A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography / 中华烧伤杂志

Objective: To explore the preoperative whole perforator evaluation and intraoperative eccentric design of anterolateral thigh flap (ALTF) based on superficial fascial perforators by modified computed tomography angiography (CTA), and the clinical effects were observed. Methods: A prospective observational study was adopted. Twelve patients with oral and maxillofacial tumors and 10 patients with open injury of the upper limb with large soft tissue defects were hospitalized in the Department of Hand & Microsurgery and Department of Oral & Maxillofacial Surgery of Affiliated Hospital of Binzhou Medical University from January 2021 to July 2022, with 12 males and 10 females, aged from 33 to 75 years, an average age of 56.6 years. The wounds of the patients with oral and maxillofacial tumors were reconstructed by ALTF after the extensive tumor resection and radical cervical lymph node dissection in the same stage; the wounds of the patients with skin and soft tissue defect on the upper limb were covered by ALTF in stage Ⅱ after debridement in stage Ⅰ. After debridement, the area of wound was 3.5 cm×3.5 cm-25.0 cm×10.0 cm and the area of the required flap area was 4.0 cm×4.0 cm-23.0 cm×13.0 cm. Modified CTA scan was performed on the donor site of ALTF before the operation, with the parameters of modified CTA being set to mainly reduce the tube voltage and tube current, and increase the contrast dose and the dual phase scan. The acquired image data were sent to GE AW 4.7 workstation and adopted the volume reconstruction function for visual reconstruction and evaluation of the whole perforator. The information of perforator and source artery was marked on the body surface before operation according to the above evaluation. During the operation, an eccentric flap centered on the visible superficial fascia whole perforator was designed and cut according to the desired flap area and shape. The donor sites of the flap were repaired by direct sutures or full-thickness skin grafts. The total radiation dose was compared between the modified CTA scan and the traditional CTA scan. The distribution of outlet point of perforator of double thighs, the length and direction of superficial fascia perforators based modified CTA were recorded. The type, number, and origin of the target perforator, distribution of of outlet point of perforator, and the diameter, course, and branch of the source artery observed before the operation were compared with those observed during the operation. The healing of donor site wound and the survival of flaps in recipient site were observed after operation. The texture and appearance of flap, oral and upper limb functions, and the functions of femoral donor sites were followed up. Results: The total radiation dose of modified CTA scan was lower than that of the traditional CTA scan. A total of 48 perforators of double thighs were observed, among which, 31 (64.6%) perforators went outward and downward, 9 (18.8%) perforators went inward and downward, 6 (12.5%) perforators went outward and upward, and 2 (4.2%) perforators went inward and upward, and the average length of superficial fascia perforators was 19.94 mm. The preoperative observed type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery were basically consistent with the intraoperative exploration. The types of 15 septocutaneous (including musculoseptocutaneous) perforators and 10 musculocutaneous perforators observed before the operation was consistent with intraoperative exploration. The distance between the mark of the surface perforator point and the actual exit point of the perforator during operation was (0.38±0.11) mm. All flaps survived without vascular crisis. The donor site wounds of 5 cases of skin grafting and 17 cases of direct suturing wounds healed well. The postoperative follow-up was 2 months to 1 year, with an average of 8.2 months, the flaps were soft and slightly bloated; the function of diet and mouth closing was accessible in patients with oral and maxillofacial tumors, the speech function was mildly impaired in patients with tongue cancer, but they could complete basic oral communication; the wrist and elbow joints and forearm rotation function were not significantly limited in patients with upper limb soft tissue injuries; there was no obvious tightness in the donor sites, and the function of the hip and knee joints was not limited. Conclusions: The whole perforator and even the subcutaneous perforator of the donor site of ALTF can be evaluated by modified CTA, and the flap can be used in oral or maxillofacial reconstruction and repair of skin and soft tissue defects of upper limbs to achieve good results. By clarifying the type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery before the operation, the eccentric design of the ALTF based on the superficial fascia perforator was realized. This study has strong guiding value.

