Objective To observe the effect and safety of butyl cyanoacrylate used to close type Ⅰ and Ⅱ skin incisions in non-emergency operations of general surgery.Methods We have enrolled 31 cases with written consent.Upon completion of the surgery butyl cyanoacrylate was used to close skin incisions instead of surgical sutures after suturing subcutaneous tissue with 4-0 absorbable thread.Results The length of incisions was 12 - 180 mm (32 ± 32) mm.On the first post-op day,2 cases had redness and 1 had some effusion within the incision subsiding on the second day,there were no fever.Moderate pain was recorded in 3 cases on the first day after operation.The number of cases reporting slight pain on the first day,third day and fifth day were respectively 28,18 and 5.The others had no any pain.The healing time was (6.3 ± 1.1 ) d,there was no delayed healing,no other complications.Conclusions The tissue adhesive method,using butyl cyanoacrylate is of value in closing type Ⅰ and Ⅱskin incisions in general surgery.It has the advantage of reducing scar and inflammation.

Pancreatic cancer is a highly malignant gastrointestinal tumor with high invasiveness, easy metastasis, and poor chemoresistance. Surgery is still the preferred treatment for resectable pancreatic cancer. At present,inflammatory scoring systems based on serological indicators in patients with resectable pancreatic cancer can be divided into two types:the inflammatory scoring system based on c?reactive protein albumin and the inflammatory scoring system based on peripheral blood cell count. However, the specific mechanism between these inflammatory markers and the prognostic value of resectable pancreatic cancer remains unclear. This article reviews the correlation between systemic inflammatory response indexes and prognosis of patients with resectable pancreatic cancer,so as to provide help for the comprehensive treatment of pancreatic cancer.

Pancreatic cancer is a highly malignant gastrointestinal tumor with high invasiveness, easy metastasis, and poor chemoresistance. Surgery is still the preferred treatment for resectable pancreatic cancer. At present,inflammatory scoring systems based on serological indicators in patients with resectable pancreatic cancer can be divided into two types:the inflammatory scoring system based on c?reactive protein albumin and the inflammatory scoring system based on peripheral blood cell count. However, the specific mechanism between these inflammatory markers and the prognostic value of resectable pancreatic cancer remains unclear. This article reviews the correlation between systemic inflammatory response indexes and prognosis of patients with resectable pancreatic cancer,so as to provide help for the comprehensive treatment of pancreatic cancer.

Objective:To explore the feasibility of an "ABC" three line perforator locating method in design and harvest of free anterolateral perforator flap of calf.Methods:Between March 2021 and November 2021, 42 patients with 62 wounds on hand and foot were treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. The "ABC" three line perforator locating method was applied to determine the location and source of perforating branch before operation and to guide the design and harvest of flap during operation in wound reconstruction. Among the 42 patients, 24 had the injury of single digit, 7 had the injuries with 2 digits, 4 with 3 digits, 1 with 4 digits, 1 of the first web, 1 in the wrist, 2 of the great toe, 1 of second toe and 1 in dorsal foot. The sizes of soft tissue defect were 1.5 cm×2.0 cm-3.0 cm×14.0 cm. The sizes of the flaps were 2.0 cm×2.5 cm-3.5 cm×15.0 cm. All donor sites were sutured directly. In the follow-up, sensations of flaps were evaluated following the sensory function evaluation standard of British Medical Research Council(BMRC), and the recovery of the donor and recipient sites was evaluated by the flap comprehensive evaluation scale. Regular follow-up were scheduled at outpatient clinic.Results:A total of 162 perforators were located before operation. There were 95 perforating branches being explored in the operation, of which 5 patients had 1 extra perforating branch than that located before surgery. Seventy-six perforating branches were found consistent with preoperative localisation, with a coincidence rate of 84.4%(76/90). Sixty-four perforating branches were found consistent with the preoperative source with an accuracy rate of 84.2%(64/76). All the 62 flaps survived without a vascular compromise. Follow-up lasted for 6-10(mean 7.1) months. The colour and texture of the flaps were excellent. The flaps were thin and wear-resistant. The sensory function of the flaps was evaluated at S 1-S 3 by BMRC. Comprehensive evaluation scale of flap was excellent in 38 patients and good in 4 patients. Conclusion:"ABC" three line perforator locating method in design of free anterolateral calf flap is a feasible and an ideal auxiliary method in surgical practice. It combines anatomical knowledge, clinical experience and Doppler ultrasound localisation as well as accurately guides the location and source prediction of perforator before surgery.

