Objective:To evaluate clinical outcomes of occlusion-guided vascularized folded fibula flap reconstruction with delayed implant restoration for mandibular defects after benign tumor resection.Methods:A total of 12 patients with benign mandibular tumors underwent free folded fibula flap reconstruction at the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2023, including 7 males and 5 females, aged 21-52 years. Six months after mandibular reconstruction, the internal fixation titanium plates were removed, and dental implants were placed using a preoperatively fabricated occlusal guide, followed by second-stage implant surgery and prosthetic restoration. Mandibular CT scans were obtained 6 months after reconstruction to compare the fitting accuracy between the preoperative virtual design and the actual reconstructed mandible. The implant stability quotient (ISQ) was measured 3 months after implant placement. Masticatory efficiency and Enneking lower limb function scores were evaluated at the following time points: before tumor surgery (T1), before implant placement (T2), 6 months (T3) and 9 months (T4) after implant crown restoration. One-way repeated measures ANOVA was used to analyze the masticatory efficiency and lower limb function scores.Results:The free folded fibula grafts were successfully performed via an intraoral approach in all 12 patients, with a 100% of survival rate. Mandibular defects included Brown class I in 6 cases, class II in 2 cases, and class III in 4 cases. A total of 42 implants were placed with successful osseointegration. The ISQ measured at 3 months post-placement was 64.10±4.18. At 6 months postoperatively, morphological analysis comparing the preoperative virtual surgical design with the actual postoperative reconstructed mandible revealed a reconstruction accuracy of 84.27%±4.23%. Significant differences were observed in Enneking scores and masticatory efficiency across all four time points (all P<0.001). Masticatory function showed significant improvement at T4 compared that at T2 [(88.06±3.66)% vs. (65.44±3.82)%, P<0.05]. Conclusion:Occlusal function-guided mandibular reconstruction with vascularized folded fibula flap after removal of benign mandibular tumors is a reliable method, which is associated with minimal donor-site morbidity and enables patients to restore precise occlusion and to achieve favorable masticatory efficiency.

Objective:To evaluate clinical outcomes of occlusion-guided vascularized folded fibula flap reconstruction with delayed implant restoration for mandibular defects after benign tumor resection.Methods:A total of 12 patients with benign mandibular tumors underwent free folded fibula flap reconstruction at the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2023, including 7 males and 5 females, aged 21-52 years. Six months after mandibular reconstruction, the internal fixation titanium plates were removed, and dental implants were placed using a preoperatively fabricated occlusal guide, followed by second-stage implant surgery and prosthetic restoration. Mandibular CT scans were obtained 6 months after reconstruction to compare the fitting accuracy between the preoperative virtual design and the actual reconstructed mandible. The implant stability quotient (ISQ) was measured 3 months after implant placement. Masticatory efficiency and Enneking lower limb function scores were evaluated at the following time points: before tumor surgery (T1), before implant placement (T2), 6 months (T3) and 9 months (T4) after implant crown restoration. One-way repeated measures ANOVA was used to analyze the masticatory efficiency and lower limb function scores.Results:The free folded fibula grafts were successfully performed via an intraoral approach in all 12 patients, with a 100% of survival rate. Mandibular defects included Brown class I in 6 cases, class II in 2 cases, and class III in 4 cases. A total of 42 implants were placed with successful osseointegration. The ISQ measured at 3 months post-placement was 64.10±4.18. At 6 months postoperatively, morphological analysis comparing the preoperative virtual surgical design with the actual postoperative reconstructed mandible revealed a reconstruction accuracy of 84.27%±4.23%. Significant differences were observed in Enneking scores and masticatory efficiency across all four time points (all P<0.001). Masticatory function showed significant improvement at T4 compared that at T2 [(88.06±3.66)% vs. (65.44±3.82)%, P<0.05]. Conclusion:Occlusal function-guided mandibular reconstruction with vascularized folded fibula flap after removal of benign mandibular tumors is a reliable method, which is associated with minimal donor-site morbidity and enables patients to restore precise occlusion and to achieve favorable masticatory efficiency.

Objective To explore the effects of bronchoalveolar lavage combined with microbiological rapid on-site evaluation in potential donor lung maintenance.Methods Brain death patients who met the inclusion criteria and were admitted to the Intensive Care Unit(ICU)of Calmette Hospital Affiliated to Kunming Medical University from September 2020 to December 2022 were selected for bronchoalveolar lavage(BAL)and(BAL)and the lavage fluid were collected for M-ROSE to compare the pathogen detection rate and initial diagnosis time.According to the positive results of the microbiological rapid on-site evaluation,patients with the brain death were treated with empirical anti-infective therapy,and the oxygenation index,chest X-ray score,and the infection index(WBC,CRP,PCT)of anti-infective treatment 48 hours were evaluated.Results 1.Comparison of the detection rate of pathogenic microorganisms:The results of M-ROSE were highly consistent with a routine microbiological smear(Kappa = 0.921,P<0.001).2.Comparison of diagnostic time:The initial diagnosis time of M-ROSE was significantly lower than routine microbiological smear time and microbial culture time(P<0.001).3.Comparison of therapeutic effects of anti-infective therapy for 48 hours:There was no significant difference in oxygenation index,white blood cells and hypersensitive C-reactive protein before and after the anti-infective treatment(P>0.05).There were significant differences in procalcitonin and chest X-ray before and after the anti-infective treatment(P<0.05).Conclusion Bronchoalveolar lavage combined with microbiological rapid on-site evaluation has the high timeliness in the diagnosis of potential donor pulmonary infection,which can provide a preliminary basis for the early anti-infective therapy of donor lung maintenance.

