Publications by authors named "Dajiang Song"

60 Publications

[Application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022 Jul;36(7):834-839

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P. R. China.

Objective: To investigate the application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect.

Methods: Between August 2018 and December 2020, 12 patients, including 4 males and 8 females, were treated with expanded anterolateral thigh myocutaneous flap to repair huge complex defects after thoracic wall tumor surgery. The age ranged from 28 to 72 years, with an average of 54.9 years. There were 4 cases of phyllodes cell sarcoma, 2 cases of soft tissue sarcoma, 1 case of metastatic chest wall tumor of lung cancer, and 5 cases of breast cancer recurrence. All cases underwent 2-7 tumor resection operations, of which 3 cases had previously received lower abdominal flap transplantation and total flap failure occurred, the other 9 cases were thin and were not suitable to use the abdomen as the flap donor site. After thorough debridement, the area of secondary chest wall defect was 300-600 cm ; the length of the flap was (24.7±0.7) cm, the width of the skin island was (10.6±0.7) cm, the length of the lateral femoral muscular flap was (26.8±0.5) cm, the width was (15.3±0.6) cm, and the length of the vascular pedicle was (7.9±0.6) cm.

Results: The myocutaneous flaps and the skin grafts on the muscular flaps were all survived in 11 patients, and the wounds in the donor and recipient sites healed by first intention. One male patient had a dehiscence of the chest wall incision, which was further repaired by omentum combined with skin graft. The appearance of the reconstructed chest wall in 12 patients was good, the texture was satisfactory, and there was no skin flap contracture and deformation. Only linear scar was left in the donor site of the flap, and slight hyperplastic scar was left in the skin harvesting site, which had no significant effect on the function of the thigh. All patients were followed up 9-15 months, with an average of 12.6 months. No tumor recurrence was found.

Conclusion: The expanded anterolateral thigh myocutaneous flap surgery is easy to operate, the effective repair area is significantly increased, and multiple flap transplantation is avoided. It can be used as a rescue means for the repair of huge chest wall defects.
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http://dx.doi.org/10.7507/1002-1892.202202001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288917PMC
July 2022

[Role of intercostal neurovascular perforator in lower abdominal flap].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022 Jun;36(6):770-775

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P. R. China.

Objective: To investigate if intercostal neurovascular perforator can nourish lower abdominal flap.

Methods: Between June 2017 and December 2020, in 39 female patients with predominant perforator originated from intercostal nerve nutrient vessels, main trunk of the deep inferior epigastric vessels was chosen to be the pedicle to harvest free lower abdominal flap for breast reconstruction. The age of the patients ranged from 28 to 52 years, with an average of 38.6 years. There were 16 cases on the left and 23 cases on the right. The duration of breast cancer was 3-32 months, with an average of 21.8 months. Pathological stage was stageⅡin 31 cases and stage Ⅲ in 8 cases. Among them, 25 cases were primary tumor resection and one stage breast reconstruction and 14 cases were delayed breast reconstruction.

Results: The lower abdominal flap pedicled with one side pedicle was harvested in 32 cases, all of which were supplied by the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator; 7 cases were harvested with bilateral pedicled lower abdominal flaps, of which 4 cases were supplied by the main trunk of the deep inferior epigastric vessel combined with intercostal neurovascular perforator on one side and deep inferior epigastric artery perforator on the other side, and the other 3 cases were supplied by bilateral main trunk of the deep inferior epigastric vessel and the intercostal neurovascular perforator. In the flaps nourished with the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator, the intercostal neurovascular perforators were one branch type in 15 cases, one branch+reticular type in 19 sides, and reticular type in 8 sides. The size of flap ranged from 26 cm×10 cm to 31 cm×13 cm; the thickness was 2.5-5.5 cm (mean, 2.9 cm); the vascular pedicle length was 7.0-11.5 cm (mean, 9.2 cm); the weight of the flap was 350-420 g (mean, 390 g). All the flaps survived completely and the incisions at donor sites healed by first intention. All patients were followed up 14-35 months (mean, 25.4 months). The shape, texture, and elasticity of reconstructed breasts were good and no flap contracture happened. Only linear scar left at the donor site, the function of abdomen was not affected. No local recurrence happened.

Conclusion: When the direct perforator of the deep inferior epigastric artery may not provide reliable blood supply for the lower abdominal flap, the intercostal neurovascular perforator with deep inferior epigastric vessels can ensure the blood supply of the free lower abdominal flap.
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http://dx.doi.org/10.7507/1002-1892.202201098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240852PMC
June 2022

Patient Management Strategies in Perioperative, Intraoperative, and Postoperative Period in Breast Reconstruction With DIEP-Flap: Clinical Recommendations.

Front Surg 2022 15;9:729181. Epub 2022 Feb 15.

Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Background And Objective: Deep Inferior Epigastric Perforator (DIEP) flap is a tissue isolated from the skin and subcutaneous tissue of the lower abdomen or rectus muscle to foster breast reconstruction. There is limited information about DIEP-flap induced complications associated with breast reconstruction surgery.

