Aim To investigate the effect of chronic intermittent hypobaric hypoxia ( CIHH) on the paeonol induced vasomotion of isolated rat ’ s thoracic aorta rings and its underlying mechanisms. Methods Spra-gue-Dawlay ( SD ) rats were randomly divided into 2 groups: control group ( CON ) and CIHH treatment group ( CIHH) . CIHH rats were exposed to hypoxia in a hypobaric chamber simulating 5 000 m altitude, 6 hours daily for 28 days. CON rats lived in the same en-vironment as CIHH animals except hypoxia. Organ bath technique was used to observe the effect of pae-onol on isolated thoracic aorta rings of rats. Results There were no significant differences of noradrenaline ( NE )- and KCl-induced contraction in thoracic aorta rings among CIHH and CON rats;CIHH enhanced va-sodilative effects of paeonol on isolated thoracic aorta rings of rats; the vasodilative effects on CIHH rats could be partly decreased by β-receptor blocker prop-ranolol,ATP-sensitive potassium channel ( KATP ) bloc-ker glibenclamide and NO synthase inhibitor L-NAME. Paeonol significantly inhibited NE-induced intracellular and extracellular calcium-dependent contraction in CIHH rats. Paeonol didn ’ t inhibit NE-induced con-traction by intracellular calcium release and its inhibi-tory effect couldn ’ t be blocked by glibenclamide in CON. Vasodilative effects of paeonol couldn ’ t be re-versed by indomethacin, a cyclooxygenase inhibitor, in CIHH and CON rats. Conclusion CIHH significantly enhances vasodilative effects of paeonol on isolated tho-racic aorta rings of rats. Besides promoting the signa-ling pathway of paeonol in CON, CIHH significantly enhances vasodilative effects of paeonol via activating KATP and inhibiting Ca2+ release from sarcoplasmic re-ticulum.

Objective:To investigate the clinical features of direct and indirect carotid cavernous fistulas (CCFs).Methods:Patients with CCF treated in the Affiliated Hospital of Xuzhou Medical University from January 2010 to August 2020 were enrolled retrospectively. Relevant clinical data were collected, including the main clinical manifestations, neuroimaging features, and treatment methods. The clinical features of direct and indirect CCFs were compared.Results:A total of 31 patients were enrolled in the study, 29 (93.5%) had ocular symptoms, of which conjunctival hyperemia and edema ( n=24, 77.4%), exophthalmos ( n=19, 61.3%) and orbital murmur ( n=18, 58.1%) were most common. There were 23 patients (74.2%) in direct CCF group and 8 (25.8%) in indirect CCF group. The former had more history of head trauma (78.2% vs. 12.5%; P=0.002), more flow volume (high-flow CCFs: 100% vs. 37.5%; P<0.001) and more likely to cause orbital murmur (69.6% vs. 25.0%; P=0.043). Endovascular embolization was safe and effective. The common methods of endovascular embolization were EVAL glue combined with coil embolization ( n=18, 66.7%) and detachable balloon embolization alone ( n=6, 22.2%). Conclusion:Ocular manifestations are most prominent in patients with CCFs. Direct CCF is more common, usually with a history of head trauma, and the clinical and imaging features are more typical. Interventional embolization is the preferred treatment option for patients with CCF.

Objective To observe the outcome of free TAAP flap in the reconstruction of defect after oral tumor radical resection.Methods From June,2010 to April,2015,12 patients with oral tumor underwent radical resection,including 4 cases of gingival carcinoma,3 cases of tongue carcinoma and 5 case of buccal cancer.The cause ranged from 2 to 12 months.The radical resection left defects with size ranged from 4.5 cm×3.5 cm to 6.0 cm× 4.5 cm which were reconstructed by free TAAP flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm.The length of TAAP flap was (6.5±0.6) cm.The width of flap was (4.3±0.5) cm.And the thickness of flap was (1.1±0.3)cm.The length of pedicle was(8.4±0.2) cm.All the arteries of TAAP were anastomosed with superior thyroid arteries,while the venae comitans were anastomosed with superior thyroid venae or internal jugular venae.Results The perforators existed consistently.All 12 flaps survived uneventfully.The donor sites were closed directly in all cases.All patients were followed up for 14-38 months with satisfied esthetic and functional results in reconstructed tongue.No local recurrence happened.The shoulder function was not affected.Conclusion The TAAP flap has consistent blood supply,good color match and texture,while leaving minimal morbidity at donor site,is an ideal choice for buccal tumor reconstruction.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective: To investigate the application of free medial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. Methods: From June 2013 to November 2015, 17 cases with tongue carcinoma underwent radical resection and tongue and mouth floor defects after surgery were reconstructed with medial thigh chimeric myocutaneous perforator flaps at the same stage. These 17 cases included tongue carcinoma on lingual margin (n=9), ventral tongue (n=7) and mouth floor (n=1). Appearance and functional results were evaluated with follow-up. Results: Medial thigh chimeric myocutaneous perforator flap was (9.0±0.3) cm in length, (4.5±0.3) cm in width , and (1.8±0.4) cm in thickness. The length of pedicle was (7.4±0.6) cm. All of the 17 flaps survived uneventfully, and the donor sites were closed directly in all cases. All patients were followed up for 10-28 months with satisfied esthetic and functional results in reconstructed tongue. Aside from linear scar in the donor sites, the functions of thighs were not affected. No local recurrence occurred. Conclusion The free medial thigh chimeric myocutaneous perforator flap is an ideal choice to reconstruct the tongue and mouth floor defect after radical resection of tongue carcinoma.

