Objective:To evaluate Masquelet technique plus flap transfer in repair of tibial infected defects complicated with extensive soft tissue defects in the lower leg.Methods:A retrospective analysis was performed in the 23 patients who had been treated by Masquelet technique plus flap transfer at Institute of Orthopedics and Trauma, 920 Hospital for tibial infected defects complicated with extensive soft tissue defects in the lower leg from March 2016 to June 2019. They were 15 males and 8 females, aged from 18 to 59 years (average, 38.4 years). The duration of disease ranged from 6 to 312 months (average, 23.6 months). All patients underwent surgery by 2 stages:1) debridement, locking compression plate fixation, formation of induced membrane by antibiotic-loaded bone cement, and repair of soft tissue defects with lower leg flaps; 2) removal of bone cement and fixation 6 to 8 weeks after infection control, fixation of broken ends after rinse, followed by grafting of cancellous bone particles in the induced membrane. The area of wound soft tissue defects after debridement ranged from 4.0 cm × 3.5 cm to 18.0 cm × 6.0 cm, and the length of bone defects from 6 to 12 cm (average, 8.4 cm). Locally grafted were pedicled fasciocutaneous flap in 4 cases, sural nerve nutrition skin flap in 9 cases (including 4 anterograde and 5 retrograde ones), saphenous nerve nutrition vascular flap in 7 cases (including 2 anterograde and 5 retrograde ones), retrograde superficial peroneal nerve nutrient vessel flap in one and free flap in 2 cases. The curative efficacy was evaluated according to the Paley fracture healing scores.Results:All the 23 patients were followed up for 9 to 46 months (average, 15.6 months). Flaps healed by the first stage in 18 cases and after skin grafting in 3 cases; skin flap transfer was conducted again in 2 cases. Infection was controlled in 21 cases but recurred in 2 cases at 9 and 14 months respectively after secondary surgery. The time for bone reunion ranged from 4 to 11 months (average, 6.2 months). According to the Paley criteria for fracture healing, 21 cases were excellent, one was good and one poor.Conclusion:In the treatment of tibial infected defects complicated with extensive soft tissue defects, Masquelet technique plus transfer of a variety of lower leg flaps can result in reliable outcomes because it controls infection, promotes formation of complete induced membrane and accelerates the process of bone reconstruction along with repair of soft tissue defects.

Objective To report our experience in reconstruction with free jejunal flap for circumferential defect following resection of hypopharygeal and cervical esophageal carcinoma.Methods A retrospective analysis was conducted to evaluate the outcomes of reconstruction with free jejunal flaps for circumferential defects in 103 patients treated from Aug 2008 to Mar 2015.Among them,84 were hypopharyngeal carcinoma and 19 were cervical esophageal carcinoma;31 patients had total pharyngolaryngectomy,70 had total pharyngolaryngectomy and cervical esophagectomy and 2 had laryngeal preservation.All patients underwent bilateral neck dissection and 84 underwent retropharyngeal lymph node dissection.Results The 3 year overall survival rate was 51.6％ and disease-specific survival rate was 50％ The 5 year overall survival rate was 39.1％.No in-hospital death,one patient had unsalvageable flap failure and underwent second reconstruction with free jejunal flap.The success rate for the free jejunal flaps was 99％ (102/103).Pharyngocutanous fistula occurred in 3 patients and all healed with conservative treatment.Satisfactory oral intake was achieved in all patients.Conclusions Oncological and functional outcomes of reconstruction with free jejunal flap for circumferential defects of hypopharynx and cervical esophagus were satisfying.Multidisciplinary cooperation is helpful to improve surgical success rate.Free jejunal flap is an ideal method for reconstruction of circumferential hypopharyngeal and cervical esophageal defects after removal of tumor.