Objective:To investigate the feasibility and clinical outcome of anterolateral thigh flaps (ALTF) based on the transverse branch of the lateral circumflex femoral artery (LCFA) as the source artery in the repair of soft tissue defects of the extremities.Methods:A retrospective analysis was conducted to analyze the clinical data from patients who received the ALTF pedicled with the transverse branch of the LCFA to repair the wounds of the extremities from April 2020 to March 2021 at Ruihua Affiliated Hospital of Soochow University. Preoperative Doppler ultrasound was applied to locate the perforators in the anterolateral thigh area. The ALTF was prepared based on the traditional method, and the perforators were found to be too thin to meet the requirements of vascular anastomosis. The incision was extended superiorly, and the designated perforators were found in the upper segment; thus, the flap was harvested accordingly. The ALTF pedicled with the transverse branch of the LCFA was finally harvested for wound reconstruction. The donor site was directly drawn and sutured. The wound healing of the donor site and the survival rate of the flap were recorded. The comprehensive evaluation scale was used to evaluate the repair effect, which was classified as excellent (90-100 points), good (75-89 points), fair (60-74 points), and poor (<60 points).Results:Thirteen patients with extremity trauma were enrolled in the study, which consisted of nine males and four females. The age range was between 20 and 65 years old. There were 4 cases of hand/forearm wounds and 9 cases of foot/ankle wounds among the patients. The area of soft tissue defects was approximately 7 cm×4 cm to 31 cm×8 cm. Eighteen perforators from the transverse branches of the LCFA, including ten septocutaneous perforators and eight direct cutaneous perforators, were observed in thirteen surgeries. The area of flaps ranged 8 cm×6 cm to 32 cm×10 cm. One flap exhibited arterial crisis, which was relieved after thrombectomy and re-anastomosis of the injured segment; the flap survived. Other flaps survived completely. Thirteen patients were followed up for 6-20 months, and both flaps were soft in texture and good in appearance. In addition, there were no serious complications at the donor site. Finally, the curative effects of the ALTF pedicled with the transverse branch of the LCFA were estimated according to the flap comprehensive evaluation scale. Four cases obtained excellent curative effects, seven cases had good prognoses, and the effects of the remaining two cases were acceptable.Conclusions:The ALTF pedicled with the transverse branch of the LCFA can be used to repair soft tissue defects of the extremities, with a good prognosis obtained; meanwhile, the anatomy of the perforators is simple, and the donor area is relatively inconspicuous. The flap can be a useful supplement to the conventional ALTF.

