Objective To introduce a method of using perforators flap adjacent to the defect to repair small sized skin defect.Methods From October 2009 to December 2013,a total of 23 cases of skin lesions were treated with perforators flap adjacent to the defect.The perforator artery was preoperatively detected with Portable Doppler in the region of relative slack skin.Skin defects with the area changed from 1.5 cm × 2.0 cm to 5.0 cm × 4.0 cm.Results All the flap survived smoothly,with pleased appearance and primary healing.Postoperative follow-up of 3 to 6 month showed no recurrence in tumor patients during the follow-up period.Conclusions Application of perforators flap adjacent to defect to repair small sized skin defect has the advantages of flexibility,reliable blood supply,which obtains good result.

Objective To restore the profile of the youthful human fa ce, the concept of three dimensions in the full face rejuvenaton is presented. Methods Under general anaesthesia, the operation was perf ormed, in which the lap of buccal soft tissues, the liposuction of part of face, the mobilization and/or repositioning of fat pockets, the transplantation of fa t, implantation of variant plastic materials etc. were applied. Resul ts We performed the procedures for 18 patients using three dimension s facial rejuvenation and obtained good results from February 2001 to May 2004. Conclusion Through above-mentioned procedures, three-di mensional concept is embodied, and the patients not only obtain better effect o f full face rejuvenation, but also improve the facial profile.

Objective To discuss the clinical value of ~(18)F-FDG PET-CT fusion imaging in hepatocellular carcinoma after transcatheter arterial chemoembolizationTACE)with lipiodol. Methods 15 cases of hepatocellular carcinoma diameter 4～10 cm) were investigated with ~(18)F-FDG PET-CT imaging within three months after TACE. The findings of imaging were compared with the results of anteriography and clinical follow-up.Results After TACE, regions of absent~(18)F-FDG uptakes could be found in all 15 patients. Increased ~(18)F-FDG uptakes could be found in liver of 11 cases. The other 4 patients had no increased~(18)F-FDG uptakes in liver. The regions of increased ~(18)F-FDG uptakes were residual viable tumor confirmed by anteriography and clinical follow-up , and most of them locate around region of absent ~(18) F-FDG uptakes.~(18)F-FDG PET-CT fusion imaging showed that there were no correlation between increased ~(18)F-FDG uptakes and lipiodol dense distribution. After another TACE given or radiotherapy based on ~(18)F-FDG PET-CT fusion imaging, the areas of increased ~(18)F-FDG uptakes reduced or disappeared. In 4 patients without Increased ~(18)F-FDG uptakes ,DSA showed that there were still viable tumor in the peripheral zone of tumor.Conclusion Residual viable tumor can still be found in patients with hepatocellular carcinoma after TACE.~(18)F-FDG PET-CT imaging can characterize and locate the most residual viable tumor, monitor response and be a guide in following therapy, but some viable tumor can not be found by ~(18)F-FDG PET-CT imaging.

Adolescent ; Adult ; Ear Auricle ; Female ; Humans ; Keloid ; surgery ; Surgical Flaps ; Young Adult

BACKGROUND:Keloids are the result of abnormal post-traumatic skin restoration, which are characterized with overgrowth and progressive enlargement, invasion of adjacent normal skin tissue, extension beyond the scope of the original wound. Given the high recurrence, treatment with surgery alone is meaningless and, therefore, comprehensive treatment of surgery and other approaches is required. OBJECTIVE:To explore the clinical curative effect of local injection after timely removal of auricle keloid core. METHODS:Twenty patients with auricle keloid were enroled. After keloid core excision, the time interval within the incision scar tissue injection of fluorouracil or triamcinolone acetonide add lidocaine or monotherapy was gradualy lengthened, and if necessary the proper amount of compound betamethasone was added according to scar conditions. The injection dose was adjusted timely based on the regression of scar. The treatment effect was observed for 12 to 24 months. RESULTS AND CONCLUSION: Of 36 auricle keloids from 20 patients, the comprehensive treatment was effective in 1 keloid, and other 35 keloids were cured. The effective rate was 100%, the completely cured rate was 97.2% and the excelent rate was 2.8%. These findings indicate that minimaly invasive excision of keloid core and the epithelial flap coverage combined with 5-fluorouracil and corticosteroid injection is a safe and effective method to treat auricle keloids.

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects.Methods Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, in which 11 cases male; 7 cases were female, age from 5 to 73 years.Average age was 45.9 years.Repair parts: 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which 8 cases of bone exposure wounds, tendons exposed in 3 cases.Surgical repair of soft tissue defect size of about 6 cm×4 cm-22 cm × 10 cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases.Results All the flaps were survived completely without any complications.The appearance and functional results were satisfactory with following up for 3 to 36 months.18 cases of flap were survived completely, primary healing, without any complications such as vein congestion or engorgement.The 4 cases which remains the cutaneous nerve in site had an average recovery time about 13 days of the donor site.The innervated region of the cutaneous nerve had no acroesthesia or dysesthesia.Conclusion This modified operation methods of flap, enhanced the blood support of the flap, impmved the survive rates and also preserved the sensory function of the patients' donor site.This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.

OBJECTIVETo study the anatomy basis for the clinical application of the adjacent horn shaped perforator fasciocutaneous flap for the reconstruction of small and medium-sized defects in the trunk area.

