OBJECTIVE To investigate the application of near-total laryngectomy on the treatment of advanced laryngeal and hypopharyngeal carcinoma. METHODS Thirty patients with laryngeal carcinoma(T3N0～T3N1 17cases,T4N0～T4N1 13cases) and nine with hypopharyngeal carcinoma(T3N0～T3N1 6cases,T4N0～T4N1 3cases) were treated with near-total laryngectomy from May 1995 to March 2003 according to Peaeson modifying method of Tangpingzhang. Concurrent neck dissection were performed in sixteen patients. RESULTS The speech function was obtained in 36 cases (92.3 %) and good swallowing function was obtained in 38 cases(97.4%). Three year survival rates were 73.3% (22/30) in laryngeal carcinoma and 55.6 %(5/9)in hypopharyngeal carcinoma and five year survival rate in laryngeal carcinoma was 61.1%(11/18) . Local recurrence rate was only 2.56 %. CONCLUSION Near-total laryngectomy and speech rehabilitation can be used in most cases that might be treated with total laryngectomy in the past. It can provide satisfying survival rate, good swallowing and speech function.

Objective To investigate the clinical effects of irrigation sequential Flow-through type anterolat eral thigh chimeric myocutaneous flap in the treatment of chronic tibial osteomyelitis.Methods From January,2012 to December,2017,trench grooved sequential Flow-through anterolateral femoral chimeric flaps were u sed to treat chronic tibial osteomyelitis.On the basis of sensitive antibiotics,bone grooving and VSD grooved sequential Flow-through anterolateral thigh chimeric flaps were used to fill the bone cavity and cover the wound.The patients received the follow-up care in outpatient office and telephone regularly after hospital discharge.Results Among the 18 cases in this group,2 cases were positive and 16 cases were negative in secondary bacteriological detection.The flaps and donor sites survived in one stage.Fifteen cases healed in one stage,and extravasate occurred in 3 cases after operation.After dressing change,the wounds healed in 25 days,32 days and 43 days after flap operation,respectively.All the patients were followed-up for 12 to 30 months,with an average of 25 months.Local low toxicity infection symptom occurred again in 1 case with delayed healing 6 months after operation.After 1 week of antibiotic treatment,the symptom subsided.After 1 more week of antibiotic use,the patient was discharged from hospital.And followed-up for 1 year,no recurrence occurred.During the follow-up period,no recurrence of infection and no fracture occurred after primary fracture healing in other 17 cases.One year after the second operation,there was no obvi ous stenosis in the bridged vessels examined by Doppler ultrasonography and the blood flow velocity was the same as that of the contralateral limbs.Conclusion The application of irrigation and sequential Flow-through type anterolateral thigh chimeric myocutaneous flap for treatment of chronic tibial osteomyelitis can achieve good therapeutic effect and is worth popularizing.

Objective:To investigate clinical effect of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions.Methods:From January, 2014 to June, 2018, 15 cases of tibial nonunions were treated with the descending genicular corticoperiosteal free flaps combined with bone graft after soft tissue coverage. All patients had Gustilo III C fracture. In 6 cases, the descending genicular artery of periosteal flap was anastomosed with the branch of anterior tibia artery, 6 cases anastomosed with the branch of posterior tibia artery, other 3 cases had Flow-through anastomosis with the main trunk of anterior tibia artery. The accompanying vein of descending geniculate artery was anastomosed with the vein of anterior tibia or posterior tibia artery. Routine treat- ment, step-by-step functional recovery exercises, monthly X-ray examination were conducted together with close ob- servation of the healing of fracture.Results:All cases were followed-up from 6 to 29 (average, 11) months. Bone u- nion was achieved in 14 cases with the averager time of healing in 5 months. According to the evaluation criteria of Paley fracture healing, 12 cases were excellent, 2 were good and 1 was poor. Fourteen cases were able to take daily normal activities, and 1 case failed to take the daily activities because the fracture was not healed. Six months later, according to the results of Paley functional evaluation, 2 cases were scored excellent, 12 scored good and 1 scored poor.Conclusion:The method of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions can effectively improve the fracture union rate and reduce the patient treatment time with hidden donor area and simplicity of operation. It is helpful for the patients to take early exercises for the recovery of functions.

Objective:To explore the clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery.Methods:A retrospective observational study was conducted. From January 2019 to June 2021, 12 patients with wounds after lower leg limb-sparing surgery who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital, including 6 males and 6 females, aged 17 to 74 years, with original wound area ranging from 17 cm×9 cm to 40 cm×15 cm. Five patients had infection in wounds. The wounds were all repaired by free anterolateral thigh perforator flap from contralateral thigh, with area of 18 cm×10 cm to 37 cm×9 cm. The artery of flap was anastomosed with the descending genicular artery, and the wounds in donor areas were sutured directly. Seven patients were transplanted with split-thickness skin grafts from the contralateral thigh to cover the remaining wounds that can not be covered by flap and the wounds in donor areas were covered with gauze. During the operation, the types of perforating branch carried by flap and the types of arteries and veins in recipient areas were recorded. The survival and occurrence of vascular crisis of flap, the survival of skin graft, the wound healing in donor and recipient areas, and the length of hospital stay after flap transplant surgery were recorded. During follow-up, the color and texture of flap, reinfection in lower leg, and fracture healing were recorded. At the last follow-up, the limb salvage function of patients was evaluated according to the functional evaluation criteria of Chen Zhongwei's amputated limb replantation.Results:The types of perforating branches carried by flaps were as follows: 6 cases of only carrying the descending branch of the lateral circumflex femoral artery, 3 cases of only carrying the oblique branch of the lateral circumflex femoral artery, and 3 cases of carrying the descending branch of the lateral circumflex femoral artery and oblique branch of the lateral circumflex femoral artery after internal pressurization anastomosis. The types of arteries in the recipient area of flap were as follows: one case of main trunk of the descending genicular artery, 8 cases of the saphenous branch of the descending genicular artery, and 3 cases of the articular branch of the descending genicular artery. The types of veins in the recipient area of flap were as follows: 8 cases of one accompanying vein of the descending genicular artery and one branch of the great saphenous vein, and 4 cases of two branches of the great saphenous vein. All the flaps survived without vascular crisis, and all the skin grafts also survived. The wounds in the donor and recipient areas were all healed. The length of hospital stay of patient after flap transplant surgery ranged from 13 to 79 days. During the follow-up of 6 to 23 months, the color and texture of flap were both good, with no infection in lower leg wound. Internal or external fixation were removed after fracture healing in 5 patients, and bone graft internal fixation was performed in 7 patients whose fractures were not healed after surgery and all the incisions healed without infection. At the last follow-up, the limb salvage effect of patients was evaluated as followings: excellent in 7 patients, good in 4 patients, and fair in one patient.Conclusions:Free anterolateral thigh flap pedicled with descending genicular artery can effectively repair the wounds after lower leg limb-sparing surgery and control infection with short length of hospital stay, while not increasing the risk of secondary injury of distal limb vessels. Thus, it can obtain satisfactory limb salvage effect which is worthy of clinical promotion.

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.