Objective To investigate the outcome of free posterolateral leg perforator flap in the reconstruction of soft tissue defects of oral and maxillofacial area.Methods From February,2014 to August,2016,16 patients were performed defect reconstruction following oral cancer ablation with free posterolateral leg perforator flap including 3 cases of sequamous cell carcinoma of the tongue,6 cases of carcinoma of the buccal mucosa,7 cases of sequamouse cell carcinoma of the floor of mouth.The flap ranged from 5.0 cm×3.0 cm to 13.0 cm ×9.0 cm in size,and were adjected to the soft tissue defects of oral and maxillofacial area.The outcome of reconstruction was evaluated by considering the facial appearance,the swallowing and the speach function,the ranges of mouth opening and patient prognosis.Results All 15 transplanted flaps survived well and only 1 survived after disposing in time,because of vascular crisis.The donor sites were closed directly without donor-site morbidity.All patients were satisfactory with their facial appearance,the ranges of mouth opening and swallowing and speech function.Conclusion The free posterolateral leg perforator was an ideal free tissue for repairing functionally oral and maxillofacial defects,sinceit including some beneficial characteristic such as constant blood vessel,flexible and divese design,abundant and position-latent donor site tissues,small operation loss,flexible preparation and loss of major vascular nerves.

OBJECTIVETo study morphology feature of mandibular anatomical characteristics and mandibular nerve canal of hemimandibular elongation (HE) using CT, and provide reference for the clinical treatment.

METHODS19 patients with HE were scanned using multidetector CT. Mimics 10.0 software was used for three-dimensional reconstruction, and CT images were reconstructed on different sections. The position of mandibular nerve canal, mandibular foramen and thickness of mandibular cortical bone were measured, and compared with control group (without mandibular lesion).

RESULTSCompared with the control group, the distance between mandibular nerve canal and mandibular surface were statistically different at the section of long axis of mandibular first molar centre (LAMFM)-lingual, long axis of mandibular second molar centre (LAMSM)-buccal, LAMSM-superior, retromolar area centre to the mandibular angle (RAC-MA)-buccal, RAC-MA-superior, RAC-MA-inferior and horizontal level of mandibular foramen under 5 mm (HLMFU5)-lingual, HLMFU5-anterior, HLMFU5-posterior (P<0.05); the thickness of mandibular cortical bone were statistically different at the LAMFM-buccal, LAMFM-inferior (P<0.05); lowest point of mandibular foramen (LPMF)-superior border of mandibular ramus (SBMR) and LPMF-inferior border of mandibular ramus (IBMR) were statistically different (P<0.05).

CONCLUSIONIn the patients with hemimandibular elongation, the thickness of mandibular cortical bone gradually decreases in all directions from the mandibular first molar to the mandibular ramus. Compared with the control group, mandibular nerve canal located buccally and superiorly at mandibular second molar and retromolar area, mandibular foramen located more anterior and lower inside mandibular ramus.

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation.Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies,including 4 cases of buccal mucosa carcinoma,2 cases of maxilla osteosarcoma,1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma,were recruited from May,2016 to May,2018.The flap was used to repair the facial defect of recruited patients.The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm,respectively.The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate,the skin,subcutaneous tissue and mucosa of the cheek.The radiotherapy was performed 1.0-1.5 months after the operation.The prognosis including appearance,mouth opening,and the functions of deglutition,and language were assessed.Results Through 3-18 months outpatient followed-up,all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention.The patients were satisfied with the facial appearance,mouth opening,and the functions of deglutition and language at the 6 months follow-up.The radiotherapy had no damage on the survival of the bilobed perforator flap.There was no recurrence or metastasis in follow-up.Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel,abundant tissues,flexible design and operating methods.

To evaluate the clinical effect of digital assisted chimeric deep circumflex iliac artery perforator flap (DCIAPF) in the reconstruction of mandibular composite defects. Methods From January, 2018 to January, 2019, 6 cases of mandibular tumor patients with postoperative defect within side were treated. Preoperative CTA was used to evaluate the deep branches of spin iliac artery.Digital simulation software and 3D printing technolo-gy was taken, vascularized iliac flap of the design guide of bone was made, and the rebuilding effect was simulated. DCIAPF was used to repair the defect of lower jawbone. The donor sites were sutured directly. The patients were fol-lowed-up in outpatient department for 3-6 months to evaluate the recovery of the patient′s shape, jaw height and oc-clusal function, as well as the complications in the donor area. Results Postoperation pathological examination re-sults: ameloblastoma in 2 cases, 4 cases of gingival cancer. The length of cut out ilium was 6.0-13.0 cm, carrying the flap area of 3.0 cm×1.0 cm-6.0 cm×5.0 cm.Six cases of DCIAPF and iliac bone flap survived.The shape, mandibular height and occlusal function were satisfactory.And no obvious complications were found in the donor area. Conclu-sion The blood supply of DCIAPF is rich with enough bone mass and height. The position of terminal skin perfora-tors is invariant. The complications of donor sites is less. With the help of digital technology, the accuracy of mandibular defect repair and the 3-dimensional wound repair can be realized, and provides an advantage condition for subsequent dental implant.It is one of the ideal method of reconstruction of mandibular defect.

