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With the widespread use of cosmetic surgery blepharoplasty, sunken upper eyelid deformities have become a common complication after blepharoplasty. Upper eyelid depression seriously affects the appearance of the eye and may be accompanied by incomplete lid closure and corneal ulceration. The main principles of repairing upper eyelid deformity after blepharoplasty are to restore normal anatomical relationships, release adhesions, and perform tissue filling to restore tissue volume. Tipped tissue flaps and free tissue grafts have been used to repair sunken upper eyelid deformities after blepharoplasty with good clinical results. Different treatment methods should be used for different cases of sunken upper eyelid deformity, depending on the patient's condition and complaints. Now, a review of the progress of treating upper eyelid depression after blepharoplasty with tipped tissue flaps and free tissue grafts is presented in conjunction with the analysis of domestic and international literature and a comprehensive comparison. [ABSTRACT FROM AUTHOR]

The design of anchor bolt in tunnel engineering mostly depends on empirical method and analogy method. In order to study the mechanical effect of surrounding rock in prestressed anchor bolt support system, a mechanical coupling model of prestressed anchor bolt and surrounding rock is established. Considering the damage effect of surrounding rock excavation, the analytical expressions of stress distribution and radial displacement of surrounding rock after tunnel excavation are derived by elastic-plastic mechanics theory. The finite difference software FLAC3D is used to verify and analyze the influence of prestressed anchor parameters on the state of surrounding rock. The results show that the maximum tangential stress and the radius of plastic zone of surrounding rock in theoretical analysis and numerical simulation are 4.77 MPa, 15 m and 4.49 MPa, 15.86 m respectively. The stress distribution and displacement of tunnel surrounding rock calculated by theoretical analysis and numerical simulation are basically the same. The rationality of theoretical analytical solution is verified in IV and V grade surrounding rock strata. With the increase of pre-tightening force, the radial displacement of surrounding rock in plastic zone and the radius of plastic zone gradually decrease, while the elastic zone is basically unaffected. When the length of the free section of the bolt is located in the plastic zone, the radial displacement of the plastic zone and the radius of the plastic zone of the surrounding rock gradually decrease with the increase of the length of the bolt. In practical engineering, the pre-tightening force of bolt should be increased as much as possible. The increase of bolt length has limited control effect on the displacement of surrounding rock and the development of plastic zone. The length of free section of bolt should be controlled in plastic zone. [ABSTRACT FROM AUTHOR]

Objective To explore the method and clinical effect of using free posterior tibial artery perforator flaps on the head and face soft tissue defects. Methods From June 2018 to August 2022, 12 patients with head and face sofe tissue defects were treated with Posterior Tibial Artery Perforator Flap (PTAPF) to repair the head and face skin, subcutaneous tissue, and muscle tissue, and evaluation of the postoperative appearance, complications, and flap survival rate. Results Postoperatively, all 12 patients were followed up for a period of 6 to 12 months. The texture and shape of the flap were good, the chromatic aberration with the facial skin was small, and the survival rate of the flap was high. All patients were satisfied with the results. Conclusion The posterior tibial artery perforator flap has similar tissue thickness, texture, and color to the head and face, and less damage to the donor site. It is an ideal method for repairing head and face soft tissue defects. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the feasibility of applying indocyanine green angiography (ICGA) before and during the operation to evaluate the blood supply of the flap and adjust the surgical plan in flap repair surgery to increase the survival rate of flap transplantation and reduce complications after flap surgery. Methods From March 2019 to March 2021, the clinical data of 78 patients admitted to the Department of Burn Plastic and Cosmetic Surgery of Xi'an Central Hospital Affiliated to Xi'an Jiaotong University were randomly selected and divided into control group of 40 cases and experimental group of 38 cases according to the order of admission. The control group underwent traditional flap transplantation, and the experimental group underwent ICGA before and during the operation to evaluate the blood supply of the flap and adjust the surgical plan based on the results of the angiography. Results All 38 patients in the experimental group had no angiography-related complications after ICGA. Among them, 3 cases adjusted the operation plan according to the ICGA results and ended the operation smoothly, the remaining 35 cases ended the operation smoothly according to the preoperative