Objective:To analyze the clinical effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing postoperative defect of oropharyngeal carcinoma. Methods:Thirty-six patients with oropharyngeal carcinoma admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from June 2016 to June 2019 were analyzed and followed up, eighteen patients were treated with free posterior lateral peroneal artery perforator flap of the lower leg to repair the postoperative defects（experimental group）, and eighteen patients were treated with free forearm flap（control group）. The survival rate of the transplanted flap, the wound stageⅠhealing rate and average hospitalization time were compared between the two groups. Kaplan-Meier method was used to calculate the 1-year and 3-year survival rates of patients after operation, and log-rank test was used to compare the difference between the survival curves of the two groups; The recovery of swallowing and palatopharyngeal closure function of patients in the two groups at 3, 6, 12 and 18 months after operation was calculated and statistically analyzed through the water swallow test and the air blowing method. Results:There was one case of skin flap necrosis in both the experimental group and the control group, and the survival rate was 94.4%. The wound stageⅠhealing rate in the surgical area was 94.4% in both groups. The wound healing rates of the donor area in the experimental group and the control group were 100.0% and 94.4% respectively. The average hospitalization time of the experimental group and the control group was 16.9 days and 17.2 days, respectively, with no significant difference （P>0.05）. The overall survival rates of all patients at 1-year and 3-year were 91.2% and 66.5% respectively; The 1-year and 3-year survival rates of the experimental group and the control group were 94.1%, 69.3% and 88.2%, 63.7%, respectively, and there was no significant difference between the two groups （P>0.05）. The 1-year and 3-year survival rates of P16+ and P16 - patients were 100.0%, 80.0% and 85.7%, 64.3%, respectively, and there was no significant difference between the two groups （P>0.05）. There was no significant difference in the evaluation of swallowing and velopharyngeal closure function between the two groups at 3 and 6 months after operation （P>0.05）, but there was a significant difference at 12 and 18 months after operation （P<0.05）. Conclusion:The anatomic position of the perforating vessels of the free posterior lateral peroneal artery perforator flap of the lower leg is constant, and it can be prepared into single leaf, multi leaf, chimeric and other flaps according to the tissue defect space. And the concealed supply area can be directly drawn to suture. At the same time, the skin flap has strong plasticity. Therefore, the skin flap can be used as a common skin flap to repair the defects after the operation of oropharyngeal carcinoma.
目的：分析游离小腿后外侧腓动脉穿支皮瓣修复口咽癌术后缺损的临床效果。 方法：对2016年6月—2019年6月蚌埠医学院第一附属医院口腔颌面外科收治的36例口咽癌患者进行分析和随访，18例患者采用游离小腿后外侧腓动脉穿支皮瓣修复术后缺损（实验组），18例采用游离前臂皮瓣修复（对照组），比较两组患者移植皮瓣成活率、伤口Ⅰ期愈合率及平均住院时间；采用Kaplan-Meier法计算患者术后1、3年生存率，log-rank检验比较两组生存曲线间差异；通过洼田饮水试验、吹气法计算并统计分析两组患者术后3、6、12、18个月吞咽、腭咽闭合功能恢复情况。 结果：实验组与对照组均有1例皮瓣坏死，成活率均为94.4%；两组患者术区伤口Ⅰ期愈合率均为94.4%；实验组和对照组供区伤口愈合率分别为100.0%和94.4%；实验组和对照组平均住院时间分别为16.9 d和17.2 d，差异无统计学意义（P>0.05）。所有患者1、3年总体生存率为91.2%、66.5%；实验组和对照组1、3年生存率分别为94.1%、69.3%和88.2%、63.7%，两组比较差异无统计学意义（P>0.05）；P16+和P16-患者术后1、3年生存率分别为100.0%、80.0%和85.7%、64.3%，两组比较差异无统计学意义（P>0.05）。术后3、6个月两组患者吞咽及腭咽闭合功能恢复评价的差异无统计学意义（P>0.05），术后12、18个月差异有统计学意义（P<0.05）。 结论：游离小腿后外侧腓动脉穿支皮瓣穿支血管解剖恒定，可根据组织缺损空间制备成单叶、多叶、嵌合等皮瓣，且供区隐蔽可直接拉拢缝合，同时该皮瓣可塑性较强，因此可作为修复口咽癌术后缺损的常用皮瓣。.

