Objective:To investigate the different types of renal artery involvement in Stanford type B aortic dissection (TBAD) and the comparison of clinical effecacy after thoracic endovascular aortic repair (TEVAR).Methods:This is a retrospective cohort study included 330 patients with TBAD and renal artery involvement treated with TEVAR from June 2002 to September 2021 in General Hospital of Northern Theater Command of the PLA. According to aortic CTA image, unilateral renal artery involvement conditions were divided into 5 types: the true lumen type (renal artery opening completely from the true lumen), false lumen type (renal artery opening completely from the false lumen), double lumen type (renal artery opening from the true and false double lumen), compression type (renal artery opening connected with the true lumen, but the renal artery opening was extremely squeezed by the inner membrane), open type (renal artery opening with intimal tear). There were seven types of bilateral renal artery involvement: true-true type (true lumen-true lumen type), true and false type (true lumen-false lumen type), true-double type (true lumen-double lumen type), true-opening type (true lumen-opening type), false-false type (false lumen-false lumen type), false-compression type (false lumen-compression type), double-double type (double lumen-double lumen type). The primary observation index of this study was the comparison of postoperative renal function and the incidence of clinical adverse events of different types of renal artery involvement. One-way ANOVA test, Kruskal-Wallis H test and paired sample rank sum test were used to compare postoperative renal function between different types of bilateral renal artery involvement. The Chi-square test or Fisher′s exact probability test were used to compare the near and long term adverse events between different types of bilateral renal artery involvement. Kaplan-Meier method was used to compare the all-cause mortality of patients with severe renal functional injury and non-severe renal functional injury before surgery. Results:The average age of the patients included in this study was (53±11) years, including 276 males (83.6%) and 54 females (16.4%). There were statistical difference in the level of serum creatinine (preoperative: H=18.686, P=0.005, postoperative: H=18.101, P=0.006) and cystatin C (preoperative: H=17.566, P=0.007, postoperative: H=10.433, P=0.016), pre-and post-operative, between the seven groups of TBAD patients with different renal artery involvement types ( P<0.05), and the false-false type group shown the worst kidney function. However, no statistically significant differences were shown when comparing their pre- and post-operative change values ( P>0.05). The 30-day follow-up result showed that there were statistically significant differences in the incidence of postoperative acute kidney injury ( χ2=15.623, P=0.007), aorta-related adverse events ( χ2=15.523, P=0.010), and intraoperative endoleak ( χ2=17.935, P=0.004) among the seven groups, and the false-false group was the highest (2/9, 5/9 and 5/9, respectively). In terms of long-term follow-up results, there were statistically significant differences in all-cause death ( χ2=14.772, P=0.011) and non-aortic death ( χ2=15.589, P=0.008) among the seven groups. Kaplan-Meier survival analysis showed that patients with worse pre-operative renal function showed higher long-term all cause death (17.7% vs. 4.8%, P=0.009). Conclusions:For TBAD patients with renal artery involvement, there were differences in renal function among different types, and TEVAR showed no significant effect on renal function in TBAD patients. The long-term all cause death was higher in patients with worse renal function pre-operative.

【Objective】 To establish the reference interval of Thromboelastography(TEG)of healthy adult in Hainan, compare with the interval provided by the manufacturers, and analyze the influencing factors. 【Methods】 A total of 308 healthy adult volunteers were included according to the inclusion and exclusion criteria. The TEG was analyzed based on adequate quality control, and the reference interval of each parameter was calculated with 95% CI. 【Results】 The reference interval of these volunteers were R 4.27~9.20 min, K 1.60~3.83 min, Angle 44.22°~67.78°, MA 47.82~64.17 mm, CI -5.63~1.12 and G 4.58~9.03. 14.94% (46/308) of these volunteers had at least one index exceeded the reference interval provided by manufacturers. A total of 74 healthy volunteers were diagnosed with coagulation disorder, with the specificity at 79.22%. Significant differences of R, K, Angle, MA, CI, G were observed between males and females (P<0.05). Hypercoagulability was not associated with the age. 【Conclusion】 This study established a reference interval of TEG of healthy adults in Hainan, which provided reference for related clinical and basic science study.

【Objective】 To investigate the correlation between preoperative thromboelastography (TEG) parameters and routine coagulation tests of malignant tumor patients. 【Methods】 A total of 79 patients with malignant tumors, receiving preoperative TEG tests and routine coagulation tests between January 2019 and June 2020, were included. The correlation and regression between coagulation indexes and TEG parameters were analyzed. 【Results】 In patients with malignant tumors, the coagulation time(K) was negatively correlated with Plt and fibrinogen (FIB), while Angle, Ma, and G were respectively positively correlated with Plt and FIB. 【Conclusion】 There is a correlation between preoperative TEG parameters and routine coagulation tests in patients with malignant tumors. There is complementarity but not reciprocal substitutability between these two tests.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

