Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction.

BACKGROUND: The authors introduce an algorithm for preoperative planning of optimal lateral circumflex femoral artery system perforator flap (LCFAPF) supplied by the best quality and the easiest dissection of the perforators and the source vessels for simplified and customized strategies in head and neck reconstruction with perforator navigation using color Doppler ultrasound and three-dimensional reconstruction (3D-CDUS PN). METHODS: Between June 2011 and September 2015, a prospective cohort study was performed with an algorithm based on defect site, perforator type, and pedicle length using 3D-CDUS PN to select optimal perforators arising from the different branches of LCFA in 108 patients. The optimal perforator and flap were determined by perforator caliber and quality, difficulty in flap dissection, and length of the source vessels. Cause and classification of the defect, flap choice, recipient vessels, postoperative course, and complications were analyzed. RESULTS: The source vessels of the perforators were lateral descending branch in 73 cases and oblique branch in 17 cases with ALTPFs, medial descending branch in 12 cases with AMTPFs, and ascending branch in 6 cases with TFLPFs. Straightforward dissection of flaps with septocutaneous (n = 40) and semi-septocutaneous (n = 17) perforators was performed in 52.8% cases. Successful exploration rate and overall flap survival rate were both 100%. Satisfactory functional and esthetic results in both recipient and donor sites with no serious complications were observed in all patients. CONCLUSIONS: Our algorithm using 3D-CDUS PN facilitates selection of optimal flap with better caliber and quality of the perforators and sufficient pedicle length for easy dissection.

Clinical features and treatment outcomes of immunoglobulin g4-related sclerosing sialadenitis.

Idiopathic enlargement of salivary glands used to be confusing in diagnosis until immunoglobulin G4 (IgG4)-related sclerosing sialadenitis was proposed as a possible answer. In this case series, we reported the clinical features and management outcomes in 16 patients with IgG4-related sclerosing sialadenitis. We retrospectively studied 16 patients in clinical examination, serology, pathology, and sonography features. All patients were treated by corticosteroids and followed up for at least 3 months. The results of clinical features showed that all of the patients presented persistent, symmetric bilateral swelling of the salivary glands, elevated levels of serum IgG4, and/or IgG4-positive plasmacytes infiltration and tissue fibrosis. The results of all autoantibody tests were negative. The typical sonographic manifestation revealed multiple hypoechoic foci with an irregular netlike diffuse lesion in salivary glands. Most patients showed excellent response to steroids treatment. We conclude that, for patients who present (1) symmetric swelling of bilateral salivary glands for more than 3 months, (2) elevated serum IgG4 level (>135 mg/dL), and (3) enlargement in bilateral salivary glands with multiple hypoechoic areas (irregular netlike appearance) in the sonography, the diagnosis of IgG4-related sclerosing sialadenitis should be considered. A comprehensive understanding of the medical condition and appropriate pathology examination are the key to diagnose. Steroids treatment is effective, and a treatment plan should be set up and followed in the long-term.

[Ultrasonographic study on the relationship between the thickness of squamous cell carcinoma of tongue and cervical lymph node metastasis].

PURPOSE: This study aims to investigate the correlation between the thickness of the tongue carcinoma and cervical lymph node metastasis obtained with ultrasonography. METHODS: The tumor thickness of 37 primary tongue cancers were measured in the sonogram by the intraoral ultrasonography. The cervical lymph nodes were scanned, and the number, size, internal echo, and blood stream were measured to evaluate the nature. SAS6.1 software package was used for Chi-square test, non-parametric test and Logistic regression. RESULTS: The tumor thickness measured before operation with ultrasonography and after operation from pathological sections was subjected to non-parameter Wilcox rank-sum test, P=0.2013, indicating that there was no significant difference between the mean thickness obtained from the two modalities. The tumor thickness and cervical lymph node metastasis were subjected to non-parameter rank correlation test, the Spearman r=0.6824, P<0.01, indicating that there were a positive correlation between the tumor thickness measured by ultrasonography scan and cervical lymph node metastasis. Logistic regression analysis also showed that the risk of metastasis of the neck lymph nodes increased with the increased thickness of the tumors. CONCLUSIONS: The accuracy and sensitiveness of ultrasonography in measuring the tumor thickness and detection of cervical lymph metastases make it a promising pre-operative tool in staging the cancer and optimizing the treatment plan for the surgeons.