design. In the control group, all flap operations were performed by traditional surgical methods. Among them, 8 cases of flap tips had blood flow disorders during the operation, and the operations were terminated after corresponding treatments, the remaining 32 cases were successfully completed according to the preoperative design. All patients were followed up for 6 months. There was no statistically significant difference between the observation group and the control group in the incidence of postoperative flap blood supply abnormalities (X² ＝0.212，P＝0.645) and flap related complications (X² ＝0.749，P＝0.387). Conclusion ICGA before operation can play an auxiliary role in the design of random skin flap, the application of ICGA angiography in flap surgery can evaluate the blood perfusion of the flap in real time, which is helpful to adjust the flap operation plan [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of free second toe tibial flap in repairing fingertip skin and soft tissue defects. Methods From February 2016 to August 2019, 11 patients with fingertip skin and soft tissue defects were repaired with free second toe tibial flap at the Orthopaedic Trauma Center of PLA of The 988th Hospital of Joint Logistic Service of PLA. The area of soft tissue defect was 1.2 cm×2.0 cm to 2.0 cm×2.5 cm. The flap ranged from 1.3 cm×2.2 cm to 2.3 cm×2.8 cm. All donor site defects on the ipsilateral second toe were covered with full-thickness skin graft. There were 2 wounds in thumb, 4 in index finger, 4 in middle finger and 1 in ring finger. The wound defect area 1.2 cm×2.0 cm to 2.0 cm×2.5 cm. Skinflap cutting area 1.3 cm×2.2 cm to 2.3 cm×2.8 cm, the second toe on the same side of the donor site was selected and the full-thickness skin graft was transplanted. After the operation, the appearance, sensation and donor site recovery of the flap were regularly followed up by outpatient reexamination. Results All the flaps survived well in 11 cases and without any vascular crisis. Partial skin graft necrosis at the donor site was found in 1 case, and the wound healed gradually after daily dressing change. After 8 to 14 months of follow-up,the appearance and the texture of the recipient site flap was good, and no obvious dysfunction of the donor site was found. Thesensation of the 11 flaps was recovered to S2 to S3＋, and the two-point discrimination was 6 to 11 mm. The recovery of hand function was satisfactory. According to the trial criteria for evaluation of upper limb function of the Society of Hand Surgery of the Chinese Medical Association, 8 cases were excellent and 3 cases were good. The Vancouver Scar Scale was used to evaluate the fingertip scar. The scores of 11 cases in this group were 3 to 5, with an average score of 3.6. Conclusion The free second toe tibial flap is a rational therapeutic strategy for repairing the skin and soft tissue defect of fingertip. It has the advantages of constant bloodvessels, good sensory recovery, and concealed donor area. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical effect of free gracilis muscle flap grafting for repairing incision infection accompany with cerebrospinal fluid (CSF) leakage after occipital craniocerebral surgeries. Methods This study was a retrospective and observational study. From January 2017 to December 2021, 4 patients with incision infection accompany with CSF leakage occipital craniocerebral surgeries were admitted to the Plastic and Burn Department of the Second Affiliated Hospital of Air Force Medical University. All the patients were treated with local debridement combined with free gracilis muscle flap free grafting repair. Results Four patients had successful gracilis graft and without complications such as reinfection and CSF leakage. Follow-up for 3 to 10 months after operation showed that the heads had good appearance and no without significant scar hyperplasia in the donor area. Conclusion The gracilis muscle flap transplantation for repairing incision infection accompany with CSF leakage after posterior occipital craniocerebral surgery, can minimize the recurrence of reinfection and CSF leakage, achieve good functional recovery effect and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ordnance Equipment Engineering is the property of Chongqing University of Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore and summarize the causes, classification and staging of vascular crisis in free flap transfer breast reconstruction. Methods From June 2015 to June 2021, a total of 605 cases of free flap transfer breast reconstruction were included in this group, including 412 cases of primary breast reconstruction and 193 cases of delayed breast reconstruction, the flap form included 547 cases of free lower abdominal flap and 58 cases of free posterior medial thigh flap. The occurrence of vascular crisis was counted, and the specific causes, classification and staging characteristics of vascular crisis were further summarized. According to the changes of skin flap color, the difference between flap surface temperature and normal skin temperature, and the changes of monitoring data of audible Doppler, the stages of progressive arterial crisis include: hidden stage, arterial