Objective:To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities.Methods:A retrospective observational study was conducted. From October 2018 to June 2021, Suzhou Ruihua Orthopedic Hospital admitted 12 patients (11 males and 1 female, aged 24-64 years) who met the inclusion criteria, and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection, or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation. The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases. The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm, and the applied flap area was 9 cm×6 cm-25 cm×7 cm. During transplantation, the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area. Subcutaneous beauty suture was performed on all the donor wounds. After operation, the survival of the flap and vascular crisis were observed; and the wound healing at the donor site was observed. During follow-up, the texture of the flap and complications at the donor site were observed. At the last follow-up, the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table.Results:After operation, all the flaps of patients survived without vascular crisis; the wounds in the donor site healed smoothly. During follow-up of 6 to 26 months, the flaps had good texture; only linear scars remained in the donor area without scar contracture, pain or other discomfort. At the last follow-up, the total score of flap repair effect of 12 patients was 75-95, with an average of 87, of which 5 cases were rated as excellent, 6 cases as good, and 1 case as fair, and the proportion of excellent and good patients was 11/12.Conclusions:The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch, oblique branch, or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap. This operation has the advantages of simple operation, small trauma, and others, which effectively ensures the smooth operation.

Objective To compare the dosimetric differences in volumetric modulated arc therapy (VMAT) of Monaco planning system for nasopharyngeal carcinoma between Pareto and Constrained optimization in order to provide a reference for future mode selection. Methods Select 20 patients with nasopharyngeal carcinoma whom were calculated by Pareto and Constrained modes in the same CT image. Prescription dose of target PGTV, PTV1 and PTV2 was 70.29、60.39 and 54.45 Gy with 33 fractions, 5 times a week. The differences in target dose, organs at-risk dose, monitor units and segments were compared in the condition of 95% of the target volume reached the prescribed dose. Results Compared with Pareto group, Constrained group achieved a better HI and CI. CI of PGTV and PTV1 signed statistical differences (P < 0.05). Dose of OARs in Constrained group were all lower than those in Pareto group except Optical-l and lens-l. The differences of spinal cord prv dose and V₃₀ of Parotid-r between two groups was significant (P < 0.05) while the differences of monitor units and segments between two groups was not significant (P > 0.05). Conclusion The length of middle turbinate is negatively correlated with the occurrence and severity of CMS. There is no significant correlation between the degree of curling and the occurrence of CMS, but patients with lower degree of curling of middle turbinate may have more serious CMS.