Objective:To explore the distribution characteristics of the perforators of the oblique branch of the lateral circumflex femoral artery, and to report the clinical effect of the anterolateral thigh flap pedicled with the oblique branch in repairing the wounds of the extremities.Methods:The clinical data of the patients with anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery in Suzhou Ruihua Orthopaedic Hospital from December 2020 to April 2021 were analyzed retrospectively. High frequency color Doppler ultrasound was used to detect the large perforators of the oblique branch of the lateral circumflex femoral artery near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella. With reference to the location of the perforators, according to the size and shape of the defect in the recipient area, the anterolateral thigh flap pedicled with oblique branch was designed and dissected to repair the wound. During the operation, the distance between the emitting point of the main oblique branch, the skin entry point of the perforators and the anterior superior iliac spine was measured with a steel ruler, the diameter of the perforators was measured with a microscale, and the number of perforators was counted. The survival and complications of the flap were observed and followed up after operation. In the last follow-up, the comprehensive evaluation scale was used to evaluate the repair effect: 90 to 100 points is excellent, 75 to 89 points is good, 60 to 74 points is average, and less than 60 points is poor.Results:A total of 84 patients were included, including 62 males and 22 females, aged from 14 to 82 years (mean 46.9 years), including 32 cases of hand wounds, 6 cases of forearm wounds, 3 cases of upper arm wounds, 10 cases of calves and 33 cases of foot and ankle wounds. The wound area was 6 cm × 4 cm-20 cm × 45 cm. A total of 88 flaps were removed in 84 patients (skin flaps on both thighs were removed in 4 patients). The size of the skin flap of 88 thighs was 7 cm × 5 cm-37 cm × 11 cm, of which 85 sides of 82 cases survived completely. One case of diabetes had complete necrosis 1 month after operation, and 1 case of 34 cm had necrosis of the distal end of 3 cm × 3 cm skin flap. Necrotic skin flaps were repaired with skin grafting. Four patients developed arterial crisis within 24 hours after operation, and those flaps survived after surgical exploration. All donor areas healed. During the follow-up of 6 to 9 months, the shape of the recipient area was normal in all patients, and there was no deep tissue infection such as osteomyelitis. The color and texture of all flaps were good. The sensation returned to S1-S2 after operation. The skin flap comprehensive evaluation scale was used to evaluate the repair effect. The patients’ score ranged from 73 to 94 points, with an average of 88.1 points. Including 33 excellent cases, 46 good cases and 5 average cases, the excellent and good rate was 94.0%(79/84). A total of 215 perforators were marked with 88 flaps before operation, and 208 perforators were found during the operation(the diameter of the perforators was 0.4-1.5 mm), of which 130 were sent out by oblique branches. There were perforators of the oblique branch in all flaps, with an average of 1.5 on each side, including 84(64.6%) septocutaneous perforators and 46(35.4%) musculocutaneous perforators. Most of the oblique branches originate from the lateral circumflex femoral artery, which runs in the intermuscular septum between the rectus femoris and the intermediate femoris muscle. It is divided into deep branches and superficial branches at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral margin of the patella. The skin perforators of the oblique branch of the lateral circumflex femoral artery is mostly sent out from the superficial branch, and there are 118 perforators located at the midpoint and proximal end of the line between the anterior superior iliac spine and the lateral margin of the patella, accounting for 90.8% (118/130), reaching a peak at 0.4 (there are 37 perforators).Conclusion:The oblique branch of the lateral circumflex femoral artery is relatively constant, and most of the perforators are located near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella, and the proportion of septocutaneous perforator is high. The distribution of perforator is regular, the blood supply is reliable, the application mode is flexible, and the donor site position is more concealed while the blood supply of the flap is secured.

Objective:To investigate the feasibility and clinical outcome of anterolateral thigh flaps (ALTF) based on the transverse branch of the lateral circumflex femoral artery (LCFA) as the source artery in the repair of soft tissue defects of the extremities.Methods:A retrospective analysis was conducted to analyze the clinical data from patients who received the ALTF pedicled with the transverse branch of the LCFA to repair the wounds of the extremities from April 2020 to March 2021 at Ruihua Affiliated Hospital of Soochow University. Preoperative Doppler ultrasound was applied to locate the perforators in the anterolateral thigh area. The ALTF was prepared based on the traditional method, and the perforators were found to be too thin to meet the requirements of vascular anastomosis. The incision was extended superiorly, and the designated perforators were found in the upper segment; thus, the flap was harvested accordingly. The ALTF pedicled with the transverse branch of the LCFA was finally harvested for wound reconstruction. The donor site was directly drawn and sutured. The wound healing of the donor site and the survival rate of the flap were recorded. The comprehensive evaluation scale was used to evaluate the repair effect, which was classified as excellent (90-100 points), good (75-89 points), fair (60-74 points), and poor (<60 points).Results:Thirteen patients with extremity trauma were enrolled in the study, which consisted of nine males and four females. The age range was between 20 and 65 years old. There were 4 cases of hand/forearm wounds and 9 cases of foot/ankle wounds among the patients. The area of soft tissue defects was approximately 7 cm×4 cm to 31 cm×8 cm. Eighteen perforators from the transverse branches of the LCFA, including ten septocutaneous perforators and eight direct cutaneous perforators, were observed in thirteen surgeries. The area of flaps ranged 8 cm×6 cm to 32 cm×10 cm. One flap exhibited arterial crisis, which was relieved after thrombectomy and re-anastomosis of the injured segment; the flap survived. Other flaps survived completely. Thirteen patients were followed up for 6-20 months, and both flaps were soft in texture and good in appearance. In addition, there were no serious complications at the donor site. Finally, the curative effects of the ALTF pedicled with the transverse branch of the LCFA were estimated according to the flap comprehensive evaluation scale. Four cases obtained excellent curative effects, seven cases had good prognoses, and the effects of the remaining two cases were acceptable.Conclusions:The ALTF pedicled with the transverse branch of the LCFA can be used to repair soft tissue defects of the extremities, with a good prognosis obtained; meanwhile, the anatomy of the perforators is simple, and the donor area is relatively inconspicuous. The flap can be a useful supplement to the conventional ALTF.

