暂无摘要。

Maxillary canines are often impacted, which can result in tooth disorders and adversely affect occlusal and facial development. The case report describes complete bilateral impaction of maxillary canines and significant root resorption of a central incisor. The multidisciplinary approach is the optimal strategy for addressing impacted maxillary canines.

OBJECTIVE: To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of limblarge wound surface.
METHODS: Clinical data of 38 patients withlimb large wound surface (11 cm×39 cm-16 cm× 65 cm) admitted to the Department of Prosthetics and Reconstruction of Sir Run Run Shaw Hospital from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral femoral perforator flap and superficial circumflex iliac artery flap (ALTP-SCIAP) with turbocharge technique (interregional flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups.
RESULTS: In interregional flap group, 18 flaps were harvested and transplanted, the flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral flap group and 29 flaps were harvested and transplanted, the flap width, length and the viable area were (11.0-2.8) cm (21.7-3.2) cm and (186.4-49.2) cm2, respectively. There were significant differences in the flap length and survival area between the two groups (t=22.365 and 8.345, P<0.05), but not significant difference in the flap width (t=1.525, P>0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 cases, by skin retractor assisted suture in 6 cases, and by skin grafting in 1 case. In traditional anterolateral femoral flap group, the donor site of flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. No significant difference was found between the two groups (χ2=2.657, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group.
CONCLUSIONS: Compared with the traditional anterolateral thigh flap, the anterolateral femoral interregional flap with turbocharge technique has a larger flap area, less complications, and higher patient satisfaction rate. With sacrificing only one donor area and sharing a set of vascular pedicles, it can repair \"super long\", \"super large\" or irregular limb wound defects maximally. At the same time, most of the donor areas of the flap can be sutured directly without skin grafting.
目的: 对比结合内增压技术的股前外侧跨区皮瓣与传统股前外侧皮瓣在修复肢体较大创面软组织缺损中的临床疗效。方法: 回顾性分析2018年5月—2022年5月浙江大学医学院附属邵逸夫医院收治的肢体较大创面缺损共38例患者（缺损面积达到11 cm×39 cm~16 cm×65 cm），按照修复方式的不同，分为跨区皮瓣修复组（18例）和传统皮瓣修复组（20例）。跨区皮瓣修复组采用结合内增压技术的股前外侧穿支皮瓣联合旋髂浅动脉皮瓣（ALTP-SCIAP）治疗，传统皮瓣修复组采用单侧或双侧股前外侧皮瓣，必要时联合植皮。比较两组术后皮瓣存活情况、供区修复、并发症、患者满意度等。结果: 跨区皮瓣修复组共18例患者，切取移植皮瓣18例次，瓣宽为（9.9±2.0）cm，瓣长为（44.2±3.5）cm，存活面积为（343.2±79.9）cm2。传统皮瓣修复组共20例患者，切取移植皮瓣29例次（11例患者切取单侧股前外侧皮瓣联合刃厚植皮修复，9例患者切取双侧股前外侧皮瓣进行修复），瓣宽为（11.0±2.8）cm，瓣长为（21.7±3.2）cm，存活面积为（186.4±49.2）cm2。两组皮瓣瓣宽差异无统计学意义（t=1.525，P>0.05），瓣长和存活面积跨区皮瓣修复组显著大于传统皮瓣修复组（t=22.365和8.345，均P<0.05）。跨区皮瓣修复组皮瓣供区采用直接缝合11例次，皮肤牵拉器辅助下缝合6例次，部分植皮修复1例次。传统皮瓣修复组皮瓣供区采用直接缝合12例次，皮肤牵拉器辅助下缝合11例次，部分植皮修复6例次。两组差异无统计学意义（χ2=2.657，P>0.05）。跨区皮瓣修复组中出现并发症1例，患者满意度达到94.4%；而传统皮瓣修复组中出现并发症7例，患者满意度为70.0%且明显低于跨区皮瓣修复组（χ2=4.448，P<0.05）。结论: 与传统股前外侧皮瓣相比，结合内增压技术的股前外侧跨区皮瓣切取面积更大，并发症更少，患者满意度更高，只牺牲一个供区，共用一组血管蒂，就可以最大限度的修复“超长”、“超大”或不规则的肢体创面缺损，而皮瓣供区大多可Ⅰ期直接缝合，不需要植皮修复。.

