The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate,based on 10 years of experience and 1072 flaps

The aim of this study was to assess the effectiveness of early exploration of anterolateral thigh (ALT) free flap compromise in head and neck reconstruction and to correlate this with the salvage success rate. The perioperative data of 1051 patients with 1072 ALT flap reconstructions were reviewed retrospectively for the period January 2002 to December 2012. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion, and salvage rate. The success rate of free flap reconstruction was 97.3% (1043/1072). Of the 29 failures, 21 were complete and eight were partial failures (10–40% of the flap). Venous occlusions occurred in 39 flaps (83.0%) and arterial occlusions in five flaps (17.0%). Six cases were detected within 8 h postoperatively, 13 at 8–16 h postoperatively, seven at 16–24 h postoperatively, and 18 at 24–48 h postoperatively, with respective salvage rates of 66.7%, 61.5%, 28.6%, and 22.2%; three cases detected after 48 h failed. The salvage rate at ≤16 h (62.2%) was much higher than that at >16 h (21.4%, P = 0.0039). Early detection, re-exploration, and effective handling of the flap crisis increases the rate of flap salvage tremendously.     

Radical resection of a Shamblin type III carotid body tumour without cerebro-neurological deficit: Improved technique with preoperative embolization and carotid stenting

The surgical resection of a large unfavourable Shamblin type III carotid body tumour (CBT) can be very challenging technically, with many potential significant complications. Preoperative embolization aids in shrinking the lesion, reducing intraoperative blood loss, and improving visualization of the surgical field. Preoperative internal carotid artery (ICA) stenting aids in reinforcing the arterial wall, thereby providing a better dissection plane. A woman presented to our institution with a large right-sided CBT. Failure of the preoperative temporary balloon occlusion (TBO) test emphasized the importance of intraoperative preservation of the ipsilateral ICA. A combination of both preoperative embolization and carotid stenting allowed a less hazardous radical resection of the CBT. An almost bloodless surgical field permitted meticulous dissection, hence reducing the risk of intraoperative vascular and nerve injury. Embolization and carotid stenting prior to surgical resection should be considered in cases with bilateral CBT or a skull base orientated high CBT, and for those with intracranial extension and patients who have failed the TBO test.     

超声刀在颈淋巴清扫术中的临床应用

目的 :探讨超声刀技术在口腔颌面头颈部鳞癌施行颈淋巴清扫术中的临床应用价值和手术技巧。方法 :2007-02—2012-12期间,随机交叉选取口腔黏膜鳞状细胞癌432例患者,分为超声刀组(216例)和电刀组(216例)。比较2组的手术时间、失血量、术后24h引流量、术后住院天数以及术后并发症的发生等项目。结果:与电刀组相比较,超声刀组在手术时间、术中失血量、24h引流量、住院天数等方面具有明显优势,经统计学分析,P<0.05为差异有统计学意义。结论:应用超声刀技术施行颈淋巴清扫术,具有传统高频电刀所不具有的组织分离和切割、凝固止血三种功能合一体的优点,实用手术技巧与超声刀技术联合应用,可使颈淋巴清扫完全达到根治性要求。是一种值得临床推广,且有应用前景的颈淋巴清扫治疗策略。     

上颈部囊性病变的MRI分析

目的:探讨MRI检查在上颈部囊性病变中的诊断价值。方法:36例上颈部囊性肿物,术前行穿刺检查和MRI检查以明确囊液性质、嚢肿范围、来源及信号强度。根据囊液性质及MRI检查特点,决定手术方法,术后病理确诊。结果:穿刺囊液为蛋清样黏液23例,为淡黄色水样液体6例,为灰色脓汁样液体5例。另有2例患者不配合未能行穿刺检查。MRI检查T1低信号、T2高信号且囊肿有"尾状征"与口底关系密切者25例,诊断为潜突型舌下腺囊肿,采用口内入路摘除舌下腺,其余11例采用颈部入路。术后病理证实潜突型舌下腺囊肿25例,淋巴管瘤6例,鳃裂囊肿5例。所有术后病理确诊与术前诊断相符,随访3³6月,未见有患者复发。结论:上颈部囊性病变术前MRI检查,有助于术前明确诊断,以正确指导手术,避免盲目颈部探查手术。     

