The application of Pacman flap in reconstruction for skin and soft tissue defects / 中华整形外科杂志

Objective@#To introduce the experience in skin and soft tissue defects reconstruction using Pacman flap.@*Methods@#From April 2015 to April 2018, clinical data of 18 patients using Pacman flap for soft tissue defect repair were reviewed. They were 8 males and 10 females, aged from 18 to 87 years (median age of 60 years). Eight patients had benign lesions, but 10 patients had malignant tumors. The defects were on face (n=12), trunk (n=3), and limbs (n=3). The size of tissue defects ranged from 0.9 cm×0.9 cm to 10.0 cm×9.0 cm. The flap was designed along edge of the defect. Two proximal triangular flap were separated, and sutured in contraposition. The rest of the flap was advanced to cover the defect.@*Results@#The postoperative follow-up period ranged from 2 months to 20 months (median time of 9 months). All flap survived without necrosis. Hematoma occurred in 2 patients, were healed after debridement. All patients were satisfied with the aesthetic and functional outcomes.@*Conclusions@#The technique of Pacman flap is a simple and effective method to repair the skin and soft tissue defects.

Experince of supermicrosurgical lymphaticovenular anastomosis with intraoperative indocyanine green lymphangiography / 中华整形外科杂志

Objective@#To figure out the clinical application value of indocyanine green (ICG) lymphangiography in supermicrosurgical lymphaticovenular anastomosis.@*Methods@#A total of 6 supermicrosurgical lymphaticovenular anastomosis with intraoperative ICG lymphangiography were performed during April 2015 to May 2017 and were analyzed retrospectively. All the cases are female (range from 30 to 54 years old, median of 46.5 years old), including 3 cases for prevention and 3 cases for treatment of lymphedema.@*Results@#A total 6 supermicrosurgical lymphaticovenular anastomosis were performed with intraoperative ICG lymphangiography to make sure the influx of lymph fluid to the vein. During the median of 23 months follow-up (range from 7 to 32 months), the 3 preventive cases did not show upper limb lymphedema and the 3 theraputic cases were relieved at different levels.@*Conclusions@#Intraoperative ICG lymphangiography can provide real-time information to locate suitable lymph vessels and ascertain the anastomotic patency in supermicrosurgical lymphaticovenular anastomosis, thus improve the operation effectiveness.

The origin and development history of operating room / 中华整形外科杂志

In the history of modern medicine, the operating room has undergone a series of evolution since its origin. This article explains the etymology of operating theatre and illustrates the history of its origin and development. Transformed from anatomical amphitheatre and currently to surgical amphitheatre to modern operating room, the design purpose of operating room has changed from demonstration and teaching to elimination of infection and and to the pursuit of higher aseptic principles nowadays. The promotion of antisepsis and advent of anaesthesia changed the operating room in the past. In the future, the renewal of scientific ideas and technological progress will continue to promote the evolution of the form and content of the operating room and keep it moving towards medical humanism.

Experince of ICGA-guided breast reconstruction with abdominal flap / 中华整形外科杂志

Objective@#This article provides an overview of our experience using indocyanine green angiography (ICGA) in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications.@*Methods@#A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator (DIEP) flaps, 5 pedicled transverse rectus abdominis myocutaneous (TRAM) flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion.@*Results@#A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases (1 DIEP flap and 1 TRAM flap), additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and 1 vascular thrombosis were found and managed in time. During the follow-up (range from 3 to 30 months, median of 16 months), no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection.@*Conclusions@#Intraoperative ICGA can provide real-time information of flap′s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction.