1.Effectiveness of innervated medial plantar flap for reconstruction of soft tissue defects following foot tumor resection.
Wenchao ZHANG ; Luqi GUO ; Yan HAO ; Liangya WANG ; Chao ZHANG ; Yun WANG ; Jiuzuo HUANG ; Ang ZENG ; Xiao LONG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(9):1086-1090
OBJECTIVE:
To evaluate the effectiveness of the innervated medial plantar flap for reconstructing soft tissue defects, particularly in the weight-bearing zone, after resection of foot tumors.
METHODS:
A retrospective analysis was conducted on 12 patients with malignant skin and soft tissue tumors of the foot treated between October 2023 and December 2024. The cohort included 8 males and 4 females, aged 42-67 years (mean, 57.5 years). Tumor types comprised malignant melanoma (5 cases), squamous cell carcinoma (4 cases), arsenical keratosis (2 cases), and tumor-induced osteomalacia (1 case). Soft tissue defects located in the heel weight-bearing region in 10 cases and non-weight-bearing ankle region in 2 cases, with defect sizes ranging from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. Preoperative photon-counting CT angiography (PC-CTA) was performed to assess the medial plantar artery and its perforators. All patients underwent radical tumor resection with confirmed negative margins. The resulting defects were reconstructed using a innervated medial plantar flap incorporating sensory branches of the medial plantar nerve. The flap donor site was covered with a split-thickness skin graft harvested from the ipsilateral inguinal region.
RESULTS:
The operation was successfully completed in all 12 patients. All flaps survived completely without vascular compromise, partial necrosis, or total loss. Incisions healed primarily without dehiscence or infection. Minor skin graft necrosis occurred at the donor site in 3 patients, which healed within 2-3 weeks with routine dressing changes. No donor site complication (e.g., tendon or nerve injury) occurred. Patients were followed up 2-16 months (mean, 10.3 months). At last follow-up, there was no tumor recurrence. Flaps exhibited good color and texture match with surrounding tissue, restored sensation, and all feet achieved normal weight-bearing activity.
CONCLUSION
The innervated medial plantar flap, precisely designed based on PC-CTA localization, provides reliable blood supply and effective sensory restoration. It is an ideal method for reconstructing soft tissue defects after foot tumor resection, especially in the heel weight-bearing region.
Humans
;
Male
;
Middle Aged
;
Female
;
Plastic Surgery Procedures/methods*
;
Adult
;
Aged
;
Retrospective Studies
;
Soft Tissue Neoplasms/surgery*
;
Surgical Flaps/blood supply*
;
Foot/surgery*
;
Skin Neoplasms/surgery*
;
Soft Tissue Injuries/surgery*
;
Carcinoma, Squamous Cell/surgery*
;
Treatment Outcome
;
Skin Transplantation/methods*
;
Melanoma/surgery*
2.Single-stage treatment of upper limb lymphedema following breast cancer surgery using superficial circumflex iliac artery perforator-based vascularized lymph node transfer combined with lymphaticovenular anastomosis and liposuction.
Zongcan CHEN ; Junzhe CHEN ; Yuanyuan WANG ; Lingli JIANG ; Xiangkui WU ; Hai LI ; Shune XIAO ; Chengliang DENG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(9):1114-1121
OBJECTIVE:
To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery.
METHODS:
A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability.
RESULTS:
Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05).
CONCLUSION
The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans
;
Female
;
Lipectomy/methods*
;
Retrospective Studies
;
Anastomosis, Surgical/methods*
;
Lymphedema/etiology*
;
Middle Aged
;
Upper Extremity/surgery*
;
Breast Neoplasms/surgery*
;
Lymph Nodes/blood supply*
;
Adult
;
Lymphatic Vessels/surgery*
;
Iliac Artery/surgery*
;
Postoperative Complications/surgery*
;
Perforator Flap/blood supply*
;
Treatment Outcome
;
Mastectomy/adverse effects*
;
Quality of Life
;
Aged
3.Clinical study on repair of oral and perioral tissue defects with facial artery perforator myomucosal flap in 8 cases.
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(9):1137-1142
OBJECTIVE:
To explore the technical key points and effectiveness of the facial artery perforator myomucosal flap (FAPMF) in repairing oral and perioral tissue defects.
