Objective:To explore the clinical strategy of using adjacent tissue flaps to immediately repair large facial soft tissue defects after resection of lateral facial skin tumors in the elderly patients.Methods:The clinical data of the elderly patients with large soft tissue defects after resection of skin malignant tumors on the lateral facial region from July 2016 to June 2020 were reviewed by the Department of oral and maxillofacial surgery of Qilu Hospital of Shandong University and the Department of Oral and Maxillofacial Surgery of Xinjiang Uygur Autonomous Region People’s Hospital. All the soft tissue defects after tumor resection were larger than 3.0 cm×3.0 cm. The line drawn from the top of the helix to the lateral canthus was used as an anatomical marker. Twelve cases of type Ⅰ defects were located in the lower part, and 12 cases of type Ⅱ defects were located in the upper part. Type Ⅰ could be subdivided into two subclasses: Type Ⅰa, which was mainly located in the aesthetic unit of the buccal area. Submental artery island flap (SMAIF) was used to repair and restore its thickness and convexity. Type Ⅰb, the defects extended directly to the tragus, which was located in the aesthetic regions of the lateral and zygomatic subunits, cervicofacial or cervicothoracic rotation flaps were used to repair thinner tissue defects. For type Ⅱ, defects mainly located in the temporal and forehead regions abovethe dividing line, which were repaired by the cervicothoracic and forehead rotation flaps. Then, visual analogue scale (VAS) was used to evaluate patients’satisfaction about the incision design and aesthetic outcome 3 months after operation.Results:There were 24 patients (15 males and 9 females) included in this study with an average age of 68.6 years (range from 57-86 years) when the disease was at onset, including 69.7 years for males and 66.8 years for females. The average defect area after tumor resection was 37.1 cm 2 (5.0 cm×4.5 cm-8.5 cm ×7.0 cm). Six cases of type Ⅰa defect were repaired with SMAIFs. Three cases of type Ⅰb defect were repaired with the cervicofacial rotation flaps, and the other three cases of type Ⅰb were repaired with cervicothoracic rotation flaps. Twelve cases of type Ⅱ defect were repaired with cervicothoracic and forehead rotation flaps. Visual analogue scale (VAS) score was 9.3 on average (8.9-9.7) at 3 month after operation, and the patients were very satisfied with the incision design and the cosmetic outcome. No recurrences were found in patients with a follow-up period ranged from 10-43 months (average 27.1 months). Conclusions:One or more adjacent tissue flaps can be used for the immediate reconstruction of the lateral facial region soft tissue large defects. The line drawn from the top of the helix to the lateral canthus can be used as an anatomical marker. The selection of these flaps can be planned preoperatively based on the location and size of the defect or lesion. For elderly patients with relatively low malignant skin cancer, using adjacent tissue flaps to repair large lateral facial soft tissue defects could be the preferred treatment.

Objective:To explore the clinical strategy of using adjacent tissue flaps to immediately repair large facial soft tissue defects after resection of lateral facial skin tumors in the elderly patients.Methods:The clinical data of the elderly patients with large soft tissue defects after resection of skin malignant tumors on the lateral facial region from July 2016 to June 2020 were reviewed by the Department of oral and maxillofacial surgery of Qilu Hospital of Shandong University and the Department of Oral and Maxillofacial Surgery of Xinjiang Uygur Autonomous Region People’s Hospital. All the soft tissue defects after tumor resection were larger than 3.0 cm×3.0 cm. The line drawn from the top of the helix to the lateral canthus was used as an anatomical marker. Twelve cases of type Ⅰ defects were located in the lower part, and 12 cases of type Ⅱ defects were located in the upper part. Type Ⅰ could be subdivided into two subclasses: Type Ⅰa, which was mainly located in the aesthetic unit of the buccal area. Submental artery island flap (SMAIF) was used to repair and restore its thickness and convexity. Type Ⅰb, the defects extended directly to the tragus, which was located in the aesthetic regions of the lateral and zygomatic subunits, cervicofacial or cervicothoracic rotation flaps were used to repair thinner tissue defects. For type Ⅱ, defects mainly located in the temporal and forehead regions abovethe dividing line, which were repaired by the cervicothoracic and forehead rotation flaps. Then, visual analogue scale (VAS) was used to evaluate patients’satisfaction about the incision design and aesthetic outcome 3 months after operation.Results:There were 24 patients (15 males and 9 females) included in this study with an average age of 68.6 years (range from 57-86 years) when the disease was at onset, including 69.7 years for males and 66.8 years for females. The average defect area after tumor resection was 37.1 cm 2 (5.0 cm×4.5 cm-8.5 cm ×7.0 cm). Six cases of type Ⅰa defect were repaired with SMAIFs. Three cases of type Ⅰb defect were repaired with the cervicofacial rotation flaps, and the other three cases of type Ⅰb were repaired with cervicothoracic rotation flaps. Twelve cases of type Ⅱ defect were repaired with cervicothoracic and forehead rotation flaps. Visual analogue scale (VAS) score was 9.3 on average (8.9-9.7) at 3 month after operation, and the patients were very satisfied with the incision design and the cosmetic outcome. No recurrences were found in patients with a follow-up period ranged from 10-43 months (average 27.1 months). Conclusions:One or more adjacent tissue flaps can be used for the immediate reconstruction of the lateral facial region soft tissue large defects. The line drawn from the top of the helix to the lateral canthus can be used as an anatomical marker. The selection of these flaps can be planned preoperatively based on the location and size of the defect or lesion. For elderly patients with relatively low malignant skin cancer, using adjacent tissue flaps to repair large lateral facial soft tissue defects could be the preferred treatment.