Evidence: We conducted a systematic review of the published literature in the field of breast cancer reconstruction surgery. Information was gathered through internet resources such as PubMed, Medline, eMedicine, NLM, and ReleMed etc. The following key phrases were used for effective literature collection: "DIEP flap", "Breast reconstruction", "Patient management", "Postoperative DIEP", "Intraoperative anticoagulant therapy", "Clinical recommendations". A total of 106 research papers were retrieved pertaining to this systematic review.

Conclusion: A successful breast reconstruction with DIEP-flap without complications is the priority achievement for this surgical procedure. This study provides various evidence-based recommendations on patient management in the perioperative, intraoperative, and postoperative periods. The clinical recommendations provided in this review can benefit surgeons to execute breast reconstruction surgery with minimal postoperative complications. These recommendations are beneficial to improve clinical outcomes when performing surgery by minimizing complications in perioperative, intraoperative, and postoperative period.
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http://dx.doi.org/10.3389/fsurg.2022.729181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887567PMC
February 2022

Correction to: NAP1L1 interacts with hepatoma-derived growth factor to recruit c-Jun inducing breast cancer growth.

Cancer Cell Int 2022 Jan 15;22(1):26. Epub 2022 Jan 15.

Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.

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http://dx.doi.org/10.1186/s12935-021-02437-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760688PMC
January 2022

Multi-pedicled long fasciocutaneous free flaps in complex lower extremity reconstruction.

J Plast Reconstr Aesthet Surg 2022 Feb 1;75(2):893-939. Epub 2021 Dec 1.

Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK. Electronic address:

Fasciocutaneous free tissue transfer is an established limb salvage modality in lower extremity reconstruction. In severe cases, defect coverage is challenging due to the size and extent of the injury which may surpass the dimensions of most commonly utilized fasciocutaneous donor sites. This is further complicated by the considerable length between the recipient pedicle and most distal segment of the defect requiring coverage. Available donor sites that are able to provide free fasciocutaneous flaps extended length (>40 cm) are combinations between the lateral thoracic, lower abdomen/groin and lateral thigh regions. Advantages of this include a single donor site that can be closed primarily, the ability to utilize healthy vessels outside the zone of trauma/injury for microvascular anastomosis and single stage reconstruction. In addition, from a logistical perspective, single flap harvest would theoretically be more efficient and less resource intensive than harvesting two separate flaps or performing large skin grafts. Herein, we present current available donor sites that allow harvest of long fasciocutaneous free flaps incorporating multiple pedicles with a single skin paddle for lower extremity reconstruction.
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http://dx.doi.org/10.1016/j.bjps.2021.11.097DOI Listing
February 2022

NAP1L1 interacts with hepatoma-derived growth factor to recruit c-Jun inducing breast cancer growth.

Cancer Cell Int 2021 Nov 13;21(1):605. Epub 2021 Nov 13.

Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.

Background: Breast cancer is a common cancer among women in the world. However, its pathogenesis is still to be determined. The role and molecular mechanism of Nucleosome Assembly Protein 1 Like 1 (NAP1L1) in breast cancer have not been reported. Elucidation of molecular mechanism might provide a novel therapeutic target for breast cancer treatment.

Methods: A bioinformatics analysis was conducted to determine the differential expression of NAP1L1 in breast cancer and find the potential biomarker that interacts with NAP1L1 and hepatoma-derived growth factor (HDGF). The expression of NAP1L1 in tissues was detected by using immunohistochemistry. Breast cancer cells were transfected with the corresponding lentiviral particles and siRNA. The efficiency of transfection was measured by RT-qPCR and western blotting. Then, MTT, Edu, plate clone formation, and subcutaneous tumorigenesis in nude mice were used to detect the cell proliferation in breast cancer. Furthermore, coimmunoprecipitation (Co-IP) assay and confocal microscopy were performed to explore the detailed molecular mechanism of NAP1L1 in breast cancer.

Results: In this study, NAP1L1 protein was upregulated based on the Clinical Proteomic Tumor Analysis Consortium (CPTAC) database. Consistent with the prediction, immunohistochemistry staining showed that NAP1L1 protein expression was significantly increased in breast cancer tissues. Its elevated expression was an unfavorable factor for breast cancer clinical progression and poor prognosis. Stably or transiently knocking down NAP1L1 reduced the cell growth in vivo and in vitro via repressing the cell cycle signal in breast cancer. Furthermore, the molecular basis of NAP1L1-induced cell cycle signal was further studied. NAP1L1 interacted with the HDGF, an oncogenic factor for tumors, and the latter subsequently recruited the key oncogenic transcription factor c-Jun, which finally induced the expression of cell cycle promoter Cyclin D1(CCND1) and thus the cell growth of breast cancer.

Conclusions: Our data demonstrated that NAP1L1 functions as a potential oncogene via interacting with HDGF to recruit c-Jun in breast cancer.
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http://dx.doi.org/10.1186/s12935-021-02301-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590370PMC
November 2021

[Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Oct;35(10):1323-1327

Ultrasound Diagnosis Center, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.

Methods: The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.

Results: All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.

Conclusion: It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
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http://dx.doi.org/10.7507/1002-1892.202105016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505943PMC
October 2021

[Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Sep;35(9):1172-1176

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.

Methods: Between January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.

Results: In antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups ( =2.904, =0.091). The difference in delayed healing rate of donor site between the two groups was significant ( =0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).