Objective:To explore the clinical application of bilateral free posteromedial thigh perforator flaps for unilateral breast reconstruction.Methods:Retrospective analysis of bilateral free posteromedial thigh perforator flaps application in six breast cancer cases for immediate or two-staged breast reconstruction. The age of patients ranged from 31 to 47 years old. All cancer occurred in hemi-lateral, 3 cases on left and 3 cases on right. Pathological diagnosis included invasive ductal carcinoma in 3 cases and invasive lobular carcinoma in 3 cases. One or two-staged breast reconstruction using bilateral free posteomedial thigh perforator flaps was carried out in 6 breast cancer patients. In stage Ⅰ cases the breast tumor size ranged from 2.5 to 4.0 cm, (2.8±0.5) cm on average; 3 cases of breast cancer were in stage Ⅰ and 3 cases was in stage Ⅱ. Postoperative follow-up of recipient and donor sites were evaluated.Results:The length of flap was (24.4±0.5) cm, the width of flap was (8.3±0.5) cm, the thickness of flap was (3.4±0.5) cm. The length of pedicle was (8.9±0.4) cm, the outer diameter of pedicle artery was (1.5±0.4) mm, the outer diameter of pedicle vein was (1.9±0.3) mm. The average weight of flap was 235 g (ranged from 165 g to 345 g). Lymphatic leakage occurred in the donor site in 1 case 1 week postoperatively and healed with continuous negative pressure suction in 2 weeks. All flaps survived totally. The reconstructed breasts’ shape, texture and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of thighs was not affected. All 6 patients were followed up for 5-8 months (5.5 months on average) with satisfied result. No local recurrence happened.Conclusions:Bilateral free posteromedial thigh perforator flaps transferring is feasible to reconstruct unilateral breast.

Objective:To investigate the relationship between satisfaction and quality of life of patients with breast reconstruction after mastectomy, and analyze the influencing factors of satisfaction.Methods:In this study, 157 female breast reconstruction patients who were treated in Hunan Cancer Hospital from January 2016 to June 2019 were selected as the object of this study. The BRECON-31 and QLQ-BR23 were used to assess satisfaction and quality of life respectively, and the clinical and demographic data were collected, Pearson correlation test was applied to analyze the correlation between satisfaction and quality of life, univariate analysis and multiple linear regression analysis were performed to investigate the influence factors of satisfaction.Results:A total of 157 patients, whose age was (41.8±8.3) years and median follow-up time was 11 months were included and 147 valid questionnaires were collected. The satisfaction score was 74.44±6.29, which meant patients with breast reconstruction after mastectomy had high satisfaction. There was a significant correlation between intimacy and body image ( r=-0.183, P=0.043), sexual function ( r=0.201, P=0.026), sexual interest ( r=0.204, P=0.029), breast symptoms ( r=-0.247, P=0.006) and arm symptoms ( r=-0.246, P=0.006) in patients with breast reconstruction after mastectomy, the patient’s self-awareness was significantly influenced by factors such as body shape ( r=-0.228, P=0.006), sexual function ( r=-0.293, P<0.001), sexual interest ( r=-0.258, P=0.003), breast symptoms ( r=-0.183, P=0.029), hair loss-induced annoyance ( r=-0.187, P=0.027). The result of univariate analysis showed that age ( P=0.047), tumor stage ( P=0.004), reconstruction method ( P<0.001), chemoradiotherapy ( P=0.043) were the influencing factors of total satisfaction score, multiple linear regression result showed that the reconstruction method ( P<0.001) was an independent influence factor of satisfaction score. The total satisfaction score of patients with autologous tissue reconstruction (75.99±5.94) was better than that of patients with autologous tissue combined prosthesis (71.08±4.99) and patients with simple prosthesis implantation (70.81±8.54). Conclusions:Mutual impact was identified for life quality and satisfaction among patients with breast reconstruction after mastectomy. In addition, age, tumor stage, reconstruction method and chemoradiotherapy are the influence factor of satisfaction. Among them, the reconstruction method is independent influence factor, and the breast reconstruction with autologous tissue is a better choice.

Objective:To explore the extending design and anatomical basis of pedicled gracilis musculocutaneous flaps in perineal reconstruction.Methods:On six female cadavers (age ranged from 27 to 52 years old, 41.2 on average), bilateral gracilis flaps were designed, raised and transferred in the standard surgical manner and tunneled under the adductor longus muscle. Measured the distance from the tip of 12 flaps to the bilateral anterior superior iliac spine (ASIS). The myocutaneous flaps were then transferred and the distances from the tip of flaps to the ASIS were measured again. The paired sample t test (double tail) was used to compare the data measured by the two transfer method.Results:Cadaveric dissection revealed that in 6 corpses, bilateral profunda artery muscular branches all courses between the longus adductor and mangus adductor muscles, the pedicle length of 12 gracilis musculocutaneous flaps was(7.84±0.71) cm. In the standard surgical manner group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (9.23±0.95) cm, ranged from 6.9 cm to 10.5 cm, the distance from the tip of flaps to the contralateral ASIS was(11.45±2.27) cm, ranged from 7.5 cm to 14.8 cm. In the tunnelled under the adductor longus muscle extension design group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (4.52±1.18) cm, ranged from 2.7 cm to 6.5 cm, the distance from the tip of flaps to the contralateral ASIS was (8.92 ±1.82) cm, ranged from 4.8 cm to 11.7 cm. Compared with the standard surgical manner group, tunneling the flap under the adductor longus muscle to the ipsilateral side increased the reach by 3.5 cm to 7.3 cm, (4.71±1.14) cm, to contralateral side increased the reach by 0.9 cm to 4.1 cm, (2.53±0.89) cm. The distance to the ipsilateral anterior superior iliac spine measured by the two method , t=13.194, P<0.001, and the distance to the contralateral anterior superior iliac spine, t=9.057, P<0.001. The difference was statistically significant. The tunneled under the adductor longus muscle extension design group can increase the reach of reconstructive scope by 3.62 cm on average. The additional increasing length of tunneled under the adductor longus muscle method is 46.2%(3.62/7.84) of the average vascular pedicle length. Conclusions:Cadaveric dissection result have shown that tunneling of the gracilis musculocutaneous flap in a novel extension design way can enlengthen the pedicle length, increase its reach across the perineum.