面中区恶性肿瘤80例手术缺损的修复

Objective To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms. Methods Eighty cases (54 males, and 26 females, age ranging from 23-79, with a median age of 53.5 years) ,of midface malignant tumors from 1997-2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects,reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients,6 cases were with type Ⅰ ( external nasal ) defect,56 with type Ⅱ (maxillary) defect, 14 with type Ⅲ (naso-facio-maxillary)defect and 4 with type Ⅳ ( maxillary defect combined with naso-facio-orbital cutaneous deficiency). Results The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases (91.2%). KaplanMeier analysis showed total 3-year and 5-year survival rates were 63.8% and 40. 6%, respectively.Conclusions One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.     

Different forms of free radial collateral artery perforator flaps for reconstruction after removal of oral tumors北大核心CSCD

Objective To investigate the efficacies of different forms of free radial collateral artery perforator flaps in repairing the defects after oral tumor surgeries. Methods From May 2016 to March 2021, 28 patients (22 males, 6 females, aged 35 ⁃ 62 years) with oral tumors admitted by Hunan Cancer Hospital received the reconstructive surgeries with the free radial collateral artery perforator flaps after removal of oral tumors, including 24 cases of tongue cancer (11 cases of tongue marginal cancer, 9 cases of tongue belly cancer and 4 cases of tongue cancer involved in the floor of the mouth) and 4 cases of buccal and oral cancer. Four forms of radial collateral artery perforator flaps were used: single perforator flaps for 6 cases, double perforators flaps for 7 cases, flaps without perforator visualization for 10 cases and chimeric perforator myocutaneous flaps for 5 cases. The recipient vessels were the superior thyroid artery and superior thyroid vein, and if second concomitant vein available, it was anastomosed with internal jugular vein in end‑to‑side fashion. SPSS 20.0 statistical software was used to analyze the data. Results The mean length of flaps was (9.7±0.4) cm, mean width (4.4±0.3) cm and mean thickness (1.1±0.4) cm. The mean length of the vascular pedicles was (7.1±0.6)cm (6.0-8.0 cm), the mean diameter of the radial accessory arteries was (1.1±0.3)mm (0.8-1.3 mm). Eleven cases(39.3%) had respectively one accompanying vein and 17 cases(60.7%) had respectively two accompanying veins, with the mean diameter of (1.1±0.3) mm (0.8-1.3 mm). All the 28 flaps survived, the donor and recipient wounds healed in one stage, the appearances of the flaps were satisfactory, only linear scars remained in the donor sites, and the upper arm functions were not significantly affected. Follow up for 12‑43 months showed that the flaps were soft with partially mucosalization, the reconstructed tongue and buccal cavity were in good shape, and the swallowing and language functions were satisfactory. The swallowing and language functions were retained to the greatest extent in 3 cases with near total tongue resection, although the functions were still significantly affected. There was no local recurrence of the tumor during follow‑up. One case had regional lymph node metastasis, and further lymph node dissection and comprehensive treatment were performed, with satisfactory outcomes. Conclusions The vascular pedicle of the radial collateral artery perforator flap has a constant anatomy, which can be prepared in different forms to improve the safety of the operation and minimize the donor site damage. It is an ideal choice for the repair of small and medium‑sized defects after oral tumor surgery. © 2023 Authors. All rights reserved.     

transcervical approach for resection of lateral skull base tumors

Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.     

Comparison of the application methods and effects of skin flaps in the repair of defects in different parts of the nose according to the concept of aesthetic nosesubunits北大核心CSCD

Objective To analyze the difference of application methods and effects of local flap in small and medium‑sized defects of different aesthetic subunits of nose, in order to provide reference for clinical work. Methods A retrospective analysis was made on 59 patients with external nasal masses and scars who underwent surgical treatment in the Department of Aesthetic Plastic Surgery of the Affiliated Hospital of Qingdao University from July 1, 2021 to January 30, 2022, including 27 females and 32 males, aged 15 to 69 years. Using Likert scale, the repair methods and effects of local flap for nasal soft tissue defects were evaluated and summarized from three aspects of texture, flatness and scar concealment. GraphPad Prism 5.0 software was used for data statistics and analysis. Results The use of skin flaps to repair small and medium‑sized areas of the nose could achieve satisfactory results. For patients with different subunits, in terms of skin flatness and scar concealment degree in the operation area, patients′ satisfaction with the dorsal and lateral nasal areas was higher than that of the alar and tip areas, respectively (F=6.40, P=0.001; F=10.57, P<0.001). For patients with different skin flap repair methods, the satisfaction of patients with Z‑plasty and Dufourmentel skin flap was higher than that of other skin flap repair methods (F=4.38, P=0.002), and the satisfaction of patients with Dufourmentel skin flap was the highest in the degree of scar concealment (F=2.57, P=0.038). Conclusions In the small and medium‑sized defects of the nose, the use of multiple local flaps can achieve good cosmetic effects and functional recovery. The operator should select the appropriate flap repair method according to the characteristics of different aesthetic subunits of the nose. © 2023 Authors. All rights reserved.     

