In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective:To evaluate the clinical efficacy of a replay propeller distal perforator flap of the lateral circumflex femoral artery in reconstruction of the donor site defect left by the harvest of a free anterolateral thigh perforator flap (ALTPF).Methods:From June 2023 to June 2024, retrospective analysis of 11 patients with foot and ankle soft tissue defects were treated in the Department of Microsurgery, Sichuan Modern Hospital. The patients were 7 males and 4 females, aged 9-57 (average 28.6) years. Causes of injury were car accident (5 patients), machine crush (5 patients) and skin necrosis following a fall (1 patient). The size of soft tissue defects was 8.0 cm ×11.0 cm - 9.0 cm×14.5 cm. A reversed perforator island flap of distal descending branch of the lateral circumflex femoral artery was prepared to reconstruct the defect left at the donor site after the harvest of a free ALTPF. The ALTPFs were 8.5 cm × 11.5 cm to 9.5 cm × 15.5 cm in size, and the sizes of the perforator flap of descending branch of lateral circumflex femoral artery designed to reconstruct the donor site defects were at 5.0 cm × 9.0 cm to 6.0 cm × 12.0 cm. After the surgery, scheduled follow-ups were carried out at outpatient clinic and via telephone and WeChat reviews. Wound healing at recipient and donor sites, flap survival and functional recovery were observed.Results:All flaps survived smoothly after surgery, and the wounds in the donor and recipient sites healed primarily. No vascular compromise, wound dehiscence or significant swelling occurred. A total of 9 patients completed the 6-18 months postoperative follow-up, with an average of 11 months. Two patients lost in the follow-up. Only linear scars left in the donor sites, without significant impact on the thigh function. The colour and appearance of the flaps were natural.Conclusion:It is effective to use a distal replay flap of the descending branch of lateral circumflex femoral artery for reconstruction of the donor site defect left by the harvest of a free ALTPF.

Objective:To evaluate the clinical efficacy of free anterolateral thigh perforator flap (ALTPF) for reconstruction of soft tissue defects in lower extremity in elderly patient.Methods:From February 2018 to August 2024, 24 elderly patients (14 males, 10 females. Age range: 70-89 years, mean age: 73.47 years) with soft tissue defects in lower extremity were treated with free ALTPFs in the Department of Hand Microsurgery, Sichuan Modern Hospital. All patients had comorbidities including chronic pulmonary diseases (10 cases), anaemia in various severity (15 cases), atherosclerosis (9 cases), diabetes mellitus (6 cases), hypertension (5 cases) and great saphenous varicose veins (4 cases). Fourteen patients were admitted to hospital though emergency department due to trauma. Of these patients, 2 underwent emergency flap transfer surgery, 12 had temporary wound coverage with negative pressure wound therapy (NPWT) or bone cement, followed by flap surgery at 3-7 days later. Ten patients with chronic wounds were admitted through outpatient clinic and underwent flap surgery at approximately 7 days after multidisciplinary team consultation and completion of preoperative preparation. A total of 15 patients received blood transfusion: 3 before the surgery, 10 in the surgery and 2 after the surgery. Defect locations were: right calf and ankle (6 cases), right foot (5 cases), left calf and ankle (10 cases) and left foot (3 cases). Defect sizes ranged from 5.0 cm×7.0 cm to 9.0 cm×30.0 cm, with exposure of tendon, bone or internal fixation. The size of ALTPFs ranged from 6.0 cm×8.0 cm to 10.0 cm×40.0 cm. All artery of flaps was end-to-end anastomosed with the recipient artery, and the vein of flaps was anastomosed with the accompanying vein by recipient artery. Donor sites were either closed directly or reconstructed with skin grafts. All patients were included in postoperative follow-up via visit of outpatient clinic or WeChat for evaluation of flap and donor sites.Results:All 24 flaps survived. Two cases presented with venous occlusion after surgery and surgical exploration discovered: 1 patient had a long-segment venous thrombosis in the recipient vein and was treated with great saphenous vein transposition for re-anastomosis; the other had a deep haematoma compressing of the flap, which was removed surgically with haemostasis. Follow-up lasted for 3 to 24 months. All donor sites healed well without local tenderness, leaving only linear or skin graft scars. The flap survived well, without infection, ulceration or necrosis. All ankle function was preserved.Conclusion:Transfer of free ALTPF is a valuable technique for treatment of soft tissue defects in lower extremity in elderly patients. Despite higher risks, satisfactory outcome can be achieved with thorough preoperative evaluation and surgical intervention, especially when the condition of a patient is stable, an early ambulation for functional recovery should be started.