blood supply disorder stage, venous reflux obstruction stage, thrombosis stage and flap necrosis stage. The stages of progressive venous crisis include: hidden stage, venous reflux obstruction stage, venous embolism stage, arterial blood supply disorder stage, thrombosis stage and flap necrosis stage. Results Vascular crisis occurred in 65 cases of this group, including 16 cases of acute arterial vascular crisis and 25 cases of acute venous vascular crisis, all of which were treated in time and rescued successfully during the operation. There were 10 cases of progressive arterial vascular crisis, of which 2 cases were treated in time and successfully rescued. Total flap failure occurred in the other 8 cases, in 5 cases the wound was closed directly, in other 3 cases free posterior medial thigh flap was transferred for salvage. In 14 cases of progressive venous vascular crisis, the flaps in 5 cases received successfully salvage, and the flaps in the other 9 cases totally failed. In 7 cases the wound was closed directly, in other 2 cases free posterior medial thigh flap was transferred for salvage. Conclusion In breast reconstruction with free flap transplantation, classification and staging of vascular crisis of flap is helpful to discriminate the cause and progress of vascular crisis, and to predict the significance and success rate of reexploration, the risk of flap necrosis and the postoperative effect. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effects of free secondtoe medial flaps for repair of digital nail bed defects. Methods From June 2010 to July 2018, 16 cases with digital nail bed defects were treated by free second toe medial flaps in our department. The size of the flap was from 1.8 cm×1.6 cm to 2.4 cm ×2.6 cm. The wound of the donor sites was repaired by the full-thickness skin graft from the dorsum of the foot or lower leg. Results All 16 flaps survived in one stage. The skin graft of the foot donor site survived in all the cases. Postoperatively the patients were follow-up for 6 to 24 months with an average of 14 months. The contour of the free flap was satisfactory and its color was similar to that of the adjacent skin. The appearance of the repaired finger was satisfactory. All the patients walked and wore shoes well without obvious abnormality. According to the trial criteria for evaluation of upper limb function of the Society of Hand Surgery of the Chinese Medical Association, the excellent was in 12 cases, the good was in 3 cases and the fair was in 1 case. The excellent and good rate was 93.8%. Conclusion It is an ideal method to repair digital nail bed defects using free second-toe medial flaps. This method is simple with tiny damage in the donor site. The appearance and functional recovery of the repaired finger are satisfactory. [ABSTRACT FROM AUTHOR]

Objective To explore the feasibility and clinical efficacy of super-thin scar flap in the repair of wounds in trunk and extremities after medium-sized or large keloid resection. Methods From October 2018 to November 2020, 17 patients with medium-sized or large keloids in trunk and extremities were treated in the Department of Burn and Plastic Surgery of Jining First People's Hospital, including 8 cases of shoulder and back and 9 case of extremities. The size of keloid was from 2.0 cm × 6.0 cm to 5.0 cm × 15.0 cm. The operation was performed along the central part of the long axis of keloid, and sharp dissection was made to both sides. The thickness of scar flap was from 1.5 to 2.0 mm. The scar tissue under the scar flap and the infection were completely removed, and the incision of the scar flap was closed by interrupted suture. Sixteen adult patients received superficial electron beam radiotherapy within 24 hours after operation. Ten patients received vacuum sealing drainage (VSD) treatment for 10 days after radiotherapy, and 1 child received VSD treatment for 14 days immediately after operation. Results The incisions of 17 patients healed from 14 to 21 days after operation. Sixteen patients who received electron beam radiotherapy had different degrees of local superficial necrosis of scar flap, without affecting the flap survival and wound repair. All patients were followed up for 11 to 30 months. No hyperplasia of keloid was found in all patients. Patients with small scope recurrence of keloid were treated with triamcinolone acetonide. The preserved pathological scars gradually recovered to normal scar tissue in 16 patients who received radiotherapy. Conclusion It is feasible to use super-thin scar flap to repair the wounds in trunk and extremities after medium-sized or large keloid resection. This method will not increase wounds of donor site and has positive clinical significance. [ABSTRACT FROM AUTHOR]