To evaluate the clinical effect of application of free peroneal artery perforator flap in repairing postoperative tissue defect after resection of oral maxillary malignant tumor. Methods From January, 2016 to June, 2018, 14 patients with maxillary malignant tumor were treated with tumor excision. Then the free per-oneal artery perforator flap was used to reconstruct tissue defect caused by tumorectomy. There were 6 cases of squa-mous-cell carcinoma of palatine, 2 cases of adenoid cystic carcinoma of palatine, and 6 cases of maxillagingiva squa-mous cell carcinoma. The incised area of flap was 4.0 cm×5.0 cm to 7.0 cm×8.0 cm. There were 5 cases of hard palate soft tissue defect repair and 9 cases of simultaneous repair of soft and hard palate. Followed-up by outpatient service in 3-12 months after operation, postoperative maxillamorphology, phonetic function, swallow function, opening degree and prognosis of the patients were evaluated. Results All 14 implanted flaps were alive.One flap had vas-cular crisis, and rescued by surgical exploration and timely rescue.Three flaps were prolonged healing.All donor sites were sutured directly.All surgical incisions healed primarily.Half a year after the operation, the appearance of maxilla was formed gradually. The phonetic function, swallowing function, opening degree and movement of lower leg were all recovered normal. One year after the operation, epithelization was done in 6 cases. And there was no tumor recur-rence.Conclusion The peroneal artery perforator flap has long vascular pedicle, larg diameter, high survival rate after vascular anastomosis and relatively concealed donor area. It can be used to repair and reconstruct the tissue defect in maxillary malignant tumor resection and achieved good result.

Objective:To investigate the application effect of bilobed skin flap with peroneal artery perforation in repairing postoperative defects of tongue cancer and oral floor cancer.Methods:Six patients with oral squamous cell carcinoma (4 males and 2 females, aged 28-72 years) admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Benbu Medical College from May 2017 to December 2019 were repaired with the peroneal artery perforator bilobed flap, one lobe repaired the tongue, and the other repaired the floor of the mouth. The donor area is directly closed and sutured. Postoperative follow-up was conducted to observe tumor recurrence and metastasis, and the patient’s appearance, mouth opening, swallowing function, speech function and lower limb recovery were evaluated.Results:All the 6 flaps survived. One of the patients had a single flap because the pedicle of the perforator vessel was not long enough. The other 5 cases were repaired with bilobed leaf flap. All the flaps survived and the wound surface healed in the first stage. One case was infected with effusion after operation, which was healed by washing and dressing change. The donor area can be sutured directly. No tumor recurrence or metastasis occurred 6 months after surgery. Speech, swallowing and lower limb movement basically returned to normal, facial morphology was basically symmetrical, and the degree of opening Ⅱ-Ⅲ. Six months after the operation, 5 patients with bilobed valve returned to a nearly normal state with a degree of opening Ⅱ-Ⅲ. One patient with single lobe recovered moderately, but speech and swallowing were still restricted. In 6 cases, the donor scar was concealed and the lower limb was basically normal.Conclusions:The bilobed flap with peroneal artery perforation can be used to repair postoperative defects of tongue carcinoma and floor of mouth carcinoma.

Objective:To evaluate the clinical effect of free peroneal artery perforator flap (FPAPF) for reconstructing defects of total glossotomy and subtotal glossotomy.Method:A retrospective analysis of the clinical data of the patients with tongue cancer was performed. The patients were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2019. All the patients underwent total tongue and subtotal tongue resection and one-stage repair with FPAPF. The function of swallowing, speech and chewing were evaluated with the water swallow test, the speech intelligibility test and the screening and weighing method at 3 months, 6 months, and 12 months after the operation. Use t-test to analyze the data and P< 0.05 was considered statistically significant. Results:A total of 20 patients were selected, including 16 males and 4 females, aged 46 to 68 years, with an average of 54.1 years old. The area of the peroneal artery perforator flap was 6.0 cm×7.0 cm—6.5 cm×8.0 cm, and the length of the pedicle was 6.0 cm—7.0 cm. The overall survival rate of the flap was approximately 95.0%(19/20). The survival rates of 1, 2, and 3 years after operation were 95.0%, 73.7%, and 64.3%, and the tumor-free survival rates were 95.0%, 63.2%, and 57.1%. With the prolongation of postoperative time, the functions of swallowing, speech and chewing gradually improved, and there was a statistically significant difference in 6 months after operation compared with 3 months after operation ( P<0.05). Speech was improved 12 months after operation compared to 6 months after operation.The difference was statistically significant ( P<0.05). Conclusions:The research showed that the peroneal artery perforator exhibited a constant anatomic location, and its diameter and length were more suitable for the preparation of free perforator flaps. The posterolateral tissues of lower legs are abundant, which is beneficial for repairing full tongue and subtotal tongue defects. The recovery of functions such as swallowing, speech intelligibility and chewing was ideal.

