Objective:Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess.Methods:Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine, brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results:The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions:Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.

Objective:To explore the clinical value of 18F-fluoromisonidazole (FMISO) PET/CT hypoxia imaging in early response to heavy ion radiotherapy in patients with non-small cell lung cancer(NSCLC). Methods:From April 2018 to January 2021, the 18F-FMISO PET/CT images of 23 NSCLC patients (19 males, 4 females; age (64.9±10.3) years) who received heavy ion radiotherapy in Shanghai Proton and Heavy Ion Center were retrospectively analyzed. The evaluation parameters included tumor volume (TV), tumor to background ratio (TBR) before and after radiotherapy. Patients were divided into hypoxia group and non-hypoxia group with the baseline TBR value≥1.4 as hypoxia threshold. Wilcoxon signed rank test was used to compare the differences of TV and TBR before and after radiotherapy in 2 groups. Results:Of 23 NSCLC patients, 17 were hypoxia and 6 were non-hypoxia. Compared with the baseline, TV after the radiotherapy (59.44(22.86, 99.43) and 33.78(8.68, 54.44) cm 3; z=-3.05, P=0.002) and TBR after the radiotherapy (2.25(2.09, 2.82) and 1.42(1.24, 1.67); z=-3.39, P=0.001) of the hypoxia group were significantly lower, while TV (16.19(6.74, 36.52) and 8.59(4.38, 25.47) cm 3; z=-1.57, P=0.120) and TBR (1.19(1.05, 1.27) and 1.10 (0.97, 1.14); z=-1.89, P=0.060) of the non-hypoxia group decreased with no significant differences. Conclusions:Hypoxic NSCLC tumors are sensitive to heavy ion radiation. Compared with non-hypoxic tumors, hypoxic tumors respond more quickly, and a significant reduction in TV can be observed early after radiotherapy. Heavy ion radiation can significantly improve tumor hypoxia.

Objective:To evaluate the clinical effect of transferred direct popliteal cutaneous artery perforator propeller flap for repairing soft tissue defects of the popliteal fossa.Methods:The clinical data of 9 patients with defects of popliteal fossa from June 2013 to June 2019 were analyzed retrospectively, in which including 6 men and 3 women whose ages ranged from 25 to 73 years old. The sizes of soft tissue defects ranged from 6.5 cm×3.5 cm to 17.0 cm×8.5 cm. Perforator propeller flap was designed and cut to repair the defects according to the location, size and shape of defects, in which the largest was 18.0 cm×10.0 cm and the smallest was 7.5 cm×4.5 cm. To evaluate the effect according to survival, infection control, elasticity and color, appearance of the flaps, the scar at the donor site, cutaneous sense, knee joint function, and patients’satisfaction.Results:All the flaps survived. The incisions in donor and recipient site were primary healing. The survival of flaps was good. The appearance, color, and elasticity were close to normal. On the other hand, the scar at the donor site was small after 6 to 60 months follow-up. 2 cases appeared necrosis on edge of distal flaps and were healed after dressing. The efficacy was satisfactory in 8 cases, general in 1 case and without dissatisfactory. The function of knee joint was excellent in 7 cases, good in 1 case, and general in 1 case. Skin swelling rating in early-stage was 1st degree in 6 patients, 2nd degree in 2 patients, 3rd degree in 1 patient; in the later stage was 1st degree in 8 patients, 2nd degree in 1 patient.Conclusions:It is simple, safe and reliable to repair soft tissue defects of popliteal fossa with transferred direct popliteal cutaneous artery perforator propeller flap, which would be an ideal method for repairing soft tissue defects of the popliteal fossa.

Objective:To evaluate the clinical effect of transferred direct popliteal cutaneous artery perforator propeller flap for repairing soft tissue defects of the popliteal fossa.Methods:The clinical data of 9 patients with defects of popliteal fossa from June 2013 to June 2019 were analyzed retrospectively, in which including 6 men and 3 women whose ages ranged from 25 to 73 years old. The sizes of soft tissue defects ranged from 6.5 cm×3.5 cm to 17.0 cm×8.5 cm. Perforator propeller flap was designed and cut to repair the defects according to the location, size and shape of defects, in which the largest was 18.0 cm×10.0 cm and the smallest was 7.5 cm×4.5 cm. To evaluate the effect according to survival, infection control, elasticity and color, appearance of the flaps, the scar at the donor site, cutaneous sense, knee joint function, and patients’satisfaction.Results:All the flaps survived. The incisions in donor and recipient site were primary healing. The survival of flaps was good. The appearance, color, and elasticity were close to normal. On the other hand, the scar at the donor site was small after 6 to 60 months follow-up. 2 cases appeared necrosis on edge of distal flaps and were healed after dressing. The efficacy was satisfactory in 8 cases, general in 1 case and without dissatisfactory. The function of knee joint was excellent in 7 cases, good in 1 case, and general in 1 case. Skin swelling rating in early-stage was 1st degree in 6 patients, 2nd degree in 2 patients, 3rd degree in 1 patient; in the later stage was 1st degree in 8 patients, 2nd degree in 1 patient.Conclusions:It is simple, safe and reliable to repair soft tissue defects of popliteal fossa with transferred direct popliteal cutaneous artery perforator propeller flap, which would be an ideal method for repairing soft tissue defects of the popliteal fossa.

