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 discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect.Methods ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction.The regulation and origins of the perforator vessel in proper palmar digital artery was observed.②From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps.The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm.We put the head end of flaps at defect side.The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect.The defect at donor site was closed directly.Results We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries.The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers.All 9 flaps survived after the operation.Both the recipient area and donor areas received sound healing.With 2 months to 1.5 years of follow-up visit,the shape,color and luster,texture and function all had good healing.Conclusions The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design,reliable perforator vessels.The defect at donor site can be closed directly with no skin graft.This method considers both shape and function and is a good way for finger soft tissue defect.

Objective To discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect.Methods ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction.The regulation and origins of the perforator vessel in proper palmar digital artery was observed.②From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps.The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm.We put the head end of flaps at defect side.The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect.The defect at donor site was closed directly.Results We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries.The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers.All 9 flaps survived after the operation.Both the recipient area and donor areas received sound healing.With 2 months to 1.5 years of follow-up visit,the shape,color and luster,texture and function all had good healing.Conclusions The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design,reliable perforator vessels.The defect at donor site can be closed directly with no skin graft.This method considers both shape and function and is a good way for finger soft tissue defect.

Objective: To investigate the clinicopathological characteristics and surgical outcomes of adrenal hemolymphangioma,so as to enhance the understanding of this disease. Methods: Clinical and pathological data of 8 patients with adrenal hemolymphangioma admitted to the Department of Urology of our hospital during Jan.2013 and Dec.2022 were retrospectively analyzed,and relevant literature was reviewed. Results: The patients included 5 males and 3 female,median age 54(25-75) years.Adrenal hemolymphangioma was detected in all patients in physical examinations without obvious symptoms.And 4 of the patients had a history of hypertension.Adrenal function test results showed no abnormalities.A total of 9 tumors were identified by imaging examination,including 1 unilateral multiple and 7 unilateral solitary tumors,with a median diameter of 3.6(1.0-5.4) cm.Posterior laparoscopic adrenal tumor resection was performed in 7 cases and robot-assisted laparoscopic adrenal tumor resection in 1 case；all of the tumors were completely removed.The median operation time was 77(53-115) min,median intraoperative blood loss 7.5(2.0-20.0) mL,and median postoperative hospital stay 4(1-7) d.Postoperative pathology showed interwoven deformed and dilated blood vessels and lymphatic vessels in the cystic tumors,with a large amount of lymphoid fluid,lymphocytes and red blood cells.Chronic lymphocyte infiltration was visible between the tube walls.The cystic cavity was partially connected,with flat endothelial cells lining.The pathological diagnosis was adrenal hemolymphangioma.During the median follow-up of 53.5(12.0-106.8) months,all patients recovered well,with stable blood pressure and no tumor recurrence or metastasis. Conclusion: Adrenal hemolymphangioma has no specific clinical symptoms.As adrenal functional tests show no obvious abnormalities,the diagnosis depends on pathological examinations.Popsterior laparoscopic or robot-assisted laparoscopic resection has good efficacy and prognosis.

Vascular structure pattern，namely the maturity，morphology and distribution of blood vessels，as one of the pathological features of renal cell carcinoma (RCC)，cannot be ignored when the prognosis is concerned.The current mainstream classification of vascular structure patterns includes pseudoacini，Golgi，lacunar and dispersion patterns.Many studies have shown that the vascular structure patterns in RCC are closely related to the diagnosis and prognosis.Early features such as dendritic penetration of the endothelium contribute to the differential diagnosis of RCC，while different vascular structure patterns are not only related to tumor grade，but also affect the responsiveness of targeted therapy and prognosis.Evaluating these vascular structural patterns can help to understand the biological behaviors of tumors and guide the treatment options，but a unified assessment of vascular structural patterns is still lacking.This paper reviews the research progress on the relationship between vascular structure patterns and RCC prognosis，aiming to provide clinical reference.

[Objective] To investigate the efficacy of nephron-sparing surgery (NSS) for the treatment of renal sinus angiomyolipoma and summarize the surgical experience. [Methods] The clinical data and follow-up results of 10 cases of renal sinus angiomyolipoma treated during Sep.2014 and Feb.2022 in our hospital were retrospectively analyzed. [Results] The patients included 1 male and 9 female.The mean tumor diameter was (5.7±2.8) cm.The RENAL score was 8 in 1 case, 9 in 3 cases, 10 in 4 cases, and 11 in 2 cases.Retroperitoneal laparoscopic partial nephrectomy was conducted in 3 cases, robot-assisted laparoscopic partial nephrectomy in 3 cases, and open partial nephrectomy by transabdominal approach in 4 cases.All operations were successful.The median operation time was 225 (97-340) minutes and the median warm ischemic time was 30.5 (5-43) minutes.Two patients underwent renal vein clamping simultaneously, with clamping time of 18 and 29 minutes, respectively.The median estimated blood loss was 200(10-600) mL, and no patients received blood transfusion.The difference between postoperative and preoperative hemoglobin concentration was statistically significant [113 (94-130) g/L vs.136 (95-150) g/L, P=0.041]. The difference between the postoperative and preoperative serum creatinine level was not statistically significant [58(35-89) μmol/L vs. 62(39-77) μmol/L, P=0.722]. One case suffered lymphorrhagia (Clavien-Dindo grade Ⅰ) and recovered with conservative treatment; 1 case experienced local recurrence after a follow-up of 99 months; 9 patients recovered uneventfully without any postoperative complications. [Conclusion] NSS is an effective treatment strategy for renal sinus angiomyolipoma.Complete resection plays a key role.Due to possible recurrence, long-term follow-up is recommended.