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Free submental flap for defects reconstruction after oral cancer ablation

Chinese Journal of Microsurgery.2015;38(1):8-11. doi:10.3760/cma.j.issn.1001-2036.2015.01.003

Objective To investigate the clinical application of free submental flap for defects reconstruction after oral cancer ablation.Methods Eleven cases of free submental flaps for defects reconstruction after oral cancer ablation from April,2013 to May,2014 were reviewed.The primary disease,defect type,flap side,flap size and flap survival rate were recorded.The follow-up data of tumor recurrence,lymph node metastasis,as well as postoperative facial appearance and function of marginal mandibular branch of facial nerve were collected.Results Primary disease of all 11 cases was oral squamous cell carcinoma.No flap failure was reported and the overall flap survived.The follow-up period was 6-18 months with the average of 9 months.There was no tumor recurrence and metastasis of lymph node.Postoperative facial appearance was satisfactory and there was no nerve injury of marginal mandibular branch which showed normal and symmetrical expression motion.Conclusion Free submental flap owns many ad vantages including constant anatomy,long vascular pedicle,wide range of indications and low donor-site morbidity.Contralater submental flap may avoid potential lymph node metastasis.Free submentai flaps is an ideal choice for reconstruction of oral and maxillofacial defects after cancer ablation.

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Application of vascularized anterolateral thigh perforator flap harvested with free-style approach in oral and maxillofacial reconstruction

Jie CHEN ; Canhua JIANG ; Ping YIN ; Long YANG ; Xiaoshan WU ; Long HUANG ; Xinchun JIAN

Chinese Journal of Microsurgery.2015;38(1):20-24. doi:10.3760/cma.j.issn.1001-2036.2015.01.006

Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in some cases to compromise the need of the accepting site.Results All 53 flaps survived after transplantation while skin exfoliation occurred in 5 cases due to flap thinning.Four cases sustained partial necrosis and was cured by trimming and dressing changes.Five to 14 months' post-operative followup showed satisfactory accepting-site morphology with good speech function and swallowing recovery.All donor sites were closed primarily without skin-grafting,leaving no donor-site complications including incision disruption,scar hyperplasia and muscle strength degeneration of the lower limb.Conclusion Multiple perforators have been accu rately located preoperatively in free-style harvest approach of ALTPFs,thus optimal effects can be reached with decreased donor-site morbidity and improved aesthetic outcome to the uttermost,which accords with the refined,personalized and minimal invasive development concept of modem reconstructive surgery.

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Application of venous flow-through flap in complex finger replantation

Dawei ZHENG ; Zhangcan LI ; Li XU ; Xuyang ZHANG ; Rongjian SHI ; Feng SUN ; Kuishui SHOU

Chinese Journal of Microsurgery.2015;38(1):25-28. doi:10.3760/cma.j.issn.1001-2036.2015.01.007

Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.

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Transplantation of the free anterolateral thigh flap combined with iliotibial band for reconstruction of children's soft tissue defects at foot and ankle

Rui HU ; Yijun REN ; Li YAN ; Fan LI ; Qiong HAN ; Wenjun CHENG ; Wusheng KAN

Chinese Journal of Microsurgery.2014;37(5):457-460. doi:10.3760/cma.j.issn.1001-2036.2014.05.011

Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were injuryed in traffic accidents.The areas of free anterolateral thigh flaps were 8 cm × 5 cm to 18 cm × 12 cm.All the patients begined to early rehabilitative exercise under the protection of orthosis after 2 weeks of the operation.Results All cases were followed up from 6 to 24 months,averaged of 14 months.All the flaps survived,and only 2 cases with necrosis of small area in distal,and which were healed by dressing.The healing time were 12 to 24 days,and the average of 15.1 days; The surgery function were assessed according to Thermann's scale,and the results was 14 cases for excellent,9 cases was good,the general was 2 cases,and the excellent and good rate was 92％.Conclusion The transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defect at foot and ankle and functional reconstruction is a safe and effective strategy,and it has the advantages such as covering the wound at foot and ankle approvingly,reconstruction of power device once,the flap and iliotibial band were in the same wound,the trauma of doner site is small invasive,early recovery functional exercise,shorten the treatment cycle,and relieve the suffering of children.

