Objective To evaluate operation method in with microscopic flap breast reconstruction after breast cancer case management care blueprint. Methods According to the building of case management care blueprint, according to the questions, plan, action, observation and reflection, improvement of summarizing the research process, formulate, modify with microscopic flap breast reconstruction after breast cancer case management care blueprint, and applied to clinical. Results Through the research of two phase research analyses the results after the intervention. Microscopic flap breast reconstruction after breast cancer patients′ quality of life evaluation, cancer, mental adaptation level, determination of postoperative body image, adjust the importance of breast score in the first stage, respectively (28.54 ± 3.78), (13.56±2.51), (2.71±1.08), (3.00±0.87) points, the second phase, respectively (80.32 ± 5.94), (45.02 ± 3.51), (6.85 ± 0.36), (7.34 ± 0.66) points. Two phase comparison difference was statistically significant (-47.070--21.551, P<0.05 or 0.01). Conclusions Based on the study of action with microscopic flap breast reconstruction after breast cancer case management care blueprint to build, implement the evaluation, plan, service, coordination and monitoring of health care management system, improve the patients′ life quality, standardize nursing process, improve the effect of nursing quality.

Objective To observe the outcome of free TAAP flap in the reconstruction of defect after oral tumor radical resection.Methods From June,2010 to April,2015,12 patients with oral tumor underwent radical resection,including 4 cases of gingival carcinoma,3 cases of tongue carcinoma and 5 case of buccal cancer.The cause ranged from 2 to 12 months.The radical resection left defects with size ranged from 4.5 cm×3.5 cm to 6.0 cm× 4.5 cm which were reconstructed by free TAAP flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm.The length of TAAP flap was (6.5±0.6) cm.The width of flap was (4.3±0.5) cm.And the thickness of flap was (1.1±0.3)cm.The length of pedicle was(8.4±0.2) cm.All the arteries of TAAP were anastomosed with superior thyroid arteries,while the venae comitans were anastomosed with superior thyroid venae or internal jugular venae.Results The perforators existed consistently.All 12 flaps survived uneventfully.The donor sites were closed directly in all cases.All patients were followed up for 14-38 months with satisfied esthetic and functional results in reconstructed tongue.No local recurrence happened.The shoulder function was not affected.Conclusion The TAAP flap has consistent blood supply,good color match and texture,while leaving minimal morbidity at donor site,is an ideal choice for buccal tumor reconstruction.

Objective: To investigate the application of free medial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. Methods: From June 2013 to November 2015, 17 cases with tongue carcinoma underwent radical resection and tongue and mouth floor defects after surgery were reconstructed with medial thigh chimeric myocutaneous perforator flaps at the same stage. These 17 cases included tongue carcinoma on lingual margin (n=9), ventral tongue (n=7) and mouth floor (n=1). Appearance and functional results were evaluated with follow-up. Results: Medial thigh chimeric myocutaneous perforator flap was (9.0±0.3) cm in length, (4.5±0.3) cm in width , and (1.8±0.4) cm in thickness. The length of pedicle was (7.4±0.6) cm. All of the 17 flaps survived uneventfully, and the donor sites were closed directly in all cases. All patients were followed up for 10-28 months with satisfied esthetic and functional results in reconstructed tongue. Aside from linear scar in the donor sites, the functions of thighs were not affected. No local recurrence occurred. Conclusion The free medial thigh chimeric myocutaneous perforator flap is an ideal choice to reconstruct the tongue and mouth floor defect after radical resection of tongue carcinoma.

Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective To evaluate the action research method in the effect of swallowing disorder in patients with tongue cancer recovery path. Methods Based on the recovery path construction, according to the questions, plan, action, observation and reflection, improvement of summarizing the research process, through two stages of the research, assessment, diagnosis, planning, implementation, evaluation and comparison of stage 1 and stage 2 swallowing disorder in patients with rehabilitation evaluation, quality of life score, spirit to adapt to the score. Results Nearly 79.69% (51/64) of first phase swallowing rehabilitation effectively, and 93.75% (60/64) effectively in the second stage. Compared to the first stage,the second stage had an obvious increase. Two stages at the university of Washington Quality of Life Score, the first phase of (770.400 ±87.299) points, (1117.100 ± 43.153) points in the second stage, two stages of life quality score comparison, the difference was statistically significant (t=-19.500, P=0.012). The comparison of two stage patients mental adjustment scale scores, the first phase of (15.933±1.285) points, (31.733±2.083) points in the second stage, two stages score spirit to adapt to the comparison, the difference was statistically significant (t=-35.357, P=0.003). Conclusions Tongue cancer patients with swallowing disorder treatment on the basis of action study method to build and implement path specification, can improve the quality of care and quality of life of patients.

