Lung cancer is the leading cause of death worldwide. With the prevalence of CT screening and early diagnosis and treatment of lung cancer in China, more and more patients with early-stage lung cancer characterized with ground-glass opacity are discovered and urgently require treatment, which poses a significant challenge to surgeons. As an emerging technology, three dimensional reconstruction technology plays a crucial auxiliary role in clinical work. This review aims to briefly introduce this technology, focusing on its latest advances in surgical applications in early lung cancer screening, malignant risk assessment, and perioperative period application and medical education.

Objective:To explore the effects of specially formed radial collateral artery perforator flaps in reconstruction of the complex digit defects.Methods:From April, 2014 to March, 2020, 20 patients with multiple digit injuries combined with bone defects were treated by digit reconstruction with radial collateral artery chimeric and polyfoliate perforator flaps. Of the 20 patients, 7 patients were treated by chimeric perforator flaps, 12 by polyfoliate perforator flaps and 1 by chimeric polyfoliate perforator flap. Altogether 28 perforator flaps and 13 bone flaps were taken. The size of perforator flaps were 9.5 cm×4.0 cm to 4.0 cm×2.0 cm, and bone flap were 1.5 cm×0.6 cm×0.6 cm to 2.5 cm×1.0 cm×0.6 cm. All the donor sites were closed directly. Regular follow-up was performed. Function and clinical effect evaluation of repaired digits were made according to the Standard for Upper Limb Function Assessment of Hand Surgery Society of Chinese Medical Association and Sensory Function Assessment Criteria of British Medical Research Council (BMRC).Results:Twenty-seven flaps survived without any event. Venous congestion occurred in 1 flap with partial skin necrosis. Postoperative follow-up lasted from 3 months to 3.5 years (average 17.5 months). The appearance and texture of all flaps were good. All bone flaps properly healed. Sensory recovery achieved S 4 in 8 flaps, S 3 in 16 flaps and S 2 in 4 flaps. Hand function evaluation showed excellent in 12 patients and good in 8 patients. Conclusion:The specially formed radial collateral artery perforator flaps have the features of various designs with reliable blood supply, and are effective in repair of multiple digit injuries combined with soft tissue and bone defects.

Objective:To introduce a novel surgical technique for dissecting perforator vessels (orderly retrograde four-side dissection) in anterolateral thigh perforator flap (ALTPF) and explore its clinical outcome.Methods:Respective analysis of 94 patients who underwent reconstruction of soft tissue defects with ALTPF which were dissected by orderly retrograde four-side dissection between June, 2013 and December, 2016. After surgery, the survival of flaps, recovery in shape and function of the recipient sites, and the effect on shape and function of the donor sites were observed.Results:The size of ALTPF ranged from 7 cm×5 cm to 32 cm×10 cm. Ninety-four perforators were included in 94 ALTPF, which were 89 perforators of the descending branch of circumflex femoral lateral artery, 4 perforators of the transverse branch of circumflex femoral lateral artery and 1 perforator of femoral medial artery. The time for flap harvesting was 35-95(54.39±16.39) min. Success rate of perforator harvesting was 98.9%, only 1 perforator was injured and another encountered vasospasm during surgery. Three cases had vascular crisis after flap transfer with 2 venous crises and 1 artery crisis. All of the flaps completely survived except 1 that had a partial necrosis. The follow-up time was (12.91±9.17) months. No muscular weakness on donor sites was shown in all cases.Conclusion:Orderly retrograde four-side dissection of perforator vessels in the ALTPF has achieved less donor site morbidity, shorter surgical time and is safer than the traditional techniques. It is a reliable technique to harvest perforator flaps.

