OBJECTIVETo explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy.

METHODSSix patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back.

RESULTSPain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well.

CONCLUSIONSOn the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.

Breast Neoplasms ; radiotherapy ; surgery ; Debridement ; Humans ; Mastectomy, Radical ; methods ; Myocutaneous Flap ; Neck Injuries ; surgery ; Necrosis ; Pressure Ulcer ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Superficial Back Muscles ; Surgical Flaps ; blood supply ; Wound Healing

OBJECTIVETo discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection.

METHODSA total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap. The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3. Vascular crises were reviewed for analysis.

RESULTSThe incidence rate of vascular crisis was 8.1% (21/259), with 15 males and 6 females. The average age was 54.8 years old (17-68), and the average time of vascular crisis was 100.8 h post-operation (3-432). There were 7 cases of free jejunum flaps and 14 dermal free flaps. Seven of these 21 cases with vascular crisis were rescued by surgery. The success rate of salvage surgery within 72 hours from the primary operation was 54.5% (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0%, 1/10, P=0.043). There were 14 cases of flap necrosis, two of which died of local infection.

CONCLUSIONEarly detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.

Adolescent ; Adult ; Aged ; Female ; Femur ; Free Tissue Flaps ; blood supply ; pathology ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Jejunum ; Male ; Middle Aged ; Necrosis ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Salvage Therapy ; Time Factors ; Treatment Outcome

Intraosseous haemangiomas (IOHs) are benign vascular bone tumours that account for 1% of all primary bone tumours. They are most frequently seen in the vertebrae and skull, and are rarely found in long bones. Herein, we present an uncommon case of a 25-year-old woman with a solitary IOH that occupied the left femoral neck. We describe the clinical, radiological and histological details of the case, as well as the three-year outcome of the surgical treatment, which successfully preserved the femoral head. We also conducted a review of the literature on this uncommon entity.
Adult ; Angiography ; Diagnosis, Differential ; Female ; Femur Neck ; blood supply ; Humans ; Magnetic Resonance Imaging ; Skull ; abnormalities ; surgery ; Spine ; abnormalities ; surgery ; Tomography, X-Ray Computed ; Vascular Malformations ; diagnosis ; surgery ; Vascular Surgical Procedures ; methods

OBJECTIVETo investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture.

METHODSBased on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly.

RESULTS17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance.

CONCLUSIONSExpanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Arteries ; Cicatrix ; surgery ; Clavicle ; Contracture ; surgery ; Dissection ; methods ; Fasciotomy ; Humans ; Neck ; blood supply ; Neck Muscles ; anatomy & histology ; Surgical Flaps ; blood supply

Ultrasonography (US)-guided procedures such as ethanol ablation, radiofrequency ablation, laser ablation, selective nerve block, and core needle biopsy have been widely applied in the diagnosis and management of thyroid and neck lesions. For a safe and effective US-guided procedure, knowledge of neck anatomy, particularly that of the nerves, vessels, and other critical structures, is essential. However, most previous reports evaluated neck anatomy based on cadavers, computed tomography, or magnetic resonance imaging rather than US. Therefore, the aim of this article was to elucidate US-based thyroidal and perithyroidal anatomy, as well as its clinical significance in the use of prevention techniques for complications during the US-guided procedures. Knowledge of these areas may be helpful for maximizing the efficacy and minimizing the complications of US-guided procedures for the thyroid and other neck lesions.
Biopsy, Large-Core Needle/methods ; Catheter Ablation/methods ; Humans ; Laser Therapy/methods ; Neck/*anatomy & histology/blood supply/*ultrasonography ; Surgery, Computer-Assisted/*methods ; Thyroid Gland/*anatomy & histology/blood supply/*ultrasonography

