Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.

Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation between with the three dimensional configuration of the skin ligament.Methods:1) 12 fresh adult cadaver specimens (7 males, 5 females, aged 54-87 years) were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices, and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the midface (cheek, nose, orbital eyelid) . (2) A retrospective analysis was made of the case data of midface soft tissue defects admitted to the Plastic Surgery Department of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flap. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences of flap area and flap aspect ratio in different parts of the midface.Results:1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal The supracutaneous ligaments run down the alar of the nose. (2) The clinical study included 18 patients, 8 males and 10 females, aged (65.1±22.9) years. The flaps of 18 patients survived after operation, the flap area was (13.85±9.38) cm 2, and the advancing distance was (1.94±0.75) cm. Statistical analysis showed that there was a correlation between the flap advancement distance and the flap incision area ( r=-0.712, P=0.022) and the flap aspect ratio ( r=-0.580, P =0.012). There was no correlation with the defect area ( r=-0.227, P=0.365) ; the aspect ratios of the cheek, nose and orbital lid flaps were 2.06±0.42 , 2.50±1.18, 3.25±0.93, and the differences were statistically significant ( H= 6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing midface soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation with the three-dimensional configuration of the skin ligament.Methods:(1) Tweleve fresh adult cadaver specimens, including seven males and five females, aged 54-87 years old, were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the mid-face (cheek, nose, orbital eyelid). (2) A retrospective study was conducted with the data of mid-face soft tissue defects admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flaps. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences in flap size and aspect ratio in different parts of the mid-face. The measurement data were described by Mean±SD or M( Q1, Q3). Results:(1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal cutaneous ligaments run down the nose alar. (2) The clinical study included 18 patients, including eight males and ten females, aged (64.6±23.4) years old. All flaps survived uneventfully. The average flap size was 10.6(8.0, 18.0) cm 2, and the average advancing distance was 2.8(2.0, 4.0) cm. Statistical analysis showed a correlation between the flap advancement distance, the flap incision area ( r=-0.71, P=0.022), and the flap aspect ratio ( r=-0.58, P=0.012). There was no correlation with the defect area ( r=-0.23, P=0.365); the aspect ratios of the cheek, nose, and orbital lid flaps were 2.1(1.9, 2.3), 2.0(1.6, 3.5), 3.5(3.0, 4.0), and the differences were statistically significant ( H=6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing mid-face soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation between with the three dimensional configuration of the skin ligament.Methods:1) 12 fresh adult cadaver specimens (7 males, 5 females, aged 54-87 years) were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices, and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the midface (cheek, nose, orbital eyelid) . (2) A retrospective analysis was made of the case data of midface soft tissue defects admitted to the Plastic Surgery Department of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flap. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences of flap area and flap aspect ratio in different parts of the midface.Results:1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal The supracutaneous ligaments run down the alar of the nose. (2) The clinical study included 18 patients, 8 males and 10 females, aged (65.1±22.9) years. The flaps of 18 patients survived after operation, the flap area was (13.85±9.38) cm 2, and the advancing distance was (1.94±0.75) cm. Statistical analysis showed that there was a correlation between the flap advancement distance and the flap incision area ( r=-0.712, P=0.022) and the flap aspect ratio ( r=-0.580, P =0.012). There was no correlation with the defect area ( r=-0.227, P=0.365) ; the aspect ratios of the cheek, nose and orbital lid flaps were 2.06±0.42 , 2.50±1.18, 3.25±0.93, and the differences were statistically significant ( H= 6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing midface soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation with the three-dimensional configuration of the skin ligament.Methods:(1) Tweleve fresh adult cadaver specimens, including seven males and five females, aged 54-87 years old, were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the mid-face (cheek, nose, orbital eyelid). (2) A retrospective study was conducted with the data of mid-face soft tissue defects admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flaps. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences in flap size and aspect ratio in different parts of the mid-face. The measurement data were described by Mean±SD or M( Q1, Q3). Results:(1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal cutaneous ligaments run down the nose alar. (2) The clinical study included 18 patients, including eight males and ten females, aged (64.6±23.4) years old. All flaps survived uneventfully. The average flap size was 10.6(8.0, 18.0) cm 2, and the average advancing distance was 2.8(2.0, 4.0) cm. Statistical analysis showed a correlation between the flap advancement distance, the flap incision area ( r=-0.71, P=0.022), and the flap aspect ratio ( r=-0.58, P=0.012). There was no correlation with the defect area ( r=-0.23, P=0.365); the aspect ratios of the cheek, nose, and orbital lid flaps were 2.1(1.9, 2.3), 2.0(1.6, 3.5), 3.5(3.0, 4.0), and the differences were statistically significant ( H=6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing mid-face soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To explore the clinical effect of frontalis muscle flap combined with check ligament double suspension in the treatment of severe blepharoptosis.Methods:13 patients(16 eyes) who were almost zero muscle strength with severe blepharoptosis, was treated with double eyelid incision. Check ligament was isolated from the superior conjunctival fornix which was between the superior rectus muscle and the levator eyelid muscle. Then the upper edge of the tarsal plate was fastened so that the upper eyelid margin can be raised by about 2-3 mm. The forehead muscle flaps formed by the post separation of septa orbitale were sutured and fixed at the lower end of the check ligament, and the height of the upper eyelid was increased dynamically to about 1-2 mm above the cornea.And then the effect of this operation was evaluated and the efficiency was calculated after operation.Results:There were 13 cases which include 16 eyes in our group. Stitches were taken out 7 days after the operations, and the incisions healed well. All the upper eyelid margins were located at about 1-2 mm above the cornea when they opened the eyes. These eyes were all accompanied by different degrees of hypophasis when they closed. All of the patients in our group were followed up effectively for 4 to 12 months. Twelve eyes were greatly corrected. Three eyes were moderately corrected. And only one eyes were corrected insufficiently. The overall effective correction rate was about 93.75%. The correction effect was satisfactory. No complication, such as exposed keratitis, ectropion and conjunctival prolapse were found in all cases.Conclusions:The double suspension of frontalis muscle flap combined with check ligament can effectively increase the height of upper eyelid margin, which is beneficial for the accurate rectification effect, stable long-term effect and little complications. It is suitable for the correction of severe upper eyelid sag with extremely weak muscle strength of upper eyelid lifter.