Objective:To investigate the feasibility and clinical effects of the chimeric multi-paddled anteriolateral thigh perforator flap (ALTP) for reconstruction of complex defects in extremities, which was pedicled with the descending branch of lateral circumflex femoral artery (d-LCFA).Methods:From August, 2010 to December, 2017, 11 cases of severe soft-tissue defects were repaired with this flap, including 4 cases of car accident trauma, 2 of machine injury, 2 of fall injuries, 1 of ploughing machine injury, 1 of crushing injury, and 1 of spoke injury. The injuries accompanied with different degrees of infections, dead space and left huge soft-tissue defects after radical debridement (10.0 cm×9.0 cm-20.0 cm×18.0 cm) . Dead cavity was filled by the muscular flap, and the large area soft-tissue defects were repaired by chimeric multi-paddled perforator flap. Appearance, colour and texture of the flap, recurrence of infection and knee extension were recorded at 1, 3, 6, 9 and 12 months follow-up.Results:After the operation, all recipient sites had no hematoma and no infection. Eight flaps survived successfully, and donor sites healed primarily. One flap had partial necrosis because of a mechanical stretch of the perforator during the operation, then repaired by the ipsilateral chimeric perforator flap based on d-LCFA. One flap occurred vascular crisis on the second day after the surgery, and it was rescued and survived completely after surgical exploration. The other flap which repaired wound on hand had partial necrosis too, and then repaired with posterior interosseous artery perforator flap. The follow-up periods ranged from 2 to 32 (mean, 10.2) months. All flaps had satisfactory appearance and texture. Only linear scars left at the donor sites. There were no motion limitations at the hip and knee joints of the effected leg.Conclusion:The anteriolateral thigh perforator flap combined with multi-paddled and chimeric techniques can reduce donor site morbidities, simplify the anastomosis of blood vessel, and improve the appearance and effects of the recipient site. It is a feasible method in repairing severe soft tissue defects of limbs.

Objective:To investigate the feasibility and clinical effect of combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery in the reconstruction of large soft tissue defects of lower limbs.Methods:From January, 2014 to September, 2019, 35 cases of large soft tissue defects of lower limbs were repaired by combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery, and the donor sites were directly closed. The wound involved the shank, ankle and foot; The areas of defect ranged from 17.0 cm×12.0 cm to 33.0 cm×18.0 cm. External fixation were performed on 19 cases with open comminuted tibia fracture, and flap transplantation was preformed after through debridement and negative-pressure wound therapy for 5-7 days. The lateral femoral cutaneous nerve was remained in the flap, which was anastomosed with sensory nerves in the recipient site. The colour, texture, sensation, secondary ulcer of the flap and limb function were followed-up after the operation.Results:Of the 35 cases, 34 cases completely survived, and necrosis occurred in 1 case. The donor sites were closed primarily and complication was not observed in any of the cases. The followed-up period ranged from 6 to 38 months, at 17.6 months in average. The appearance and function of the reconstructed lower limbs were satisfactory.Conclusion:The combined transplantation of the perforate flap of descending branch of lateral femoral circumflex artery is safe and reliable. It can be used to repair large defect and the damage of the donor site is limited. It is an effective method to repair large area of soft tissue defects of lower limbs.

Objective: To explore the efficiency and effect of radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus to reconstruct thumb complex defects. Methods: 5 cases of thumb complex tissue defects patients admitted to Xiangya Hospital of Central South University from June 2014 to October 2018. The patients were all male and aged from 35 to 63 years (average age was 47 years). There were 2 cases of right thumb and 3 cases of left thumb. The skin defect area was from 16.0 cm×4.0 cm to 3.5 cm×2.0 cm, and the bone defect length was 2-3 cm.All defects were reconstructed with radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus. The sizes of perforator flap were from 4 cm×2 cm to 18 cm×5 cm, and the sizes of bone were from 2.0 cm×0.6 cm×0.5 cm to 2.5 cm×1.0 cm×0.5 cm.The posterior branchial cutaneous of the arm was included in skin flap. 2 flaps underlied microdissect to defat. After fixing bone flap and finger/metacarpal bone with Kirschner wires, the radial accessory vessels were anastomosed with the radial vessels and cephalic vein at the nasopharyngeal fossa.All donor sites were closed directly. Results: All flaps survived uneventfully. Kirschner wires were removed 4 to 6 weeks after operation. Postoperative follow-up ranged from 3 months to 4.5 years (average 19 months). All bone aps healed without union. Functions of thumb opposition and thumb to finger were all good. The hand function had excellent result in 3 cases and good in 2 cases. Sensory recovered to S4 in 1 case, S3 in 3 cases and S2 in 1 case. Evaluation of the appearance satisfaction of patients was 5 points in 3 cases and 4 points in 2 cases. Conclusions The radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus, which can reconstruct skin soft tissue and bone simultaneously, has good postoperative feeling and function recovery, and satisfactory appearance, and is an effective method to repair the defect of thumb complex tissue.