Conclusion: The modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
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http://dx.doi.org/10.7507/1002-1892.202102049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8444136PMC
September 2021

The Role of Measurement of Pedicle Length for DIEP Flap Transferring in Breast Reconstruction: A Single-Center, Open-Label, Randomized Controlled Trial.

Ann Plast Surg 2021 Sep 10. Epub 2021 Sep 10.

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.

Background: Intraoperative venous congestion is a main complication in deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction. We present a pedicle measuring technique to precisely predict the length of pedicle needed in DIEP free flap, to improve the outcome, and to reduce the risk of donor site morbidity and complications.

Materials And Methods: A single-center, open-label, prospective, randomized study was carried out to access efficacy and safety of a pedicle measuring technique in 389 patients. Each patient received a delayed breast reconstruction using free unipedicled DIEP flap, and internal mammary vessels were chosen as recipient vessels. During the surgery, the conventional DIEP flap technique was used in the control group, in which the course of the pedicle was fully dissected. In the measuring group, the flap in setting way was decided preoperatively, the distance (A) between the internal mammary vessels (a) and the point of DIEP perforator into the subcutaneous tissue (b) was measured, and then the length (B) of the perforator (c) and the main trunk (d) is measured and dissected to achieve 1 cm longer than A.

Results: There are 180 and 209 patients enrolled in the control and measuring group, respectively. Venous congestion occurred in 15 patients (8.3%) in the control group, and 1 patient (0.5%) in the measuring group (P < 0.001). All the 16 patients were found venous thrombosis. Then successful free flap salvage surgeries were performed in 10 patients. Six patients (3.3%) had total flap necrosis due to recurrent venous thromboembolisms. Fat necrosis occurred in 16 patients (8.9%) in the control group, and 5 patients (2.4%) in the measuring group (P = 0.006). Partial flap necrosis was found in 12 patients (6.7%) in the control group, and in 3 patients (1.4%) in the measuring group (P = 0.008). Total flap necrosis occurred in 6 patients (3.3%) in the control group, but no (0%) patient in the measuring group (P = 0.009).

Conclusions: Measurement of pedicle length for DIEP flap transferring in breast reconstruction is a reliable technique that could secure the DIEP free flap, reduce operative invasiveness, and lower the risk of complications considerably.
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http://dx.doi.org/10.1097/SAP.0000000000002978DOI Listing
September 2021

Bilateral Anterolateral Thigh Myocutaneous Flaps for Giant Complex Chest Wall Reconstruction.

Ann Plast Surg 2021 09;87(3):298-309

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan.

Background: Extensive reconstruction of complex full-thickness chest wall oncological defects is challenging. Bilateral free anterolateral thigh (ALT) myocutaneous flap transfer for the complex reconstruction of a large area of the chest wall is discussed.

Materials And Methods: We reported a single unit's experience in 1-staged multilayered reconstruction of large full-thickness chest wall defects in 22 patients (16 primary chest wall tumor cases, 5 locally advanced breast cancer cases, and 1 osteoradionecrosis case) treated between 2011 and 2018. Bilateral ALT myocutaneous flaps together with traditional cement implant or unmovable/movable joint conformable titanium struts were used for chest wall reconstruction. The anatomical characteristics of pedicle origin and pattern of the venae comitantes of the ALT myocutaneous flap, recipient vessels, and anastomosis patterns were described.

Results: Bilateral ALT myocutaneous flaps were used for soft tissue reconstruction in 22 cases. Different methods of flap harvesting and vascular anastomosis were selected as needed. No vein grafts or arteriovenous loops were required. We observed 3 vascular patterns of the flap pedicle, including 1 oblique branch and descending branch (59.1%, n = 26), 2 single descending branch (9.1%, n = 4), and 3 double branches of the descending branch (31.8%, n = 14). The flap was harvested pedicled with solely the oblique branch in 7 (15.9%) cases, solely the descending branch in 28 (63.6%) cases to minimize the donor site morbidity, and pedicled with the oblique and descending branch in 9 (20.5%) cases to achieve multiple vascular anastomosis choices. Stable skeletal reconstructions were achieved using traditional cement implant (13.6%, n = 3) or conformable titanium struts (86.4%, n = 19), with good fixation strength. Complication risk was low. An algorithmic approach to management is presented and recommended.

Conclusion: Various forms of bilateral ALT myocutaneous flap transfer with different skeletal reconstruction presents as a reliable treatment for patients with large full-thickness chest wall defects. Anatomical variations in the pedicle and pattern of venae comitantes of the ALT myocutaneous flap are reported. In some challenging cases, finding the vessels in the recipient area is difficult. The clinical significance of each vascular pattern is delineated, and surgical technical considerations are discussed on the basis of the recipient area requirements and types of a flap's vascular anatomy.
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http://dx.doi.org/10.1097/SAP.0000000000002860DOI Listing
September 2021

[Muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 May;35(5):605-610

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the surgical technique, effectiveness, and safety of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction.