Mild degenerative changes of hip cartilage in elderly patients: an available sample representative of early osteoarthritis

This study investigated the cellular and molecular changes which occur in cartilage from adults with femoral neck fracture (FNF) and osteoarthritis (OA), and explored the similarities in hip cartilage obtained from elderly patients and patients with early OA. Femoral heads were retrieved from 23 female patients undergoing total hip arthroplasty (THA). This group included 7 healthy patients with FNF (hFNF), 8 elderly adults with FNF (eFNF), and 8 elderly patients with hip OA (OA). After high-field MRI T2 mapping, osteochondral plugs were harvested from the weight-bearing area of femoral heads for subsequent macroscopic, histologic, and immunochemical evaluation. Additionally, the contents of cartilage matrix were analyzed, and gene expression was detected. The surface of cartilage from hFNF and eFNF patients appeared smooth, regular, and elastic, whereas it showed irregularities, thinning, and defects in OA patients. Elevated T2 values and decreased accumulation of glycosaminoglycans (GAGs) were detected in cartilage from eFNF patients. Furthermore, type I collagen accumulation was slightly increased and type X collagen concentration was obviously elevated in eFNF patients; however, type II collagen distribution and the contents and anisotropy of collagen fibrils in eFNF patients showed no significant changes. Consistent with histology and immunohistochemical results, aggrecan was downregulated and type X collagen was upregulated, while collagens types I and II showed no significant changes in eFNF patients. The cellular and molecular characteristics of hip cartilage in eFNF patients who showed no symptoms of OA were similar to those in patients with mild OA. Thus, eFNF cartilage can serve as a comparative specimen for use in studies investigating early OA.     

Postoperative bleeding risk for cutaneous surgery in the head and neck region with continued phenprocoumon therapy

In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3–3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively.     

肌内效贴联合深部肌肉刺激对非特异性颈痛的疗效

目的 观察肌内效贴联合深部肌肉刺激(DMS)对非特异性颈痛(NNP)的治疗效果。方法 2018年1月至12月,NNP患者56例随机分为对照组(n = 28)和观察组(n = 28),对照组予干扰电和磁热治疗,观察组加用肌内效贴和DMS,共2周。治疗前、治疗1周和治疗2周时,采用疼痛视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)进行评定。结果 两组治疗后,VAS和NDI评分均降低(F > 4.137, P< 0.05);观察组在治疗1周和2周后各项评分显著低于对照组(t > 4.008, P < 0.001)。 结论 肌内效贴联合DMS可有效缓解NNP。     

续骨活血汤联合抗凝对股骨颈骨折患者术后关节功能、疼痛及下肢血栓风险的影响

目的探讨续骨活血汤联合抗凝对股骨颈骨折患者术后关节功能、疼痛及下肢血栓风险的影响。方法选取我院2014年12月至2017年12月收治的114例股骨颈骨折患者为研究对象,根据随机数字表法将其分成对照组与观察组,各57例。所有患者均行内固定术治疗,对照组在术后给予抗凝治疗,观察组在对照组基础上加用续骨活血汤治疗。比较两组的髋关节功能恢复效果、术前及术后1、3、6个月的疼痛评分、下肢深静脉血栓发生情况。结果观察组的髋关节功能恢复优良率高于对照组(P<0.05)。术后1、3、6个月,两组的VAS评分均低于术前(P<0.05);术后1、3个月,观察组的VAS评分均低于对照组(P<0.05)。观察组的下肢深静脉血栓发生率显著低于对照组(P<0.05)。结论续骨活血汤联合抗凝能进一步改善股骨颈骨折患者的关节功能,缓解疼痛,降低下肢深静脉血栓发生率。