Risk factors of vascular crisis of free tissue flap after the repairation of oral and maxillofacial tissue defect / 中华显微外科杂志

Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.

Reconstruction of extensive full thickness cheek defects with free anterolateral thigh flap / 中华显微外科杂志

Objective To assess the clinical features and therapeutic efficacy of extensive full thickness cheek defects reconstruction with free anterolateral thigh flap.Methods From December,2008 to June,2014,a total of 17 patients underwent simultaneous tumor radical resection and full thickness cheek defects reconstruction with free anterolateral thigh flap.In these 17 patients,12 patients had undergone the reconstruction of full thickness cheek defects with the folded anterolateral thigh flap (two skin islands and an intervening de-epithelialized zone); 5 patients had undergone the reconstruction of full thickness cheek defects with the two separate skin paddles anterolateral thigh flap in one single pedicle.Results All of 17 free anterolateral thigh flaps survived,besides 1 case resulted in partial loss of flap adge due to diabetes.After 3 to 12 months' follow-up,all cases of free anterolateral thigh flap were good in color,shape and texture,and patients were satisfied with oral morphological and functional reconstruction.Conclusion The free anterolateral thigh flap is one of versatile soft tissue flaps in the extensive full thickness cheek defects reconstruction.

Treatment of chronic prolonged mandibular dislocations / 实用口腔医学杂志

5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.

The extended free lateral arm flap for buccal soft tissue reconstruction after buccal cancer / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summary the application of the extended free lateral arm flaps for buccal soft tissue reconstruction after buccal cancer.</p><p><b>METHODS</b>From January to August 2011, three patients underwent the operation of buccal defect reconstruction using the extended free lateral arm flap in one-stage. PRCA was identification with the Doppler probe. According to the mark of PRCA, size and shape of defects, the flaps were designed and extended to the lateral epicondyle of humerus. The flap size ranged from 9 cm x 5 cm to 10 cm x 6 cm with a pedicle of 10 cm in length. The wounds at donor sites were closed directly.</p><p><b>RESULTS</b>Vascular crisis happened in one case due to local negative pressure, which resolved after emergency management. All the flaps survived completely. The patients were followed up for 6 to 10 months with no recurrence. Both the esthetic and functional results were satisfactory. Two cases suffered from numb feeling in donor sites which alleviated six months later.</p><p><b>CONCLUSIONS</b>The extended free lateral arm flap has reliable blood supply with appropriate thickness. It is an optional method for reconstruction of buccal defects after ablation of buccal cancer.</p>

Clinical application of free thin anterolateral thigh flap in the reconstruction of intraoral defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the clinical features and therapeutic effect of free thin anterolateral thigh flap for the reconstruction of intraoral defects.</p><p><b>METHODS</b>The clinicopathologic data of 34 cases with oral carcinoma were obtained from Institute and Hospital of Stomatology, Nanjing University Medical School, from December 2008 to December 2011. These 34 patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free thin anterolateral thigh flaps. The defects were located at tongue, buccal, mouth floor, and so on. The subcutaneous fat thickness of the flap at the site of the perforator is usually measured by ultrasound before the operation. If the thickness of the subcutaneous fat at the site of the perforator exceeded 1.5 cm, the patient was excluded from the study.</p><p><b>RESULTS</b>There were 16 male and 18 female patients. The mean age was 55.4 years. Among the 34 patients, 26 flaps with musculocutaneous perforators and 8 flaps with septo-cutaneous perforators were used. Partial flap necrosis occurred in 2 patients.</p><p><b>CONCLUSIONS</b>The free thin anterolateral thigh flap is the ideal soft tissue flap for the intraoral defects reconstruction. Satisfactory functional results can he achieved at recipient area with minimal morbidity at the donor site area.</p>