METHODS:
Between June 2023 and December 2024, 8 patients with oral and perioral tissue defects were repaired with the FAPMF. There were 4 males and 4 females, with an average age of 57.6 years (range, 45-72 years). Among them, 4 cases had floor-of-mouth defects and 3 cases had buccal mucosa defects remaining after squamous cell carcinoma resection, and 1 case had lower lip defect caused by trauma. The size of tissue defects ranged from 4.5 cm×3.0 cm to 6.0 cm×5.0 cm. The preoperative mouth opening was (39.55±1.88) mm, and the preoperative swallowing score of the University of Washington Quality of Life Questionnaire (UW-QOL) was 64.64±8.47. Preoperatively, CT angiography and Doppler ultrasound were used to locate the perforator vessels. A myomucosal flap pedicled with the perioral perforators of the facial artery was designed, with the harvesting size ranging from 4.0 cm×2.5 cm to 6.5 cm×4.0 cm. The length of the vascular pedicle was 4.2-6.8 cm (mean, 5.2 cm). Postoperatively, FAPMF survival, complications, and functional recovery were observed.
RESULTS:
All 8 surgeries were successfully completed without conversion to other repair methods or complications such as facial nerve injury. The total operation time ranged from 110 to 180 minutes, with an average of 142.5 minutes; among this, the harvesting time of the FAPMF ranged from 35 to 65 minutes, with an average of 48.7 minutes. The intraoperative blood loss was 50-150 mL, with an average of 85.6 mL. All FAPMFs survived completely. One patient developed venous reflux disorder at 24 hours after operation, which relieved after conservative treatment. All patients were followed up 7-16 months (mean, 12.4 months). All FAPMFs achieved complete epithelialization at 3 months after operation, showing a similar soft texture to the surrounding mucosa. At 7 months after operation, the mouth opening was (39.11±1.79) mm, slightly lower than preoperative level, but the difference was not significant (P>0.05). The swallowing score of the UW-QOL was 63.78±8.31, which was significantly lower than preoperative score (P<0.05). The visual analogue scale (VAS) score for patient satisfaction was 7-10, with an average of 8.9.
CONCLUSION
The FAPMF has advantages such as reliable blood supply, high mucosal matching degree, and concealed donor site, making it an ideal option for repairing small and medium-sized oral and perioral tissue defects.
Humans
;
Male
;
Middle Aged
;
Female
;
Perforator Flap/blood supply*
;
Aged
;
Plastic Surgery Procedures/methods*
;
Mouth Neoplasms/surgery*
;
Mouth Mucosa/surgery*
;
Mouth/surgery*
;
Quality of Life
;
Face/surgery*
;
Treatment Outcome
;
Carcinoma, Squamous Cell/surgery*
;
Arteries/surgery*
4.Clinical observation of free rectus femoris flap for repair of surgical defect in pharyngo-laryngeal malignant tumor.
Wen LI ; Zhe CHEN ; Jiayan WANG ; Xiaojiao LAN ; Zila PURA ; Xiaoxing XIONG ; Liu YANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1452-1458
OBJECTIVE:
To explore the feasibility and effectiveness of repairing surgical defect in pharyngo-laryngeal malignant tumor with free rectus femoris flap.
METHODS:
The clinical data of 34 patients with surgical defects in pharyngo-laryngeal malignant tumor who met the selection criteria between July 2014 and August 2024 were retrospectively analyzed. There were 25 males and 9 females, aged 25-82 years, with a median age of 54 years. The disease duration ranged from 2 months to 2 years, with a median of 7 months. The tumor locations included the oropharynx, hypopharynx, cervical esophagus, and larynx. Pathological types included squamous cell carcinoma (29 cases), myoepithelial carcinoma (2 cases), adenoid cystic carcinoma (1 case), and diffuse large B-cell lymphoma (2 cases). TNM staging: 16 cases of T 4N 1M 0, 3 cases of T 4N 2M 0, 3 cases of T 4N 0M 0, 10 cases of T 3N 1M 0, and 2 cases of T 3N 0M 0. The 2017 American Joint Committee on Cancer (AJCC) staging was stage Ⅲ in 2 cases and stage Ⅳ in 32 cases. The blood supply of the proximal rectus femoris muscle was observed by enhanced CT of the lower limb vessels before operation, and the surgical defects ranged from 3.0 cm×2.0 cm to 12.0 cm×8.5 cm. The blood supply and perforators of rectus femoris muscle were explored during operation, and the free rectus femoris flap pedicled with the direct vascular stem of rectus femoris muscle was used to repair the defect. For the patients with pharyngeal fistula or obvious neck swelling after operation, the blood supply of the flap was analyzed by vascular enhanced CT to determine the corresponding strategies of nutritional support, anti-infection, dressing change and drainage. Radiotherapy and chemotherapy were supplemented in 27 patients with lymph node metastasis after operation.