Change of zygomatic and temporal soft tissue after coronal incision / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the change of zygomatic and temporal soft tissue after coronal incision.</p><p><b>METHODS</b>A retrospective analysis was performed in 33 patients who received firm fixation for unilateral zygomatic comminuted fracture through semi-coronal incision. All the patients were followed up for more than one year. Craniofacial anthropometric measurement through 3D-CT reconstruction and facial profile was performed. The difference between the operated side and healthy side was analyzed.</p><p><b>RESULTS</b>At the temporal concave point, the soft tissue thickness at healthy side was (1.60 +/- 0. 97) mm more than that at operated side, showing a significant difference between them (P < 0.01). While the soft tissue thickness was not statistically different between two sides at zygion, malar prominence, zygomaxillare, and temporal convex point (P > 0.05).</p><p><b>CONCLUSIONS</b>The soft tissue atrophy may happen at temporal fat pad after semi-coronal incision, but not at zygomatic area. Intraoperative precise dissection and less stretch of soft tissue may be helpful to avoid the postoperative facial asymmetry.</p>

Expression and significance of vascular cell adhesion molecule-1 in human oral squamous cell carcinoma / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To study the expression and the location of vascular cell adhesion molecule-1 (VCAM-1) gene and its clinical significance in human oral squamous cell carcinoma (OSCC).</p><p><b>METHODS</b>In situ hybridization, PV-9000 polymer detection system for immunohistochemical staining was used to detect the expression and the location of VCAM-1 mRNA and VCAM-1 protein in 48 cases of OSCC and 10 cases of normal controls. Statistical analysis was performed using chi-square test in SPSS 13.0.</p><p><b>RESULTS</b>VCAM-1 protein was mainly expressed in tumor cell cytoplasm and membrane, VCAM-1 mRNA was mainly expressed in tumor cell cytoplasm. The expression rate of VCAM-1 mRNA and VCAM-1 protein was significantly higher in OSCC than that in normal oral mucosa (P<0.01). The expression of VCAM-1 mRNA was positively correlated with that of VCAM-1 protein (P<0.01). In the clinicopathologic factors, lymph node metastasis and depth of infiltration were closely correlated with VCAM-1 expression (P<0.01). The expression of VCAM-1 was significantly higher in tumor with lymph node metastasis than in tumor without lymph node metastasis (P<0.01).</p><p><b>CONCLUSION</b>Overexpression of VCAM-1 gene in OSCC may play a potential role in the development of OSCC. The overexpression of VCAM-1 gene in OSCC may be related to the tumor infiltration and metastasis.</p>

Influence of prostaglandin E2 on proliferation of melanocytes in full-thickness skin graft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of the prostaglandin E2 on the proliferation of the melanocytes in the full-thickness skin graft.</p><p><b>METHODS</b>Sixty-eight guinea-pigs were divided into experimental-1 group (skin graft), experimental-2 group (skin graft + diclofenac), and control groups. After the full-thickness skin graft, the dynamic changes of the prostaglandin E2 were measured and the proliferation of the melanocyte with its density was also evaluated by using histochemical and autoradiographic methods.</p><p><b>RESULTS</b>In the experimental-1 group, the content of PGE2 was increasing in seven days after the operation, continued to the one month, and then returned to the base level. The labelling indices of 3H-MC-TdR of the group was also increasing postoperatively between the second day and the fourteenth day, and reach a second peak after one month, then came to the normal level. The density of the melanocytes was decreasing rapidly 3 days after the surgery, then began to increase and exceeded over the normal level 21 days after the operation. However, in the experimental-2 group, the content of PGE2 decreased in two days after the surgery, and then showed the inclination similar to the experimental-1 group with the different points in narrower range. The number of melanocytes labelled by 3H-TdR began to increase at the first day after the surgery, which appeared earlier than the experimental-1 group and was similar in the changing tendency with a less extent. The density of MC showed the similar tendency to the experimental-1 group in a narrower changing range with both of increasing and decreasing. The density of the MC was much lower in 21 after the operation than the experimental-1 group and normal control group.</p><p><b>CONCLUSION</b>The increased PGE2 in the earlier stage of the skin grafting could enhance the inflammatory reaction to the tissue, as well as the melanocytes. It may stimulate the proliferation of the MC with the result of increasing their density. The use of the diclofenac might reduce the inflammation and suppress the proliferation of melanocytes, and result in the skin with light color due to decreasing the number of MC in the epidermis of the graft.</p>