Objective:To evaluate the clinical effect of soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap.Methods:The clinical data of 125 patients with defects of popliteal fossa from May 2008 to October 2019 were analyzed retrospectively, in which 71 men and 54 women were included aged from 16 to 87 years old. The sizes of soft tissue defect ranged from 3.5 cm×2.5 cm to 12.0 cm×6.0 cm. Perforator propeller flap was designed and cut to repair the defects according to their location, size and shape. 62 cases of distal radial artery perforator propeller flap, 48 cases of distal ulnar artery perforator propeller flap and 15 cases of distal posterior interosseous artery perforator propeller flap were included, in which the largest was 14.0 cm×6.0 cm and the smallest was 4.0 cm×3.0 cm. The donor sites were covered with free full-thickness skin grafts. Skin swelling rating in early and later stage and the color after 3 to 60 months follow-up were evaluated for the effect.Results:All the flaps survived in 116 patients, though the distal edge of the flaps were necrotic in 9 cases. The incisions in donor and recipient sites were primarily healed. After 3 to 60 months follow-up, we found no deformity of wrist joints and the appearance was good; the color and elasticity were close to normal; the scar was small; two-point discrimination was 6 mm to 9 mm. The outcome was satisfactory in 89 cases, average in 36 cases and without dissatisfactory. Skin swelling rating in early stage was first degree in 80 cases, second degree in 30 cases, third degree in 15 cases; in later stage was first degree in 85 cases, second degree in 35 cases, third degree in 15 cases. Wrist function was assessed in four aspects: palmar flexion, dorsiflexion, radial deviation, and ulnar deviation. Results were excellent in 29 cases, good in 63 cases, average in 33 cases and the good rate was 73.6%. The pain of wrist did not affect the patients’ daily routines and activities.Conclusions:It is reliable to repair soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap which is worthy of clinical use, especially in middle-aged and senile patients.

Objective:To evaluate the clinical effect of soft tissue defects around knee joints repaired with thigh distal perforator propeller flap.Methods:Clinical data of 72 patients with defects around knee joints from January, 2009 to October, 2019 were analyzed retrospectively, including 43 males and 29 females, aged from 17 to 83 years. The sizes of soft tissue defects ranged from 4.0 cm×3.0 cm to 22.0 cm×13.0 cm. Perforator propeller flaps were designed and harvested to repair the defects according to anatomical features of the origin, course, branches, distribution and anastomosis of vascular network of the perforator vessels and location as well as the size and shape of defects. Nine patients repaired with the lateral distal perforator propeller flaps (LDF), 53 with descending genicular artery perforator propeller flaps (DGF) and 10 with direct popliteal artery perforator propeller flaps (DPF). The size of flap was 4.5 cm×3.5 cm to 24.0 cm×14.0 cm. The donor sites were sutured directly or covered with free full-thickness skin. To evaluate the effect, the skin swelling rating in early and later stage were taken. Three to 72 months of followed-up was conducted through outpatient clinic (78%), telephone (15%) and WeChat (7%).Results:The flaps totally survived in 65 patients and 7 patients underwent partial necrosis at the distal end of the flaps ( 2 cases of LDF, 4 cases of DGF, 1 case of DPF) who were treated with dressing, and the donor sites were completely healed. The appearance and shape of the repaired knee joints was good, and the color and elasticity was close to surrounding normal skin, TPD of the flaps were 7-10 mm, and the scar was small after 3 to 72 months' follow-up. The efficacy was satisfactory in 48 cases ( 4 cases of LDF, 39 cases of DGF, 5 cases of DPF), general in 24 cases ( 5 cases of LDF, 14 cases of DGF, 5 cases of DPF). Degree of flap swelling: in early stage, I° in 40 cases ( 4 cases of LDF, 31 cases of DGF, 5 cases of DPF), II° in 20 cases ( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF), III° in 10 cases ( 2 cases of LDF, 7 cases of DGF, 1 case of DPF), IV° in 2 cases(1 case of DGF, 1 case of DPF); in later stage: I° in 55 cases ( 6 cases of LDF, 41 cases of DGF, 8 cases of DPF), II° in 15 cases ( 2 cases of LDF, 12 cases of DGF, 1 case of DPF), III° in 2 cases ( 1 case of LDF, 1 case of DPF). The evaluation of knee joint function: excellent in 17 cases ( 2 cases of LDF, 12 cases of DGF, 3 cases of DPF), good in 35 cases( 4 cases of LDF, 27 cases of DGF, 4 cases of DPF), general in 20 cases( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF). The good rate was about 73%. The range of motion and stability of the knee joint were basically normal and there was no pain found to affect study and life. All the patients were satisfied with the effect.Conclusion:Repairing soft tissue defect around knee joint with thigh distal perforator propeller flap is reliable and clinical applicable.