RESULTS:
All the 34 patients were followed up 1-10 years, with an average of 3 years. The flap was found to be necrotic by fibrolaryngoscopy at 1 week after operation in 2 cases, and the incision healed after dressing change and nutritional support, and no reoperation was performed. The flap was in good condition at 1 week after operation in 4 cases, and the signs of gradual necrosis of the flap were found within 1 month after operation, of which 2 cases were healed after dressing change, 1 case was removed the necrotic tissue by reoperation, and 1 case was healed after pectoralis major myocutaneous flap was used to repair the pharyngeal tissue defect. The flaps survived in 28 cases, including 4 cases of pharyngeal fistula, which healed by dressing change. Twenty-two cases achieved satisfactory results in swallowing or phonation. Two patients with total laryngectomy and voice reconstruction underwent reoperation to seal the voice tube because of postoperative aspiration. During the follow-up, 1 case had tracheal stomal recurrence, 2 cases had bone metastasis, and 1 case had bone and lung metastasis.
CONCLUSION
The free rectus femoris flap has good flexibility, the volume of the flap is easy to adjust, and the incision of the donor site is concealed, which is expected to become a new choice for the repair of the surgical defect in pharyngo-laryngeal malignant tumor.
Humans
;
Male
;
Middle Aged
;
Female
;
Aged
;
Adult
;
Plastic Surgery Procedures/methods*
;
Retrospective Studies
;
Laryngeal Neoplasms/pathology*
;
Aged, 80 and over
;
Pharyngeal Neoplasms/pathology*
;
Free Tissue Flaps/blood supply*
;
Quadriceps Muscle/transplantation*
;
Surgical Wound/surgery*
;
Treatment Outcome
5.The clinical outcomes of using superficial circumflex iliac artery perforator flap and radial forearm free flap for reconstructing oral and maxillofacial soft tissue defects.
Changquan WANG ; Tianbin HUANG ; Shanbin GUAN ; Guangru HUANG ; Xiaoyuan CHENG ; Liushan LU
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2025;39(6):534-541
Objective:To compare the clinical outcomes of reconstruction of oral and maxillofacial soft tissue defects using superficial circumflex iliac artery perforator flap (SCIA PF) and radial forearm free flap (RFF). Methods:A retrospective analysis was conducted on 90 patients with head, neck, and maxillofacial tumors who were treated in our department from June 2019 to January 2024. Patients were divided into two groups based on the surgical method used: the SCIA group(n=45), who underwent reconstruction with SCIA PF, and the RFF group(n=45), who received RFF reconstruction. Six months postoperatively, clinical efficacy was evaluated by comparing flap swelling, flap survival rate, and patient satisfaction. Oral function was assessed using standardized scoring systems before surgery, at 1 week, 3 months, and 6 months post-surgery. Hemorheological parameters, including high-shear viscosity(shear rate 200/s), low-shear viscosity(shear rate 30/s), plasma viscosity, erythrocyte aggregation index, and erythrocyte sedimentation rate(ESR), were also measured at each time point. Results:Compared with the RFF group, the SCIA group showed significantly larger flap size, longer flap harvesting and reconstruction times, earlier nasogastric tube removal and oral intake initiation, higher scores in all aspects of oral function, reduced flap edema and faster resolution, higher flap survival rates, and greater overall satisfaction (all P<0.05). During the follow-up period (preoperative, 1 week, 3 months, and 6 months post-surgery), hemorheological indices including high-and low-shear viscosity, plasma viscosity, erythrocyte aggregation index, and ESR progressively decreased in the SCIA group (P<0.05). In the RFF group, these parameters improved significantly by 6 months postoperatively compared with preoperatively and 1-week postoperatively, with a notable decrease in erythrocyte aggregation index at 6 months (P<0.05). Conclusion:Compared with RFF, SCIA PF provides larger flaps, better functional recovery, higher patient satisfaction, improved flap survival, fewer complications, and more favorable hemorheological profiles following reconstructive surgery for oral and maxillofacial defects.