Objective To explore the nursing effect of discharge preparation service on breast reconstruction after breast cancer operation. Methods Totally142 patients with breast cancer were divided into intervention group and control group according to the random number table, 71 cases in each group.The intervention group carried out discharge plan mode,the control group did not carry out discharge plan mode, only routine nursing and telephone follow-up after discharge.To compare the differences of discharge readiness, self-efficacy,quality of life and patient satisfaction score of family caregivers at 2 days after admission,when discharge,2 months,3 months and 6 months after discharge.Results The score of discharge readiness of family caregivers in intervention group,score of self-efficacy,quality of life score and patient satisfaction score of nursing were 29.76 ± 1.06, 35.72 ± 2.06, 69.20 ± 2.76, 30.79 ± 2.23, the control group were 24.85 ± 2.94, 35.72 ± 2.81, 64.55 ± 4.75, 26.99 ± 3.27, the difference between the two groups was statistically significant (t=-13.25--7.13, P<0.05). Conclusions Discharge preparation service can improve the discharge readiness of family caregivers of breast cancer patients after breast cancer reconstruction, their self-efficacy after discharge, their quality of life and nursing satisfaction, so it is worthy of promotion.

Objective To describe the relationship status of breast reconstruction after mammary gland surgery, and to explore the changes of sexual and emotional experience in breast reconstruction. Methods A semi-structured in-depth interview was conducted in 19 patients admitted to Hunan Cancer Hospital from October 2015 to December 2017 for reexamination in the hospital from 2 to 26 months after breast reconstruction. The Giorigi method was used to analyze data in the phenomenological analysis of qualitative research. Data collection, transfer and analysis are conducted simultaneously, and the method and content of the next interview were constantly adjusted with the existing data analysis results. Results The sex and emotional experience of breast reconstruction after breast surgery could be summarized into 5 subjects. The first was cognition of sexual life . The second was sexual psychological change.The third was physiological changes. The forth was the desire for sexual information. The fifth was breast reconstruction surgery brings the emotional fluctuation of both husband and wife. Conclusions Understanding of breast cancer postoperative breast reformer sexual and emotional experience can help medical personnel through effective communication and evaluation, provide targeted health education and consultation, improve recovery quality of life of patients.

Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two-point discrimination distances of the sites repaired with relaying ALT perforator flaps were ranged from 7 to 12 mm. The function of thigh was not obviously affected, and patients could walk normally and do related daily activities. Conclusions Reconstruction of defect after oral tumor radical resection with free AMT perforator flap can achieve good outcome, and wound in the donor site of free AMT perforator flap repaired with relaying ALT perforator flap can achieve good appearance and function recovery.

Objective To introduce the clinical experience of relaying anterolateral thigh (ALT)flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer.Methods From February 2014 to December 2015,16 cases with oral carcinoma underwent radical resection,leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps.The flap size ranged from 7.5 cm ×4.5 cm to 13.0 cm × 7.5 cm [the patients was 45.6 years (range 31-72 years),body mass index (BMI) range 17.5-24.3 kg/m2].Flaps'width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5％ on average (ranging from 9.8％ to 15.7％).The flap donor sites were reconstructed with relaying ALT flap at the same stage,the flap size ranged from 7.5 cm × 4.0 cm to 12.0 cm x 7.0 cm.Results The AMT and ALT perforators existed consistently in all cases of this serie.All free AMT flaps and relaying ALT flaps survived uneventfully.All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites.2-point discrimination distance of AMT flaps ranged from 7 to 14 mm,2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm,the function of thighs were not affected.Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap.