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 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.