Humans
;
Perforator Flap/blood supply*
;
Plastic Surgery Procedures/methods*
;
Retrospective Studies
;
Free Tissue Flaps
;
Iliac Artery/transplantation*
;
Forearm/surgery*
;
Male
;
Female
;
Soft Tissue Injuries/surgery*
;
Head and Neck Neoplasms/surgery*
;
Middle Aged
;
Treatment Outcome
;
Adult
6.3D visualization-based classification of left intrahepatic vessels and its application in precision hepatectomy.
Jun ZHENG ; Zhihua WANG ; Xiaojun HU ; Xiang HE ; Yingfang FAN
Journal of Southern Medical University 2025;45(5):1047-1055
OBJECTIVES:
To establish a three-dimensional (3D) visualization-based classification of the left hepatic portal vein (LHPV) and left hepatic vein (LHV) systems using 3D reconstruction technology to facilitate precise segmental/subsegmental resection of left liver lesions.
METHODS:
Thin-slice contrast-enhanced CT datasets from 244 patients were reconstructed using MI-3DV Works software. The spatial anatomy (origins, branching patterns, and spatial relationships) of the LHPV and LHV branches was analyzed to determine their 3D classifications and segmental liver divisions for guiding surgical planning for anatomical left liver resections.
RESULTS:
The 3D models of the third- and fourth-order branches of the LHPV and LHV were successfully reconstructed for all the 244 patients. Two types of the LHPV system were identified, where the LHPV either had independent origins [242 cases (99.1%)] or had right anterior portal branches arising from the LHPV trunk [2 cases (0.9%)]. 3D classifications identified two types of the Segment II of the LHPV (based on branch number), 3 types of the Segment III (by spatial distribution of the branches), compact vs dispersed types of the left lateral lobe (determined by Segment II/III branches proximity), 3 types of the Segment IV (by branch number and origin), and 3 types the fourth hilar vessels (transverse branches of the left portal vein) for their supplied segments. The LHV system had two drainage types into the inferior vena cava, and the umbilical fissure veins were classified into 3 types by drainage patterns and distance to the venous roots. These classifications combined with liver segmentations allowed individualized surgical planning for segment-specific resections.
CONCLUSIONS
The 3D classification of the LHPV and LHV provides valuable clinical guidance for precise anatomical resections of left liver lesions using liver segments or subsegments as anatomical units to enhance surgical accuracy and improve the outcomes of hepatobiliary surgery.
Humans
;
Hepatectomy/methods*
;
Imaging, Three-Dimensional
;
Hepatic Veins/anatomy & histology*
;
Portal Vein/anatomy & histology*
;
Liver/surgery*
;
Liver Neoplasms/blood supply*
;
Tomography, X-Ray Computed
;
Female
7.Effect of transcutaneous electrical acupoint stimulation on postoperative pain in patients undergoing modified radical mastectomy for breast cancer.
Li YAN ; Bin SUN ; Meiyan ZHOU ; Yan ZHANG ; Fei GAO ; Qianwen ZHAO ; Liwei WANG
Chinese Acupuncture & Moxibustion 2025;45(2):162-166
OBJECTIVE:
To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer.
METHODS:
A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups.
RESULTS:
In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05).
CONCLUSION
TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.
Humans
;
Female
;
Acupuncture Points
;
Pain, Postoperative/blood*
;
Middle Aged
;
Breast Neoplasms/surgery*
;
Adult
;
Transcutaneous Electric Nerve Stimulation
;
Mastectomy, Modified Radical/adverse effects*
;
Interleukin-6/blood*
;
Tumor Necrosis Factor-alpha/blood*
;
Interleukin-10/blood*
;
Aged
8.Comparative study of orthopaedic robot-assisted minimally invasive surgery and open surgery for limb osteoid osteoma.
Junwei FENG ; Weimin LIANG ; Yue WANG ; Zhi TANG ; MuFuSha A ; Baoxiu XU ; Niezhenghao HE ; Peng HAO
Chinese Journal of Reparative and Reconstructive Surgery 2024;38(1):40-45
OBJECTIVE:
To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma.
METHODS:
A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively.
RESULTS:
Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05).
CONCLUSION
Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.
