Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:To investigate the incidence, prevalence and disease characteristics of Crohn′s disease (CD) in Zhangjiagang city.Methods:A cross-sectional study was conducted. During the period of January 1st to December 31st, 2017, through a voluntary consultation and the medical records retrieval of 5 hospitals in Zhangjiagang city (the First People′s Hospital of Zhangjiagang, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang Aoyang Hospital, Zhangjiagang Jinfeng People′s Hospital and Zhangjiagang Leyu Hospital) , the patients who were the registered residents of Zhangjiagang city and diagnosed as CD were collected and included in the study. The general clinical data and epidemiological data were collected by the questionnaire. The age-standardized prevalence and incidence of CD in Zhangjiagang city in 2017 was calculated. The clinical characteristics were described. The single factor analysis and multivariate Logistic regression analysis were performed to identify the independent influencing factors for delayed diagnosis.Results:A total of 123 CD patients were included and 14 patients were newly diagnosed in 2017. The age-standardized prevalence of CD was 12.08 per 100 000 persons in this city in 2017 and the age-standardized incidence was 1.54 per 100 000 persons. There were 73 male patients and 50 female patients, the ratio of male to female was 1.46∶1. The age at diagnosis was 39 (27, 51) years old. The peak ages of diagnosis were 20 to 29 years old and 40 to 49 years old and there were 27 (21.95%) and 25 (20.33%) patients in the two ages respectively. The duration was 45 (24, 82) months. The disease involved the terminal ileum in 72 patients (58.5%) including 2 (1.6%) in the upper gastrointestinal tract simultaneously, the colon in 28 (22.8%) and the ileocolon in 23 (18.7%) . The non-stricturing non-penetrating type of disease was observed in 71 patients (57.7%) , stricturing type in 42 patients (34.1%) , penetrating type in 10 patients (8.1%) . Twenty-three patients (18.7%) had simultaneous perianal disease. 5-aminosalicylic acid was used in 96 patients (78.0%) and nutritional support therapy was used in 64 patients (52.0%) . Delayed diagnosis occurred in 63 patients (51.2%) , the delayed diagnosis time was 8 (2, 36) months. Multivariate analysis showed that simultaneous perianal disease ( OR = 4.081, 95% CI: 1.159-14.367, P = 0.029) was the independent risk factor of delayed diagnosis, and urban resident ( OR = 0.169, 95% CI: 0.073-0.393, P<0.001) was the independent protection factor. Conclusions:The prevalence and incidence of CD in Zhangjiagang city are relatively high. There are more male CD patients and the distribution of age at diagnosis is bimodal. The terminal ileum is the most common site and non-stricturing non-penetrating type is most common in the city. 5-aminosalicylic acid and nutritional support therapy are the most common treatments. Over a half of the patients present delayed diagnosis. The patients with simultaneous perianal disease have higher risk of delayed diagnosis, while the urban patients have lower risk of delayed diagnosis.