Objective:To investigate the salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap.Methods:The anatomical study was conducted from September 2015 to December 2019. Four fresh adult female cadavers were dissected to measure the number, length, diameter and origin of the anterior serratus branch of the thoracodorsal artery. The clinical data of patients who underwent modified radical mastectomy and immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap from March 2015 to March 2019 were analyzed retrospectively. It was found that the thoracodorsal artery was damaged during the flap dissection and harvestion. The latissimus dorsi myocutaneous flap was harvested pedicled with the anterior serratus branch of the thoracodorsal artery as the pedicle to reconstruct the breast instead. Postoperative flap survival, breast appearance and texture, cancer recurrence and donor site were followed up.Results:A total of 11 branches of anterior serratus muscle were found in 4 specimens (8 sides), with a length of (6.3 ± 1.8) cm and a diameter of (2.4 ± 0.4) mm, including 7 from the trunk of dorsal thoracic artery, 3 from the vertical branch of dorsal thoracic artery and 1 from the horizontal branch of dorsal thoracic artery. A total of 6 female breast cancer patients aged 29-61 years, mean 42.7 years, were included in the clinical cases. The course of disease ranged from 2 to 36 months [(10.7 ± 5.4) months]. The area of secondary breast defect after modified mastectomy was 14 cm×6 cm to 16 cm×7 cm, the area of latissimus dorsi flap was 13 cm×6 cm to 17 cm×6 cm. All flaps survived thoroughly, the appearance of reconstructed breast was good. The follow-up ranged from 9 to 28 months, with an average of 13.7 months. The breast appearance and texture of all patients were satisfactory, there was no local recurrence, only linear scar was left in the donor area, and the shoulder joint activity was not affected.Conclusions:The anatomy of the anterior serratus branch of the thoracodorsal artery is constant, and the anatomical basis of communicating with the thoracodorsal artery can supply blood to the latissimus dorsi muscle. The pedicled latissimus dorsi myocutaneous flap with anterior serratus branch of thoracodorsal artery can effectively ensure the flap blood supply safety, and can be used as a salvage method for breast reconstruction in the case of thoracodorsal artery trunk injury.

Objective:To investigate the salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap.Methods:The anatomical study was conducted from September 2015 to December 2019. Four fresh adult female cadavers were dissected to measure the number, length, diameter and origin of the anterior serratus branch of the thoracodorsal artery. The clinical data of patients who underwent modified radical mastectomy and immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap from March 2015 to March 2019 were analyzed retrospectively. It was found that the thoracodorsal artery was damaged during the flap dissection and harvestion. The latissimus dorsi myocutaneous flap was harvested pedicled with the anterior serratus branch of the thoracodorsal artery as the pedicle to reconstruct the breast instead. Postoperative flap survival, breast appearance and texture, cancer recurrence and donor site were followed up.Results:A total of 11 branches of anterior serratus muscle were found in 4 specimens (8 sides), with a length of (6.3 ± 1.8) cm and a diameter of (2.4 ± 0.4) mm, including 7 from the trunk of dorsal thoracic artery, 3 from the vertical branch of dorsal thoracic artery and 1 from the horizontal branch of dorsal thoracic artery. A total of 6 female breast cancer patients aged 29-61 years, mean 42.7 years, were included in the clinical cases. The course of disease ranged from 2 to 36 months [(10.7 ± 5.4) months]. The area of secondary breast defect after modified mastectomy was 14 cm×6 cm to 16 cm×7 cm, the area of latissimus dorsi flap was 13 cm×6 cm to 17 cm×6 cm. All flaps survived thoroughly, the appearance of reconstructed breast was good. The follow-up ranged from 9 to 28 months, with an average of 13.7 months. The breast appearance and texture of all patients were satisfactory, there was no local recurrence, only linear scar was left in the donor area, and the shoulder joint activity was not affected.Conclusions:The anatomy of the anterior serratus branch of the thoracodorsal artery is constant, and the anatomical basis of communicating with the thoracodorsal artery can supply blood to the latissimus dorsi muscle. The pedicled latissimus dorsi myocutaneous flap with anterior serratus branch of thoracodorsal artery can effectively ensure the flap blood supply safety, and can be used as a salvage method for breast reconstruction in the case of thoracodorsal artery trunk injury.

Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two-point discrimination distances of the sites repaired with relaying ALT perforator flaps were ranged from 7 to 12 mm. The function of thigh was not obviously affected, and patients could walk normally and do related daily activities. Conclusions Reconstruction of defect after oral tumor radical resection with free AMT perforator flap can achieve good outcome, and wound in the donor site of free AMT perforator flap repaired with relaying ALT perforator flap can achieve good appearance and function recovery.

Objective: To investigate the effect of modified distally based propeller sural perforator flap for defect at foot and ankle and lateral gastrocnemius artery perforator flap for defect at donor site. Methods: From January 2014 to January 2016, 12 cases with defects at foot and ankle were reconstructed by modified distally based propeller sural perforator flaps. The result ed defects at donor sites were reconstructed by lateral gastrocnemius artery perforator flaps.The flaps size ranged from 5.5 cm×3.5 cm to 13.0 cm×7.0 cm for modified distally based propeller sural perforator flaps, and 7.0 cm×4.0 cm to 10.0 cm×6.0 cm for lateral gastrocnemius artery perforator flaps. The 12 cases included 10 males and 2 females, aged from 14 to 48 years (25.7 years on average). Results: The lateral gastrocnemius artery perforators existed consistently in all cases. All flaps survived completely with no vascular crisis, wound dishesecense or obvious swelling. Primary healing was achieved in both recipient and donor sites. 12 cases were followed up for 6-14 months (12.4 months on average) with satisfactory esthetic and functional result in both recipient and donor sites, only linear scar was left on the donor sites. Conclusions The lateral gastrocnemius artery perforator flap is suitable for defect left by modified distally based propeller sural perforator flap. Combination of the two flaps is an optional choice for defects at foot and ankle.

Objective:To investigate the anatomical classification of the femoral artery perforator flap and its application in the reconstruction of oral tumors.Methods:Retrospective analysis was made on the clinical data of oral cancer patients who were admitted to Hunan Cancer Hospital from December 2016 to December 2020. After radical resection surgery, free femoral artery perforator flap was used to repair soft tissue defects. According to the location of the perforator vessel pedicle, the flaps were divided into three categories. (1) Anteromedial proximal thigh perforator flap, the perforator vessels originate from the rectus femoris, medial femoris and sartorius muscles. (2) Medial thigh perforator flap, the perforator vessels from the anterior edge of the adductor longus. (3) The anteromedial distal thigh perforator flap, the perforator vessels from the medial femoral muscle. The specific harvesting methods include: (1) simple femoral artery perforator flap; (2) medial thigh myocutaneous flap combined with femoral artery perforator flap; (3) chimeric femoral artery perforator adductor longus myocutaneous flap. The donor site was closed after delamination and tension reduction. The survival and appearance of the flap, the swallowing and oral function of the patient, and the appearance and function of the donor site were followed up after the operation.Results:A total of 32 cases of the patients with oral tumors were included, consisting of 28 males and 4 females, aged from 37 to 54 years; 17 cases of tongue cancer, 10 cases of gingival cancer, 5 cases of buccal cancer; and the duration of disease was 2-13 months. After radical tumor resection, 5.5 cm× 3.5 cm-12.0 cm × 7.0 cm soft tissue defects were left. The perforator of femoral artery was found in all 32 cases during operation. Among them, the proximal perforator of anteromedial femoral artery was used in 12 cases. The flap was (11.3 ± 0.5) cm long, (5.1 ± 0.6) cm wide and (3.4 ± 0.3) cm thick. The medial femoral perforator was used in 6 cases. The flap was (10.8 ± 0.4) cm long, (5.0 ± 0.5) cm wide and (3.6 ± 0.4) cm thick. The anteromedial distal perforator was used in 14 cases. The flap was (11.5 ± 0.3) cm long, (4.6 ± 0.4) cm wide and (3.1 ± 0.2) cm thick. The form of flap: sixteen cases were simple femoral artery perforator flap, fourteen cases were femoral artery perforator flap with medial thigh muscle flap, and two cases were femoral artery perforator flap with adductor longus muscle flap. All 32 flaps survived after operation. The appearance and texture of the flap were good, without obviously bulky tissue, and the swallowing and speech functions recovered well. Only linear scars were left in the thigh donor area, and the thigh function was not significantly affected. There were 4 cases with local recurrence of tumor, and the tumor was repaired with pedicled pectoralis major myocutaneous flap after radical resection. One case recovered well, and 3 cases died of tumor metastasis. Three patients had cervical lymph node metastasis and recovered well after cervical lymph node dissection.Conclusions:The vascular anatomy of the femoral artery perforator vessel is constant. According to its location, different types of perforator flaps can be harvested from the proximal, distal or medial femoral anteromedial area. The femoral artery perforator flap is soft, and the anatomy of the perforator vessel is constant. The specific location and harvesting form of the donor site are flexible, and the donor site is less damaged. It is a good method for the repair and reconstruction of soft tissue defects after the removal of oral tumors.