Objective:To explore the role of digital three-dimensional printing technology and multifunctional occlusal splint in the treatment of mandibular fracture in children.Methods:From January 2006 to January 2022, 42 children with mandibular fracture were treated by Department of Stomatology, in The First Affiliated Hospital of Bengbu Medical College, including 25 males and 17 females. The patients, aged from 4 to 12 years, with the median age was 10 years old, were divided into observation group (22 cases) and routine group (20 cases) according to the treatment methods. In the observation group, the multifunctional occlusal splint was made before operation, and the CT data of the children were imported into Mimics software in".dicom"format, and the displaced mandible was virtually reset. The jaw reduction model was made by three-dimensional printing, and the surgical operation was simulated on the reduction model to determine the model and position of the internal fixation device and shape it. During the operation, the fracture was reduced and fixed according to the preoperative design. The conventional group was treated with open reduction and internal fixation of mandibular fracture by traditional methods, and the clinical application value was compared and analyzed through the intraoperative situation, occlusal relationship, and follow-up of the two groups.Results:The total intraoperative bleeding volume [(30.25±4.02) ml] and surgical time [(64.3±9.2) min] in the observation group were significantly lower than those in the conventional group [(35.13±5.69) ml and (84.6±13.9) min, respectively] ( F=6.18, P=0.003; F=1.32, P=0.001). The excellent and good rate of occlusal relationship in the observation group [96% (21/22)] was significantly higher than that in the conventional group [85% (17/20)] ( F=4.27, P=0.039). The incidence of complications, the observation group, 1 case of poor occlusion, 1 case of postoperative infection; In the routine group, there were 3 cases with poor occlusion, 1 case with nerve injury, 1 case with root injury and 1 case with tooth germ injury. Conclusions:The application of digitization three-dimensional printing technology combined with multifunctional occlusal splint in children′s mandibular fracture is minimally invasive, safe, efficient and accurate, and the clinical effect is good.

Objective:To evaluate the clinical effect of free peroneal artery perforator flap (FPAPF) for reconstructing defects of total glossotomy and subtotal glossotomy.Method:A retrospective analysis of the clinical data of the patients with tongue cancer was performed. The patients were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2019. All the patients underwent total tongue and subtotal tongue resection and one-stage repair with FPAPF. The function of swallowing, speech and chewing were evaluated with the water swallow test, the speech intelligibility test and the screening and weighing method at 3 months, 6 months, and 12 months after the operation. Use t-test to analyze the data and P< 0.05 was considered statistically significant. Results:A total of 20 patients were selected, including 16 males and 4 females, aged 46 to 68 years, with an average of 54.1 years old. The area of the peroneal artery perforator flap was 6.0 cm×7.0 cm—6.5 cm×8.0 cm, and the length of the pedicle was 6.0 cm—7.0 cm. The overall survival rate of the flap was approximately 95.0%(19/20). The survival rates of 1, 2, and 3 years after operation were 95.0%, 73.7%, and 64.3%, and the tumor-free survival rates were 95.0%, 63.2%, and 57.1%. With the prolongation of postoperative time, the functions of swallowing, speech and chewing gradually improved, and there was a statistically significant difference in 6 months after operation compared with 3 months after operation ( P<0.05). Speech was improved 12 months after operation compared to 6 months after operation.The difference was statistically significant ( P<0.05). Conclusions:The research showed that the peroneal artery perforator exhibited a constant anatomic location, and its diameter and length were more suitable for the preparation of free perforator flaps. The posterolateral tissues of lower legs are abundant, which is beneficial for repairing full tongue and subtotal tongue defects. The recovery of functions such as swallowing, speech intelligibility and chewing was ideal.