暂无摘要。

BACKGROUND: The perforator flap has garnered significant interest since its inception due to its advantage of not needing a vascular network at the deep fascial level. Perforator flaps are commonly utilized in different flap transplant surgeries, and the thigh flap is presently the most widely used perforator flap. Is it possible for the calf to replace the thigh as a more suitable site for harvesting materials? Currently, there is a lack of relevant anatomical research. This study aims to address this question from an anatomical and imaging perspective.
METHODS: This study used cadavers to observe the branches and courses of perforators on the calf and the distribution of skin branches using microdissection techniques, digital X-ray photography, and micro-computed tomography techniques.
RESULTS: The perforators had three main branches: the vertical cutaneous branch, the oblique cutaneous branch, and the superficial fascial branch. The superficial fascial branch traveled in the superficial fascia and connected with the nearby perforators. The vertical and oblique cutaneous branches entered the subdermal layer and connected with each other to create the subdermal vascular network.
CONCLUSIONS: We observed an intact calf cutaneous branch chain between the cutaneous nerve and the perforator of the infrapopliteal main artery at the superficial vein site. Utilizing this anatomical structure, the calfskin branch has the potential to serve as a substitute for thigh skin flap transplantation and may be applied to perforator flap transplantation in more locations.

Flaps are commonly used to repair large tissue defects caused by tumor resection and are often combined with radiotherapy. Relevant explanations for the mechanism underlying the effect of radiotherapy on flaps and the selection of the sequence of flaps and radiotherapy plan have emerged. The combination of flap and radiotherapy is most widely used in breast, head and neck cancers, while free flaps are the most widely used. Although, reduction of the incidence of complications of flap reconstruction, prevention of flap reconstruction failure and best integration of flap reconstruction with radiation therapy remains controversial. In the present review, these questions and debates were addressed by reviewing the literature on radiotherapy and flap reconstruction in cancer treatment.

BACKGROUND: Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various etiological factors was less investigated and neglected.
METHODS: Three types of posterior fourchette deformity were proposed: (1) Redundant posterior fourchette, (2) Relaxed posterior fourchette, and (3) Constricted posterior fourchette. Local flap transfer technique was applied. Y-V-plasty and 5-Z-Flap-plasty were used to treat web type and tight type of the constricted posterior fourchette, respectively. Follow-ups were arranged on the Internet or at the outpatient clinic. Visual analogue scale (VAS) was utilized to evaluate sexual discomfort in the satisfaction questionnaires during follow-up.
RESULTS: A total of 48 patients with constricted posterior fourchette deformity from May 2022 to May 2023 were reviewed in the study. Y-V-plasty could decrease VAS in patients with web-type deformity by 4.13 ± 1.46 (p＜0.001). 5-Z-Flap-plasty could decrease VAS in patients with tight-type deformity by 3.76 ± 1.53 (p＜0.05). Satisfaction rates of the web type and tight type were 93.1% (27/29) and 86.7% (13/15) respectively. Complications include two cases of hematoma, one case of persistent pain and two cases of dehiscence.
CONCLUSIONS: Constricted posterior fourchette seriously affects the quality of life. Y-V-plasty and 5-Z-Flap-plasty can be utilized to treat the two subtypes of constricted posterior fourchette, which can effectively reduce the pain score of patients with high satisfaction and few long-term complications.

UNASSIGNED: It is challenging to reconstruct defects resulting from surgical procedures in areas with high tension. We present modified kite flaps that allowed us to reconstruct the defect with high mechanical tension.
UNASSIGNED: With the combination of advancement and rotation, the defect using bilateral modified kite flaps closes with significantly reduced tension. The double flap not only advances but also rotates the flap. This technique retained and exploited the limbs of the flaps, which were often removed with the traditional V-Y flaps.
UNASSIGNED: Eleven patients have had their surgical defects repaired using this technique, and the results were satisfactory. A follow-up period of three months or longer was conducted. There were no perioperative complications, and major anatomic landmarks were reconstructed. All patients were satisfied with the functional recovery.
UNASSIGNED: The modified method enables a significantly shortened advancement distance of flaps, more flexible flap movement, and sacrifice of healthy tissue to be minimal, and significantly diminished tension for closure. Approximately half the width and length of traditional V-Y flaps were used in this flap donor. Preserving the flap limbs, which were often removed with the traditional V-Y flaps, was also applied to fill defects. Modified kite flaps are a suitable option for the repair of defects in areas with high tension.