Methods: Between December 2016 and February 2019, 6 cases of early breast cancer received modified radical surgery, lower abdominal flap was applied for one- or two-staged breast reconstruction. The average age of the patients was 34.6 years (range, 29-56 years). The disease duration ranged from 2 to 16 months, with an average of 9.5 months. The tumor was located in the upper outer quadrant in 4 cases and the lower outer quadrant in 2 cases. Pathological examination showed that they were all invasive ductal carcinoma. Four cases of breast cancer were in stage Ⅰ and 2 cases was in stage Ⅱ. During operation, the inferior epigastric artery perforators were found to be close to the upper edge of the flap and/or near the umbilical cord in 4 cases, the inferior epigastric artery perforator vessels were relatively small (<0.3 mm) in 2 cases; and the breast was reconstructed with muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator. The length, width, and thickness of the flap were (28.9±0.2), (12.1±0.4), and (4.4±0.3) cm, respectively. The length of the vascular pedicle was (11.5±0.2) cm and the weight of the flap was (420.5±32.7) g.

Results: All 6 muscle-sparing rectus abdominis myocutaneous flaps were successful, and the breast incisions healed by first intention. There was no vascular crisis, donor site effusion, hematoma, or infection. All 6 patients were followed up 12-36 months (mean, 26.8 months). The reconstructed breast had a good shape, good elasticity, and no flap contracture or deformation; only linear scars left at the donor site of the flap, and the abdominal wall function was not affected. During follow-up, there was no breast cancer recurrence and metastasis.

Conclusion: When the inferior epigastric artery perforators are too close to the upper edge of the flap and/or near the umbilical cord, the vascularity of lower abdominal flap can be ruined, harvested in form of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator can efficiently ensure blood supply safety.
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http://dx.doi.org/10.7507/1002-1892.202011020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175202PMC
May 2021

[Application and prospect of preoperative computed tomographic angiography in deep inferior epigastric artery perforator flap for breast reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Jul;34(7):927-931

Department of Head and Neck/Oncology Plastic Surgery, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To generalize the application and prospect of computed tomographic angiography (CTA) in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction.

Methods: The related literature using CTA for DIEP flap reconstruction of breast in recent years was reviewed and analyzed.

Results: Preoperative CTA can accurately assess the vascular anatomy of the chest and abdomen wall, precisely locating the perforator in the abdominal donor site, and identifying the dominant perforator; guide the selection of intercostal space to explore internal mammary artery and internal mammary artery perforator in the chest recipient vessels. It can also reconstruct the volume of the abdominal flap with reference to the size of the contralateral breast and pre-shape the abdominal flap, which are crucial to formulate the surgical plan and improve the reliability of flap.

Conclusion: Preoperative CTA has enormous application potential and prospects in locating donor area perforator, in selecting recipient vessels, and in evaluating breast volume for autologous breast reconstruction with DIEP flap.
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http://dx.doi.org/10.7507/1002-1892.201907017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180424PMC
July 2020

[Free sensate intercostal artery perforator flap for hand soft tissue reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Apr;34(4):497-500

Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.

Methods: Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).

Results: All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily.

Conclusion: Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
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http://dx.doi.org/10.7507/1002-1892.201904072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171518PMC
April 2020

Postoperative drain after transoral endoscopic thyroidectomy vestibular approach (TOETVA) with single incision.

Surg Endosc 2021 01 7;35(1):358-366. Epub 2020 Feb 7.

Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, Hunan, China.

Objective: To find the optimal size of a drain for the reliable drainage and the best cosmetic result in TOETVA. To explore the normal drainage flow rate after TOETVA.

Methods: A prospective randomized controlled trial was performed in a single center from December 2016 to December 2018. One hundred and fifty-three (153) patients had TOETVA with a single incision and were randomly divided into two groups. Self-made drainage tubes with a small diameter (outer diameter 2.0 mm, inner diameter 1.0 mm) were used in 80 patients (experimental group). No. 8 tubes were used in 73 patients (control group). The clinical characteristics and results between both groups were compared by t test or chi-square test, and the results of normal drainage flow rate were calculated.

Results: The experimental group had a longer intraoperative tube-inserting time, compared with the control group (9.5 ± 2.5 min vs. 5.6 ± 1.4 min, p = 0.001), a smaller scar six months after the operation (1.8 ± 2.3 mm vs. 3.1 ± 2.6 mm, p = 0.002), and a lower Vancouver Scar Scale score at both one month (3.20 ± 1.44 vs. 4.19 ± 1.92, p = 0.001) and six months after the operation(1.43 ± 1.84 vs. 2.40 ± 2.37, p = 0.006). The drainage volume, pain score on the first day, postoperative complications (tube blockage, air leakage, subcutaneous hydrops, hematoma, regional infection), and the extubation time were not significantly different. The average drainage of 148 patients without postoperative complications was 78.3 ± 10.9 ml. The cumulative drainage within 8 h, and 32 h after the operation accounted for 53.2% and 91.9% of the total drainage, respectively. The residual drainage at 32 h was estimated to be 6.5 ± 2.9 ml (P95 = 11.0 ml). A linear regression equation between total volume (V) and the size of resected tissue (S) was established: V = 1.625 S + 56.604 (p = 0.0001).