Objective:To evaluate the clinical effect of soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap.Methods:The clinical data of 125 patients with defects of popliteal fossa from May 2008 to October 2019 were analyzed retrospectively, in which 71 men and 54 women were included aged from 16 to 87 years old. The sizes of soft tissue defect ranged from 3.5 cm×2.5 cm to 12.0 cm×6.0 cm. Perforator propeller flap was designed and cut to repair the defects according to their location, size and shape. 62 cases of distal radial artery perforator propeller flap, 48 cases of distal ulnar artery perforator propeller flap and 15 cases of distal posterior interosseous artery perforator propeller flap were included, in which the largest was 14.0 cm×6.0 cm and the smallest was 4.0 cm×3.0 cm. The donor sites were covered with free full-thickness skin grafts. Skin swelling rating in early and later stage and the color after 3 to 60 months follow-up were evaluated for the effect.Results:All the flaps survived in 116 patients, though the distal edge of the flaps were necrotic in 9 cases. The incisions in donor and recipient sites were primarily healed. After 3 to 60 months follow-up, we found no deformity of wrist joints and the appearance was good; the color and elasticity were close to normal; the scar was small; two-point discrimination was 6 mm to 9 mm. The outcome was satisfactory in 89 cases, average in 36 cases and without dissatisfactory. Skin swelling rating in early stage was first degree in 80 cases, second degree in 30 cases, third degree in 15 cases; in later stage was first degree in 85 cases, second degree in 35 cases, third degree in 15 cases. Wrist function was assessed in four aspects: palmar flexion, dorsiflexion, radial deviation, and ulnar deviation. Results were excellent in 29 cases, good in 63 cases, average in 33 cases and the good rate was 73.6%. The pain of wrist did not affect the patients’ daily routines and activities.Conclusions:It is reliable to repair soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap which is worthy of clinical use, especially in middle-aged and senile patients.

Objective:To observe the status of the sinus membrane using fiber optic endoscope during the lateral window approach sinus floor elevation to provide a reference for clinicians when evelvating the sinus mucoperiosteum.Methods:Sixty-six patients (72 sides) who underwent maxillary sinus floor elevation in Beijing Ruicheng Stomatology Hospital from September 2016 to December 2019 were selected, including 40 males and 26 females, aged 26-80 years old [(56.2±11.5) years]. And fiber optic endoscopy was used to observe the maxillary mucoperiosteum during the operation.Results:The status of maxillary sinus mucoperiosteal during lateral window approach sinus floor elevation can be divided into four categories: ① Class Ⅰ, complete periosteal, no damage to mucoperiosteum; ②Class Ⅱ, periosteal injury, unexposed laminae propria; ③Class Ⅲ, periosteal Rupture, exposed lamina propria; ④ Class Ⅳ, mucoperiosteum perforation, rupture of periosteum, lamina propria and epithelial layer. A total of 72 operations were performed, including 18 cases of class I, 28 cases of class Ⅱ, 4 cases of class Ⅲ, and 22 cases of class Ⅳ.Conclusions:The status of maxillary sinus mucoperiosteal during lateral window approach sinus floor elevation can be divided into four categories. Fiberoptic endoscopy as a clinical auxiliary examination method can improve the operator′s control of the status of the maxillary sinus membrane and assist the peeling of the mucosa.

Objective: To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area. Methods: Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery. Results: All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S₃. The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes. Conclusions Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.

Objective: To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues. Methods: We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017. Results: All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up. Conclusions In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.