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective:To evaluate the clinical efficacy of a replay propeller distal perforator flap of the lateral circumflex femoral artery in reconstruction of the donor site defect left by the harvest of a free anterolateral thigh perforator flap (ALTPF).Methods:From June 2023 to June 2024, retrospective analysis of 11 patients with foot and ankle soft tissue defects were treated in the Department of Microsurgery, Sichuan Modern Hospital. The patients were 7 males and 4 females, aged 9-57 (average 28.6) years. Causes of injury were car accident (5 patients), machine crush (5 patients) and skin necrosis following a fall (1 patient). The size of soft tissue defects was 8.0 cm ×11.0 cm - 9.0 cm×14.5 cm. A reversed perforator island flap of distal descending branch of the lateral circumflex femoral artery was prepared to reconstruct the defect left at the donor site after the harvest of a free ALTPF. The ALTPFs were 8.5 cm × 11.5 cm to 9.5 cm × 15.5 cm in size, and the sizes of the perforator flap of descending branch of lateral circumflex femoral artery designed to reconstruct the donor site defects were at 5.0 cm × 9.0 cm to 6.0 cm × 12.0 cm. After the surgery, scheduled follow-ups were carried out at outpatient clinic and via telephone and WeChat reviews. Wound healing at recipient and donor sites, flap survival and functional recovery were observed.Results:All flaps survived smoothly after surgery, and the wounds in the donor and recipient sites healed primarily. No vascular compromise, wound dehiscence or significant swelling occurred. A total of 9 patients completed the 6-18 months postoperative follow-up, with an average of 11 months. Two patients lost in the follow-up. Only linear scars left in the donor sites, without significant impact on the thigh function. The colour and appearance of the flaps were natural.Conclusion:It is effective to use a distal replay flap of the descending branch of lateral circumflex femoral artery for reconstruction of the donor site defect left by the harvest of a free ALTPF.

Objective:To evaluate the clinical efficacy of free anterolateral thigh perforator flap (ALTPF) for reconstruction of soft tissue defects in lower extremity in elderly patient.Methods:From February 2018 to August 2024, 24 elderly patients (14 males, 10 females. Age range: 70-89 years, mean age: 73.47 years) with soft tissue defects in lower extremity were treated with free ALTPFs in the Department of Hand Microsurgery, Sichuan Modern Hospital. All patients had comorbidities including chronic pulmonary diseases (10 cases), anaemia in various severity (15 cases), atherosclerosis (9 cases), diabetes mellitus (6 cases), hypertension (5 cases) and great saphenous varicose veins (4 cases). Fourteen patients were admitted to hospital though emergency department due to trauma. Of these patients, 2 underwent emergency flap transfer surgery, 12 had temporary wound coverage with negative pressure wound therapy (NPWT) or bone cement, followed by flap surgery at 3-7 days later. Ten patients with chronic wounds were admitted through outpatient clinic and underwent flap surgery at approximately 7 days after multidisciplinary team consultation and completion of preoperative preparation. A total of 15 patients received blood transfusion: 3 before the surgery, 10 in the surgery and 2 after the surgery. Defect locations were: right calf and ankle (6 cases), right foot (5 cases), left calf and ankle (10 cases) and left foot (3 cases). Defect sizes ranged from 5.0 cm×7.0 cm to 9.0 cm×30.0 cm, with exposure of tendon, bone or internal fixation. The size of ALTPFs ranged from 6.0 cm×8.0 cm to 10.0 cm×40.0 cm. All artery of flaps was end-to-end anastomosed with the recipient artery, and the vein of flaps was anastomosed with the accompanying vein by recipient artery. Donor sites were either closed directly or reconstructed with skin grafts. All patients were included in postoperative follow-up via visit of outpatient clinic or WeChat for evaluation of flap and donor sites.Results:All 24 flaps survived. Two cases presented with venous occlusion after surgery and surgical exploration discovered: 1 patient had a long-segment venous thrombosis in the recipient vein and was treated with great saphenous vein transposition for re-anastomosis; the other had a deep haematoma compressing of the flap, which was removed surgically with haemostasis. Follow-up lasted for 3 to 24 months. All donor sites healed well without local tenderness, leaving only linear or skin graft scars. The flap survived well, without infection, ulceration or necrosis. All ankle function was preserved.Conclusion:Transfer of free ALTPF is a valuable technique for treatment of soft tissue defects in lower extremity in elderly patients. Despite higher risks, satisfactory outcome can be achieved with thorough preoperative evaluation and surgical intervention, especially when the condition of a patient is stable, an early ambulation for functional recovery should be started.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