上颌骨缺损类型与游离组织瓣修复选择的初步研究

目的 观察和评价应用不同游离组织瓣Ⅰ期修复上颌骨切除术后缺损的效果.方法 同顾性分析1997年10月至2010年6月中国医学科学院肿瘤医院头颈外科应用游离组织瓣Ⅰ期修复因肿瘤切除造成的上颌骨缺损共66例,其中43例为术后复发挽救性手术.46例患者曾行放射治疗.上颌骨Brown缺损类型分别为:Ⅰ型10例,Ⅱ型13例,Ⅲ型23例,Ⅳ型20例.游离组织瓣种类有:腓骨肌皮瓣26例.前臂桡侧皮瓣10例,背阔肌肌皮瓣7例,腹直肌肌皮瓣7例,股前外侧穿支皮瓣7例,腹壁下动脉穿支皮瓣5例,背阔肌-肋骨肌皮瓣2例,髂骨肌皮瓣2例.术后对29例患者进行外观和功能评估.结果 游离组织瓣修复成功率为93.9%(62/66).修复失败的4例中3例为腹直肌肌皮瓣,1例为腓骨肌皮瓣.术后对29例患者进行功能评估,62.1%(18/29)的患者恢复普通饮食,交流基本无障碍的比例为82.8%(24/29),对外观满意的比例为86.2%(25/29).结论 对于上颌骨Ⅰ型缺损建议主要采用游离前臂皮瓣修复,Ⅱ型和Ⅲ型主要以游离腓骨肌皮瓣,Ⅳ型采用穿支皮瓣修复.

Abstract：

Objective To evaluate the efficacy of the distinct free flaps in reconstruction of different types of maxillectomy defects. Methods A retrospective reviews was performed of in 66 consecutive cases of reconstructions with free flaps for maxillary tumor ablation defects from October 1997 to June 2010. There were 43 patients who had recurrences after previous operations and 46 patients had accepted radiation therapy before. According to the classification of Brown's maxilla defect; 10 cases were in class Ⅰ ,13 in class Ⅱ , 23 in class Ⅲ and 20 in class Ⅳ. The reconstructive free flaps included 26 fibula flaps, 10 radial forearm flaps, 7 latissimus dorsi flaps, 7 rectus abdominis flaps, 7 anteriolateral thigh perforator flaps, 5 deep inferior epigastric artery perforators, 2 latissimus dorsi/rib flaps and 2 iliac crest flaps. Postoperative features and functions were assessed in 29 patients. Results The overall free flap success rate was 93. 9% (62/66). Three rectus abdominis flaps and one fibula flap failed. There were 29 patients who received postoperative function assessment Sixty-two percent of the patients restored to taking regular diets, 24(82. 8% ) patients had normal language communication ability, and 25(86.2%) patients were satisfied with their feature. Conclusions Radial forearm flap was recommended to reconstruct the class 1 defect, fibula flap to class 2 or class 3 and preforatoe flap to class 4.     

Porous titanium granules in critical size defects of rabbit tibia with or without membranes

Recently, porous titanium granules （PTGs） have been indicated for the preservation of the dimensions of post-extraction sockets, as a filler in sinus lift procedures and for the treatment of peri-implant and periodontal defects, based on the osteoconductivity and dimensional stability of the titanium granules. However, there is a lack of information regarding the use of this material in larger defects and in conjunction with membranes. The objective of this study is to test the behavior of PTGs used to fill critical size defects in rabbit tibiae, with and without membranes. Critical defects were created in both tibiae of rabbits, divided randomly into three groups： Group A （defect filled with PTG）, Group B （defect filled with PTG＋collagen membrane） and a control group （empty defect）. After six weeks, histomorphometric analysis was performed. The results showed more defect closures at the cortical area （87.37%±2.2%） and more bone formation at the marrow area （57.6%± 1.3%） in Group B, in comparison with the other groups （P〈0.05）; the use of membranes improved the material stability expressed as more percentages of the original material when membranes were used （P〈0.05）. Finally, inflammatory reactions were observed when the granules were not protected by membranes. In spite of the limitations of this animal study, it may be concluded that PTG particles are osteoconductive and allow bone growth. The PTG particles must be covered by a membrane, especially when grafting larger defects, in order to control particle migration, promote clot stabilization and separate the PTG graft from undesired soft tissue cells.     

