future stem cell-based precise repair strategies.