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Objective: To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site. Methods: From June 2015 to June 2019, 30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital, including 10 males and 20 females, aged 25-64 years, with 18 cases of head soft tissue defects caused by the growth and rupture of tumor, 7 cases of hypertrophic scar in trunk and limbs, and 5 cases of facial and neck soft tissue defects caused by trauma. The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm. Preoperative evaluation of 20 patients showed that the wound was relatively large, and the donor site could not be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so the bilobed latissimus dorsi myocutaneous flap with area of 14 cm×5 cm-18 cm×8 cm was cut to repair the wound, and the donor site was directly closed by suturing. Preoperative evaluation of 10 patients showed that the donor site could be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so that conventional single-lobe latissimus dorsi myocutaneous flap with area of 11 cm×9 cm-13 cm×10 cm was resected to repair the primary wound, resulting in big tension in donor site and secondary wound with area of 6 cm×4 cm-8 cm×6 cm that couldn't be directly sutured, which was repaired with donor site local flap with area of 7 cm×4 cm-9 cm×6 cm, and the second donor site was directly closed by suturing. Intraoperative end-to-end anastomosis was performed between the thoracodorsal arteries and veins of the latissimus dorsi myocutaneous flap and the arteries and veins of the primary recipient wound. The survival of latissimus dorsi myocutaneous flaps and local flaps were observed after surgery, and the appearance and function of the donor and recipient areas were observed during follow-up. Results: All the latissimus dorsi myocutaneous flaps and local flaps survived in the patients after surgery. Follow-up of 6-12 months showed that the latissimus dorsi myocutaneous flap was similar in color to the surrounding normal skin, with soft texture and good elasticity. The donor site of 20 patients repaired with bilobed latissimus dorsi myocutaneous flaps were only left with linear scars, among which 2 patients had hypertrophic scars and none had functional impairment. The donor site of 10 patients repaired with single-lobe latissimus dorsi myocutaneous flaps and donor site local flaps had good appearance, left with linear scar, irregular shape, but no local traction or dysfunction. Conclusions: When repairing a large soft tissue defect, the bilobed latissimus dorsi myocutaneous flap or the single-lobe latissimus dorsi myocutaneous flap combined with the local flap transfer in the donor site can be used after preoperative evaluation so that the donor site wound can be closed at one time while repairing the primary wound. The donor site has less scar, and both the recipient and donor sites have good appearance and function after surgery.

Objective: To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting. Methods: From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People's Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction. Results: The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group ( P <0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group ( P <0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group ( H =16.5, 9.8, P <0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group ( H =6.6, P <0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group ( P <0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group ( P <0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups ( F =0.3, P >0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma. Conclusions: Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.

Objective: To investigate the factors influencing life-threatening complications during perioperative period in patients undergoing traditional cystectomy with orthotopic neobladder., Methods: To retrospectively analyze the clinical data of 206 cases who underwent radical cystectomy with orthotopic neobladder. Logistic regression analysis was used to analyze the significance of the factors such as age, amount of bleeding, pathological stage, effective supplement of albumin, cardiovascular disease, diabetes mellitus, operation duration, intestinal preparation, etc., on the occurrence of severe complications., Results: Among the 206 patients who underwent radical cystectomy with orthotopic neobladder, 22 cases (10.7%) had life-threatening complications (intestinal fistula, hemorrhagic shock, severe infection) during the perioperative period, and 9 cases died (mortality rate 4.4%). Logistic regression analysis showed that the elderly age, long operation duration, lack of effective supplement of albumin, diabetes mellitus are independent factors influencing the occurrence of life-threatening complications during the perioperative period of radical cystectomy with orthotopic ileal neobladder (P<0.05 for all), and are risk factors positively correlated with the severe complications., Conclusion: The elderly age, long operation duration, lack of effective supplement of albumin, and diabetes mellitus are risk factors of the occurrence of life-threatening complications during the perioperative period in patients undergoing radical cystectomy with orthotopic ileal neobladder, therefore, attention should be paid to this issue.

The sign of the temporomandibular joint(TMJ) noise was assessed through the comparison among seventy orthodontic patients before and after orthondontic treatment. The results showed, after orthondontic treatment the TMJ noise was less than before, no significant correlation was found between TMJ noise and the orthondontic treatment with or without tooth extraction.

A retrospective analysis of 73 patients with glioblastoma multiforme treated with surgery plus radiotherapy (63 cases) or surgery alone (10 cases) showed that the 5-year survival was 16% versus 0% and the median survival time was 14 versus 5 months. The median survival time in patients receiving postoperative radiotherapy was almost 3 times as long as that in patients treated with surgery alone. The difference in survival was insignificant between patients treated with a local extended field and those with whole brain plus local irradiation. The age, sex, course of disease, extent of operation and dose of irradiation are the factors influencing prognosis.