Objective To summarize the key points of perioperative nursing care of continuous vacuum sealing drainage (VSD) assisted perforator flap in the repair of orbital exenteration. Methods From September 2016 to December 2020, 32 patients repaired by perforator flap after orbital exenteration were selected. All patients were divided into 2 groups according to the treatment method, 16 cases in each group. In the conventional treatment group, routine perioperative nursing care was performed. In the VSD group, psychological counseling was given before operation and strengthened after operation. In order to prevent vascular crisis, the negative pressure under VSD membrane and the color of flap was observed intensively. The wound secretion was cleaned immediately to keep the negative pressure. Results In the conventional treatment group, 4 cases showed positive results of bacterial culture around incision at 3 days after operation; flap bruise and black occurred within 3 days after operation; the orbital CT results showed that 2 cases of flaps did not tightly fitted to the orbital cavity at 3 days after operation; all wounds healed by second intention at 1 month after operation. In the VSD group, the results of bacterial culture around incision were all negative at 3 days after operation; the orbital CT results showed that the flap tightly fitted to the orbital cavity at 3 days after operation; the pressure package was removed at 2 weeks after operation. The flap in 1 patient developed vascular crisis at 2 days after operation and survived after symptomatic treatment. No other complications occurred. At 6 months after operation, all flaps had good fusion with surrounding skin. Conclusion By strengthening perioperative observation of VSD combined with perforator flap in the repair of tissue defects after orbital exenteration and continuous negative pressure suction, the occurrence of complications reduced and the quality of transplanted tissue improved. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy, advantages and disadvantages of free second toe in the reconstruction of thumb and finger defects in emergency. Methods From March 2010 to May 2017, 98 patients with thumb and finger defects (105 fingers) were collected. There were 18 cases of thumb, 33 cases of index finger, 31 cases of middle finger and 16 cases of ring finger. Defects or degloving injuries of index finger and middle finger at the same time were found in 9 patients. Eleven cases of defects were distal to the middle of the metacarpal bone, 53 cases were distal to the base of the proximal phalanx, 19 cases were distal to the proximal interphalangeal joint and 15 cases were distal segment. Thirteen cases of nerves were extracted from the proximal end about 3 to 5 cm, and the skin at the proximal end of defects was slightly contused. Twenty-nine cases (31 fingers) were reconstructed with the free second toe, and 69 cases (74 fingers) were reconstructed with the second toe combined with the dorsal foot flap. Regular follow-up after operation was performed to evaluate the appearance, function and condition of the donor site. Results All reconstructed fingers (105 fingers) survived and were followed up for 1 to 3 years. The appearance and functional recovery of the reconstructed fingers were satisfactory. According to the trial standard of the upper limb function evaluation of the Chinese Society of Hand Surgery, 87 cases (92 fingers) were excellent, 9 cases (11 fingers) were good and 2 cases (2 fingers) were poor. The excellent and good rate was 97.9%. No obvious hypertrophic scar and dysfunction was found in the donor site. There was no obvious discomfort in weight-bearing and walking. Conclusion Application of free second toe in the reconstruction of thumb and finger defects in emergency can restore good appearance and function, which is an ideal treatment method. [ABSTRACT FROM AUTHOR]

The quality of vessel anastomosis is a key element for the success of free flap reconstruction. When adopting free flaps for oral and maxillofacial defect reconstruction, skills in selecting vessels, determining the clinical manifestations of the recipient vessel, and anastomosis technique are needed. Key points on postoperative flap observation were also required. We are experienced on this subject given that we have accomplished more than 1 000 free flaps for patients with oral and maxillofacial defects in the last 5 years. In this article, we summarize the skills and key points in free flap reconstruction of oral and maxillofacial defects, including vessel anastomosis skills, vessel selection, and vessel crisis diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the clinical efficacy of dorsal metacarpal star flap in the reconstruction of finger/toe web in syndactyly. Methods From March 2018 to May 2020, 17 patients with syndactyly were selected. There were 7 cases of congenital syndactyly, 4 cases of syndactyly caused by flap repair of trauma and 6 cases of toe syndactyly. The dorsal metacarpal star flap was used in the reconstruction of finger/toe web and the continuous Z-shaped flap separation was used among the fingers/toes. The condition of skin graft, incision infection, skin flap necrosis, morphology of finger/toe web, scar and long-term finger/toe web advancement were recorded. Results No skin graft was performed in all patients. The wounds closed directly and healed by first intention. No complications such as flap necrosis, incision infection and nonhealing occurred. All patients were followed-up for 3 to 12 months, the morphology of finger/toe web was normal and no obvious scar contracture was found. Conclusion Application of dorsal metacarpal star flap in the reconstruction of finger/toe web was safe. There was no need of skin graft during the operation. The operative time was short, the morphology of finger/toe web after operation was good and the scar was concealed. This method was satisfactory. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of lateral upper arm free flap transplantation in the repair of small and medium-sized skin and soft tissue defects of hand. Methods From January 2015 to January 2020, 15 patients with skin and soft tissue defects of hand were repaired by lateral upper arm free flap transplantation. The area of defects ranged from 1.5 cm × 5.0 cm to 5.0 cm × 7.0 cm. All patients were followed up for 6 to 12 months. The survival rate, color, temperature, capillary filling reaction and sensory recovery of flap were observed. The complications of recipient site were counted and the sensory function of hand was evaluated. Results One patient developed venous crisis after operation, which healed after timely exploration and reanastomosis. Thirteen flaps survived, 2 flaps had partial necrosis and healed after dressing change. Three cases of flaps were slightly bloated and two-stage flap repair was performed at 6 months after operation. The remaining patients had good texture and appearance of flap. The recovery of hand function was satisfactory, 14 cases were excellent and 1 case was good. The sensory recovery of hand was good. No serious complications occurred in the recipient area. Conclusion The lateral upper arm free flap is an ideal flap in the repair of small and medium-sized skin and soft tissue defects of hand. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of a simple negative pressure suction drainage device based on a disposable infusion set and a plastic bottle of normal saline in drainage after auricular reconstruction with expanded method. Methods From March 2020 to September 2021, 23 patients received auricular reconstruction with expanded method. A simple negative pressure suction drainage device based on a disposable infusion set and a plastic bottle of normal saline with air drawn was applied for drainage. The efficacy of negative pressure drainage was observed. The postoperative drainage volume, time to extubation, wound healing, infection and flap survival were observed and recorded. Results This simple negative pressure suction drainage device was always unobstructed for all patients. The flap closely fitted the framework. The substructure of auricle was clear. The average drainage volume of the wound was 11 ml daily, and the time to extubation was from 4 to 7 days, with an average of 5 days. All incisions healed by first intension. No necrosis, infection and hematoma of incisions occurred. The blood supply of flap was good. No flap necrosis or framework exposure occurred. Conclusion This device can maintain appropriate negative pressure, which not only ensures the close fit of flap and framework but also does not affect the blood supply of flap. The efficacy of drainage is good and the substructure of reconstructed auricle is clear. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total hip arthroplasty is the most effective method for the treatment of middle and late developmental dysplasia of the hip. The anatomical structure of developmental dysplasia of the hip patients is malformed, and acetabulum reconstruction is the difficulty of operation. At present, three-dimensional (3D) printing technology is used to reconstruct the pelvis model and guide the preoperative planning, but the direction and depth of the file have not been well solved. Thus, we will further mine the CT scan data of pelvis, and make a guide device using 3D printing technology to guide the direction of the file. OBJECTIVE: To investigate the clinical effect of 3D-printing assisted individualized total hip arthroplasty for adult developmental dysplasia of the hip. METHODS: Thirty patients with developmental dysplasia of the hip were included and randomly divided into two groups (n=15 per group). In the observation group, 3D pelvis model and operation guide plate were made through 3D printing technology to develop individual operation plan. In the control group, the operation was completed according to the routine operation process. The operation time, intraoperative blood loss, and Harris score of hip joint in the last follow-up were compared between the two groups, and the difference of abduction angle, vertical and horizontal distance with the design value was compared to evaluate the accuracy of acetabular prosthesis placement. RESULTS AND CONCLUSION: (1) There was no significant difference in the abduction angle, Harris score during the last follow-up and horizontal distance between the two groups after surgery (P > 0.05). (2) The operation time and intraoperative blood loss of the observation group were significantly less than those of the control group (P < 0.05). (3) The vertical difference between the two groups was statistically significant (P < 0.05), and the design deviation of the observation group was smaller. (4) It is indicated that with the help of 3D printing technology, preoperative observation of personalized 3D model was used to enhance the understanding of the anatomical variation of developmental dysplasia of the hip. During the operation, the guiding function of acetabular prosthesis was used to improve the accuracy of acetabular prosthesis placement, shorten the operation time and reduce the amount of intraoperative blood loss. [ABSTRACT FROM AUTHOR]