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Reconstruction of severe atresic eye socket with lateral arm free flap

Weiqiao ZHU ; Dongmei LI ; Jingming LIU ; Chi MAO ; Ge QI

Chinese Journal of Microsurgery.2014;37(5):461-463. doi:10.3760/cma.j.issn.1001-2036.2014.05.012

Objective To study the method and effect of lateral arm free flap in reconstruction of severe atresic eye socket.Methods Forteen cases of severe atresic eye socket,from June,2011 to June,2013,were repaired by lateral arm free flap.The flaps were designed and harvested as drop shape with size about 6 cm × 10 cm and then were removed epidermis except distal 6 cm × 6 cm area which were transferred to orbit for eye socket reconstruction.The remaining fascia and dermis were filled to augment temporal defect.Superficial temporal artery was anastomosed with posterior branch of radial collateral artery in 14 cases and superficial temporal vein was anstomosed with radial collateral vein in 11 cases,with middle temporal vein in 3 cases.Results All 14 cases lateral arm free flaps survived with no donor site morbidity.Followed up for 1 year to 3 years,artificial eye could be fitted satisfactorily and temporal contour improved.Conclusion Lateral arm free flap is a recommendable option for severe atresic eye socket reconstruction because of concealed donor site scar,proper volume,matched vascular caliber and minor donor site morbidity.

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Effect of chitosan on vascular smooth muscle cells inhibiting proliferation from rabbit arteriovenous fistula and its mechanisms

Yan YAN ; Jie ZHENG ; Jianjun XIE ; Xiaoxia SU ; Jinlei LYU ; Jun XIAO ; Qinkai CHEN

Chinese Journal of Microsurgery.2014;37(5):475-479. doi:10.3760/cma.j.issn.1001-2036.2014.05.016

Objective To explore the effect of chitosan on vascular smooth muscle cells inhibited proliferation from rabbit arteriovenous fistula and its mechanisms.Methods Established rabbit fistula model on carotid arteryinternal jugular vein.After 1 month cultured VSMCs with primary culture by tissue-pieces inoculation.Cultured VSMCs were divided into three groups:①normal control group.②FBS-treated group:cell were treated with 5％,10％,20％ for 48 h,respectively; established the model of rabbit VSMCs proliferation.③chitosan-treated group:VSMCs cultured with 20％ FBS were exposed to different doses of chitosan(10,100,500,1000,2000μg/ml) for 48 h.And VSMCs were treated for different time (0,12,24,48 h) with Chitosan 1000 μg/ml.Expression levels of PCNA and TLR4/ NF-κB were detected by Western blotting.RT-PCR were applied to measure the mRNA expression of PCNA and TLR4.The protein levels of TLR4 and NF-κB were detected by immunofluorescence.Results Compared with low concentration serum group,FBS-treated VSMCs exhibited a increase in mRNA and protein expression of PCNA and TLR4.FBS-induced protein expression of PCNA and TLR4/NF-κB were reduced by chitosan.Also mRNA expression of PCNA and TLR4 were reduced.They were dependent on concentration and time.In rabbit VSMCs TLR4 was mainly expressed in the cytoplasm and NF-κB expressed mainly in the nucleus.Compared with normal control group,TLR4 and NF-κB protein expression were significantly decreased by chitosan.Conclusion High concentration serum induced VSMCs proliferation.Chitosan can inhibit the proliferation of rabbit VSMCs.It is speculated that the mechanism may be related to the expression of TLR4 receptor activation,reducing expression of downstream factor MyD88 and NF-κB.It is suggest that chitosan can become potential new drugs of arteriovenous fistula prevention of intimal hyperplasia.

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Direct popliteal artery perforator flap: anatomical study and clinical application

Jian LIN ; Hua LU ; Heping ZHENG ; Jiafu LIN

Chinese Journal of Microsurgery.2014;37(5):480-482. doi:10.3760/cma.j.issn.1001-2036.2014.05.017

Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.

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Compound flaps of foot with joint transplantation bridging severed segmental damage type finger

Zhongjian SUN ; Peng XU ; Changxin YUAN ; Jiaxiang TIAN ; Zhong PENG

Chinese Journal of Microsurgery.2015;38(1):48-51. doi:10.3760/cma.j.issn.1001-2036.2015.01.012

Objective To investigate the clinical effect of the compound flaps of foot with joint transplantation bridging severed segmental damage type finger.Methods Eleven cases with segmental composite tissue damaged fingers,emergency free with plantar metatarsal or metatarsophalangeal,interphalangeal joint of the foot com posite tissue flap transplantation and bridging replanted finger form February,2006 to September,2011 were retrospective reviewed in our study.The therapeutic effect was evaluated according to the assessment standard of Chinese Medical Association of Hand Surgery.Results All patients were followed-up for 6 to 48 months.The composite flap and amputated fingers in the 11 cases were survived after surgery,with satisfactory appearance.Range of motion of interphalangeal joints from 40° to 90°,and metacarpophalangeal joints from 45° to 65°.There was no nonunion or refracture.Two-point discrimination of finger pulp was 5-8 mm.According to the Chinese Medical Society of Hand Surgery Trial upper part of the standard evaluation function assessment,the results were excellent in 3 cases,good in 6 cases,may in 2 case.Conclusion Compound flaps of foot with joint transplantation bridging severed segmental damage type finger could recover the appearance and functions of amputated fingers to satisfy the daily need of patients in a maximum degree.