Objective To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma.Methods A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished.In the 149 patients,the site of origin were pyriform sinus (n =121),posterior pharyngeal wall (n =21) and postcricoid (n =7).According to UICC 2002 criteria,there were 3 in stage Ⅰ,15 in stage Ⅱ,29 in stage Ⅲ and 102 in stage Ⅳ.Surgical methods for primary tumor were:pyriform sinus resection or posterior pharyngeal wall resection in 22 cases,partial pharyngectomy and partial laryngectomy in 29 cases,partial pharyngectomy and total laryngectomy in 67 cases,total pharyngectomy and total laryngectomy in 16 cases,total pharyngolaryngectomy and partial esophagus resection in 12 cases,and total esophagus resection in 3 cases.All the patients received elective and/or radical neck dissection.Unilateral or bilateral thyroid lobectomy was performed in 98 cases.Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University.Individualized adjustment of the radiation field was made according to the surgical condition.Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy).Laryngeal function was restored in 51 patients (34.2％).The risk clinicopathological factors of survival and the causes of death were analyzed.Results The survival rate was calculated with Kaplan-Meier method.The overall 3-and 5-year survival rates were 47.7％ and 38.7％,respectively.There were no significant differences in 3-year survival between T1-2 and T3-4 groups,N0 and N + groups,stage Ⅰ-Ⅱ and Ⅲ-Ⅳ groups,laryngeal function preserved and unpreserved groups.The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (x2 =6.851,P ＜ 0.05).The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend,although still no statistical significance (x2 =0.176,P ＞ 0.05).The cause of death in 86 patients,including regional lymph nodes recurrence in 25 cases (29.1％).Of them,one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1％) ; local recurrence in 13 cases,local or regional recurrence with distant metastasis in 8 cases (9.3％),and second primary cancer in 6 cases (7.0％).Conclusions The overall prognosis of hypopharyngeal carcinoma was poor and dismal.In accordance with specific conditions of surgery,active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.

Objective To investigate the necessity and feasibility of planned dissection of the retropharyngeal lymph nodes (RPLN) in advanced hypopharyngeal cancer.Methods Between February 2011 and December 2012,54 patients with advanced hypopharyngeal cancer accepted planned dissection of the RPLN during primary surgery.There were 45 cases of pyriform sinus carcinoma,5 cases of posterior pharyngeal wall carcinoma,and 4 cases of postcricoid carcinoma.All patients underwent surgery and postoperative adjuvant radiotherapy,meanwhile bilateral neck dissection and RPLN dissection were performed.All patients received preoperative CT scanning (with contrast).The results of the radiographic assessment were compared with the postoperative pathologic findings respectively.Results RPLN were confirmed positive by pathology in 13 cases,and negative in another 43 cases.For the entire treatment group,metastasis to the RPLN was confirmed hispathologically in 12 patients (22.2％).Eight patients were pyriform sinus carcinoma,4 were posterior pharyngeal wall carcinoma.Among them,seven patients were diagnosed as RPLN metastasis by CT imaging and another 5 patients were not confirmed.The overall accuracy for the radiologist's interpretation was 79.6％,the sensitivity was 58.3％,and the specificity was found to be 85.7％.Eleven patients were N2-3 and 6 patients were N2c.No RPLN metastasis or recurrence was found during more than one year follow-up period.Conclusions It is not rare for the RPLN metastasis in patients with advanced hypopharyngeal carcinoma.CT imaging is not effective in determining the early presence of RPLN metastasis.The planned dissection of the RPLN is highly recommended during the initial surgery of hypopharyngeal cancer,especially in posterior pharyngeal wall carcinoma,T3-4 pyriform sinus carcinoma and staged N2-3 cases.