Objective:To explore the distribution characteristics of the perforators of the oblique branch of the lateral circumflex femoral artery, and to report the clinical effect of the anterolateral thigh flap pedicled with the oblique branch in repairing the wounds of the extremities.Methods:The clinical data of the patients with anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery in Suzhou Ruihua Orthopaedic Hospital from December 2020 to April 2021 were analyzed retrospectively. High frequency color Doppler ultrasound was used to detect the large perforators of the oblique branch of the lateral circumflex femoral artery near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella. With reference to the location of the perforators, according to the size and shape of the defect in the recipient area, the anterolateral thigh flap pedicled with oblique branch was designed and dissected to repair the wound. During the operation, the distance between the emitting point of the main oblique branch, the skin entry point of the perforators and the anterior superior iliac spine was measured with a steel ruler, the diameter of the perforators was measured with a microscale, and the number of perforators was counted. The survival and complications of the flap were observed and followed up after operation. In the last follow-up, the comprehensive evaluation scale was used to evaluate the repair effect: 90 to 100 points is excellent, 75 to 89 points is good, 60 to 74 points is average, and less than 60 points is poor.Results:A total of 84 patients were included, including 62 males and 22 females, aged from 14 to 82 years (mean 46.9 years), including 32 cases of hand wounds, 6 cases of forearm wounds, 3 cases of upper arm wounds, 10 cases of calves and 33 cases of foot and ankle wounds. The wound area was 6 cm × 4 cm-20 cm × 45 cm. A total of 88 flaps were removed in 84 patients (skin flaps on both thighs were removed in 4 patients). The size of the skin flap of 88 thighs was 7 cm × 5 cm-37 cm × 11 cm, of which 85 sides of 82 cases survived completely. One case of diabetes had complete necrosis 1 month after operation, and 1 case of 34 cm had necrosis of the distal end of 3 cm × 3 cm skin flap. Necrotic skin flaps were repaired with skin grafting. Four patients developed arterial crisis within 24 hours after operation, and those flaps survived after surgical exploration. All donor areas healed. During the follow-up of 6 to 9 months, the shape of the recipient area was normal in all patients, and there was no deep tissue infection such as osteomyelitis. The color and texture of all flaps were good. The sensation returned to S1-S2 after operation. The skin flap comprehensive evaluation scale was used to evaluate the repair effect. The patients’ score ranged from 73 to 94 points, with an average of 88.1 points. Including 33 excellent cases, 46 good cases and 5 average cases, the excellent and good rate was 94.0%(79/84). A total of 215 perforators were marked with 88 flaps before operation, and 208 perforators were found during the operation(the diameter of the perforators was 0.4-1.5 mm), of which 130 were sent out by oblique branches. There were perforators of the oblique branch in all flaps, with an average of 1.5 on each side, including 84(64.6%) septocutaneous perforators and 46(35.4%) musculocutaneous perforators. Most of the oblique branches originate from the lateral circumflex femoral artery, which runs in the intermuscular septum between the rectus femoris and the intermediate femoris muscle. It is divided into deep branches and superficial branches at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral margin of the patella. The skin perforators of the oblique branch of the lateral circumflex femoral artery is mostly sent out from the superficial branch, and there are 118 perforators located at the midpoint and proximal end of the line between the anterior superior iliac spine and the lateral margin of the patella, accounting for 90.8% (118/130), reaching a peak at 0.4 (there are 37 perforators).Conclusion:The oblique branch of the lateral circumflex femoral artery is relatively constant, and most of the perforators are located near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella, and the proportion of septocutaneous perforator is high. The distribution of perforator is regular, the blood supply is reliable, the application mode is flexible, and the donor site position is more concealed while the blood supply of the flap is secured.