Objective:To investigate the incidence, prevalence and disease characteristics of Crohn′s disease (CD) in Zhangjiagang city.Methods:A cross-sectional study was conducted. During the period of January 1st to December 31st, 2017, through a voluntary consultation and the medical records retrieval of 5 hospitals in Zhangjiagang city (the First People′s Hospital of Zhangjiagang, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang Aoyang Hospital, Zhangjiagang Jinfeng People′s Hospital and Zhangjiagang Leyu Hospital) , the patients who were the registered residents of Zhangjiagang city and diagnosed as CD were collected and included in the study. The general clinical data and epidemiological data were collected by the questionnaire. The age-standardized prevalence and incidence of CD in Zhangjiagang city in 2017 was calculated. The clinical characteristics were described. The single factor analysis and multivariate Logistic regression analysis were performed to identify the independent influencing factors for delayed diagnosis.Results:A total of 123 CD patients were included and 14 patients were newly diagnosed in 2017. The age-standardized prevalence of CD was 12.08 per 100 000 persons in this city in 2017 and the age-standardized incidence was 1.54 per 100 000 persons. There were 73 male patients and 50 female patients, the ratio of male to female was 1.46∶1. The age at diagnosis was 39 (27, 51) years old. The peak ages of diagnosis were 20 to 29 years old and 40 to 49 years old and there were 27 (21.95%) and 25 (20.33%) patients in the two ages respectively. The duration was 45 (24, 82) months. The disease involved the terminal ileum in 72 patients (58.5%) including 2 (1.6%) in the upper gastrointestinal tract simultaneously, the colon in 28 (22.8%) and the ileocolon in 23 (18.7%) . The non-stricturing non-penetrating type of disease was observed in 71 patients (57.7%) , stricturing type in 42 patients (34.1%) , penetrating type in 10 patients (8.1%) . Twenty-three patients (18.7%) had simultaneous perianal disease. 5-aminosalicylic acid was used in 96 patients (78.0%) and nutritional support therapy was used in 64 patients (52.0%) . Delayed diagnosis occurred in 63 patients (51.2%) , the delayed diagnosis time was 8 (2, 36) months. Multivariate analysis showed that simultaneous perianal disease ( OR = 4.081, 95% CI: 1.159-14.367, P = 0.029) was the independent risk factor of delayed diagnosis, and urban resident ( OR = 0.169, 95% CI: 0.073-0.393, P<0.001) was the independent protection factor. Conclusions:The prevalence and incidence of CD in Zhangjiagang city are relatively high. There are more male CD patients and the distribution of age at diagnosis is bimodal. The terminal ileum is the most common site and non-stricturing non-penetrating type is most common in the city. 5-aminosalicylic acid and nutritional support therapy are the most common treatments. Over a half of the patients present delayed diagnosis. The patients with simultaneous perianal disease have higher risk of delayed diagnosis, while the urban patients have lower risk of delayed diagnosis.

Objective:To investigate the diagnosis and treatment for intra-abdominal fistula in China, and to explore the prognostic factors.Methods:A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of patients with intra-abdominal fistula from 18 medical centers from January 1, 2018 to December 31, 2018, including basic information, medical records and prognosis.Results:A total of 106 patients were enrolled in this study, including 57 males and 49 females, with an average age of (48.0±17.8)years. The most common type of intra-abdominal fistula was entero-vesical fistula (34.0%), followed by entero-vaginal fistula (31.1%), entero-enteric fistula (26.4%) and multiple fistula (8.5%). The direct causes of intra-abdominal fistula were mainly surgical operation (66.0%), followed by spontaneous fistula due to Crohn′s disease (18.9%), radiation intestinal injury (11.3%), and 4 cases (3.8%) of unknown reasons. During the whole treatment, 95 patients received nutritional support therapy, mainly EN+ PN (75.8%). Finally, 86 patients (81.1%) received surgical treatment, with a healing rate of 95.3%. After surgery, 8.1% of patients developed surgical site infections (SSI), and 10.5% had a relapse of fistula. 20 patients (18.9%) were treated conservatively, with a self-healing rate of 80.0%. The overall mortality rate was 8.5%, and the highest mortality (15.2%) was found in entero-enteric fistula. Statistical analysis showed that the age ( t=-4.664, P<0.001), leucocyte level ( U=663.000, P=0.010), sepsis ( P=0.002) and multiple organ dysfunction syndrome (MODS) ( P=0.019) were higher in the death group than those in the healing group. Multivariate analysis suggested that advanced age ( OR=1.073, 95% CI: 1.008-1.141, P=0.026) and complications of sepsis ( OR=11.806, 95% CI: 1.064-131.048, P=0.044) were independent risk factors of the death for patients with intra-abdominal fistula. Conclusions:The overall mortality rate of intra-abdominal fistula is still high, and malignant tumor is the most common primary disease. Advanced age and sepsis are independent risk factors for death in patients with intra-abdominal fistula.

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ²=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ²=5.460, P=0.019), multiple ECF (χ²=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ²=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ²=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ²=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ²=179.699, P<0.001), sepsis (χ²=211.851, P<0.001), hemorrhage (χ²=85.300, P<0.001), pulmonary infection (χ²=60.096, P<0.001), catheter-associated infection (χ²=10.617, P=0.001) and malnutrition (χ²=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.