Objective:To investigate the application effect of bilobed skin flap with peroneal artery perforation in repairing postoperative defects of tongue cancer and oral floor cancer.Methods:Six patients with oral squamous cell carcinoma (4 males and 2 females, aged 28-72 years) admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Benbu Medical College from May 2017 to December 2019 were repaired with the peroneal artery perforator bilobed flap, one lobe repaired the tongue, and the other repaired the floor of the mouth. The donor area is directly closed and sutured. Postoperative follow-up was conducted to observe tumor recurrence and metastasis, and the patient’s appearance, mouth opening, swallowing function, speech function and lower limb recovery were evaluated.Results:All the 6 flaps survived. One of the patients had a single flap because the pedicle of the perforator vessel was not long enough. The other 5 cases were repaired with bilobed leaf flap. All the flaps survived and the wound surface healed in the first stage. One case was infected with effusion after operation, which was healed by washing and dressing change. The donor area can be sutured directly. No tumor recurrence or metastasis occurred 6 months after surgery. Speech, swallowing and lower limb movement basically returned to normal, facial morphology was basically symmetrical, and the degree of opening Ⅱ-Ⅲ. Six months after the operation, 5 patients with bilobed valve returned to a nearly normal state with a degree of opening Ⅱ-Ⅲ. One patient with single lobe recovered moderately, but speech and swallowing were still restricted. In 6 cases, the donor scar was concealed and the lower limb was basically normal.Conclusions:The bilobed flap with peroneal artery perforation can be used to repair postoperative defects of tongue carcinoma and floor of mouth carcinoma.

Objective:To evaluate the clinical effect of free peroneal artery perforator flap (FPAPF) for reconstructing defects of total glossotomy and subtotal glossotomy.Method:A retrospective analysis of the clinical data of the patients with tongue cancer was performed. The patients were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2019. All the patients underwent total tongue and subtotal tongue resection and one-stage repair with FPAPF. The function of swallowing, speech and chewing were evaluated with the water swallow test, the speech intelligibility test and the screening and weighing method at 3 months, 6 months, and 12 months after the operation. Use t-test to analyze the data and P< 0.05 was considered statistically significant. Results:A total of 20 patients were selected, including 16 males and 4 females, aged 46 to 68 years, with an average of 54.1 years old. The area of the peroneal artery perforator flap was 6.0 cm×7.0 cm—6.5 cm×8.0 cm, and the length of the pedicle was 6.0 cm—7.0 cm. The overall survival rate of the flap was approximately 95.0%(19/20). The survival rates of 1, 2, and 3 years after operation were 95.0%, 73.7%, and 64.3%, and the tumor-free survival rates were 95.0%, 63.2%, and 57.1%. With the prolongation of postoperative time, the functions of swallowing, speech and chewing gradually improved, and there was a statistically significant difference in 6 months after operation compared with 3 months after operation ( P<0.05). Speech was improved 12 months after operation compared to 6 months after operation.The difference was statistically significant ( P<0.05). Conclusions:The research showed that the peroneal artery perforator exhibited a constant anatomic location, and its diameter and length were more suitable for the preparation of free perforator flaps. The posterolateral tissues of lower legs are abundant, which is beneficial for repairing full tongue and subtotal tongue defects. The recovery of functions such as swallowing, speech intelligibility and chewing was ideal.

Objective To explore the effects of bronchoalveolar lavage combined with microbiological rapid on-site evaluation in potential donor lung maintenance.Methods Brain death patients who met the inclusion criteria and were admitted to the Intensive Care Unit(ICU)of Calmette Hospital Affiliated to Kunming Medical University from September 2020 to December 2022 were selected for bronchoalveolar lavage(BAL)and(BAL)and the lavage fluid were collected for M-ROSE to compare the pathogen detection rate and initial diagnosis time.According to the positive results of the microbiological rapid on-site evaluation,patients with the brain death were treated with empirical anti-infective therapy,and the oxygenation index,chest X-ray score,and the infection index(WBC,CRP,PCT)of anti-infective treatment 48 hours were evaluated.Results 1.Comparison of the detection rate of pathogenic microorganisms:The results of M-ROSE were highly consistent with a routine microbiological smear(Kappa = 0.921,P<0.001).2.Comparison of diagnostic time:The initial diagnosis time of M-ROSE was significantly lower than routine microbiological smear time and microbial culture time(P<0.001).3.Comparison of therapeutic effects of anti-infective therapy for 48 hours:There was no significant difference in oxygenation index,white blood cells and hypersensitive C-reactive protein before and after the anti-infective treatment(P>0.05).There were significant differences in procalcitonin and chest X-ray before and after the anti-infective treatment(P<0.05).Conclusion Bronchoalveolar lavage combined with microbiological rapid on-site evaluation has the high timeliness in the diagnosis of potential donor pulmonary infection,which can provide a preliminary basis for the early anti-infective therapy of donor lung maintenance.