Conclusion: In TOETVA, a small drain can provide a good cosmetic appearance and reliable drainage. The main exudation period of the wound is within 8 h after the operation. If a residual volume of less than 11 ml is considered to be self-absorbable, the shortest safe extubation point for 95% of patients should be 32 h after the operation.
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http://dx.doi.org/10.1007/s00464-020-07408-8DOI Listing
January 2021

[Multivariable analysis for flap-related complications in autologous breast reconstruction and economic analysis of intraoperative indocyanine green angiography].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Jan;34(1):92-97

Department of Oncology Plastic Surgery/Head & Neck Surgery, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha Hunan, 410013, P.R.China.

Objective: To investigate the influencing factors of flap-related complications and the economic benefits of intraoperative indocyanine green (ICG) angiography in the patients undergoing autologous breast reconstruction.

Methods: Between July 2013 and June 2018, the clinical data of 150 patients (152 breasts) who met the selection criteria after autologous breast reconstruction were analyzed retrospectively. Ten factors including age, body mass index, preoperative neoadjuvant chemotherapy (NC), chest radiation history, diabetes, abdominal operation history, chest wall reconstruction, reconstruction timing, flap type, intraoperative ICG angiography were analyzed by univariate analysis. Significant variables found in univariate analysis were used to perform backward multivariate logistic regression of flap related complications and local necrosis. According to the above multi factor analysis results, the patients were divided into 4 groups: ICG+NC group (group A), ICG+non-NC group (group B), non-ICG+NC group (group C), non-ICG+non-NC group (group D). The average extra costs of surgical treatment (including ICG imaging cost+cost of handling flap related complications) of each group was calculated.

Results: All the 152 flaps survived. There were 33 flap-related complications, including 22 regional necrosis, 9 regional infection, 5 hematoma, 5 simple fat liquefaction, and 2 anasto-motic thrombosis. Univariate analysis showed that preoperative NC, flap type, and intraoperative ICG angiography had significant influence on the incidence of flap-related complications ( <0.05). Multivariate analysis showed that preoperative NC and non-ICG angiography were the risk factors of flap-related complications ( <0.05), and also the risk factors of regional flap necrosis ( <0.05). For patients who had NC, intraoperative ICG angiography could greatly save the average extra costs. The average extra costs in group A was 1 378 yuan less than that in group C. For the patients without NC, intraoperative ICG angiography would increase the average extra costs, which was 747 yuan in group B more than that in group D.

Conclusion: In autologous breast reconstruction, ICG angiography can reduce the incidence of flap-related complications, especially the incidence of regional flap necrosis, while NC is the opposite. For patients without NC, ICG angiography is not cost-effective but still can be used if conditions permit. However, for those with NC, ICG angiography is cost-effective and recommended.
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http://dx.doi.org/10.7507/1002-1892.201906023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171835PMC
January 2020

Synchronous Closure of A Large Medial Perforator-Based Superficial Circumflex Iliac Artery Perforator Free Flap Donor Site Using an Ipsilateral Lateral Perforator-Based Superficial Circumflex Iliac Artery Perforator Propeller Flap.

Ann Plast Surg 2020 08;85(2):146-148

Plastic and Reconstructive Surgery Department, Clinica Colsanitas, Bogotá, Colombia.

A superior advantage of the superficial circumflex iliac artery perforator flap is that any donor site residue can easily be hidden by clothing. Usually designed as narrow or moderate-sized flaps based on medial perforators of the superficial branch, this readily allows primary donor site closure. However, for larger flaps, tension-free closure requires that the thigh remain flexed or even a skin graft used. Another alternative would be to use an adequate lateral perforator of the deep branch, if available, as the vascular hub of a propeller flap that extended into the adjacent flank, that could then be rotated into the medial groin to facilitate simultaneous direct closure of both flap donor sites.
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http://dx.doi.org/10.1097/SAP.0000000000002159DOI Listing
August 2020

A Sequential Thoracoacromial Artery Perforator Flap for Reconstructing the Donor Site of Sternocleidomastoid Myocutaneous Flaps: Extended Indications and Technical Modifications.

Ann Plast Surg 2020 06;84(6):657-664

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha, Hunan, China.

Background: The current study introduces and demonstrates our experience of using a sequential thoracoacromial artery perforator (TAAP) flap to repair the sternocleidomastoid (SCM) flap donor site in this context. The aims of this technique are to optimize both esthetic and functional outcomes and to reduce postoperative complications for patients.

Methods: Between September 2013 and March 2017, the SCM flap combined with sequential TAAP flap was used for reconstruction postradical parotidectomy in 12 patients. Flap characteristics, patient outcomes, and postoperative complications were monitored and objectively measured, with 10 to 24 months of follow-up.

Results: There were no incidences of total flap loss. All TAAP flap donor sites were closed directly, and all healed without any complications. The SCM flap and TAAP flap donor areas were esthetically acceptable, with good esthetic and functional outcomes achieved in all 12 patients.

Conclusions: The sequential TAAP flap has a consistent vascular supply and provides a reliable surgical approach to reconstruct the SCM flap donor site with good esthetic and functional outcomes.
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http://dx.doi.org/10.1097/SAP.0000000000002042DOI Listing
June 2020

[Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Oct;33(10):1305-1309

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction.

Methods: Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly.

Results: All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying.

Conclusion: Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
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http://dx.doi.org/10.7507/1002-1892.201903030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8337640PMC
October 2019

[Application of pedicled omentum flap in breast reconstruction of breast cancer patients].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Aug;33(8):1006-1010

Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients.