Random flaps are widely used in the treatment of injuries, tumors, congenital malformations, and other diseases. However, postoperative skin flaps are prone to ischemic necrosis, leading to surgical failure. Insulin-like growth factor- 1(IGF-1) belongs to the IGF family and exerts its growth-promoting effects in various tissues through autocrine or paracrine mechanisms. Its application in skin flaps and other traumatic diseases is relatively limited. Poly (lactic-co-glycolic acid) (PLGA) is a degradable high-molecular-weight organic compound commonly used in biomaterials. This study prepared IGF-PLGA sustained-release microspheres to explore their impact on the survival rate of flaps both in vitro and in vivo, as well as the mechanisms involved. The research results demonstrate that IGF-PLGA has a good sustained-release effect. At the cellular level, it can promote 3T3 cell proliferation by inhibiting oxidative stress, inhibit apoptosis, and enhance the tube formation ability of human umbilical vein endothelial cells (HUVEC) . At the animal level, it accelerates flap healing by promoting vascularization through the inhibition of oxidative stress. Furthermore, this study reveals the role of IGF-PLGA in activating the Angiopoietin-1(Ang1)/Tie2 signaling pathway in promoting flap vascularization, providing a strong theoretical basis and therapeutic target for the application of IGF-1 in flaps and other traumatic diseases.

BACKGROUND: The clinical application of skin flaps in surgical reconstruction is frequently impeded by the occurrence of distant necrosis. L-Borneol exhibits myogenic properties in traditional Chinese medicine and is used in clinical settings to promote wound healing and conditions such as stroke. Nevertheless, the precise mechanism by which borneol exerts its protective effects on skin flap survival remains unclear.
OBJECTIVE: To explore the potential of L-borneol to promote skin flap survival and elucidate the underlying mechanisms.
METHODS: Thirty-six male Sprague-Dawley rats were randomly divided into three groups: a high-dose (200 mg/kg L-borneol per day), a low-dose (50 mg/kg/day), and control group (same volume of solvent). In each rat, a modified rectangular McFarlane flap model measuring 3 × 9 cm was constructed. Daily intragastric administration of L-borneol or solvent was performed. The flap was divided into three square sections of equal size, namely Zone I (the proximal zone), Zone II (the intermediate zone), and Zone III (the distal zone). The survival rate was quantified, and the histological state of each flap was evaluated on the seventh day following the surgical procedure. The assessment of angiogenesis was conducted using lead oxide/gelatin angiography, whereas the evaluation of blood flow in the free flap was performed using laser Doppler flow imaging. Superoxide dismutase activity was detected using the water-soluble tetrazolium salt-8 method. The quantities of vascular endothelial growth factor, interleukin (IL)-1β, IL-6, and tumour necrosis factor-α were determined using immunohistochemistry. The levels of nuclear transcription factor-κB, hypoxia-inducible factor-1, B-cell lymphoma-2 (BCL-2), and BCL-2-associated X (BAX) were determined by Western blotting technique.
RESULTS: Flap survival rate significantly improved and neutrophil recruitment and release were enhanced after treatment with the compound. Angiogenesis was promoted. L-borneol protected against oxidative stress by increasing superoxide dismutase activity and decreasing malondialdehyde content. It downregulated the hypoxia-inducible factor nuclear transcription factor-κB pathway, leading to the inhibition of several inflammatory factors. Simultaneously, it facilitated the expression of vascular endothelial growth factor and BCL-2.
CONCLUSIONS: The study shows that L-borneol may promote skin flap survival by inhibiting HIF-1α/NF-κB pathway.