游离股前外侧皮瓣在头颈外科中的应用

目的 总结应用游离股前外侧皮瓣修复头颈肿瘤术后缺损的临床经验.方法 回顾性分析2007年11月至2010年6月辽宁省肿瘤医院头颈外科应用游离股前外侧皮瓣修复重建头颈部恶性肿瘤术后缺损43例患者的临床资料.患者男32例,女11例;年龄40～81岁,中位年龄56岁.口腔癌23例,咽侧壁扁桃体7例,下咽癌11例,头皮癌、枕部肉瘤各1例.肿瘤分期:T1期9例,T2期17例,T3期11例,T4期6例.为保证有足够的安全切缘,所有患者手术切除范围为距肉眼所见肿瘤边缘至少2 cm,43例患者肿瘤切除术后应用游离股前外侧皮瓣进行修复重建,恢复咀嚼、吞咽及呼吸功能.皮瓣血管蒂长8～18 cm,平均12.5 cm.左股前外侧皮瓣41例,右侧2例.皮瓣面积(4～15)cm×(5～25)cm.结果 游离股前外侧皮瓣移植一期成功40例,1例术后第5天出现静脉血栓,重新吻合血管皮瓣成活.坏死3例,其中2例分别于术后第1天、第4天胸大肌肌皮瓣修复.1例第20天皮瓣坏死脱落后长肉芽愈合.11例下咽癌患者中3例行喉全切除术,8例保留喉功能(72.7%).23例口腔癌、7例咽侧壁扁桃体癌术后均恢复较好的咀嚼、吞咽、发音功能.头皮癌、枕部肉瘤患者较好地修复了大面积皮肤缺损.结论 游离股前外侧皮瓣修复技术可靠,成活率高,供区无严重并发症.皮瓣薄厚适中,可塑性好,是头颈肿瘤术后修复重建理想的修复皮瓣.

Abstract：

Objective To evaluate the results of reconstruction by free anterolateral thigh flaps ( ALT) after operation of head and neck tumors. Methods Forty-three cases underwent the reconstruction of postoperative defects with free anterolateral thigh flaps after head and neck cancer surgeries between November 2007 and June 2010 were reviewed. Ages of the patients ranged from 40 to 81 years, with a median of 56 years; 32 males and 11 females; 23 cases of oral carcinoma, 7 cases of tonsil carcinoma, 11 cases of hypopharyngeal carcinoma,and 2 cases of head skin cancer. TNM classified as follows; no case of distant metastasis; T1 9 cases; T2 17 cases; T3 11 cases; T4 6 cases. All patients were applied with ALT to restore swallowing and respiratory functions. The mean length of blood vessel pedicles of the ALT free flaps was 12. 5 (8-18) cm. The flaps were 4 - 15 cm in width,5 - 25 cm in length. Results In the 43 cases applied with ALT free flaps, 40 cases were successful and 3 cases unsuccessful. Two of the failed cases were reconstructed with pectoralis major flap. In 11 cases of hypopharyngeal carcinoma, except 3 cases with total laryngectomy, 8 cases(72. 7% ) had their laryngeal function been preserved. Conclusions The successful rate of ALT free flaps is perfect. There were no serious complication in offered areas. The flap could be shaped into various forms. ALT free flap is an ideal flap to reconstruct the defect after surgery in some head and neck tumors.     

Auricular Reconstruction Using a Porous Polyethylene Framework

Objective To report utility of Medpor frameworks in auricular reconstruction and management of frameworks protrusion. Methods Retrorespectively analysis of clinical information in 31 patients who underwent auricular reconstruction from April 2000 to October 2002. Results All 31 reconstructed auricles were in good condition at two weeks postoperatively. Framework protrusion occurred later in 11 patients. The framework was retained in 8 of these cases after secondary repair, but had to be removed in 3 patients. In 27 patients, the reconstructed auricle was rated as esthetically succesful. Conclusion Medpor framework protrusion is likely to occur when skin tension is high with minimal soft tissue coverage over the framework and can result from impact by strong external force. Despite the concern of protrusion, Medpor frameworks can be used in place of autologous cartilaginous graft in auricular reconstruction.     