Objective To evaluate the effect of peer education on postoperative rehabilitation of patients with laryngeal cancer.Methods From January 2010 to December 2012,240 cases of primary laryngeal cancer were treated with partial or total laryngectomy as well as tracheotomy in the Department of Head and Neck Surgery in Shandong Provincial Hospital.The patients were randomly divided into experimental group or control group by Stochastic tables law,120 patients in control group accepted only conventional nursing,120 patients in experimental group accepted both conventional nursing and peer education.The difference in the treatment nursing cooperation attitude,postoperative recovery,postoperative symptoms and the incidence of complications between two groups were evaluated by postoperative quality of life (UW-QOL),Eysenck personality questionnaire (EPQ) and coping style questionnaire (CSQ) score.The independent sample T-test and x2 test were used for statistical analysis.Results The patients of experimental group showed more positive attitude to treatment and care compared to the patients of control group (x2 =10.7,P ＜0.01).Experimental group had less time in postoperative wound healing time,gastric tube indwelling time and postoperative hospital stay than control group,with statistically significant differences (t =6.89,t =6.36,t =6.42,respectively,P ＜ 0.01) ; Incidence of postoperative discomfort symptoms in experimental group was less than that in control group (P ＜ 0.05).Total score for quality of life (UW-QOL) in experimental group was higher than that in control group (t =2.40,P ＜ 0.05).The P and N scores of EPQ in experimental group were lower than those in control group (t =2.28,t =2.60,P ＜ 0.05),while the E score of EPQ in experimental group was significantly higher than that in control group (t =4.50,P ＜ 0.01),with no significant difference in the L score of EPQ between two groups (P ＞ 0.05).scores of factor to solve problem and help factor of CSQ in experimental group were higher than those in control group (t =7.05,t =7.73,P ＜ 0.01),and the era factor score of experimental group was lower than that of control group(t =2.05,P ＜ 0.05).Conclusions Peer education can help the patients with laryngectomy to maintain good psychological and mental status,to cooperate actively with treatment,to reduce symptoms and complications,and to shorten the length of hospital stay,improving their postoperative rehabilitation and quality of life.

Objective To study the feasibility and therapeutic effect of recurrent laryngeal nerve (RLN) decompression in the treatment of bilateral paralyzed RLN after thyroid surgery.Methods From March 2005 to June 2013,15 cases of bilateral RLN paralyses occurring within 3 months after thyroid surgery were treated with RLN decompression.Bilateral RLN paralyses were caused by revised thyroid surgery in 8 cases and by primary thyroid surgery in 7 cases.Results RLN injuries were found in 15 cases/ 22 side,including RLN-cut in 9 sides and RLN-ligated in 13 sides.RLN decompression was performed in the 10 cases/13 sides of ligated RLN.Vocal cord mobility was detected through electrolaryngoscope for evaluating the postoperative functional recovery of decompressed RLN.Of 8 patients with bilateral RLN paralyses due to the ligation of RLN after previous revised thyroid surgeries,functional adduction and abduction of the vocal cord was recovered completely in 4 patients and recovered basically with a slight weak abduction in one patient after RLN decompression,and the 5 patients were decannulated in 1-4 months postoperatively.For 7 patients with bilateral RLN paralyses resulted from previous primary surgeries,unilateral or bilateral RLN decompress was performed in 2 cases and in 3 cases respectively.The mobility of the paralyzed vocal cord restored in 1-6 months after RLN decompression,besides one case with relative deficient abduction and one case with slight limited abduction and adduction,and the 5 patients were decannulated successfully.Conclusion Exploration surgery could be performed as soon as possible in patients with bilateral RLN paralyses and RLN decompress is effective for the restoration of the function of the nerve.

Objective:To analyze the clinical phenotype and genetic basis for a child featuring familial short stature.Methods:A child who was admitted to Huzhou Maternal and Child Health Care Hospital on October 7, 2021 for growth retardation and pectus carinatum was selected as the study subject. Physical exam and medical imaging was performed. The child was subjected to whole exome sequencing, and candidate variants were verified by Sanger sequencing and bioinformatic analysis.Results:The child, a 1-year-old male, had manifested with slightly short stature ( Z = -2.03), midfacial dysplasia, and multiple skeletal dysplasia such as pectus carinatum, irregular vertebral morphology, and defect of lumbar anterior bones. His mother, maternal grandmother and great-maternal grandfather also had short stature. WES revealed that the child has harbored a heterozygous c. 2858dupA (p.Asp953GlufsTer476) frameshifting variant of the ACAN gene, which was inherited from his mother. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c. 2858dup (p.Sp953Glufster476) variant was classified as likely pathogenic (PVS1+ PM2_Supporting). The patient has shown marked improved height after receiving 11 months of treatment with human recombinant growth hormone (supplemental dose) starting from 20 months of age. Conclusion:The ACAN: c. 2858dup (p.Asp953GlufsTer476) variant probably underlay the pathogenesis of short stature in this child.