METHODS(1) Ten adult antiseptic cadavers (20 sides) were perfused with red latex. The skin blood supply, line of the blood vessels, branches in accordance with the distribution and crossing were observed. (2) Fifteen cases with defects in the trunk were treated with the adjacent horn shaped perforator fasciocutaneous flaps. The defects size ranged from 5 cm x 5 cm to 13 cm x 13 cm with the size of the flaps ranging from 10 cm x 6 cm to 35 cm x 15 cm.

RESULTSThe trunk skin is supplied by mainly 17 groups arteries such as thyrocervical trunk, internal thoracic artery, posterior intercostal arteries, superior epigastric artery, arteria epigastrica inferior, lumbar arteries, and so on. The perforators (diameter > 0.5 mm) numbers are about 20, 40, 24, 6, on the chest, abdomen and perineum, upper back, waist, respectively. All the flaps survived completely with primary healing both on donor and recipient sites. The flaps color, texture, function and appearance were satisfactory during the follow-up period of 1-24 months.

CONCLUSIONSThe adjacent horn shaped perforator fasciocutaneous flap should be designed flexibly. The defects in the donor sites could be closed directly without skin graft. It is an effective, easy and ideal method for the reconstruction of large defects in the trunk.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Perforator Flap ; Skin Transplantation ; Torso ; surgery ; Young Adult

OBJECTIVETo explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.

METHODS(1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.

RESULTSThe facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.

CONCLUSIONSThe flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Anastomosis, Surgical ; methods ; Arteries ; anatomy & histology ; Cadaver ; Carcinoma, Basal Cell ; surgery ; Carcinoma, Squamous Cell ; surgery ; Face ; blood supply ; Facial Neoplasms ; surgery ; Humans ; Nevus ; surgery ; Nose ; blood supply ; Perforator Flap ; blood supply ; transplantation ; Skin Neoplasms ; surgery ; Skin Transplantation ; Software ; Tomography, Spiral Computed

Objective To compare the clinical efficacy of neoadjuvant chemotherapy plus vaginal intracavitary irradiation,neoadjuvant chemotherapy alone and vaginal intracavitary irradiation alone followed by radical hysterectomy in patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma.Methods Between January 2000 and December 2009,224 patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma ( tumor diameter ＞ 4 cm) received neoadjuvant therapy combined surgery in Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences were respectively analyzed,and they were divided into 3 groups according to the preoperative neoadjuvant therapy,the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group (chemotherapy combined irradiation group,n =86 ),the neoadjuvant chemotherapy alone group ( chemotherapy group,n =48 ),the vaginal intracavitary irradiation alone group ( irradiation group,n =90).The efficacy,postoperative risk factors,postoperative adjuvant therapy and survival were compared among the 3 groups.Results Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the response rate (RR) were respectively 62％ (53/86),42％(20/48) and 37％ ( 33/90 ),and there was significant difference ( P =0.003 ).The comparison of deep stromal invasion,lymph node metastases,lympho-vascular space involvement(LVSI) and other risk factors among the 3 groups,which showed that there were no statistically significant differences ( P ＞ 0.05 ).In chemotherapy combined irradiation group,the percentage of stromal invasion ≥ 1/2 was lower than that in chemotherapy group [ 53％ ( 46/86 ) vs.73％ ( 35/48 ),P =0.027 ],and the percentage of lymph node metastases was significantly lower than irradiation group [ 17％ ( 15/86)vs.29％ (26/90),P =0.046],and the risk factors-free rate was significantly higher than chemotherapy group [ 44％ (38/86)vs.25％ ( 12/48 ),P =0.028 ].Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the percentage of postoperative radiation therapy were respectively 47％ (40/86),67％ (32/48)and 62％ (56/90),and the differences were statistically significant (P =0.035).The five-year disease free survival (DFS) was 79％,75％ and 78％,respectively.The five-year overall survival (OS) was respectively 81％,78％ and 81％ among 3 groups,and there were no statistically significant differences (P ＞ 0.05).Among 224 patients,the five-year DFS of the patients with 0,1 and ≥ 2 risk factors after surgery were 90％,75％ and 57％,and OS were 95％,82％ and 65％,and there were no statistically significant differences( P ＜ 0.01,respectively).Of patients without postoperative risk factors,the five-year OS in those without receiving postoperative radiation therapy was 96％,while 89％ in received postoperative radiation therapy patients,there were no statistically significant differences ( P =0.263 ).Conclusion There are no differences of DFS and OS among the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group,the neoadjuvant chemotherapy alone group and the vaginal intracavitary irradiation alone group patients with stage Ⅰ b2 and Ⅱ a2.Patients without risk factors after neoadjuvant therapies have better prognosis.

Objective To propose a practical method for moderate-to-server cup-ear correction.Methods Auricular reconstruction was performed in a manner of two-stage approach with mastoid flap and costal cartilage support.In the first stage,the autogenous costal cartilage framework was inserted under the retroauricular mastoid skin flap.The corrected ear was raised in the second operation and wound was closed with grafting skin.Results Satisfaction of appearance was achieved for totally 18 cases except one case of partly necrosis of cartilage.They were followed-up for 3-26 months.Conclusions This integrative two-stage approach of mastoid flap combining three dimensional costal cartilage is safe and effctive for moderate to severe cup-ear correction,which brings about good appearances and symmetry.The complications are in control.