内镜下带血管蒂鼻中隔黏骨膜瓣修复颅底缺损

目的 探讨内镜下应用带血管蒂的鼻中隔黏骨膜瓣修复颅底硬膜缺损的方法及疗效.方法 回顾性分析2008年7月至2010年3月间收治的8例应用带血管蒂的鼻中隔黏骨膜瓣鼻内镜下修复术后颅底硬膜缺损及创伤性脑脊液鼻漏患者的临床资料及随访结果.8例患者均为男性,年龄28～60岁,平均年龄41岁.其中前颅底血管外皮瘤1例、嗅神经母细胞瘤1例(Kadish C型)、筛窦癌1例、鼻咽癌放疗后局部复发3例、颅底类癌1例、脑脊液鼻漏伴反复颅内感染1例.其中前颅底缺损6例,中颅底缺损2例.手术采用内镜经鼻入路,直视下获取以鼻后动脉为蒂的一侧鼻中隔黏骨膜瓣.组织瓣覆盖硬膜缺损后,周缘敷以明胶海绵,并用生物蛋白胶固定,鼻内以碘仿纱条、水囊及膨胀海绵支撑.术后5～7 d撤除全部鼻内支撑物.结果 1例鼻中隔瓣部分坏死,其余7例鼻中隔瓣全部成活.1例术后7 d有脑脊液鼻漏,再次手术探查以腹部脂肪封堵漏口成功,术后随访6～24个月,颅底组织愈合良好,无延迟性脑脊液漏及颅内感染发生.结论 内镜经鼻入路采用带血管蒂鼻中隔黏骨膜瓣修复颅底硬膜缺损是一种可靠的颅底重建方法.

Abstract：

Objective To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach. Methods The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemoangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C) , one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy,one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively. Results Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat.All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period. Conclusion The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.     

Necrotising otitis externa: A single centre experience

Introduction:Necrotising otitis externa(NOE)is a rare infection of the ear canal with frequent bone erosion.This study’s objective is to describe the different features of NOE as well as its management in an ear-nose-throat department.We also tried to identify the particularities of the fungal infection.Patients and methods:It is an observational cohort that included all the patients hospitalised for the management of NOE.The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019.Results:A total of 40 patients were included.The mean age was 65±12.9 years and the sex ratio was 0.9.Ninety percent of the patients included were diabetics.The most common signs found were oedema of the external canal(97.5%)and auricular discharge(92.5%).The main pathogen isolated was Pseudomonas aeruginosa(61.7%).Fungi were isolated in 9 cases(26.47%).Computed tomography was performed for 32 patients(80%).Bone erosion was seen in 26 cases(81.3%).The main complications were cerebral venous thrombosis,retropharyngeal abscess and cerebral empyema.Thirty one patients received only antibiotics,2 received only antifungal treatment,and 7 received both antibiotics and antifungal treatment.All patients had a favorable outcome.Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections.No other differences were noted.Conclusion:Our management protocol seems to be efficient since all patients had initial favorable outcome.A higher median erythrocyte sedimentation rate was associated with fungal infections.     

Management of cancer of the base of tongue

The management of base of tongue cancer has evolved steadily over time. Organ preservation with primary radiation therapy has produced excellent oncologic and functional outcomes. Concomitant chemotherapy has become important in patients with locoregionally advanced disease. Planned neck dissection after organ preservation therapy continues to be an integral step for regional control. This article reports the results of a literature review of base of tongue cancer emphasizing a multidisciplinary approach to obtain optimal results in terms of cure and quality of life.     

耳廓开放性外伤的治疗方法探析

目的 探讨耳廓开放性外伤的治疗方法。方法 23耳耳廓开放性外伤经彻底清创，肝素生理盐水冲洗伤口后，对位缝合。术后用抗生素抗感染、丹参扩张血管、罂粟碱改善微循环。结果 23耳中2耳失访，18耳完全成活，1耳部分成活，2耳完全坏死。结论 耳廓撕裂伤、断伤、带有皮蒂的耳廓离断伤，由于断端双侧血管丰富，经对位缝合后容易成活。但耳廓完全离断伤由于缺乏血供，经对位缝合后不易成活，可采用去皮血管植入包埋法，带肌蒂皮瓣移植法或尝试显微外科技术施行血管吻合，以提高耳廓完全离断伤的成活率。