Liver is a common site for distant metastasis of colorectal cancer and a large proportion of patients with colorectal liver metastasis cannot receive the radical hepatectomy. Liver transplantation has been proven to bring a survival benefit in highly selected unresectable colorectal liver metastasis (u-CRLM) patients, but the shortage of donor liver severely restricts its application. Resection and partial liver transplantation with delayed total hepatectomy (RAPID) is a newly deve-loped liver transplantation procedure, which innovatively combined auxiliary liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy. With the small and partial liver graft, RAPID can cure u-CRLM safely and effectively. In RAPID, the reconstruction of portal vein and hepatic vein is the key point, while the control of portal vein pressure and flow is the difficulty and also the key for success. Thereafter, living donor-RAPID is created by combing RAPID with living donor liver transplantation. Besides, the application of RAPID also extends to other primary liver diseases, including liver cirrhosis and liver cancer. RAPID is difficult, complex and under an exploratory stage at present. In this paper, based on the developing process of RAPID, the authors give a comprehensive overview of its surgical procedures and key points, and discuss its potential application area.

Objective:To explore the anatomical characteristics of the anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum and the clinical effect of this flap in repairing skin and soft tissue defects in the extremities.Methods:A retrospective observational study was conducted. From December 2020 to April 2021, 59 patients with skin and soft tissue defects in the extremities admitted to the Department of Hand Surgery of Suzhou Ruihua Orthopaedic Hospital met the inclusion criteria, including 46 males and 13 females, aged 20 to 81 years. The wound area after debridement ranged from 8 cm×5 cm to 38 cm×20 cm. According to the condition of the wound, the perforators in the anterolateral femoral region on the unaffected side were located by color Doppler ultrasound. The anterolateral thigh perforator flap with the oblique branch of lateral circumflex femoral artery as the source artery was designed, and the wound was repaired by unilateral flap or series combination of bilateral flaps (with the area of unilateral flap ranging from 7 cm×5 cm to 37 cm×11 cm). The wound of the donor site was sutured directly. The following items were recorded, including the number of perforators in the anterolateral femoral region marked before operation, the course characteristics of oblique branch trunk of lateral circumflex femoral artery and its perforators, and the number, origin, and type of perforators observed during operation, the flap repair mode and the flap harvest time. After operation, the survival condition of the flap, the wound healing time in the recipient site, and the suture healing in the donor area were observed, and the recovery of the donor and recipient areas was followed up. At the last follow-up, the sensation function evaluated by sensory rating scale of British Medical Research Association and two-point discrimination of the area transplanted with flap were recorded, and the improved comprehensive curative effect evaluation scale of flap was used to evaluate the repair effect of the flap.Results:A total of 156 perforators were marked in the anterolateral femoral region before operation, and 144 perforators were observed during the operation, of which 98 came from the oblique branch of the lateral circumflex femoral artery, and the first perforator of the oblique branch was the intermuscular septal perforator. Once formed, most oblique branch trunk of lateral circumflex femoral artery in the muscular septum could be divided into the deep branch and the superficial branch at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral edge of the patella, the deep branch mainly ran in the muscle of vastus intermedius and vastus lateralis, and rarely developed the skin perforators, while the superficial branch mainly ran in the muscular septum between the rectus femoris and the vastus lateralis, and grew out the perforators to the proximal skin of the anterolateral femoral region. Fifty-six patients were repaired with unilateral flap and 3 patients with bilateral flap in series combination, with the harvesting time of the unilateral flap ranged from 9 to 99 min. Three patients developed arterial crisis within 48 hours after operation and survived after timely exploration; the flap of 1 patient developed necrosis 11 days after operation and was repaired by abdominal split-thickness skin graft; the other flaps survived smoothly. The wound healing time in the recipient area was 10 to 42 days after operation, and the sutures in the donor area healed well. During the follow-up of 6 to 10 months, 8 patients underwent thinning and plastic surgery 6 months after operation because of bloating in the flap transplantation area, while the other patients had a good shape of the flap transplantation area, with no deep tissue infection such as osteomyelitis, with soft texture, good elasticity, no pain, and good blood circulation; all the donor areas were left with linear scars, normal blood circulation in the distal extremities, no limitation of knee joint motion or quadriceps muscle strength. At the last follow-up, the sensation function was restored in the flap transplantation area of the affected limb, including 14 cases of S 1 grade and 45 cases of S 2 grade; there was only one point of two-point discrimination; the curative effect evaluation of flap repair included excellent in 24 cases, good in 35 cases, and general in 3 cases. Conclusions:The anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum has the advantages of relatively concealed donor area, large cutting width, and simple operation during surgery. It protects the donor area to the greatest extent while repairing skin and soft tissue defects in the extremities, and is a useful supplement to the classic anterolateral thigh perforator flap.