Reconstruction of oral soft tissue defects with free anterolateral thigh flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the clinical features and therapeutic efficacy of anterolateral thigh (ALT) flaps for the intraoral defects reconstruction.</p><p><b>METHODS</b>The clinicopathologic data of 67 cases with oral tumors were obtained from School of Stomatology, Nanjing University Medical Center from Dec. 2008 to Dec. 2010. All the patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. The defects included the tongue, buccal, gingival, mouth floor, and so on. The descending branch of lateral femoral circumflex artery was anastomosed to the external maxillary artery or superior thyroid artery; the vein was anastomosed to the common facial vein or external jugular vein. The flaps were divided into three types: musculocutaneous ALT flap, fasciocutaneous ALT flap and thinned ALT flap.</p><p><b>RESULTS</b>There were 38 male patients and 29 female. The anterolateral thigh flaps included 35 musculocutaneous flaps, 17 fasciocutaneous flaps and 15 thinned flaps. The success rate was 98.5% (66/67). Partial necrosis happened in one case with diabetes, which healed after debridement and dressing. 1 flap was totally necrosis. Double venous anastomosis was performed in 41 flaps, and one venous anastomosis was performed in 26 flaps. 8 patients required operative exploration in the perioperative period including 6 flaps with thrombotic events (5 flaps were complete survival after the salvages, and 1 flap was failure) , 1 flap with hematoma, and 1 flap with twisting of perforator. The follow-up period ranged from 2 to 24 months( mean, 8.7 months). The result was satisfied. The donor sites were closed directly in all patients, and the wounds healed uneventfully.</p><p><b>CONCLUSIONS</b>The free anterolateral thigh flap is an ideal soft tissue flap for the intraoral defects reconstruction with good functional result at recipient area and less morbidity at the donor site.</p>

Research on the correlation of vascular endothelial growth factor and dendritic cell in patients with oral squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of vascular endothelial growth factor (VEGF) on the differentiation, formation and function of the dendritic cell (DC) in peripheral blood of patients with oral squamous cell carcinoma (OSCC).</p><p><b>METHODS</b>Flow cytometry was used to detect the number of DC in peripheral blood of 81 patients with OSCC, and ELISA applied to test serum VEGF concentration the OSCC patients, and immunohistochemistry used to observe the expression of VEGF in primary foci of 57 patients with OSCC. DC from CD-14 peripheral blood mononuclear cells were cultured with VEGF(165) in vitro to investigate the cytokine's effect on DC.</p><p><b>RESULTS</b>In comparison with controls [(325.70 +/- 117.54) ng/L], the level of serum VEGF [(764.33 +/- 263.64) ng/L] was significantly increased (P < 0.01) and the DC numbers was significantly decreased (P < 0.01) in patients with OSCC. There was a negative correlation between serum VEGF concentration and the level of DC (P < 0.01). The expression of VEGF in primary focus was positively correlated with serum VEGF concentration, but was negatively correlated with the level of peripheral blood DC (P < 0.01). DC cultured in vitro with VEGF(165) decreased the expression of CD-1a, CD-40, CD-80, CD-86, CD-83, HLA-DR, and revealed a lower ability of stimulating T lymphocyte proliferation but a higher ability of uptake, compared to controls.</p><p><b>CONCLUSIONS</b>The overexpressed VEGF in patients with OSCC might be one of the important reasons for blocking the differentiation and maturation of DC.</p>

Application of titanium mesh and free forearm flap for reconstruction of maxillary defect resulted from tumor resection / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of titanium mesh and free forearm flap for reconstruction of maxillary defect resulted from tumor resection.</p><p><b>METHODS</b>From 2004 to 2008, 19 cases with maxillary tumor underwent tumor resection. The defects were reconstructed immediately with titanium mesh for bony defects and free forearm flap for oral mucosa defects.</p><p><b>RESULTS</b>16 cases achieved satisfactory functional and cosmetic results. The speech assessment was good without oronasal reflux. The titanium mesh was exposed and infected in 3 cases. Then the meshes were taken out and the defects were covered with the forearm flap to close the oronasal fistula. The midface was slightly depressed with no functional morbidity.</p><p><b>CONCLUSIONS</b>It is simple and practical to reconstruct maxillary defect with titanium mesh and free forearm flap. Both the functional and cosmetic results are satisfactory.</p>

