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Titanium plates and screws are common material used for rigid bone flap fixation after retrosigmoid craniotomy such as microvascular decompression (MVD). We conducted this study to evaluate outcomes of the free bone flap cranioplasty without fixation in MVD and compared its postoperative complication rate with routine methods. We retrospectively reviewed all patients who underwent MVD at our institution from May 2017 to August 2022. Patients were divided into two groups according to whether the bone flap was fixed or not. Follow-ups periods spanned 6-28 months after the operation. Of 189 patients who underwent MVDs via retrosigmoid approach, 79 cases (42%) had their bone flaps replaced without titanium fixation after craniotomies (< 3 cm x 3 cm). Compared to fixed bone flap group, free bone flap group had shorter operative time (105.56 ± 15.87 min vs. 113.72 ± 17.80 min, P = 0.001), less in-patient costs (¥23059.66 ± 4488.54 vs. ¥27714.82 ± 2705.74, P < 0.001), and less proportion of postoperative headache and incisional pain (43.0% vs. 60.9%, P = 0.015). One case of incisional cerebrospinal fluid leak happened in free bone flap group while one case of incisional infection happened in fixed bone flap group. No statistical difference in bone flap displacement, duration of postoperative hospital stays or complication rate was found between the two groups. Nineteen patients in free bone flap group received long-term CT follow-up and all were proved to have good skull union. This study proves that free bone flap cranioplasty in MVD without titanium plate fixation can shorten the operation time and reduce hospitalization expenditure without increasing complication rates.

Objective:To investigate the therapeutic effect of free forearm flaps in repairing the postoperative defect of external nasal malignant tumor. Methods:Six patients with nasal malignant tumor were treated with radical operation of external nasal malignant tumor and simultaneous reconstruction of external nasal defects with free forearm flap. Preoperative Allen experiment, ultrasonic Doppler blood flow meter or CT angiography confirmed that the forearm blood vessels were in good condition. Results:The free forearm flaps were obtained from six patients, and completely survived. During the follow-up period of 6-12months, all patients had good external nasal morphology, good nasal function, no nasal obstruction and anterior nostril stenosis, no obvious complications in donor hand and no local cancer recurrence. Conclusion:The free forearm flap is a reliable method to reconstruction the postoperative defect of external nasal malignant tumor, with a high success rate and good recovery of morphology and function recovery.
目的：探讨游离前臂皮瓣在外鼻恶性肿瘤术后缺损修复中的应用效果。 方法：对6例鼻部恶性肿瘤患者行外鼻恶性肿瘤根治性切除并同期行游离前臂皮瓣修复外鼻缺损，术前Allen实验及超声多普勒血流测量仪或CT血管造影确定前臂血管状态良好。 结果：6例患者游离前臂皮瓣制备及修复外鼻部缺损均成功，随访6～12个月，所有患者外鼻形态恢复良好，鼻腔功能良好，无鼻塞及前鼻孔狭窄出现，供区手部无明显并发症，局部无癌症复发。 结论：游离前臂皮瓣修复外鼻恶性肿瘤术后缺损成功率高，形态和功能恢复良好，是一种修复外鼻恶性肿瘤术后缺损的可靠方法。.

Free flap reconstruction for postoperative tissue defects in oral and maxillofacial tumors is a critical component of reconstructive surgery. Identifying risk factors for flap necrosis is essential for improving surgical outcomes and patient quality of life. A retrospective study was conducted on patients who underwent free flap reconstruction between January 2020 and December 2023. Patients were included if they had comprehensive medical records and at least a six-month follow-up. We excluded those with a history of flap necrosis, uncontrolled systemic diseases, non-adherence to postoperative care, or concurrent malignancy treatments. Data on demographics, comorbidities, flap characteristics, and operative details were collected and analyzed using univariate analysis and logistic regression tests. Univariate analysis did not find a significant correlation between flap necrosis and factors such as hyperlipidemia, lymph node metastasis, or flap type. However, diabetes mellitus, oral infections, and albumin levels below 35 g/L were significantly associated with flap necrosis. Multivariate logistic regression showed diabetes mellitus increased the odds of flap necrosis by approximately ninefold, and oral infection increased it by over tenfold. Diabetes mellitus, oral infection, and low albumin levels are significant risk factors for flap necrosis in free flap reconstruction after oral and maxillofacial surgery. Prompt identification and management of these factors are crucial to mitigate the risk of flap necrosis.