Methods: Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm.

Results: According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened.

Conclusion: The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.
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http://dx.doi.org/10.7507/1002-1892.201901007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8337907PMC
August 2019

Extensive Microsurgical Reconstruction of Chest Wall Defects for Locally Advanced Breast Cancer: A 10-Year Single-Unit Experience.

Ann Plast Surg 2020 03;84(3):293-299

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan.

Background: Despite improvements in the early detection of breast cancer, locally advanced breast cancer (LABC) involving the chest wall exists in developing countries. Surgical resection remains a controversial management option. This study aims to demonstrate the value of chest wall reconstructive techniques for large LABC defects and report long-term outcomes.

Materials And Methods: We report a 10-years single-unit experience in the reconstruction of large defects (>300 cm). From 2007 to 2017, all LABC cases managed with large surgical resection with immediate microsurgical chest wall reconstruction were included in this study. Herein, we present the demographics, comorbidities, clinicopathological LABC characteristics, surgical techniques (free flap choice, recipient vessels), and outcomes (survival, complication, cosmesis, and patient satisfaction).

Results: Of the 104 LABC cases, free deep inferior epigastric artery perforator flap was performed in 41 (39.4%) cases, free anterolateral thigh flap in 5 (4.8%), free deep inferior epigastric artery perforator combined with pedicled transverse rectus abdominis myocutaneous (TRAM) flap in 23 (22.1%), free muscle-sparing transverse rectus abdominis muscle flap in 30 (28.9%), and free transverse upper gracilis flap in 5 (4.8%). Complications were low. Over a median follow-up of 49.5 months, the 3-year local recurrence rate and distant metastasis-free survival were 13.9% and 84.9%, respectively. In addition, the 3-year disease-free survival and overall survival were 84.2% and 92.0%, respectively. The rate of excellent and good ratings by the esthetic assessment panel was 83.0%, and the patient satisfaction rate was 90.0%.

Conclusion: Wide resection and microvascular free tissue transfer is oncologically safe in LABC with huge tumors and provides versatile solutions for the reconstruction of extensive chest wall defects. With favorable long-term survival and cosmetic outcomes, surgical resection of LABC combined with flap reconstruction may offer a practical approach in difficult and complicated cases.

Implications For Practice: In this retrospective review, it was demonstrated that wide resection followed by distinct chest wall reconstructive free flaps transfer is oncologically safe in LABC with huge tumors and provides useful solutions for the reconstruction of extensive chest wall defects.
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http://dx.doi.org/10.1097/SAP.0000000000002000DOI Listing
March 2020

The lateral thoracic vessels: A novel recipient site for breast reconstruction with DIEP flap.

J Plast Reconstr Aesthet Surg 2019 Sep 22;72(9):1530-1536. Epub 2019 May 22.

Department of Oncology, Plastic Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.

Background: Adequate selection of recipient vessel to minimize recipient site morbidity is essential for a successful breast reconstruction. The authors explored the clinical use of the lateral thoracic vessels as recipient vessels in the deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods: This study included 63 patients with breast cancer. The age of patients ranged from 26 to 67 years (43.23 ± 8.63). All patients received an immediate DIEP flap breast reconstruction using the lateral thoracic vessels as recipient vessels in the authors' department from 2014 May to 2018 September. The flap blood supply, complications, and outcomes were assessed.

Results: The patients were followed up for 6 to 29 months with satisfactory results. All the flaps had stable blood supply except for two cases, which had an event of partial skin necrosis and were repaired by debridement.

Conclusions: Lateral thoracic vessels are not only easy to explore but also have reliable blood supply, which present a safe and reliable choice for immediate DIEP flap breast reconstruction.
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http://dx.doi.org/10.1016/j.bjps.2019.05.012DOI Listing
September 2019

[Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Jun;33(6):712-716

Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection.

Methods: Between September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly.

Results: All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites.

Conclusion: Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
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http://dx.doi.org/10.7507/1002-1892.201901005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355767PMC
June 2019

The clinical application of mental nerve dissection in transoral endoscopic thyroidectomy via an oral vestibular approach.

Surg Endosc 2020 01 14;34(1):153-158. Epub 2019 Mar 14.

The Department of Head and Neck Surgery, Hunan Cancer Hospital, The Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China.

Background: Transoral endoscopic thyroidectomy vestibular approach is the natural orifice surgery to avoid surgical scars. However, mental nerve injury is a characteristic complication. Herein, we report the development of a novel method to dissect the mental nerve proactively during surgery to minimize the morbidity from mental nerve injury.

Methods: In this study, a total of 105 patients from June 2016 to February 2018 were categorized as the mental nerve dissection group (MND) or not mental nerve dissection group (NMND). We analyzed the demographics, operative data, hospital stay, pathologic results, and postoperative complications between the two groups.

Results: There were no significant differences with respect to age, gender, tumor size, extent of surgery, the amount of bleeding, or postoperative hospitalization between groups. The specimen removal time was shorter in the MND group. The average operation time in both groups was similar, but the operation time for a hemithyroidectomy with CND in the MND group was shorter than in the NMND group. The VAS pain scores and complication rates that included transient hypocalcemia, seroma, subcutaneous emphysema, transient, and permanent recurrent laryngeal nerve palsy did not differ significantly between groups. In terms of mental nerve injury, the morbidity rate in the MND group was lower than in the NMND group.

