Clinical application of thoracodorsal artery perforator flaps in the repair of head and neck defects / 中华耳鼻咽喉头颈外科杂志

Objective: To analyse the clinical application of thoracodorsal artery perforator flaps (TDAPF) in the repair of head and neck defects. Methods: A retrospective review was conducted on 38 patients with oral and maxillofacial head and neck malignant tumors who underwent radical resection of oral and oropharyngeal carcinoma and TDAPF repair in the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to November 2018. Among them, 32 were males and 6 were females, aged 30-74 years. Flap size, vessel pedicle length, diameter and number of perforators, and flap fat thickness were recorded and counted. Elasti Meter and Skin Fibro Meter were applied to measure the skin elasticity and hardness in the donor areas of 4 kinds of skin flaps before the flap preparation. SPSS 19.0 statistical software was used for statistical analysis of the data. Results: All the flaps survived (100%). The mean elasticity of TDAPF [(41.2±12.9) N/m] was significantly lower than that of anterolateral thigh [(77.6±23.3) N/m, χ²=88.89, P<0.05], anterolateral thigh [(62.6±17.7) N/m, χ²=59.99, P<0.05] and or forearm flap [(51.7±8.6) N/m, χ²=37.82, P<0.05]. The hardness of TDAPF [(0.037±0.016) N] was also significantly lower than that of anterolateral femoral [(0.088±0.019) N, F=93.27, P<0.05], anteromedial femoral [(0.059±0.020) N, F=25.71, P<0.05] or forearm flap [(0.062±0.016) N, F=29.11, P<0.05]. Follow-up period ranged from 2 to 14 months. The 38 patients treated with TDAPF had a good recovery of the functions in the recipient areas, and the scars of the donor areas were not obvious after surgery, without serious complications. Conclusion: TDAPF is suitable for reconstruction of head and neck defect, with ductile texture and good recovery of the morphology and function of head and neck.

Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.</p><p><b>METHODS</b>Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.</p><p><b>RESULTS</b>Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).</p><p><b>CONCLUSION</b>Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.</p>

The application of a new method of microvascular anastomosis: a review of 109 microvascular anastomosis surgery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and clinical significance of the new method for microvascular anastomosis.</p><p><b>METHODS</b>Between February 2013 and May 2013, 108 patients aged 31 to 73 years underwent free flap reconstruction of the defects as a result of resection of oralmaxillofacial tumors. Of 108 patients, 78 were men and 30 were women. The cases were divided into experimental group(46 flaps) and control group (63 flaps) according to different methods of microvascular anastomosis.Isometric double notches end to end microvascular anastomosis was used for artery anastomosis in experimental group, conventional end to end anastomosis was used for artery anastomosis in control group and venous anastomosis was performed in both groups.</p><p><b>RESULTS</b>The entire procedure of artery anastomosis took (7.3 ± 1.7) min in experimental group, (14.5 ± 2.6) min in control group, the difference between the two groups was significant (P = 0.00). There was only one venous compromise which was complete failure in experimental group. There were two venous compromise and one artery compromise in control group, and one of the venous compromise was a complete failure.</p><p><b>CONCLUSIONS</b>The isometric double notches end to end microvascular anastomosis proved successful and clinically feasible with advantages of fixed-point accuracy, time-saving and high patency rate.</p>