Objective:To explore the clinical effect of frontalis muscle flap combined with check ligament double suspension in the treatment of severe blepharoptosis.Methods:13 patients(16 eyes) who were almost zero muscle strength with severe blepharoptosis, was treated with double eyelid incision. Check ligament was isolated from the superior conjunctival fornix which was between the superior rectus muscle and the levator eyelid muscle. Then the upper edge of the tarsal plate was fastened so that the upper eyelid margin can be raised by about 2-3 mm. The forehead muscle flaps formed by the post separation of septa orbitale were sutured and fixed at the lower end of the check ligament, and the height of the upper eyelid was increased dynamically to about 1-2 mm above the cornea.And then the effect of this operation was evaluated and the efficiency was calculated after operation.Results:There were 13 cases which include 16 eyes in our group. Stitches were taken out 7 days after the operations, and the incisions healed well. All the upper eyelid margins were located at about 1-2 mm above the cornea when they opened the eyes. These eyes were all accompanied by different degrees of hypophasis when they closed. All of the patients in our group were followed up effectively for 4 to 12 months. Twelve eyes were greatly corrected. Three eyes were moderately corrected. And only one eyes were corrected insufficiently. The overall effective correction rate was about 93.75%. The correction effect was satisfactory. No complication, such as exposed keratitis, ectropion and conjunctival prolapse were found in all cases.Conclusions:The double suspension of frontalis muscle flap combined with check ligament can effectively increase the height of upper eyelid margin, which is beneficial for the accurate rectification effect, stable long-term effect and little complications. It is suitable for the correction of severe upper eyelid sag with extremely weak muscle strength of upper eyelid lifter.

Objective: To explore the method and result of repairing segmental ear defect with postauricular skin flap according to different region. Methods: 25 partial ear defects were divided into 5 regions.The cases with defect in 1 and 2nd regions were treated by postauricular flap combined with ipsilateral conchal cartilage graft in one stage; Cases in the 3rd regions were repaired with the posterior pedicled flap combined with conchal or rib cartilage graft in two stages; According to the defect in 4th region, post-auricular skin flap was transplanted anteriorly to repair; The temporal fascial flap and skin graft were used for the 3 cases with post-operative cartilage exposure. Results: All flaps survived with good shape except one case with partial epidermal necrosis and 3 cases deep color after the temporal fascial flap and skin graft. 9 cases that needed second operation. Conclusions The postauricular flap is a preferred alternative method in case periauricular skin is in fact, which yields closer tissue match, color, and texture. It is safe and effective for the correction of segmental ear defect with satisfied shape. The temporal fascial flap can be regarded as the last alternatives.

Objective To analyze the efficacy and safety of tetrandrine in the adjuvant treatment of relapsed/refractory acute leukemia (except M3).Methods A total of 58 patients with relapsed/refractory acute leukemia (except M3) admitted to six tertiary hospitals in Jiangsu Province from January 2015 to December 2017 were included in this study.The tetrandrine-adjuvant standard chemotherapy regimen and standard chemotherapy regimen were given to treatment and control groups respectively.There were 17 and 41 patients in treatment and control groups.The treatment group was given tetrandrine for 5 days before the use of standard chemotherapy.The dose of tetrandrine was 4 mg ·kg-1 ·d-1,and patients had continuous oral administration of 5 days.After that,the patients in the treatment group started chemotherapy immediately.On the other side,the control group received standard chemotherapy without any other multidrug reversal medicine.Then the clinical efficacy and safety outcomes in both groups were analyzed.Results In the treatment group,5,3,and 9 cases achieved complete remission (CR),partial remission (PR),and nonremission (NR) respectively,and the total effective (CR+PR) rate was 47.06 ％ (8/17);in the control group,14,10,and 17 cases achieved CR,PR,and NR,and the total effective rate was 58.54 ％ (24/41).There was no significant difference in the total effective rate between the two groups (x2 =0.64,P =0.424).There was no significant difference in the efficacy between the two groups of patients with different genders (P ＞ 0.05).When the disease duration was 6-11 months,the difference of efficacy between the two groups was statistically significant (P =0.041).There was no significant difference in the proportion of myeloid leukemia cells,white blood cell count,platelet count,red blood cell count,and hemoglobin between the two groups before and after treatment (all P ＞ 0.05).There was no significant difference in clinical safety indicators (urine,faecal routine,liver and kidney function,and electrocardiogram) between the two groups (all P ＞ 0.05).Conclusions Tetrandrine is more effective in patients with relapsed/refractory acute leukemia (except M3) with shorter duration of disease.Compared with chemotherapy alone,the clinical efficacy of adding tetrandrine in chemotherapy cannot be considered superior to the former.