Clinical teaching way in pediatrics has been investigated,and its current state understood to provide the direction of clinical teaching in pediatrics.

Objective To analyze our clinical results of head and neck reconstruction using microsur- gical free flap transfer techniques.Methods The free flap donor sites with long vascular pedicle and large diameter of vessel were routinely chosed,and chose receipt vessels with large diameter and proper position, and perform vessel ananstomosis under surgical loups instead of microscope.The un-buried free flap with a mo- nitoring window were harvest,and do double venous anastomoses in some flaps to ensure adequate venous out- flow.Results From May 1999 to March 2005,1066 consecutive free flap transfers were used to reconstruct head and neck defects.The overall success rate of free flap was 98.3%.The vessel thrombosis rate was 3.1%,and the flap salvage rate was 45.5%.Conclusion Head and neck reconstruetion using microsurgi- cal free flap transfer technique is safe and reliable,and good clinical results can be obtained.

Ear ; surgery ; Humans ; Parotid Neoplasms ; surgery ; Surgical Procedures, Operative ; methods

Objective To investigate the clinical feature,treatment,and prognosis of hospitalized patients with jaw osteoradionecrosis. Methods A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed.Of the 93 cases,79 cases were with mandible lesions,13 cases with maxillary lesions,and 1 case with both mandible and maxillary lesions.Sixty-six cases received one course of radiotherapy,with the radiation doses of 34 -90 Gy (mean 64.6 Gy).Twenty-two cases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis.The interval time between radiotherapy and the onset of osteoradioneerosis varied from 2 weeks to 32 years (mean 54 months).Results Of 93 cases,56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps,in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels,and flaps were survival by new vascular anastomosis in 3 cases,the failed flaps were removed and replaced successfully by non vascularized bone grafts in 2 cases,and the failed flaps removed and the defects were repaired with adjacent skin in other 2 cases.In the 56 cases,only one case was with disease recurrence and 53 cases with significant improvement in chewing and swallowing functions.Only 2 of 93 cases underwent resection of the pathologic bone and reconstruction with titanium plates,and thereafter they encountered titanium exposure.Scaling of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recurrence.Fifteen cases had resection of the effected mandible without reconstruction.Disease relapse was encountered in 2 of them,others had poor chewing and swallowing.Conclusions The mandible is more susceptible to osteoradionecrosis than maxilla.Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis,and scaling and reconstruction only with titanium plate should be avoided because of high risks of titanium exposure and disease relapse.

OBJECTIVETo describe a new method of accessory nerve defect reconstruction with sternocleidomastoid muscle-great auricular flap.

METHODSThirty-four cases receiving traditional radical neck dissection were divided into two groups: single neck dissection group (n = 19) and accessory nerve reconstruction group (n = 15). Surgical procedure of the reconstruction was described in detail. Postoperative shoulder functions were compared between the two groups.

RESULTSAccessory nerve reconstruction group experienced much better shoulder function recovery than that in single neck dissection group.

CONCLUSIONSReconstruction of accessory nerve defects with sternocleidomastoid muscle-great auricular nerve flap is simple, effective and complication-free.

Accessory Nerve ; surgery ; Accessory Nerve Injuries ; Adult ; Aged ; Carcinoma, Squamous Cell ; secondary ; surgery ; Ear ; innervation ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Neck ; Neck Dissection ; methods ; Neck Muscles ; surgery ; Nerve Transfer ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo analyze the rate of postoperative vessel thrombosis and its management after free tissue transfers in head and neck region.

METHODSEight hundred and forty-nine consecutive free flap transfers were performed from May 1999 to September 2004. Among them, the flaps with postoperative vessel thrombosis were selected and reviewed. Data concerning each case included time of vessel thrombosis, kind of thrombosis, time of emergent exploration, and salvage of free flaps.

RESULTSAmong the 849 free flaps, postoperative vessel thrombosis occurred in 28 free flaps, between 8 to 120 hours after operation. There were 5 arterial thrombosis, and 23 venous thrombosis. Thirteen flaps were salvaged after emergent exploration, and 15 flaps were lost. The rate of postoperative vessel thrombosis was 3.3% in this group, the salvage rate of flap was 46.4%, and the overall successful rate was 98.2%.