Objective To analyze the donor specific antibody (DSA) in liver transplantation,and discuss the therapeutic schemes.Methods We retrospectively analyzed prospectively collected samples from 139 cases of liver transplantation from September 1,2013 to July 1,2015.Luminex assays were applied to determine human leukocyte antigen,panel reactive antibody (PRA).For PRA positive cases,DSA,C1q and C4d were detected,and liver biopsy was done.Results Of 139 cases enrolled,there were 12 cases positive for DSAs,including 2 cases of PreDSA:1 case of Ⅰ DSA (HLA-A mismatch),and 1 case of Ⅱ DSA (HLA-DQ mismatch).Ten cases of de novo DSA (including 1 case of PreDSA) all were HLA-DQ mismatch.The liver biopsy on 5 cases showed hepatic fibrosis,early rejection and intrahepatic cholestasis,and only 2 cases showed positive C4d.Of 6 cases of DSA,5 cases showed positive C1q.In the patients positive for DSA,tacrolimus dose was adjusted postoperatively,adding mycophenolatemofetil or increasing its dose,or methylprednisolone and immunoglobulin given.Conclusion DSAs are important indicators of sensitized recipients in liver transplantation,associated with trends toward worse outcomes in patients or allografts.The monitoring of DSA is requisite in order to adjust the immunosuppressant.

Objective To investigate the factors affecting the number of lymph nodes obtained by unilateral lobectomy and isthmus combined with prophylactic ipsilateral central lymph node dissection for papillary thyroid cancer,and to analyze the pattern of change so as to provide an important basis for clinical treatment of papillary thyroid cancer.Methods Retrospective analysis was performed on the clinical and pathological data of 193 patients admitted to the department of Thyroid Surgery of the First Affiliated Hospital of Jinzhou Medical University from January 2019 to January 2022 for papillary thyroid cancer who underwent unilateral glandular lobe and isthmus resec-tion combined with prophylactic ipsilateral central lymph node dissection.The number of obtained lymph nodes was divided into a group with high number of obtained lymph nodes(n>6)and a group with low number of obtained lymph nodes(n≤6).Univariate analysis and multivariate analysis were used to explore the factors affecting the num-ber of obtained lymph nodes.The influence of the number of lymph nodes on the central lymph node metastasis was evaluated by correlation analysis,and the influence of the number of lymph nodes on the quality of life of patients by postoperative complications analysis.Results The number of lymph nodes obtained was positively correlated with the number of lymph node metastases in the central region(r = 0.240,P<0.05)and the rate of lymph node metastasis(r = 0.161,P<0.05),respectively.The number of lymph node metastases controlled remained unchanged,and the rate of lymph node metastasis decreased with the increase of the number of obtained lymph nodes(r =-0.444,P<0.05).Univariate analysis of the number of lymph nodes between the two groups showed no significant differences in terms of sex,age,operation duration,BMI,maximum tumor diameter,multifocality,Hashimoto's thyroiditis,focal location,capsular invasion,contralateral thyroid nodule,parathyroid transplantation and BRAF gene V600E mutation(P>0.05).There was statistical significance in the application of nano carbon between the two groups(P<0.05).Logistic binary regression analysis showed that the combination of Hashimoto's thyroiditis and the application of carbon nanoparticles were independent influencing factors for the high number of lymph nodes obtained(P<0.05).ROC curve analysis suggested that the area under the curve occupied by carbon nanoscale was 0.658(95%CI:0.580～0.735,P<0.05),and the area under the curve occupied by Hashimoto's thyroiditis was 0.584(95%CI:0.504～0.665,P<0.05).In addition,there was no significant difference in the incidence of vocal cord paralysis and lymphatic leakage between the two groups(P>0.05).Conclusions When the number of lymph nodes in the cen-tral region remained unchanged,the higher the number of lymph nodes obtained,the lower the rate of lymph node metastasis.The application of nano-carbon and patients with Hashimoto's thyroiditis could increase the number of lymph nodes obtained,and there is no significant difference in the incidence of postoperative complications between high and low number of lymph nodes obtained.