Objective To study the value of breast vascularity in differential diagnosis of benign and malignant breast lesions. Methods The data of 37 patients with benign and malignant breast lesions in the Second Hospital of Shanxi Medical University from February 2017 to November 2017 were respectively analyzed. The number, diameter, length and breast-feeding arteries of bilateral breast vessel were recorded in the maximal intensity projection (MIP) of magnetic resonance imaging (MRI) and were scored according to Sardanellie. The patients were divided into the benign group and the malignant group according to the pathological results. Besides, ≥2 cm group and <2 cm group was also divided according to the maximum diameter of lesions. The differences in number and score of vascularity in both groups were compared. And the diagnostic efficacy of MRI was evaluated based on Sardanellie score and breast-feeding arteries. Results There were no significant differences in the number and score of vascularity between bilateral breast in benign breast lesions group (1.11 ±0.35 vs. 1.22 ±0.45, t= 0.19, P= 0.85; 0.89 ±0.38 vs. 0.95 ±0.21, t= 0.25, P=0.80). The number and score of vascularity of the affected side were higher than those of the healthy side in breast malignant lesions group (2.61 ±1.29 vs. 0.61 ±0.21, t= 6.18, P= 0.00; 1.78 ±0.65 vs. 0.61 ±0.21, t=6.30, P=0.00 respectively). The number and score of vascularity were statistically different between benign and malignant breast lesions (t= 8.57, P< 0.001; t= 12.61, P< 0.001). The number of vascularity in the malignant group was higher than that in the benign group with the maximum diameter of lesion<2 cm (1.27 ± 0.59 vs. 2.57±0.98, t=90.5, P< 0.05), and there was no significant difference in the scores of vascularity in the malignant group and the benign group (1.09 ±0.43 vs. 1.86 ±0.38, t= 87.0, P> 0.05); The number and score of vascularity in the malignant group were higher than those in the benign group with the maximum diameter ≥2 cm (0.92±0.63 vs. 2.64±1.50, t=47.5, P<0.05; 0.92±0.33 vs. 1.73±0.79, t=53.5, P< 0.05). There was no significant improvement in the diagnostic efficacy of MRI based on the score of vascularity and positive breast-feeding arteries in the identification of benign and malignant lesions when the maximum diameter of lesions were<2 cm, and it had a high diagnostic efficacy when the maximum diameter of lesions were ≥2 cm. Conclusions The vascularity of breast can be clearly seen by using breast dynamic contrast enhanced (DCE) MRI. The increase and score of vascularity in the differential diagnosis of benign and malignant breast lesions have a certain application value. The positive of breast-feeding arteries may increase the diagnostic efficiency of MRI.

Objective:To explore the surgical technique and clinical effect of pressure boost in repairing soft tissue defects of limbs with thinned anterolateral thigh perforator flap (ALTP) .Methods:From January, 2015 to December, 2018, 18 cases with soft tissue defects of limbs with various damages of blood vessels and nerves with explosure of tendon and bone. There were 13 males and 5 females aged between 18 to 56 (averaged of 36.3) years, which were 6 defects in shank, 4 in foot and ankle, 5 in forearm, and 3 in hand. The soft tissue defect area was 7 cm ×12 cm to 13 cm ×30 cm. Thinned ALTP was used to repair the wound surface. The perforating vessels of the distal flap were anastomosed with one branch of the internal vessel pedicle flap to increase the pressure hence the blood supply of the distal region. The donor sites were sutured directly or covered by skin graft. Followed-up was conducted by 1-2 monthly clinic visits and telephone or on-line review to check the flap survival and recovery of functions.Results:All flaps survived without arterial or venous crisis. One flap had partial necrosis at the distal end, and healed after dressing change. One case had a swelling flap due to a congestion beneath the flap. The wound achieved primary healing after removal of sutures, ligation of subcutaneous vessels and drainage of hematoma. All patients were followed-up for 6 to 18 (average, 9.5) months. All flaps had good appearance and texture. After rehabilitation treatment, most of the joint activity had been recovered: extension and flexion of wrists joints ranged 60°-80°, 70°-80° for metacarpophalangeal joints and 40°-60° for ankle joints. One patient underwent ankle joint dorsiflexion function reconstruction and flap thinning at 6 months after operation due to the defects of most of the extensor tendon.Conclusion:During the use of free ALTP to repair soft tissue defect of limbs, application of the technique of pressure boost is able to increase blood supply to the distal region of flap. It helps to reduce the incidence of infection and necrosis at the edge of the flap.