Objective: To analyze the value and reliability of combined free fibula flap and radial forearm flap in the reconstruction of extensive composite oro-mandibular defects. Methods: Extensive composite oro-mandibular defects were reconstructed in 23 consecutive cases (averagely aged 52.9 years old) with combined free fibula flap and radial forearm flap from March 2000 to January 2002. Data concerning the operation, defect description and site, recipient vessel and complications were reviewed. Results: The overall flap survival rate was 100% (all of 46 flaps) without partial or total flap necrosis. The overall complication rate was 30.4%. The vessel thrombosis rate was 2.2%, and the flap salvage rate was 100%. Conclusion: In selected cases, combined free fibula flap and radial forearm flap method may provide satisfactory reconstruction for extensive oro-mandibular defect, and greatly improve the quality of life of patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Vessels ; injuries ; Child ; Child, Preschool ; Female ; Free Tissue Flaps ; blood supply ; Head ; surgery ; Humans ; Male ; Middle Aged ; Neck ; surgery ; Tissue Transplantation ; adverse effects ; methods ; Young Adult

OBJECTIVEThe paper reviewed the effectiveness and reliability of skin paddles of free fibula flaps in the reconstruction of maxillofacial defects.

METHODSFifty-five consecutive free fibula osteocutaneous flap transfers performed from June 21, 1999 to October 31, 2000 were reviewed. The skin paddles of each flap were analyzed in terms of surgical design, blood supply, size, reconstruction location, and survival.

RESULTSFifty-seven skin paddles were used for the 55 free fibula flaps (double skin paddles for 2 flaps), 37 were nurtured by one perforator, 18 by two and two by 3 perforators. Twenty-eight skin paddles were used for intraoral reconstruction, 7 for extraoral reconstruction, 1 for both intraoral and extraoral reconstruction, 2 for soft tissue augmentation, and the remaining 19 were simply used as window for monitoring the blood flow of fibula flap. One free fibula flap with one skin paddle was lost because of venous thrombosis, and the other 54 flaps survived completely, with 100% survival of 56 skin paddles.

CONCLUSIONThe skin paddle of free fibula flap is safe and reliable. It can be used for all kinds of soft tissue reconstruction, as well as window for monitoring the blood flow of fibula flap after operation.

Adolescent ; Adult ; Aged ; Child ; Female ; Fibula ; Humans ; Male ; Mandible ; surgery ; Mandibular Neoplasms ; pathology ; surgery ; Microsurgery ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Oral Surgical Procedures ; methods ; Postoperative Complications ; surgery ; Reconstructive Surgical Procedures ; methods ; Reoperation ; Skin Transplantation ; Surgical Flaps ; blood supply ; Tissue and Organ Harvesting ; methods

Objective:To investigate the defect types and reconstruction methods of maxillary defects. Methods:The database of 1 107 cases with maxillary defects in Peking University School and Hospital of Stomatology from January 1985 to December 2010 was established. There construction methods were re-viewed. The defect types were classified according to Brown classification system. Results: In the 1 107 cases, 1 104 cases could be classified according to Brown classification system. The most common type was 2a with 559 cases (50. 6%). Among all the 1 107 cases, 349 cases were reconstructed with auto-transplantation, 443 cases with prosthesis, 107 cases untreated, and 208 patients lost to the follow-up. There was a significant growing trend over time for the application of free flaps and a downward trend of prosthesis. The most popular free flaps were fibular flap (88 cases) and radial forearm flap (75 cases) . Rectus abdominis flap and anterolatreal thigh flap were fit for extensive maxillary defects. Conclusion:The most common defect type is 2a. Free flap has become the dominant option for maxillary reconstruc-tion. Free flaps could be selected according to the maxillary defect types.

BACKGROUND:Prefabricated customized bone flaps have the advantages of few trauma, good vascularization, ossification with predetermined shape, and can be used to restore bone defects with compromised blood bed.
OBJECTIVE:To establish animal models of mandibular reconstruction with prefabricated, customized bone flaps.
METHODS:After computed tomography scanning of nine rhesus’ head, customized meshes were made. After loading with recombinant human bone morphogenetic protein-2-incorporated demineralized freeze-dried bone al ograft (DFDBA) or coral ine hydroxyapatite (CHA), the constructs were implanted in latissimus dorsi muscle. Meanwhile, segmental mandibular defects were created, and the customized meshes loaded with DFDBA, CHA, or recombinant human bone morphogenetic protein-2-incooperated DFDBA and CHA were implanted in situ. At 13 weeks, prefabricated bone flaps with recombinant human bone morphogenetic protein-2-incorporated DFDBA or CHA were transferred to repair segmental mandibular defects. Clinical and histological analyses were used to evaluate the ossification and vascularization of the prefabricated implants in ectopic and orthotopic sites.
RESULTS AND CONCLUSION:Segmental mandibular defects were successful y restored with prefabricated bone flaps and recombinant human bone morphogenetic protein-2-incorporated CHA in situ, but other segmental mandibular defects remained with recombinant human bone morphogenetic protein-2-incorporated DFDBA, DFDBA and CHA in situ. Moreover, mandibles reconstructed with prefabricated bone flaps revealed more regenerated and homogeneous bone formation than other reconstructions. These findings suggest that the animal model of mandibular reconstruction with prefabricated, customized bone in rhesus monkey is applicable.

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.