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Classification and reconstruction of the defects after combined cranio-maxillo-facial resection

Jian SUN ; Yi SHEN ; Jun LI ; Yiqun WU ; Chenping ZHANG ; Hanguang ZHU ; Zhiyuan ZHANG

Chinese Journal of Microsurgery.2014;37(5):421-426. doi:10.3760/cma.j.issn.1001-2036.2014.05.002

Objective To review our patients who underwent reconstruction of the defect after combined cranio-maxillo-facial resection in recent years.Methods From January,2005 to January,2011,88 patients underwent reconstruction of the defect after combined cranio-maxillo-facial resection.Different reconstructive techniques were used according to the defect classifications in dura,skull base bone,and facial tissues.For dural defects,no repair (37 cases),primary closure (25 cases),and dural repair (26 cases) were performed,respectively.Dural repair materials included thigh fascia lata (2 cases),temporalis fascia (2 cases),pericranium (1 case) and artificial dural patch (21 cases).Bone reconstruction of the skull base were performed in 61 patients with titanium mesh (57 cases),free iliac bone graft (1 case),free cranial bone graft (2 cases) and Medpor (1 case),respectively.Limited facial soft and hard tissue defects in 44 patients were reconstructed with temporalis system of flaps (36 cases),sternocleidomastoid myocutaneous flap (6 cases),and pterygoid muscle flap (2 cases),respectively.Extensive facial soft and hard tissue defects in 44 patients were reconstructed with free latissimus dorsi myocutaneous flap (26 cases),free pectoralis major myocutaneous flap (12 cases),free anterolateral thigh perforator flap (5 cases cases) and free anteromedial thigh perforator flap (1 case),respectively.Results The overall success rate of 88 flaps was 100％.Cerebrospinal fluid leak was found in 4 patients,wound infection was found in 2 patients,intracranial infection was found in 2 patients,respectively.Six patients with cerebrospinal fluid leak or wound infection were cured by conservative treatment.Two patients with intracranial infection were dead although they underwent salvage surgery.Overall rate of complications was 9.1％,dead rate was 2.3％.Conclusion Successful reconstruction of the defect after combined cranio-maxillo-facial resection can be achieved by watertight dural repair,bone reconstruction of the skull base and well-vascularized tissue covered.Regional flap and free tissue transfer are both preferred reconstructive technique depending on the anatomic site and the extent of the defect.

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Application of microvascular anastomotic device in head and neck reconstruction

Lei ZHANG ; Xiuling HUANG ; Xiaofeng SHAN ; Xuguang LU ; Zhigang CAI ; Guangyan YU

Chinese Journal of Microsurgery.2014;37(5):427-431. doi:10.3760/cma.j.issn.1001-2036.2014.05.003

Objective To describe the clinical application of microvascular anastomotic device in head and neck reconstruction.Methods From July,2013 to November,2013,microvascular free flaps were transferred to reconstruct the defects simultaneously after tumor resection of head and neck region in 12 cases in Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology.Microvascular anastomotic coupling devices (MACD) were used in vascular anastomosis.The clinical data were collected and analyzed,including the selection of free flap,diameter of donor and recipient vessels,type of MACD,time of anastomosis,instant patency of anastomosis.The flap was monitored closely after operation and the final survival rate was calculated.Results Twelve microvascular free flaps were done in this series,including 6 fibula flaps,4 forearm flaps and 2 anterolateral thigh flaps.Totally 17 MACD were used by end-to-end anastomosis in this series,including 5 arterial anastomosis and 12 venous anastomosis.The anastomose time using MACD was from 4 to 10 minutes,with a median time 6.8 minutes.The instant patency rate of anastomosis was 100％.There were some blood leakages near the anastomotic stoma in 1 arterial anastomosis using MACD.It was resolved successfully by changing a new MACD.Conclusion Our primary clinical experience showed that the MACD was well suited to the microvascular reconstruction of head and neck defect.The feasibility and reliability was confirmed by our clinical cases.It should be recommended as a safe,fast and reliable adjuvant anastomotic instrument for free tissue transfer.

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