Objective:To evaluate the clinical effect of free peroneal artery perforator flap (FPAPF) for reconstructing defects of total glossotomy and subtotal glossotomy.Method:A retrospective analysis of the clinical data of the patients with tongue cancer was performed. The patients were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2019. All the patients underwent total tongue and subtotal tongue resection and one-stage repair with FPAPF. The function of swallowing, speech and chewing were evaluated with the water swallow test, the speech intelligibility test and the screening and weighing method at 3 months, 6 months, and 12 months after the operation. Use t-test to analyze the data and P< 0.05 was considered statistically significant. Results:A total of 20 patients were selected, including 16 males and 4 females, aged 46 to 68 years, with an average of 54.1 years old. The area of the peroneal artery perforator flap was 6.0 cm×7.0 cm—6.5 cm×8.0 cm, and the length of the pedicle was 6.0 cm—7.0 cm. The overall survival rate of the flap was approximately 95.0%(19/20). The survival rates of 1, 2, and 3 years after operation were 95.0%, 73.7%, and 64.3%, and the tumor-free survival rates were 95.0%, 63.2%, and 57.1%. With the prolongation of postoperative time, the functions of swallowing, speech and chewing gradually improved, and there was a statistically significant difference in 6 months after operation compared with 3 months after operation ( P<0.05). Speech was improved 12 months after operation compared to 6 months after operation.The difference was statistically significant ( P<0.05). Conclusions:The research showed that the peroneal artery perforator exhibited a constant anatomic location, and its diameter and length were more suitable for the preparation of free perforator flaps. The posterolateral tissues of lower legs are abundant, which is beneficial for repairing full tongue and subtotal tongue defects. The recovery of functions such as swallowing, speech intelligibility and chewing was ideal.

OBJECTIVE: To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. METHODS: Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). RESULTS: All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation ( < 0.05). CONCLUSIONS The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.
Arteries ; Free Tissue Flaps ; Humans ; Oropharyngeal Neoplasms ; Perforator Flap ; Quality of Life ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries

Objective:To investigate the application effect of bilobed skin flap with peroneal artery perforation in repairing postoperative defects of tongue cancer and oral floor cancer.Methods:Six patients with oral squamous cell carcinoma (4 males and 2 females, aged 28-72 years) admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Benbu Medical College from May 2017 to December 2019 were repaired with the peroneal artery perforator bilobed flap, one lobe repaired the tongue, and the other repaired the floor of the mouth. The donor area is directly closed and sutured. Postoperative follow-up was conducted to observe tumor recurrence and metastasis, and the patient’s appearance, mouth opening, swallowing function, speech function and lower limb recovery were evaluated.Results:All the 6 flaps survived. One of the patients had a single flap because the pedicle of the perforator vessel was not long enough. The other 5 cases were repaired with bilobed leaf flap. All the flaps survived and the wound surface healed in the first stage. One case was infected with effusion after operation, which was healed by washing and dressing change. The donor area can be sutured directly. No tumor recurrence or metastasis occurred 6 months after surgery. Speech, swallowing and lower limb movement basically returned to normal, facial morphology was basically symmetrical, and the degree of opening Ⅱ-Ⅲ. Six months after the operation, 5 patients with bilobed valve returned to a nearly normal state with a degree of opening Ⅱ-Ⅲ. One patient with single lobe recovered moderately, but speech and swallowing were still restricted. In 6 cases, the donor scar was concealed and the lower limb was basically normal.Conclusions:The bilobed flap with peroneal artery perforation can be used to repair postoperative defects of tongue carcinoma and floor of mouth carcinoma.

Objective:To investigate the application effect of bilobed skin flap with peroneal artery perforation in repairing postoperative defects of tongue cancer and oral floor cancer.Methods:Six patients with oral squamous cell carcinoma (4 males and 2 females, aged 28-72 years) admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Benbu Medical College from May 2017 to December 2019 were repaired with the peroneal artery perforator bilobed flap, one lobe repaired the tongue, and the other repaired the floor of the mouth. The donor area is directly closed and sutured. Postoperative follow-up was conducted to observe tumor recurrence and metastasis, and the patient’s appearance, mouth opening, swallowing function, speech function and lower limb recovery were evaluated.Results:All the 6 flaps survived. One of the patients had a single flap because the pedicle of the perforator vessel was not long enough. The other 5 cases were repaired with bilobed leaf flap. All the flaps survived and the wound surface healed in the first stage. One case was infected with effusion after operation, which was healed by washing and dressing change. The donor area can be sutured directly. No tumor recurrence or metastasis occurred 6 months after surgery. Speech, swallowing and lower limb movement basically returned to normal, facial morphology was basically symmetrical, and the degree of opening Ⅱ-Ⅲ. Six months after the operation, 5 patients with bilobed valve returned to a nearly normal state with a degree of opening Ⅱ-Ⅲ. One patient with single lobe recovered moderately, but speech and swallowing were still restricted. In 6 cases, the donor scar was concealed and the lower limb was basically normal.Conclusions:The bilobed flap with peroneal artery perforation can be used to repair postoperative defects of tongue carcinoma and floor of mouth carcinoma.

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation.Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies,including 4 cases of buccal mucosa carcinoma,2 cases of maxilla osteosarcoma,1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma,were recruited from May,2016 to May,2018.The flap was used to repair the facial defect of recruited patients.The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm,respectively.The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate,the skin,subcutaneous tissue and mucosa of the cheek.The radiotherapy was performed 1.0-1.5 months after the operation.The prognosis including appearance,mouth opening,and the functions of deglutition,and language were assessed.Results Through 3-18 months outpatient followed-up,all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention.The patients were satisfied with the facial appearance,mouth opening,and the functions of deglutition and language at the 6 months follow-up.The radiotherapy had no damage on the survival of the bilobed perforator flap.There was no recurrence or metastasis in follow-up.Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel,abundant tissues,flexible design and operating methods.