Objective To study the change of miR-146a in the development and progression of papillary thyroid carcinoma(PTC).Methods Real-time fluorescence quantitative polymerase chain reaction was used to detect the change of miR-146a in tumor tissues of 43 cases of PTC and 36 cases of nodular goiter,also in peripheral blood of 32 cases of PTC and 23 cases of nodular goiter.The correlation of miR-146a change and the clinicopathological parameters of patients with PTC was analyzed.Results ① The relative content of miR-146a in the 43 patients with PTC and 36 patients with nodular goiter was 0.0280 ± 0.0131 and 0.0212 ± 0.0111 respectively.The difference had statistical significance (P ＜ 0.05).miR-146a in PTC tissues was significantly correlated to clinicopathological parameters such as lymph node metastasis,tumor stage (P ＜ 0.05),and it was unrelated to age or tumor size(P ＞0.05).② The relative content of miR-146a in peripheral blood of 32 patients with PTC and 23 patients with nodular goiter was 0.0891 ±0.0419 and 0.0922 ±0.0456 respectively.The difference had no statistical significance(P ＞ 0.05).There was no significant correlation between miR-146a in peripheral blood of patients with PTC and age,tumor stage,lymph node metastasis,or tumor size of patients (P ＞ 0.05).Conclusions MiR-146a expression is upregulated in patients with PTC,and there is a significant correlation between miR-146a content and clinicopathological parameters such as lymph node metastasis,tumor stage,especially in advanced stage.It suggests that miR-146a may play a role in carcinogenesis and development of PTC.

Objective To explore the correlation between left atrial diameter(LAD)and renal function in patients with atrial fibrillation.Methods A total of 364 patients with atrial fibrillation were selected as study subjects.Clinical data of the patients were collected,including gender,age,height,body weight,smoking history,drinking history,atrial fibrillation type,history of hyperten-sion,coronary heart disease,diabetes,heart failure,medication history,high-sensitivity troponin I,brain natriuretic peptide,C-reactive protein,creatinine,urea nitrogen,LAD,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thick-ness(LVPWTd),and interventricular septal thickness(IVSTd).Estimated glomerular filtration rate(eGFR)and body mass index were calculated.Spearman correlation analysis was used to explore the correlations of LAD with creatinine,urea nitrogen,and eGFR.With eGFR＜60 mL/(min·1.73 m2)setting as renal insufficiency,univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation.Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation.Results Spearman correlation analysis showed that LAD was positively correlated with creatinine(r=0.279,P＜0.001)and urea nitrogen(r=0.190,P＜0.001)in patients with atrial fibrillation,and negatively correlated with eGFR(r=-0.263,P＜0.001).Univariate Logistic regression analysis showed that gender,history of diabetes,hypertension,coronary heart disease,heart failure,atrial fibrillation type,sodium-glucose cotransporter 2 inhibitor medication history,diuretic medication history,LAD,LVEF,LVDd,and IVSTd were all influencing factors of renal insufficiency in pa-tients with atrial fibrillation(P＜0.05).Binary Logistic regression analysis showed that compared with the first quartile of LAD(LAD ≤38 mm),the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD(LAD＞47 mm)increased by 5.199 times(OR=5.199;95％CI,1.210 to 22.337;P=0.027).Conclusion LAD of patients with atrial fibrillation is sig-nificantly related to renal function,and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.

Objective To explore the correlation between left atrial diameter(LAD)and renal function in patients with atrial fibrillation.Methods A total of 364 patients with atrial fibrillation were selected as study subjects.Clinical data of the patients were collected,including gender,age,height,body weight,smoking history,drinking history,atrial fibrillation type,history of hyperten-sion,coronary heart disease,diabetes,heart failure,medication history,high-sensitivity troponin I,brain natriuretic peptide,C-reactive protein,creatinine,urea nitrogen,LAD,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thick-ness(LVPWTd),and interventricular septal thickness(IVSTd).Estimated glomerular filtration rate(eGFR)and body mass index were calculated.Spearman correlation analysis was used to explore the correlations of LAD with creatinine,urea nitrogen,and eGFR.With eGFR＜60 mL/(min·1.73 m2)setting as renal insufficiency,univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation.Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation.Results Spearman correlation analysis showed that LAD was positively correlated with creatinine(r=0.279,P＜0.001)and urea nitrogen(r=0.190,P＜0.001)in patients with atrial fibrillation,and negatively correlated with eGFR(r=-0.263,P＜0.001).Univariate Logistic regression analysis showed that gender,history of diabetes,hypertension,coronary heart disease,heart failure,atrial fibrillation type,sodium-glucose cotransporter 2 inhibitor medication history,diuretic medication history,LAD,LVEF,LVDd,and IVSTd were all influencing factors of renal insufficiency in pa-tients with atrial fibrillation(P＜0.05).Binary Logistic regression analysis showed that compared with the first quartile of LAD(LAD ≤38 mm),the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD(LAD＞47 mm)increased by 5.199 times(OR=5.199;95％CI,1.210 to 22.337;P=0.027).Conclusion LAD of patients with atrial fibrillation is sig-nificantly related to renal function,and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.

BACKGROUNDIt is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.

METHODSFrom January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively.

RESULTSDiabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention.

CONCLUSIONSCoronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

Aged ; Coronary Artery Bypass ; adverse effects ; methods ; Coronary Artery Disease ; surgery ; Endarterectomy ; methods ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; surgery ; Postoperative Complications ; Treatment Outcome