CONCLUSIONClinical monitoring after free flap transfer in head and neck region is very important and effective. In case of vessel thrombosis, emergent exploration is the only effective way to salvage the flap.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Free Tissue Flaps ; adverse effects ; Head ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Neck ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; Tissue Transplantation ; adverse effects ; Vascular Surgical Procedures ; Venous Thrombosis ; etiology ; Young Adult

OBJECTIVETo investigate the frequency of micrometastasis in levels lII - IV of clinical negative neck (cN0) in patients with squamous cell carcinoma (SCC) of oral tongue, and to discuss the management of cervical lymph node for cN0 tongue SCC.

METHODSA total of 471 cervical lymph nodes derived from 25 patients with cN0 tongue SCC, including 263 lymph nodes in level III and 208 lymph nodes in level IV, were included in this study. All lymph nodes were re-examined by anti-cytokeratin (CK) immunohistochemical staining combined with semi-serial section per 500 microm.

RESULTSAmong the 25 cases, seven patients were confirmed harboring metastasis in 11 lymph nodes of level III, and no positive lymph node in level IV was detected by routine hematoxylin-eosin (HE) staining. 11 positive lymph nodes in level IIl, which confirmed by HE staining, were also detected by immunohistochemical staining with CK combined with semiserial section. Among the 460 cervical lymph nodes in which HE staining did not show metastasis, only one lymph node in level III harboring a 2.0 mm x 1.5 mm micrometastasis was detected by immunohistochemical staining with CK, and no positive lymph node in level IV was detected by immunohistochemical staining with CK.

CONCLUSIONThe frequency of occult metastasis in level IV was very low, so it seemed unnecessary to dissect level IV for all patients with cN0 tongue SCC.

Adult ; Aged ; Carcinoma, Squamous Cell ; Female ; Humans ; Keratins ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Neoplasm Micrometastasis ; Tongue ; Tongue Neoplasms

OBJECTIVETo analyze the value and reliability of combined free flap and pedicled pectoralis major myocutaneous flap in the reconstruction of extensive composite head and neck defects.

METHODSNine consecutive cases of combined free flap and pedicled pectoralis major myocutaneous flap transfers for extensive head and neck defects from March 2002 to April 2005 were reviewed. Data concerning the operation included defect description, type of free flap, recipient vessel and complications.

RESULTSThere were 9 cases in this group, with 7 males and 2 females. Among the 9 free flaps, there were 6 radial forearm flaps, two fibula flaps, and one anterolateral thigh flap. The overall flap survival rate was 100% (all of 18 flaps), without partial or total flap necrosis. One radial forearm flap developed venous thrombosis 24 hours after operation, but salvaged by emergent exploration and reanastomosis of veins. The overall complication rate was 44.4%.

CONCLUSIONIn selected cases, the combined free flap and pedicled pectoralis major myocutaneous flap method provided satisfactory reconstruction for extensive head and neck defect, and simplified the double free flap method.

Female ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Myocutaneous Flap ; Neck ; Necrosis ; Reconstructive Surgical Procedures ; Reproducibility of Results ; Surgical Flaps

OBJECTIVETo evaluate speech outcomes in patients of maxillary reconstruction with free fibula composite flap.

METHODSSpeech measurements of 20 patients of maxillary reconstruction with free fibula composite flap were collected. Palatopharyngeal valve, the symmetry and movement of soft palate, hypernasality and nasal emission were examined by nasoendoscopy. At the same time the speech intelligibility was measured.

RESULTSNo palatopharyngeal valve insufficiency was found and all the soft palates had good symmetry and movement. The average speech intelligibility was 98.4%.

CONCLUSIONSFree fibula composite flap can reconstruct the phonatory structure and support the function of soft palate, which can restorate speech function well. It is a good choice for maxillary reconstruction.

Adult ; Female ; Fibula ; Humans ; Male ; Maxilla ; surgery ; Middle Aged ; Speech Intelligibility ; Surgical Flaps

OBJECTIVETo analyze the rationale and feasibility of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap.

METHODSNine consecutive cases of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flaps from August of 2002 to August of 2003 were reviewed. Data concerning the operation included description of maxillary defect, design of the fibula flaps, recipient vessel and complications.

RESULTSOne flap experienced venous thrombosis after operation, and the flap was salvaged after exploration. All the flaps survived completely with the overall success rate of 100%, as well as the 100% survival of all fibula-flexor hallucis longus myofascial flaps.

CONCLUSIONSMaxillary reconstruction using free fibula-flexor hallucis longus myofascial flap without skin paddle is feasible and reliable.

Adult ; Female ; Humans ; Male ; Maxilla ; surgery ; Middle Aged ; Surgical Flaps