Objective:To investigate the feasibility, clinical efficacy and donor site impact of the deep inferior epigastric artery perforator flap (DIEPF) with transverse symmetrical design in reconstruction of soft tissue defects in limbs.Methods:From September 2020 to August 2023, 12 patients with soft tissue defects of limbs who agreed to flap donor site in the lower abdominal wall were treated in the Department of Hand Surgery and Microsurgery, Sichuan Modern Hospital. There were 10 females and 2 males with an average age of 58.42 years old. Defect sites: 3 in upper limbs and 9 in lower limbs. Sizes of the soft tissue defect were 8.0 cm×15.0 cm-13.0 cm×40.0 cm. CTA or CDU was used to detect the perforators of deep inferior epigastric artery and appropriate perforators were selected. The width and length of redundant skin and subcutaneous tissues in the lower abdomen were evaluated according to the "pinch and lift test". Taking into account the requirements of abdominoplasty, symmetrical bilateral DIEPFs were designed in the transverse direction on the lower abdominal wall. The sizes of the flaps were 7.5 cm×24.0 cm-13.0 cm ×42.0 cm. The harvested flaps were firstly thinned under the microscope, trimmed and shaped properly to match the profile of the wounds. Blood circulation was reconstructed with various forms of vascular anastomoses, such as internal pressurisation, connection in series and Flow-through, etc. Lower abdominal wall wound should be gradually reduced in tension according to the requirements of abdominal wall plastic surgery, and cosmetic suturing should be performed.Results:All 12 DIEPFs survived. The lower abdominal donor site healed primarily. All patients were included in postoperative follow-up for 6 to 42 (average 18.31) months. All flaps were normal in colour and soft in texture. The appearance of abdominal walls were improved, and the function was not affected, except 1 patient who underwent debulking procedure 3 months after the surgery.Conclusion:The transverse symmetrical design of a DIEPF is an ideal method for reconstruction of soft tissue defects in limbs after appropriate flap modification. It is a win-win solution for an aesthetic appearance of donor and recipient sites of the flap.

Objective·To explore the correlation between the quantitative results of autofluorescence imaging under computer assistance and the grade of epithelial dysplasia in oral leukoplakia.Methods·From April 2016 to January 2024,357 patients with oral leukoplakia who visited the Department of Oral Mucosal Diseases at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,were included.Autofluorescence images of the lesions were obtained using a handheld autofluorescence device.These images were converted to grayscale images to obtain quantitative metrics.An ordered multinomial Logistic regression model was fitted in Python,and cumulative probability plots were generated.The dataset was divided into training and testing sets,and a decision tree was generated.Different hyperparameters were adjusted to achieve optimal model performance.Accuracy,precision,and F1 scores were calculated.The model performance was visualized using a confusion matrix.Results·As the degree of epithelial dysplasia increased,the relative mean color level showed a declining trend.In the binary classification of epithelial dysplasia,there was no overlap between the cumulative probability curves of different categories.In the four-category classification,only severe epithelial dysplasia overlapped with other category curves,indicating good discriminative ability of the model.In binary pathological grading,when the training and testing set ratio was 4∶1 and the maximum depth was 2,the accuracy,precision,and F1 scores were 0.792,0.801,and 0.795,respectively.In the four-category pathological grading,when the training and testing set ratio was 9∶1 and the maximum depth was 4,the accuracy,precision,and F1 scores were 0.611,0.537,and 0.569,respectively.Conclusion·Computer-assisted quantitative analysis of autofluorescence images can be used by oral mucosal specialists as a reference to predict the degree of epithelial dysplasia in patients with oral leukoplakia and to monitor their risk of cancer.