Effect of perioperative allogeneic blood transfusion on the prognostic quality of first-stage free flap repair and reconstruction in patients with oral cancer / 中国输血杂志

【Objective】 To study the effect of perioperative allogeneic blood transfusion on patients with oral squamous cell carcinoma (OSCC) after first-stage free flap transplantation. 【Methods】 A total of 306 OSCC patients who accepted primary repair and reconstruction using free flap admitted to our affiliation from January 2010 to January 2019 were selected as the research objects and retrospectively analyzed. According to their clinical data, they were divided into three groups: no transfusion group (n=98), 1-2 U transfusion group (n=131) and 3 + U transfusion group (n=77), respectively. The incidence of complications including flap infection, blood circulation disorder and hematoma in the three groups were compared. The five-year survival rate of the three groups was calculated by Kaplan-Meier analysis, and the relative risk of death was analyzed by Cox regression. 【Results】 There was no statistically significant difference among the three groups of patients (P>0.05) regarding such baseline data as embracing gender, age, primary location, degree of differentiation, adjuvant radiotherapy and chemotherapy. The complication rate of patients with 3 + U transfusion (25.97%) was significantly higher than that of no transfusion (6.12%) and 1-2 U transfusion (10.86%) (P<0.05); and the five-year survival rate of patients with 3 + U transfusion (51.95%) was significantly lower than that of no transfusion (69.38%) and 1-2 U transfusion (62.60%) (P<0.05). The results of univariate analysis showed that age, adjuvant radiotherapy, degree of tissue differentiation, collateral infiltration, vascular invasion and blood transfusion were all factors influencing the quality of prognosis after repair and reconstruction of first-stage free flap transplantation treating OSCC (P<0.05). The results of multivariate analysis showed that adjuvant chemoradiotherapy was an independent protective factor for the prognosis and survival quality of postoperative OSCC patients (P<0.01); the degree of differentiation, vascular invasion and blood transfusion were independent risk factors for the prognosis and survival quality of postoperative OSCC patients (P<0.05). 【Conclusion】 Perioperative allogeneic transfusion in OSCC patients can increase the risk of postoperative complications and directly affect their prognostic quality. It can be regarded as an important risk factor for OSCC patients.

Estableciendo protocolo de apoyo en microcirugía / Developing a protocol to support microsurgery

Microsurgery is a developing technique in our setting, and it’s success can be related to elements that are not related to the surgeon. Because of this, the Plastic Surgery Team in the Chilean Airforce Hospital has become aware of the need to develop a support protocol for microsurgery, which can be used in any setting throughout our country. It’s focus is set in optimizing and controlling physiological and anesthetic variables, and those not related to the technique itself, which can influence the microsurgery outcome and the patients perioperative morbi-mortality.

La microcirugía es una técnica en pleno desarrollo en nuestro medio y su éxito puede estar condicionado a veces a elementos externos al cirujano. Es por esto que, en el Hospital de la Fuerza Aérea de Chile, el Equipo de Cirugía Plástica ha notado la necesidad de diseñar un protocolo de apoyo a la microcirugía, el cual sea posible implementar en cualquier medio nacional. Su enfoque está dirigido a optimizar y controlar las variables fisiológicas, anestésicas y externas a la técnica quirúrgica en si misma, que podrían incidir en el éxito de la microcirugía como en la morbimortalidad perioperatoria de los pacientes.

Characteristics and Arterial Distribution of Rectus Femoris Muscle in Korean / 체질인류학회지

Free -flap which is transferred to recipients is a thin flat tissue isolated from human body and nutrient vessel of free - flap is ligated with similarly sized vessel. Free -flap reconstruction is widely used, due to high rate of flap survival and functional refinements, although it gives disadvantage of long surgery time and inefficient adaptation. This study demonstrates the characteristics and arterial supply of rectus femoris muscle of thigh. Seventy thighs (35 right, 35 left) of the 35 cadavers (19 males/16 females) which were clinically normal and without deformity were dissected and measured, according to Martin measurements. 1. The average length and width of rectus femoris muscle were 396.7 +/-39.9 mm and 36.5 +/-7.9 mm, respectively. The length of female subjects was significantly different from that of male subjects (P 0.05). 2. In the origin and insertion of rectus femoris muscle, anterior tendon and posterior tendon were not different between female and male subjects. 3. Artery of the rectus femoris muscle arises from deep femoral artery. The length of pedicle from the entering point of the rectus femoris muscle was average 19.0 +/-11.9 mm. The length from the entering point of the rectus femoris muscle to spliting point was 13.7 +/-7.7 mm of P1, 12.6 +/-7.5 mm of P2, and 14.8 +/-11.63 mm of P3 pedicles. 4. The frequency of the blood vessels inserted into the rectus femoris muscle was the first highest at the portion of 32.5 ~35% and the second highest of 35 ~37.5% and 37.5 ~40% ranges, when anterior superior iliac spine from center of the patellar was considered as 100% of portion. 5. According to the method by Kimata et al. (1998) classifying perforators based on the anatomic variations, type 1 and VIII were 83.58% and 5.97% respectively. Type 5, 6 and 7 were not observed. 6. Femoral nerves inserted into the rectus femoris muscle were distributed within 7.5 ~45% portion when anterior superior iliac spine from center of the patella was converted into 100%. The portion of 17.5 ~20% had the highest frequency of nerves. In conclusion, length of the rectus femoris muscle in Korean were different depending on gender, whereas tendon lengths were not. These data demonstrate artery pattern in Korean and provide anatomical potential for rectus femoris muscle to be used as a free -flap muscle.