OBJECTIVE: To investigate soft-to-hard tissue response following mandibular reconstruction and to develop a predictive model for projecting soft tissue movement.
METHODS: In this retrospective study, 18 patients receiving mandibular reconstruction using a vascularized iliac flap were enrolled. Various indicators for characterizing the movement of tissues were considered to identify the effective predictors for projecting soft tissue movements. Face-region-specific linear regression models for prediction were constructed and evaluated.
RESULTS: The arithmetic mean of hard tissue movement in an extended area had the strongest correlation with the movement of the focal soft tissue, while the arithmetic mean in a regional area (Ram) was a more effective predictor. The linear regression model using Ram, global extrema and distances between them as the predictors performed the best in the lower margin of the face, with an average error of 1.51 ± 1.38 mm. Soft tissue movement in the alveolar process was not correlated with the existence of dentition, only can be predicted by the soft tissue movement below it. The area of the masseter was strongly correlation with Ram, but no other factors.
CONCLUSIONS: An accurate prediction of soft tissue movements in the lower margin and the alveolar process of the face can be achieved by considering hard tissue and adjacent soft tissue movements. No effective predictor in the masseter area was identified.
CONCLUSIONS: We investigated the relationship between hard tissue movements and the soft tissue responses in the facial area. Through building predictive models for projecting postoperative soft tissue movements, we derive insights for the aesthetic outcome of face surgeries.
BACKGROUND: This study was registered on the Chinese Clinical Trial Registry (registration number: ChiCTR2100054103).

BACKGROUND: There are several surgical options for osteonecrosis of the lunate, and confirming the effectiveness of various surgical methods remains challenging. Here, we present a case of stage IIIB osteonecrosis of the lunate repaired with a free medial femoral condyle osteocutaneous flap.
METHODS: A 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient\'s medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points.
CONCLUSIONS: The success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.

BACKGROUND: The epidemiology and risk factors for postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to the Intensive Care Unit (ICU) are unknown.
METHODS: We performed a retrospective cohort study of patients with free flap reconstruction of head and neck cancer between September 2015 and April 2023 admitted to the ICU of Beijing Tongren Hospital. The univariate and multivariate analyses were used to explore the risk factors for postoperative complications related to free flap reconstruction admitted to ICU, including flap necrosis, bleeding, fistula, and infection.
RESULTS: A total of 239 patients were included in this study, and 38 (15.9%) patients had postoperative complications related to free flap reconstruction. The median length of ICU stay was 1 day (interquartile range, 1-2 days). Multivariate analysis found that low BMI (P < 0.001), high postoperative CRP (P = 0.005), low hemoglobin (P = 0.012), and inadequate fluid intake (P < 0.05) were independent risk factors for complications.
CONCLUSIONS: Postoperative complications related to free flap reconstruction were common in this ICU population. Careful fluid management and monitoring of CRP and hemoglobin levels may reduce complications.

UNASSIGNED: Myoepithelial carcinomas of soft tissue are rare, and most are malignant. The optimal treatment is surgical excision. The arches of the foot are a composite structure responsible for weight bearing and pressure distribution, so it is a vast challenge in reconstruction. We report a case of reconstruction of the midfoot with a free fibular bone flap and tendon graft. We review the literature to compare various options in foot reconstructions and sort out the outcomes of different bone flaps. The free fibula osteocutaneous flap is the superior choice for midfoot reconstruction owing to its sufficient length, strength, flexible skin paddles, easy-to-withstand osteotomy, and simultaneous tendon graft harvesting.

BACKGROUND: Amputation of the wrist or distal forearm after high-energy trauma due to a crushing mechanism is associated with complex tissue defects, making repair, and reconstruction challenging. Given the difficulty of this type of salvage, patients unfortunately experience a high revision amputation rate. However, a higher quality of life has been reported in patients with successful reconstructions. Herein, we described a protocolized approach for revascularization and reconstruction for functional hand salvage after traumatic amputation from a crushing mechanism using an anterolateral thigh flap (ALT).
METHODS: A retrospective review was performed between October 2016 and October 2023 for all patients who underwent single-stage emergent debridement, revascularization, and soft tissue coverage using the ALT after amputation at the level of the wrist or distal forearm secondary to high-energy crush injury. Charts were reviewed for the preoperative Mangled Extremity Salvage Score, intraoperative details including what structures were injured and the reconstructive method performed, and postoperative data such as follow-up duration, outcomes, and complications.
RESULTS: Eleven patients met the inclusion criteria with an average age of 35.5 (21-49) years old. The average size of the skin soft tissue defects was 17.3 × 8 cm (range, length: 13-25 cm, width: 6-13 cm), and all cases had associated injury to the underlying bone, nerves, and blood vessels. The average size of the ALT flap used for reconstruction was 19.2 × 9.8 cm (range, length: 14-27 cm, width: 7-15 cm). All patients had survival of the replanted limb. One patient experienced partial flap necrosis that required secondary debridement and skin graft. Nine patients healed without requiring any additional debridement procedures. Patient follow-up averaged 24.6 (12-38) months. All patients achieved satisfactory functional recovery with Grade II to III of Chen\'s criteria.
CONCLUSIONS: For patients with traumatic crush amputation to the wrist with surrounding soft tissue injury, thorough debridement, revascularization, and reconstruction of amputated limbs can be performed in a single stage using the ALT. A protocolized approach from two institutions is presented, demonstrating improved survival and reduced complications of the traumatized limb with improved long-term patient outcomes.

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