Objective To investigate the primary repair methods and efficacy of island pedicled pectoralis major muscle flap in soft tissue defect after the operation of head and neck malignant tumors .Methods From April 2011 to September 2012 ,27 patients from this hospital who underwent primary repair using island pedicled pectoralis major muscle flap after a head and neck extensive soft tissue defect were investigated ,including 11 cases of tongue cancer defect ,2 cases of parotid gland defect ,3 cases of gum cancer defect ,2 cases of oropharyngeal cancer defect ,9 cases of floor of the mouth cancer defect .Results 27 patients were safety in periop-erative ,27 cases of island pectoralis major muscle flap survived ,patients were satisfied with both the appearance and function .There was postoperative neck hematoma in 1 patient ,it was eliminated through timely remove the hematoma and hemostasis completely ;There was 1 case of removing the epidermal necrolysis skin as flap necrosis ,while it was acceptable efficacy as the muscle flap sur-vival and surface granulation repaired .Conclusion Island pectoralis major muscle flap obtains unique advantages in repairing a large area of soft tissue defect in head and neck cancer patients after operation ,such as abundant of tissue ,a constant arterial anatomy of thoracoacromial ,easy to operate ,rich blood supply ,strong resistance to infection ,high survival rate and so on .A fine surgery opera-tion is the key of island pectoralis major muscle flap survival .

Objective To discuss the prevention and management method for chylous fistula after neck lymph node dissec‐tion .Methods Totally 1 793 cases of neck lymph node dissection in this department from January 2005 to September 2014 were retrospectively analyzed .The clinical data in the cases of chylous fistula occurred after operation were summarized .Results Twenty one cases of chylous fistula occurred ,accounting for 1 .17% ,in which 13 cases were cured by the local compressed bandaging and continuous negative pressure drainage;5 cases adopted the conventional method for 2-3 d ,but under the ineffective condition ,then they were treated by combining with somatostatin pumping (somatostatin 6 mg+0 .9% normal saline 48 mL ,2 mL/h ,lasting for 24 h ,for successive 2-3 d) and finally cured;3 cases were cured after reoperation .Conclusion Prevention is the best treatment for chylous fistulas ,local compression bandage plus continuous negative pressure drainage is the main method for treatment of chylous fistulas after neck dissection .The combined therapy with somatostatin can increase the close rate of chylous fistulas;for the patients with long persistent time ,large drainage volume and invalid conservative therapy should adopt the remedial measure of operation .

Objective To summarize and explore the morphological characteristics,genetic alterations,immunophenotype and characteristics of molecular marker of acute eosinophilic leukemia (AEL),and improve the awareness for AEL.Methods A case of refractory hematopoietic dysplasia (MDS-RCMD) transformed to AEL in our hospital was retrospectively reviewed.Results The MDS-RC-MD patient transformed to AEL in 12 months after diagnosis.In his special bone marrow 10.4％ was blasts,while 70.8％ of bone marrow cells were eosinophils including 69.3％ of promyelocyte,myelocyte and metamyelocyte.Eosinophils accounted for 13.5％ in his peripheral blood.The blasts in bone marrow expressed CD34,CD117,HLA-DR,CD33,CD38 and CD13,and accompanied by complex chromosomal abnormalities.FI1L1/PDGFRα and ETV6/PDGFRβ fusion gene were negative.The patient died two months later following treating with AML regimen.Conclusion The AEL patient with negative FI1L1/PDGFRα and ETV6/PDGFRβ gene rearrangement,imatinib treatment is ineffectual.