Conclusions: The modified endoscopic thyroidectomy involving dissection of the mental nerve via the oral vestibular approach is safe and feasible. It is beneficial to protect the mental nerve and for specimen removal which is worth clinical promotion.
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http://dx.doi.org/10.1007/s00464-019-06743-9DOI Listing
January 2020

[Application progress of indocyanine green angiography in breast reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 11;32(11):1463-1468

Department of Oncology Plastic Surgery, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha Hunan, 410013, P.R.China.

Objective: To summarize the application progress of indocyanine green (ICG) angiography in breast reconstruction.

Methods: The literature about the application of ICG angiography in breast reconstruction was reviewed and analyzed, including its history, chemical composition, principles, usages, and attentions.

Results: ICG is a kind of fluorescent substance used in medical diagnosis and various surgical fields, especially in intraoperative vascular angiography. ICG angiography and SPY system are gradually applied in breast reconstruction, including both prosthesis/tissue expander reconstruction and autologous reconstruction. Compared to clinical judgment, portable Doppler devices, tissue oximetry, and fluorescein angiography, ICG angiography obviously has more benefits and usages.

Conclusion: ICG angiography can reveal the perfusion of flaps during the operation instantly and accurately, which refines the intraoperative strategy in order to decrease the incidence of flap-related complications. Besides, it has some economic benefits to some extent.
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http://dx.doi.org/10.7507/1002-1892.201803040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414128PMC
November 2018

[Clinical application of pedicled chimeric thoracoacromial artery perforator flap for circular hypopharyngeal reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 11;32(11):1441-1445

Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects.

Methods: Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T N M , 2 cases were T N M , 1 case was T N M , 2 cases were T N M . After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm.The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm.The donor sites were closed directly in all cases.

Results: Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients.

Conclusion: Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions..
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http://dx.doi.org/10.7507/1002-1892.201802017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414110PMC
November 2018

Anatomical Basis of the Intermediate Dorsal Pedal Neurocutaneous Perforator Pedicled Propeller Flap: A Cadaveric Dissection.

Clin Anat 2018 Oct 14;31(7):1077-1084. Epub 2018 Oct 14.

Bengbu Medical College Fuzhou General Teaching Hospital (Fuzhou General Hospital of PLA) Orthopedics Institute, Fuzhou, China.

Soft tissue defects of the forefoot represent a challenging surgical modality to reconstructive microsurgeons. This study describes the anatomical basis and design of the perforator-based intermediate dorsal pedal neurocutaneous vascular flap. Thirty fresh human lower limb specimens were injected with red latex and used for dissection of the dorsal vascular and neural anatomy of the foot. The direction and distribution of the intermediate dorsal cutaneous nerve and the vascular anatomy of the third dorsal artery of the plantar arch, along with the intermediate dorsal neurocutaneous nutrient vessels, were mapped. A simulated flap elevation procedure was performed on one fresh cadaver specimen. A clinical series of five cases is presented to demonstrate the feasibility of using the perforator-based intermediate dorsal pedal neurocutaneous vascular flap to reconstruct soft-tissue defects of the forefoot. The intermediate dorsal cutaneous nerve usually originates from the lateral branch of the superficial peroneal nerve. Crossing the surface of the cruciate ligament, it descends distally to the proximal part of the fourth intermetatarsal space and divides into the third and fourth dorsal metatarsal branches. The intermediate dorsal cutaneous neural nutrient vessels, which are multi-segmental and polyphyletic, offer innervation to the skin paddle of the flap elevated on the basis of the third dorsal perforator of the plantar arch. This perforator occupies a relatively constant position in the proximal part of the intermetatarsal space. It sends multiple tiny branches toward the intermediate dorsal cutaneous neural or paraneural nutrient vessel chain. In terms of clinical application, all flaps survived completely; one patient had partial loss of the skin graft. The design and anatomical basis of the intermediate dorsal pedal neurocutaneous vascular flap based on the third dorsal perforator of the plantar arch is a reliable reconstructive option for reconstructing small soft tissue defects in the forefoot. Clin. Anat. 31:1077-1084, 2018. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23229DOI Listing
October 2018

[Application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 06;32(6):707-713

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China.

Objective: To explore the clinical application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction of breast cancer patients after mastectomy.

Methods: Between August 2016 and February 2017, the combined transverse upper gracilis flap and adductor magnus perforator flap was used in 12 cases of breast cancer patients who received modified radical surgery for breast reconstruction. All patients were females with the age of 32 to 59 years (mean, 41.5 years). There were 7 cases in left side and 5 cases in right side. Eight cases were received breast reconstruction by one-stage operation and 4 cases by two-stage operation. In one-stage operation cases, pathological diagnosis includes invasive ductal carcinoma in 4 cases and invasive lobular carcinoma in 4 cases. The disease duration ranged from 2 to 9 months (mean, 4.5 months). In two-stage operation cases, the time interval between mastectomy and breast reconstruction ranged from 12 to 70 months (mean, 37.4 months). The length of flap was 20-28 cm, the width of flap was 5.5-7.5 cm, the thickness of flap was 2.5-4.5 cm. The length of gracilis flap pedicle was 6.5-9.2 cm, the length of adductor magnus perforator flap pedicle was 7.5-10.4 cm. The weight of flap was 295-615 g.