Objective: To compare the lateral flap repair and forearm flap repair for oral and maxillofacial tumor patients. Methods: A total of 120 patients with oral and maxillofacial tumors treated in Suining Central Hospital from August 2015 to August 2020 were chosen as research subjects. All the patients had tissue defect after tumor resection and were divided into two groups according to different flap repair methods. In which, 68 patients underwent lateral flap repair (LFR)(as LFR group) and 52 patients underwent forearm flap repair (FFR)(as FFR group). The flap repair effect, the oral function recovery and the flap survival rate after treatment, the flap crisis rate and vascular anastomosis time after operation, and the complications were compared between the two groups. Results: The total effective rate (95.59 %) of the lateral flap repair group was significantly higher than that (84.62 %) of the forearm flap repair group (P<0. 05). The scores of appearance repair, language function, chewing function, swallowing function and oral closure of the patients in the lateral skin flap repair group were significantly higher than those in the forearm flap repair group (P<0.05). There were no significant differences in the flap survival rate, postoperative flap crisis rate and vascular anastomosis time between the two groups. The total complication rate (2.94 %) of the lateral flap repair group was significantly lower than that (17.31 %) of the forearm flap repair group (P<0.05). Conclusions: The application of lateral flap repair in the patients with oral and maxillofacial tumor postoperative defects can improve the effect of flap repair and the recovery of oral function, reduce the incidence of complications, with good safety, which is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Free iliac flap combined with or without vascularised greater trochanter bone grafting is adopted in the treatment of young and middle-aged patients with non-traumatic ARCO III necrosis of the femoral head. However, the efficacy of these two operation treatments is still unclear.OBJECTIVE: To compare the clinical outcomes of free iliac flap combined with or without vascularised greater trochanter bone graft in young and middle-aged patients with ARCO III necrosis of the femoral head.METHODS: Those ARCO III necrosis of the femoral head patients aged 18-45 years who were treated with free iliac flap combined with vascularised greater trochanter bone graft(group A) or with free iliac flap(group B) from January 2009 to November 2013 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine were included in this study. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The incision length, hospitalization time, operation time and blood loss were recorded.The Harris scores and Visual Analogue Scale scores at baseline and end of follow-up in ARCO III subtypes were compared. The good and excellent rate of hip joint and hip preserving rate were calculated.RESULTS AND CONCLUSION:(1) A total of 71 patients(group A 37 patients with 42 hips; group B 34 patients with 38 hips) were included.The follow-up time was 3.5-7 years.(2) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B(P < 0.05).(3) The Harris scores and Visual Analogue Scale scores were improved significantly after surgery in ARCO III subtypes of two groups. The Harris scores and Visual Analogue Scale scores in the group A were significantly superior to group B in necrosis of the femoral head patients with ARCO III b and c(P < 0.05). The Harris scores and Visual Analogue Scale scores had no significant difference between two groups in necrosis of the femoral head patients with ARCO III a(P > 0.05).(4) The hip preserving rate in the groups A and B was 91% and 74%(Z=3.9, P < 0.05), respectively. According to the result of Harris scores, the good and excellent rate of hip joint in the groups A and B was 82% and 75%, respectively.(5) There were no serious complications after surgery.(6) These results imply that free iliac flap combined with or without vascularised greater trochanter bone grafting is an effective treatment method for young and middle-aged patients with ARCO III necrosis of the femoral head. They can effectively improve the hip joint function and release joint pain. However, free iliac flap combined with vascularised greater trochanter bone grafting can achieve good clinical outcomes in young and middle-aged patients with ARCO III b and c necrosis of the femoral head. [ABSTRACT FROM AUTHOR]