Humans
;
Robotics
;
Osteoma, Osteoid/surgery*
;
Orthopedics
;
Blood Loss, Surgical
;
Retrospective Studies
;
Neoplasm Recurrence, Local
;
Minimally Invasive Surgical Procedures
;
Bone Neoplasms/surgery*
;
Analgesics
;
Treatment Outcome
9.Application of poly ether ether ketone localization marker combined with mixed reality technology in vessel localization of anterolateral thigh perforator flap.
Qing XU ; Shuangjiang WU ; Jian WU ; Lian ZHOU ; Zhenhua LI ; Yungang HE ; Yixiu LIU
Chinese Journal of Reparative and Reconstructive Surgery 2024;38(12):1499-1504
OBJECTIVE:
To compare the effectiveness of poly ether ether ketone (PEEK) localization marker combined with mixed reality technology versus color doppler ultrasound guidance for the vessel localization of anterolateral thigh perforator flap.
METHODS:
A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group [using PEEK localization marker combined with mixed reality technology based on CT angiography (CTA) data] and color ultrasound group (using color ultrasound guidance), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration between the two groups ( P>0.05). The number of perforator vessels identified in the two groups of regions of interest was recorded, and compared them with the intraoperative actually detected number to calculate the success identifying rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded.
RESULTS:
In the PEEK group, 32 perforator vessels were identified, 34 were detected by intraoperative exploration, and the success identifying rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were detected by intraoperative exploration, and the success identifying rate was 87.8% (29/33); there was a significant difference in the success identifying rate between the two groups ( P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group ( P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in follow-up time between the two groups ( P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect.
CONCLUSION
Compared with the traditional color ultrasound guidance, the PEEK localization marker combined with mixed reality technology based on CTA data in vessel localization of anterolateral thigh perforator flap has higher success identifying rate and positioning accuracy, and the flap production time is shorter, which has high clinical application value.
Humans
;
Ketones
;
Perforator Flap/blood supply*
;
Benzophenones
;
Polymers
;
Male
;
Thigh/blood supply*
;
Polyethylene Glycols
;
Female
;
Ultrasonography, Doppler, Color
;
Computed Tomography Angiography
;
Plastic Surgery Procedures/methods*
;
Mouth Neoplasms/surgery*
;
Middle Aged
10.Central precocious puberty should be taken seriously in children with Leydig cell tumors of the testis after surgical treatment: a tertiary center experience.
Pei LIU ; Zong-Han LI ; Hong-Cheng SONG ; Chun-Xiu GONG ; Wei-Ping ZHANG
Asian Journal of Andrology 2024;26(6):617-621
Central precocious puberty secondary to Leydig cell tumors is rare in children. We retrospectively analyzed the mid- to long-term follow-up data of patients with Leydig cell tumors. The clinical data of 12 consecutive patients who were treated at Beijing Children's Hospital, Capital Medical University (Beijing, China), between January 2016 and October 2023 were retrospectively reviewed. Clinical evaluations, including physical examination, hormone examination, serum tumor marker analysis, abdominal and scrotal ultrasound, chest X-ray, and bone age measurement, were conducted before surgery and at follow-up time points. Surgical approaches were selected according to the individual conditions. Patients with an abnormal hormonal status and suspected of having central precocious puberty were referred to endocrinologists to confirm the diagnosis. Subsequently, gonadotropin-releasing hormone analog therapy was proposed. The mean patient age was 81.3 (range: 40-140) months at the time of the operation. Ten patients had peripheral precocious puberty at admission. All patients had elevated preoperative testosterone levels, whereas tumor marker levels were normal. Testis-sparing surgery was performed in eleven patients, and radical orchiectomy was performed in one patient. The follow-up duration (mean ± standard deviation) was 36.2 ± 25.3 months. Five patients had central precocious puberty, with a mean duration of 3.4 (range: 1-6) months postoperatively. Three patients were receiving gonadotropin-releasing hormone analog therapy, and good suppression of puberty was observed. No risk factors were found for secondary central precocious puberty. There was a high prevalence of central precocious puberty secondary to Leydig cell tumors in our study. Gonadotropin-releasing hormone analog therapy has satisfactory treatment effects. Larger sample sizes and long-term follow-up are needed in future studies.
Humans
;
Male
;
Puberty, Precocious/etiology*
;
Testicular Neoplasms/surgery*
;
Child
;
Retrospective Studies
;
Leydig Cell Tumor/complications*
;
Child, Preschool
;
Orchiectomy
;
Testosterone/blood*
;
Tertiary Care Centers

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