Results: The ischemia time of flap ranged from 95 to 230 minutes (mean, 135 minutes). All flaps were successfully survived. All incisions of recipient donor sites healed by first intention. All patients were followed up 7-14 months (mean, 9.5 months). The reconstructed breasts' shape, texture, and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, but the function of thighs was not affected. No local recurrence happened during follow-up.

Conclusion: With appropriate patient selection and surgical technique, the combined transverse upper gracilis flap and adductor magnus perforator flap can be a valuable option as an alternative method for autologous breast reconstruction.
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http://dx.doi.org/10.7507/1002-1892.201801001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414009PMC
June 2018

[Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017 08;31(8):987-991

Hand Surgical Centre, Nanhua Hospital, Nanhua University, Hengyang Hunan, 421001,

Objective: To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer.

Methods: Between May 2011 and December 2013, free thinned innervated ALT perforator flap was used to repair the donor defects after wrap-around flap transfer in 9 patients. There were 8 males and 1 female, with a mean age of 31.2 years (range, 19-42 years). The interval time between injury and admission was 3-12 hours (mean, 6.5 hours). Injury causes included machine crush injury (4 cases), traffic accident injury (3 cases), and twisting injury (2 cases). The wrap-around flaps were transferred to reconstruct thumb defects. And the size of donor site defect ranged from 3 cm×2 cm to 8 cm×5 cm. A branch of the lateral femoral cutaneous nerve was carried to make innervated ALT perforator flap for donor site repair. The size of innervated ALT perforator flap ranged from 3.0 cm×2.0 cm to 8.5 cm×5.0 cm. The thickness of innervated ALT perforator flap before defatting ranged from 2.0 to 4.5 cm (mean, 3.2 cm); the thickness after defatting ranged from 0.4 to 0.6 cm (mean, 0.5 cm). The defect at the anterolateral thigh was primarily closed in all cases.

Results: All reconstructed thumbs and ALT perforator flaps survived. All patients were followed up 6-30 months (mean, 15.8 months). The ALT perforator flaps had good appearance and color, with no further flap revision or defatting procedures. The static two-point discrimination was 8-15 mm (mean, 10.5 mm). All patients could walk and run normally without postoperative skin erosions or ulcerations.

Conclusion: The free thinned innervated ALT perforator flap is pliable and thin. It is suitable for repairing the donor site defects after wrap-around flap transfer for thumb reconstruction.
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http://dx.doi.org/10.7507/1002-1892.201703122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458605PMC
August 2017

[Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 05;32(5):607-611

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China.

Objective: To investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation.

Methods: Between January 2008 and December 2016,42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years (range, 31-68 years). There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin, 3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to 24 months (mean, 13.5 months). The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to 9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly.

Results: The operation time was 4.5-7.5 hours (mean, 5.5 hours). All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months (mean, 22 months). All patients were satisfied with their facial appearance and the speech function. The range of mouth opening was 3-5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive.

Conclusion: The bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral cancer ablation.
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http://dx.doi.org/10.7507/1002-1892.201708110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430020PMC
May 2018

[Application of indocyanine green-based fluorescent angiography in autologous tissue breast reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 04;32(4):491-494

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410013, P.R.China.

Objective: To investigate the effect of indocyanine green (ICG)-based fluorescent angiography in autologous tissue breast reconstruction.

Methods: Between June 2016 and June 2017, 14 female patients were treated with the autologous tissue breast reconstruction. The age ranged from 27 to 64 years with the median age of 46.5 years. There were 11 patients of one-stage reconstruction, including 9 with invasive ductal carcinoma of breast, 1 with recurrence tumor on chest wall, and 1 with angiosatcoma in the breast. The disease duration ranged from 9 days to 48 months (mean, 6.8 months). There were 3 patients of second-stage breast reconstruction, who underwent mastectomy 3-4 years ago. During operation, the first ICG-based fluorescent angiography was done before cutting off the flap pedicle. According to the results, 13 patients were adjusted the strategy of operation or cut part of flap, only 1 patient kept the original design. Then, the infusion of flaps were confirmed by the second ICG-based fluorescent angiography after transplanted to the recipient site. The area of flap ranged from 24 cm×11 cm to 36 cm×15 cm. All incisions of recipient site were closed by primary suture.

Results: The fat liquefaction of incision occurred in 1 patient with type 2 diabetes, and the incision healed after debridement operation. The other flaps survived with no flap perfusion related complication. Both donor sites and recipient sites healed by first intention. All patients were followed up 1-14 months (mean, 4 months) with satisfied result of reconstruction. There was no tumor recurrence.

Conclusion: ICG-based fluorescent angiography can reveal the perfusion of the flap in operation instantly and accurately. It should be very helpful to adjusting the strategy in reconstructive operation, especially in the large tissue demanded kinds such as breast reconstruction.
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http://dx.doi.org/10.7507/1002-1892.201708048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414334PMC
April 2018
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