BACKGROUND: Three-dimensional (3D) printing technology is currently one of the most advanced industrial manufacturing technologies. The surgical template prepared based on the 3D printing technology is mainly made of resin, and a great improvement in its accuracy is required. However, the clinical application of the surgical template made of metal is rarely reported. OBJECTIVE: To evaluate the clinical value of 3D-printing implant template in the restoration of free-end missing teeth. METHODS: A prospective study was conducted in 64 enrolled patients with free end-tooth defects. All the patients were randomly assigned to receive traditional implant template (control group, n=32) or 3D-printing implant template (study group, n=32), and 3-6 months later, the patients were subjected to crown restoration. At 6 months after crown restoration, cone beam computed tomography was performed to compare the deviation of the implant tip and neck (including vertical, buccolingual, mesial-distal). Success rate and chewing rate were compared between the two groups at 6 months after crown restoration; patient satisfaction assessment was done and compared between the two groups at 1 year after crown restoration. RESULTS AND CONCLUSION: There were no significant differences between the two groups in the success rate and chewing rate (98.7% vs. 95.6%; 97.4% vs. 97.1%, P > 0.05). The vertical, buccolingual, mesial-distal deviations of the implant tip were significantly lower in the study group than the control group (P < 0.05), while there was no difference in the vertical and buccolingual deviations of the implant neck between the two groups (P > 0.05), and the mesial-distal deviation of the implant neck was significantly lower in the study group than the control group (P < 0.05). In addition, there was no difference in the patient satisfaction between the study and control groups (94% vs. 91%, P > 0.05). To conclude, the 3D printing implant template can effectively reduce implant excursion based on the assurance of therapeutic efficacy and patient satisfaction, which is of great significance in the restoration of free-end tooth loss. [ABSTRACT FROM AUTHOR]

Objective: To explore asurgical methods for replantation of severed finger., Methods: From January 2018 to November 2022, 8 amputated-finger patients were performed surgical reconstructions by using polyfoliate free flaps with the first dorsal metatarsal artery, including 7 males and 1 female, aged from 20 to 55 years old, and defect areas ranged from (1.0 to 2.0) cm×(3.0 to 4.5) cm. Finger pulp sensation, shape and other relevant parameters were assessed following the upper extremity functional evaluation standard, which was put forward by Hand Surgery Branch of Chinese Medical Association. And maryland foot functional score was used to evaluate foot function., Results: Amputated fingers and flaps of all the 8 patients were survived. All patients were followed up for 4 to 20 months, their finger color and temperature tured to normal, with good wear-resistance and cold-resistance. According to Hand Surgery Branch of Chinese Medical Association, functional score ranged 61 to 92;4 patients got excellent result and 4 good. Maryland foot functional score ranged from 93 to 100;and 8 patients got excellent result., Conclusion: It is feasible to repair severed fingers with soft tissue defects using polyfoliate free flaps that driven by the flippers of the first and second toes of the foot. This method ccould bridge blood vessels, increase soft tissue volume of the injured finger, and avoid finger shortening, with high patient satisfaction.

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PURPOSE: To preliminarily establish a hemodynamic 3D numeric model of radial forearm free flap with vascular pedicle of radial artery' and vein, and discuss its scientific workability. METHODS: The 3D geometric model of 50mmx80mmxl0mm radial forearm flap was established by Pro/E(Wildfire 4.0). The vascular pedicle was 50mm in length including radial artery. (inside diameter was 1.9mm) and concomitant radial vein (inside diameter was 0.84mm). The half-embedded vessels went through the flap paralleling the long axis. Then the established geometric model was transferred to the SC/Tetra 8.0 software for mesh generation and calculation. According to the virtual flow volume of the radial artery, the inlet velocity was set as 20mm/s. With the different blood pressure of 53mmHg between the feeding artery and draining vein, the tentative porous values were achieved. Then porous model was applied to the flap to simulate the capillary structure. The pressure distribution on the central axis of radial artery and vein and the radial velocity distribution in three different cross sections of vessels were figured out. RESULTS: A model with 10355473 meshes and 2104014 nodes was built. When porous model was applied, the pressure difference between radial artery and vein was calculated to 7050 Pa (52.8mmHg), which was close to clinical value. The computational fluid dynamic analysis results showed that with porous model, the central pressure of radial artery was continuously kept to a higher level. When blood flowed in and flows out of the flap, the blood velocity decreased and increased greatly. While the central pressure of radial vein significantly decreased at the moment of blood flowing out of the flap. These results basically agreed with the features of normal blood circulation of the forearm flap. CONCLUSIONS: Porous model effectively simulates hemodynamic status of forearm flap, which provides a new method for the study of mechanism of blood circulation in radial forearm flap and also lays a foundation for the following hemodynamic study of vascular anastomosis. Supported by Combined Medical-Engineering Project of Shanghai Jiao Tong University (YG2009MS41). [ABSTRACT FROM AUTHOR]

