A New Design for Forearm Skin Flaps for Areas that Do not Require Additional Grafting.

Forearm skin flaps are widely used to reconstruct oral cancer due to their advantages, such as vascular stability, simple preparation, and a high success rate. However, traditional forearm skin flaps have shortcomings: the donor site requires grafting, which increases surgical trauma by creating a second surgical area, and the scarring at the donor site significantly affects the esthetics of the forearm. Therefore, we have designed a new ^-shaped radial forearm skin flap, in which the flap is designed as 2 semi-elliptical subunits. After the flap is harvested, these 2 subunits are joined, and the reserved skin at the donor site is directly sutured to the outer part of the donor site. The area of the ^-shaped radial forearm skin flap can be as large as that prepared with traditional forearm skin flaps, and there is no need for grafting at the donor site. This avoids additional trauma to the donor site after surgery, significantly reduces related complications, and enhances the esthetic outcome. This paper reports a case of a cheek cancer (carcinoma of the buccal mucosa) patient (T3N0M0), where the flap survived postoperatively, and both the surgical site and donor site healed in the first phase. The patient has no sensory or functional impairments; swallowing and speech functions are satisfactory.

[Clinical analysis of immune function and intestinal flora changes in patients with oral squamous carcinoma before and after treatment].

PURPOSE: To characterize the alterations of intestinal bacteria and immunological function in patients with oral squamous cell carcinoma(OSCC) before and after treatment. METHODS: From September 2020 to September 2021, 28 patients suffering OSCC and 10 healthy volunteers undergoing treatment at our hospital were enrolled in the study. Conventional treatment regimens were administered to OSCC patients and the changes in immune function, intestinal bacteria composition and short-chain fatty acids were measured 1 week before and 6 months after therapy. GraphPad Prism 9.0 software package was used for data analysis. RESULTS: Immunological function measurements indicated significantly lower levels of lymphocyte subsets (including CD3+, CD4+, NK, CD4+/CD8+) and immunoglobulins (including IgG, IgA, IgM) in the peripheral blood of OSCC patients before treatment compared to healthy volunteers (P<0.05), as well as remarkably lower levels of serum cytokines (including TNF-α、IL-4、IL-6) (P<0.05). Following 6 months of conventional treatment, there was an improvement in immune function in OSCC patients compared to all patients before treatment(P<0.05). Compared to healthy volunteers, the diversity of intestinal bacteria was decreased in OSCC patients before treatment, whereas the diversity of intestinal bacteria recovered in OSCC patients after conventional treatment. At the phylum, the distribution of Epsilonbacteraeota, Proteobacteria and Patescibacteria were significantly elevated and the concentration of Verrucomicrobia was decreased in OSCC patients before treatment compared to healthy volunteers(P<0.05). Intriguingly, convention therapy reversed the disturbance of intestinal bacteria, including downgrading levels of Epsilonbacteraeota, Proteobacteria and Patescibacteria and increasing levels of Verrucomicrobia(P<0.05). Short-chain fatty acids (including acetic acid, propionic acid and butyric acid) were present at a lower level in the intestine of OSCC patients before treatment and were elevated after conventional treatment. CONCLUSIONS: Conventional treatment remarkably enhances immune function, revitalizes the distribution of intestinal microflora, elevates the content of short-chain fatty acids in the intestine of OSCC patients, thereby improving the patients' health.

A More Favorable Lower-Lip Incision for the Removal of Deep Intraoral Malignancies.

The straight midline lower lip-splitting incision has traditionally been performed with different types of deep intraoral malignancies for obtaining wide surgical access, and it can also be extended to the submandibular region or the neck to concurrently perform a neck dissection. But meanwhile, it is associated with unfavorable aesthetic and functional complications such as conspicuous facial scar, lip vermilion notching, stenosis of the labial sulcus, decreased lip sensation and movement, and oral incontinence. We designed a more favorable lower-lip incision, namely, para-lower lip incision, using the exposure and en blot resection of deep intraoral tumors. Compared with the traditional incision line, our designed line is shorter, and 20 outpatients (primary tumor site including buccal mucosa, tongue, mandibular gingiva, maxillary sinus, palate, and mouth floor) follow-ups indicated the postoperative scar is inconspicuous, no lip contour deformity and dysfunction or complications of facial paralysis such as distortion of commissure happened. This article reports one case of our patients who underwent para-lower-lip incision approach for the removal of squamous cell carcinoma (T3N2M0) in the left plate and the results of the patient were favorable.