Construction of targeting-Skp2 shRNA plasmids and observation of their inhibitory effect on Tca8113 cells / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To construct the recombinant plasmids expressing Skp2 short hairpin RNA (shRNA) by pRNAT-U6.1/Neo plasmid vector and observe the effects of RNAi-mediated Skp2 gene silencing on Tca8113 cells.</p><p><b>METHODS</b>Five recombinant eukaryotic expression vectors were successfully constructed using pRNAT-U6.1/Neo plasmid vector separately. After they were transfected into Tca8113 cells with PEI, the interference effects no Skp2 and p27 were detected by RT-PCR and Western blot. The cell cycle of Tca8113 cells were tested by flow cytometry. The proliferation of Tca8113 cells were examined by MTT.</p><p><b>RESULTS</b>In Skp2shRNA-2 and Skp2shRNA-3 vectors, the expression of Skp2 protein of Tca8113 cells was down-regulated and p27 protein up-regulated (P < 0.01). The cell number during G1/G 0 phases increased 22% (P < 0.01) and during G(2)/M and S phases the number decreased 10% and 12% (P < 0.01). The proliferation of Tca8113 cells slowed down and the cells number decreased (P < 0.01).</p><p><b>CONCLUSIONS</b>Skp2shRNA-2 and Skp2shRNA-3 vectors of shRNA for Skp2 were successfully constructed. They could influence expression of Skp2 and p27 gene. Skp2 may be a promising target of gene therapy on human tongue squamous cell carcinoma.</p>

Inhibitory effect of dendritic cell vaccine on the growth of implanted tongue squamous cell carcinoma tumors in nude mice / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the inhibitory effect of dendritic cells (DCs) on the growth of the implanted tongue squamous cell carcinoma (SCC) tumors in nude mice.</p><p><b>METHODS</b>Being induced from human peripheral blood monocytes (PBMCs) with rhGM-CSF, rhIL-4 and rhTNF-alpha, DCs were pulsed by Tca8113 cells lysates. Those DCs and T lymphocytes were co-cultured to induce specific cytotoxic T lymphocytes (CTLs). Immunotherapy was then performed after those DCs and CTLs were implanted into the tumor-bearing nude mice.</p><p><b>RESULTS</b>DCs were induced from PBMCs with multiple cytokines. Compared with the control groups, the growth of tumors was significantly inhibited in the group that had been implanted with DCs and CTLs, and tumor doubling time also increased markedly (P < 0.05).</p><p><b>CONCLUSIONS</b>DCs function normally after being induced from human PBMCs with multiple cytokines; DCs pulsed with tumor cell lysates and CTLs co-cultured with those DCs have a significant anti-tumor immune activity in nude mice.</p>

Immunohistochemical analysis of dendritic cell in oral squamous cell carcinoma / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To elucidate the functional status of dendritic cells (DC) in the tissue of oral squamous cell carcinoma by analyzing characteristic phenotype of them.</p><p><b>METHODS</b>34 specimens from oral squamous cell carcinoma cases primarily treated with surgery were selected as test group. In addition, 30 specimens of normal mucosa from oral mucocele cases were used as control. Distribution of DC expressing CD1a+, HLA-DR+ and CD83+ in tumor tissue and normal mucous membrane was observed by immunohistochemistry. The number of DC expressing the antigens, which represented the density of DC infiltrating into tissue, was counted by microscope. The density of DC and the rate of DC expressing HLA-DR in oral carcinoma group and control were statistically compared.</p><p><b>RESULTS</b>There was no CD83+ DC in all cases, but CD1a+ DC was found in all samples. The density of CD1a+ DC in tumor tissue was significantly lower than that in normal mucous membrane (P < 0.05). HLA-DR antigen expressed on the surface of DC in tumoral epithelium of 27-case carcinoma specimens and in normal mucous epithelium of 23 cases. The rate of HLA-DR positive expression of TIDC had no statistic significance between the two groups.</p><p><b>CONCLUSION</b>The lower density of DC infiltrating in tumor tissue might reflect the microenviromental immunodeficiency of hosts with oral squamous cell carcinoma, and the functional mature of DC might be inhibited by the immunosuppressive action of oral squamous cell carcinoma.</p>