Objectives  Masculinizing genital gender affirmation surgery (MgGAS) consists of operative procedures designed to help the transition of transmen in their journey toward male gender role. Phalloplasty and urethral lengthening remain the most challenging of these surgeries, as the female urethra (4 cm long) must be lengthened to male dimensions (15-29 cm) with anastomosis at two sites, the native urethra/pars fixa urethra and the pars fixa urethra-penile urethra. As a result, there is a high incidence of urinary complications such as strictures and fistulae. Authors incorporated a urethral lengthening technique to reduce urinary complications in MgGAS. They compare the rates of urinary complications rates in cohorts before and after the introduction of this technique. Materials and Methods  Authors have been performing phalloplasty since past 27 years, utilizing mainly free radial artery forearm flap (fRAFFp 431 cases) and pedicled anterolateral thigh flap (pALTp 120 cases). A retrospective review and comparison of urinary complications were performed before and after the introduction of their new technique since March 2017. Results  There was a statistically significant reduction in the incidence of stricture with and without fistulae (25.94% with conventional and 4.17% with urethral lengthening technique p  = 0.001) and fistulae alone (12.81% with conventional and 2.78% with urethral lengthening technique p  = 0.011) in fRAFFp cases. In pALTp cases, the respective reductions were 43.08 to 17.07%, p  = 0.006 (significant), and 13.85 to 4.88%, p  = 0.197 (not statistically significant). Conclusion  Over years, the rates of urinary complications in MgGAS have remained constant, varying from 25 to 58% for strictures and 17 to 75% for fistulae as noted by many authors. Authors noted that in most of their cases, strictures occurred at distal pars fixa urethra (DPFU)-penile urethra anastomosis and incorporated a urethral lengthening technique, which lengthens the DPFU by 3 to 5 cm at this anastomotic site, thus significantly reducing the anastomotic tension and the rate of urinary complications.

Complex upper-limb trauma, in particular crush and avulsion injuries, present an ongoing challenge for the reconstructive hand surgeon given the extensive zone of injury, particularly involving the neurovascular structures. When replantation is deemed unsuitable, the reconstruction must be both robust and flexible enough to meet the functional needs of the patient. The authors present a case of a ring avulsion amputation of the middle digit of a young patient\'s dominant hand. Due to the distal extent of avulsion, the amputated digit was determined to be nonreplantable, and the patient\'s medical comorbidities precluded traditional delayed pedicle flap options. Therefore, a reverse radial adipofascial flap was used as a single-stage reconstruction to resurface the entirety of the circumferential digital defect. At 8 months of follow up, the patient demonstrated exceptional passive and active range of motion with excellent contour and cosmesis, illustrating the utility of this reconstructive option.

Objective:To investigate the oropharyngeal function recovery of oropharyngeal squamous cell carcinoma repaired by anterolateral thigh flap and forearm flap. Methods:Retrospective study between September 2016 and September 2020 complete line 37 cases of oropharyngeal cancer postoperative soft tissue defect of femoral anterolateral flap or forearm flap to repair the patient data, in which 22 cases, using the forearm skin flap to repair 15 cases with femoral anterolateral flap, flap survival rate of preparation, compare the two groups, the incidence of vascular crisis, The functions of swallowing, speech, and velopharyngeal closure were evaluated. Results:21 cases of forearm flaps survived, and 1 case had vascular crisis. After surgical exploration, the contralateral forearm flaps survived transplantation. Fourteen anterolateral femoral flaps survived, 2 flaps had vascular crisis, and 1 flap survived after thrombus removal. The other one was repaired with pectoralis major myocutaneous flap for necrosis. Swallowing, speech, palatopharyngeal closure and other functions of the patients after the two kinds of flap repair had higher satisfaction. Conclusion:Forearm flap and anterolateral thigh flap are good choices for soft tissue defect after oropharyngeal cancer, Must act according to the special details choice appropriate therapeutic schedule.
目的：探讨股前外侧皮瓣与前臂皮瓣修复口咽鳞状细胞癌术后缺损的口咽功能恢复情况。 方法：回顾性研究2016年9月—2020年9月在山西医科大学第一医院口腔科完成的37例口咽癌术后软组织缺损行股前外侧皮瓣或前臂皮瓣修复的患者资料，其中22例采用前臂皮瓣修复，15例采用股前外侧皮瓣修复，比较2组皮瓣制备成活率、血管危象发生率，并评估患者术后的吞咽、言语、腭咽闭合等功能。 结果：21例前臂皮瓣成活，1例出现血管危象，手术探查后未能成活，取对侧前臂皮瓣移植后成活。14例股前外侧皮瓣成活，2例皮瓣出现血管危象，其中1例手术探查去除血栓后皮瓣成活，另1例皮瓣坏死，改为胸大肌皮瓣修复。2种皮瓣修复术后患者的吞咽、言语、腭咽闭合等功能均有较高的满意度。 结论：对于口咽癌术后的软组织缺损，前臂皮瓣或股前外侧皮瓣可达到良好的功能修复，需根据具体情况选择。.

Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established.
Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures.
This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes.
The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

BACKGROUND: The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device.
METHODS: From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation.
RESULTS: The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training.
CONCLUSIONS: Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.

The concept of a flow-through flap refers to a free flap in which both the proximal and distal ends of the vascular pedicle are anastomosed to provide blood flow to the distal tissues. The purpose of this paper is to highlight the use of this technique, which may be useful in selected cases of head and neck reconstruction. In certain situations, like bilateral resection of the base of the tongue involving both lingual arteries, the application of a flow-through forearm free flap can provide an anatomical and functional restoration of the defect while revascularizing the anterior two-thirds of the tongue. We review this technique, which was used in a case of adenoid cystic carcinoma of the base of the tongue with excellent results.

OBJECTIVE: Reconstruction of an extensive full-thickness upper eyelid defect is challenging. The purpose of this report is to introduce this procedure with emphasis on reconstruction of the eyelid margin to obtain eye comfort.
METHODS: We designed a technique using a radial forearm flap for the outer layer to reconstruct the entire eyelid after resection of Merkel cell carcinoma. In additional, the inner layer and the eyelid margin were reconstructed with a buccal mucosal graft and a reverse Hughes flap.
RESULTS: There has been no recurrence of the tumor, opening and closing functions of the eyelid are maintained, and the patient has not complained of eye discomfort.
CONCLUSIONS: Maintenance of mobility, flexibility, and a good ocular surface in contact with the sensitive cornea are the main foci of upper eyelid reconstruction, with an optimal fissure height and an appropriate contour of the eyelid. In addition, to obtain eye comfort, it is important to protect the cornea without significantly restricting eyelid mobility.

OBJECTIVE: Free flap reconstruction in elderly patients is one of the most challenging surgeries in the treatment of head and neck cancers. The aim of this study was to examine the oncological and functional outcomes of free flap reconstruction for elderly patients with head and neck cancer.
METHODS: We retrospectively reviewed elderly patients who underwent free flap reconstruction for the treatment of head and neck cancers. All patients were 80 years or older. Clinicopathologic features, surgical procedures, oncological and functional outcomes were obtained from medical records.
RESULTS: Free flap reconstructions were performed in 13 patients (3 female, 10 male). The mean age was 82.6 ± 3.4 years (range: 80-91). The mean follow-up period was 23.3 months (range 4-41 months). The mean disease-free survival was 49 ± 6 months (range 4-60 months). All patients had been alive more than one year after surgery. Reconstruction was performed using free jejunum in 10 patients and radial forearm flap in 3 patients. Graft necrosis occurred in 2 patients. Other two patients experienced major postoperative medical complications.
CONCLUSIONS: Free flap reconstruction in well-selected older adults is safe and effective. Advanced age should not preclude consideration of free flap reconstruction in those patients.

Donor-site selection may play an important role in the reconstruction of large orofacial defects. The thickness and structure of transplanted tissue has to fit those of the recipient site to achieve a satisfactory outcome. To evaluate the thickness of free flaps that are frequently used for orofacial reconstruction and its association with body mass index (BMI), gender, and smoking, a prospective study was conducted. A total of 122 volunteers were included in the study, and their data regarding BMI, gender, and tobacco use were documented. Ultrasonography was used to evaluate the thickness of the radial and ulnar forearm flaps (RFFF and UFFF, respectively), the scapular and parascapular flaps (SF and PSF, respectively), the anterolateral thigh flap (ALT), and the free fibular flap (FF). Correlation and regression analysis were performed to assess any relationship among parameters and to investigate their effect on flap thickness. The UFFF showed the lowest thickness (0.65 ± 0.16 cm), followed by the RFFF (0.83 ± 0.20 cm). The FF showed a comparable thickness (0.82 ± 0.26 cm), followed by the SF (0.99 ± 0.13 cm) and the PSF (1 ± 0.14 cm). The ALT flap displayed the greatest thickness (1.42 ± 0.42 cm) and correlated especially with BMI and gender, whereas the UFFF was the thinnest with relatively constant values, regardless of potential influential factors.