The present paper aims to investigate whether or not vasculogenic mimicry (VM) exists in laryngeal squamous cell carcinoma (LSCC), and to elucidate its relationship to microvessel density (MVD), galectin-3 (Gal-3) expression, and clinicopathological factors of patients with LSCC. VM, score of MVD and expression of Gal-3 protein were detected by immunohistochemistry and histochemistry in 83 specimens of LSCC tissue and 20 specimens of normal laryngeal tissue. The positive rate of VM in normal laryngeal tissues was 0%, and was 33.7% in LSCC tissues. There was a significant difference between the two groups (P<0. 01). VM or MVD was significantly related to differentiation, pTNM stages and lymph node metastasis of LSCC (P<0.05), but not to age, gender and tumor site (P>0. 05). And there was a positive correlation between every two of VM, score of MVD, and Gal-3 protein (P< 0. 05). The results suggest that expression of Gal-3 protein may be related to the initiation, angiogenesis and VM formation in LSCC; And VM, angiogenesis and Gal-3 protein may be involved in the development, invasion and metastasis of LSCC.
Carcinoma, Squamous Cell ; blood supply ; Galectin 3 ; metabolism ; Head and Neck Neoplasms ; blood supply ; Humans ; Immunohistochemistry ; Laryngeal Neoplasms ; blood supply ; Lymphatic Metastasis ; Neovascularization, Pathologic ; Prognosis

Adult ; Aged ; Carcinoma, Squamous Cell ; rehabilitation ; surgery ; Carotid Arteries ; Female ; Head and Neck Neoplasms ; rehabilitation ; surgery ; Humans ; Male ; Middle Aged ; Neck ; blood supply ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply

OBJECTIVE: To explore the feasible monitoring techniques for the buried free flap. METHOD: Buried free flaps in reconstruction were monitored using combined monitoring techniques in five cases of advanced hypopharyngeal cancer The monitoring effects were analyzed retrospectively. RESULT: The operations were carried out successfully and all the five patients got primary healing of incision without vascular crisis. Four patients need combined monitoring techniques to confirm the microcirculatory results of the buried free flap. CONCLUSION Application of Doppler combined with flap island was feasible on monitoring the blood supply of post-operative buried free flap, it is a good monitoring technique.
Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Free Tissue Flaps ; blood supply ; Head and Neck Neoplasms ; diagnostic imaging ; pathology ; surgery ; Humans ; Hypopharyngeal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Hypopharynx ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Squamous Cell Carcinoma of Head and Neck ; Surgical Flaps ; blood supply ; Ultrasonography, Doppler

OBJECTIVE: To investigate the expression of Caspase-3 and bFGF in laryngeal squamous cell carcinoma and the affection angiogenesis. METHOD: Immunohistochemistry was used to detect the expression of Caspase-3. bFGF and MVD in 36 cases of para-carcinoma tissue and 67 cases of laryngeal squamous cell carcinoma. RESULT: The expression of bFGF in laryngeal squamous cell carcinoma was significantly higher than that in para-carcinoma tissue (P < 0.05), however the expression of Caspase-3 was significantly higher in para-carcinoma tissue than that in Laryngeal squamous cell carcinoma (P < 0.05). In laryngeal carcinoma, the expression of bFGF and Caspase-3 were associated with differentiation, lymph node metastasis and clinical stage (P < 0.05), but was independent of clinical classification,smoking history, sex and gender (P > 0.05). A significantly negative correlation was found between hFGF and Caspase-3 (P < 0.05). The value of MVD in laryngeal squamous cell carcinoma was significantly higher than that in para-carcinoma tissue (P < 0.05), and was significantly associated with lymph node metastasis (P < 0.05), but not associated with age, gender, differentiation, clinical stage, clinical classification or smoking history. The MVD of the tissue with positive expression of bFGF was significantly higher than that with negative expression of bFGF in laryngeal squamous cell carcinoma (P < 0.05). There was no significant difference between the MVI) of the tissue with positive expression of bFGF and that with negative expression of bFGF in laryngeal squamous cell carcinoma (P > 0.05). CONCLUSION bFGF was positively related to Caspase-3, which might play an important role in the carcinogenesis and development of laryngeal carcinoma by synergic effect.
Adult ; Aged ; Carcinoma, Squamous Cell ; blood supply ; metabolism ; pathology ; Caspase 3 ; metabolism ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Head and Neck Neoplasms ; blood supply ; metabolism ; pathology ; Humans ; Laryngeal Neoplasms ; blood supply ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neovascularization, Pathologic ; Squamous Cell Carcinoma of Head and Neck

OBJECTIVE: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series. METHOD: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed. RESULT: Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively. CONCLUSION Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
Adult ; Aged ; Esophagoplasty ; methods ; Esophagus ; surgery ; Graft Survival ; Humans ; Hypopharynx ; surgery ; Male ; Middle Aged ; Neck ; blood supply ; Necrosis ; Retrospective Studies ; Surgical Flaps ; pathology ; Transplant Donor Site ; anatomy & histology ; Treatment Outcome