PURPOSE: To summarize the experience of improving survival rate of microsurgical free flap transfers for oral and maxillofacial reconstruction. METHODS: One hundred and sixty-eight consecutive microsurgical free flap transfers performed in patients with oral and maxillofacial defects after surgical procedure due to carcinoma from March 2006 to August 2010 were reviewed. The series included 90 free radial forearm flaps, 31 free fibular flaps, 39 anterolateral thigh flaps and 8 latissimus dorsi musculocutaneous flaps. The microsurgical free flap survival rate and postoperative complication were evaluated. RESULTS: The overall success rate of flap was 97.6% (164/168) The overall complication rate was 6.5%(11/168) .The flap crisis rate was 5.4% (9/168) including venous thrombosis in 6/9 cases, and the flap salvage rate was 55.6% (5/9).Survival rate of radial forearm free flap, anterolateral thigh flap, fibular flap and latissimus dorsi musculocutaneous flap was 97.8%,97.4%,96.8% and 100%, respectively. Facial symmetry, swallowing and occlusion of the patients were satisfactory after 2 to 2.5 years of follow-up. CONCLUSIONS: Microsurgical free flap transfer for oral and maxillofacial region is safe and reliable. The key point was to guarantee arterial blood supply and venous drainage. To promptly discover blood vessel crisis after operation in the first 5 days and immediate surgical exploration within 6 hours when there were a crisis of blood vessel is crucial for improving successful free flap salvage. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate an optimal method to reproduce anatomical shape and occlusal function of extensive bilateral mandibular defect. METHODS: Fifteen patients with lesion involving bilateral mandible and needed for segmental resection were underwent preoperative CT scan. The 3-dimensional virtual models and the solid physical models of the mandible were created by computer-aided design/computer-aided manufacture (CAD/CAM) system and rapid prototyping technique. The osteotomy lines and the shape of reconstruction titanium meshes were designed based on solid models. Titanium meshes were punched by CNC machine and ensured to match the shape of mandibles ready for resection. Fibula osteomyocutaneous free flaps were harvested and transplanted together with prefabricated titanium meshes to repair the large mandibular defects. RESULTS: All free fibular flaps survived well. Wounds healed. No titanium mesh exposure was observed during the follow-up period. The anatomical shape of mandibles including the natural arch, curvature and height recovered satisfactorily. All patients' appearance with immediate reconstruction presented no significant change before and after surgery. CONCLUSIONS: CAD/CAM rapid prototyping technique combined with free fibular flap graft to repair extensive bilateral mandibular defect can not only rehabilitate the natural shape of the mandible, maintain the patient' appearance, but also create favorable conditions for dental implant and occlusal reconstruction. Supported by Grant from the Clinical Discipline Key Project of the Ministry of Health of China(2007292). [ABSTRACT FROM AUTHOR]

Objective: To investigate the application of the reconstruction methods for hypopharyngeal and cervical esophageal defects due to the resection of hypopharyngeal cancer and advanced laryngeal cancer between free fasciocutaneous flaps and free jejunium transfer.We compared the superiorities and inferiorities of these two reconstruction methods. Method: Retrospective review of the archives of 56 patients from 2000 to 2010 who underwent pharyngoesophageal reconstruction with free flaps (n=32) or free jejunal transfer(n=24),comparison of indications,complications, hospitalization duration, swallowing function recovery and postoperative survival time. Result: The overall 3 year survival rate of free flap group and free jejunal transfer group was 59.3%,55.7% respectively; the overall 5 year survival rate was 38.5%,37.1% respectively. The overall rate of complication rate was 18.8%, 16.7% respectively. The patients with free flaps had higher incidence rate of fistula and scarring in the donor site and lower incidence rate of hues and stricture than the ones with free jejunal transfers. The mean hospitalization duration was (15.00±7.06) days and(13.00±6.75) days. The mean time of first oral food intake was(13.00±5.83)days and (11.00±6.67) days. The differences between two groups had no statistical significance( P >0.05). Conclusion: Free flaps and free jejunium transfer are the two most common reconstruction methods for the hypopharyngeal and cervical esophageal defects. Each has its own advantages and disadvantages respectively. We should choose reconstruction method according to the site and extent of the hypopharyngeal and cervical esophageal defects, preoperative and postoperative radiotherapy requirement., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)