To investigate the feasibility and clinical efficacy of free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of femoral head (ONFH). Methods Twelve cases of ONFH(13 hips) received free graft of vascularized iliac bone flap based on deep iliac circumflex ves-sels from April, 2016 to July, 2017.The average Harris score was (74.7±6.9) in the second stage and (68.6±9.2) in the third stage. After debriding the necrosis bone of the femoral head, the contralateral vascularized iliac bone flap had been harvested, and then implanted into the femoral head. The deep iliac circumflex artery and its accompanying vein were anastomosed with the transverse branch (or ascending branch) of the lateral circumflex femoral artery and con-comitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray exami-nation (1, 3, 6, 9 and 12 months after operation, respectively) and Harris hip score (6 and 12 months after operation, respectively) were performed to evaluate the recovery results of the femoral head. Scores were recorded and analyzed by paired t-test.The difference was considered to statistically significant if P＜0.05. Results The patients were fol-lowed-up for 15(12-20)months. The iliac bone flap of 12 patients (13 hips) healed well. There was no necrosis and collapse in 12 hips, except 1 femoral head collapsed slightly because of weight loading too early. The average Harris score was (91.6±4.5) of the second stage and (84.8±6.1) of the third stage. Compared with scores before the operation, the difference was statistically significant (P＜0.05). Conclusion Free vascularized iliac bone grafting based on deep iliac circumflex vessels is an ideal treatment for ONFH head in middle and advanced stage.

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs.Methods From September,2008 to October,2016,8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap,including 4 cases of traffic accident trauma,2 cases of chronic ulcer,1 case of a fall injury,1 case of the scar after fracture operation.The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm.Seven patients were accompanied by different degrees of infections.The deep femoral artery third perforating artery perforator flap was designed to repair,including 5 cases of pedicled flaps and 3 cases of free flaps.The flap's appearance,color,texture,infection recurrence and the recovery of lower limb function were recorded at 1,3,6,9 and 12 months followed-up.Results One flap suffered partial necrosis due to cross-zone backflow disorder,the ipsilateral medial sural artery pedicled perforator flap was used to repair.The rest of the flaps survived successfully.Skin graft was used to close the donor site in 1 case,and other donor sites were closed directly.All patients had no postoperative hematoma or secondary infection.The followed-up periods ranged from 2 to 28 months (mean,8.1 months).All flaps had satisfied appearance and texture.There were no complications such as paresthesia and numbness in the donor sites.And no motion limitations in hip and knee joint of the operated leg.Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps,which is a feasible method to repair soft tissue defect in lower limbs.

Objective: To explore the clinic effects of posterior tibial artery perforator pedicled propeller flaps for children heel injuries in spoke wheel accidents. Methods: During August 2010 and May 2016, 12 children with spoke heel injuries were covered by posterior tibial artery perforator pedicled propeller flaps. The skin and soft tissue defects ranged from 4 cm×3 cm to 8 cm×3 cm. There were 4 cases with achilles tendon exposure, 8 cases with achilles tendon defect in distal, 6 cases with part of calcaneus defect. The range of achilles tendon defect were 2-5 cm(average 3.2 cm). The flap size ranged from 8.0 cm×3.0 cm to 12.5 cm×4.0 cm. In 6 cases, fascia tissue was harvested to fill the heel cavity. The donor sites were closed directly in 11 cases, and covered with skin grafting in one case. Results: All flaps survived smoothly with no complications. All patients were followed up 3 months to 20 months (mean, 8.5 months). The color and appearance of the flaps were satisfactory, with no impact on wearing shoes and walking. Conclusions Posterior tibial artery perforator pedicled propeller flap which has reliable blood supply, less donor-site morbidities, cosmetic shape, simple operation and less postoperative complications is an ideal method for surfacing heel spoke injuries in children.

Objective: To explore the feasibility of free circumflex scapular artery perforator flap for repairing the wounds of the limbs in children. Methods: From April, 2010 to October, 2017. 39 cases of pediatric patients who suffered from skin and soft defects in the limbs with exposure of bone, joint or tendon were repaired by the circumflex scapular artery perforator flap.The flap size ranged from 6.0 cm×3.5 cm to 16 cm×14 cm. Doppler detection was used to determine the distribution of the descending, ascending and transverse branches of the circumflex scapular artery. The proper perforator flap type was selected according to the shape and the size of the wound. Results: Thirty-seven flaps survived smoothly. Venous crisis occurred in one case and arterial crisis occurred in another case at the second postoperative day. Both flaps survived completely after exploration. All flaps were healed at the recipient sites. Delayed healing of the donor site wound occurred in two cases. All cases were followed up for 3 to 36 months (average 12 months), and the appearance and function of the recipient sites were satisfactory. Only linear scars remained in the donor sites. Conclusions The free circumflex scapular artery perforator flap is an ideal method to resurface the soft-tissue defects of extremities in children.