Objective: investigate the incidence of retropharyngeal lymph node (RPLN) metastasis and the risk factors for RPLN metastasis in hypopharyngeal cancer, and the relationship of planned dissection of the RPLN with the survival and tumor control rates in patients with hypopharyngeal cancer. Methods: A total of 203 patients with hypopharyngeal squamous cell carcinoma who underwent radical surgery as initial treatment from February 2011 to July 2015 were analyzed retrospectively. There were 167 cases of pyriform sinus carcinoma, 23 cases of posterior pharyngeal wall carcinoma, and 13 cases of postcricoid carcinoma. Results: The incidence of RPLN metastasis in HPC was 17.7%, with a highest rate of 43.5% in pharyngeal wall carcinoma. The incidence of RPLN metastasis in T3-4 pyriform sinus carcinoma was 18.3%, which significantly higher than 2.8% in T1-2 cases(χ²=5.360, P=0.020). The rate of RPLN metastasis was 23.8% in N2b-3 and 8.6% in N0-2a, with a statistically significant difference(χ²=7.637, P=0.006). There was no statistically significant difference in overall survival rates between patients with and without RPLN metastasis(P>0.05). Data were analyzed by SPSS 13.0 software. Conclusions RPLN metastasis is not rare in hypopharyngeal carcinoma. Planned dissection of the RPLN should be performed with the initial surgery in patients with advanced hypopharyngeal cancer, especially posterior pharyngeal wall carcinoma, T3-4 pyriform sinus carcinoma and staged N2b-3 disease, which can reduce the regional recurrence rate and provided with a better prognosis.

Objective: To evaluate the usefullness of flexible esophagoscopy and chromoendoscopy with Lugol′s solution in the detection of synchronous esophageal neoplasm in patients with hypopharyngeal squamous cell carcinoma (HSCC). Methods: A retrospective review of 96 cases with HSCC that received surgical treatment from March 2016 to March 2017 was accomplished. In these patients, the site of origin were pyriform sinus (n=75), posterior pharyngeal wall (n=11) and postcricoid (n=10). Esophagoscopy was prospectively performed on all patients before treatment for HSCC. All patients underwent conventional white-light endoscopic examination with Lugol chromoendoscopy and narrow band image. Suspicious areas of narrow band image or Lugol-voiding lesions were observed and biopsied. The treatment strategy of primary HSCC was modified according to the presence of synchronous esophageal squamous cell neoplasms by a multidisciplinary approach. Results: Ninety-six patients were enrolled (age ranging from 37-80 years). All patients did not have previous treatment.Histopathological analysis revealed middle to high-grade dysplasia in 5 cases, Tis cancer in 5 cases, cancer in 16 cases and inflammation or normal findings in the others. Four cases were treated with endoscopic submucosal dissection before hypopharygeal surgery, 3 cases with lower esophageal cancers were treated with gastric pull-up combined with free jejunal flap after total circumferential pharyngolaryngectomy (TCPL) and certical esophagectomy, and 14 cases were treated with TCPL, total esophagectomy and gastric pull-up. Conclusions Esophagoscopy is a feasible and justified procedure in HSCC cases as it enhances the detection of premalignant lesion or second primary cancer. Routine esophagoscopy for detecting synchronous second primary tumor should be recommended for patients with HSCC. The treatment strategy for primary HSCC is modified according to the presence of synchronous second primary tumor.