Association between basal metabolic rate and cardio-metabolic risk factors: Evidence from a Mendelian Randomization study.

Background: Cardio-metabolic risk factors play a crucial role in the development of cardiovascular and metabolic diseases. Basal metabolic rate (BMR) is a fundamental physiological parameter that affects energy expenditure and might contribute to variations in these risk factors. However, the exact relationship between BMR and cardio-metabolic risk factors has remained unclear. Methods: We employed Mendelian Randomization (MR) analysis to explore the association between BMR (N: 534,045) and various cardio-metabolic risk factors, including body mass index (BMI, N: 681,275), fasting glucose (N: 200,622), high-density lipoprotein (HDL) cholesterol (N = 403,943), low-density lipoprotein (LDL) cholesterol (N = 431,167), total cholesterol (N: 344,278), and triglycerides (N: 441,016), C-reactive protein (N: 436,939), waist circumference (N: 232,101), systolic blood pressure (N: 810,865), diastolic blood pressure (N: 810,865), glycated haemoglobin (N: 389,889), and N-terminal prohormone brain natriuretic peptide (N: 21,758). We leveraged genetic variants strongly associated with BMR as instrumental variables to investigate potential causal relationships, with the primary analysis using the Inverse Variance Weighted (IVW) method. Results: Our MR analysis revealed compelling evidence of a causal link between BMR and specific cardio-metabolic risk factors. Specifically, genetically determined higher BMR was associated with an increased BMI (ß = 0.7538, 95% confidence interval [CI]: 0.6418 to 0.8659, p < 0.001), lower levels of HDL cholesterol (ß = -0.3293, 95% CI: 0.4474 to -0.2111, p < 0.001), higher levels of triglycerides (ß = 0.1472, 95% CI: 0.0370 to 0.2574, p = 0.0088), waist circumference (ß = 0.4416, 95% CI: 0.2949 to 0.5883, p < 0.001), and glycated haemoglobin (ß = 0.1037, 95% CI: 0.0080 to 0.1995, p = 0.0377). However, we did not observe any significant association between BMR and fasting glucose, LDL cholesterol, total cholesterol, C-reactive protein, systolic blood pressure, diastolic blood pressure, or N-terminal prohormone brain natriuretic peptide (all p-values>0.05). Conclusion: This MR study provides valuable insights into the relationship between BMR and cardio-metabolic risk factors. Understanding the causal links between BMR and these factors could have important implications for the development of targeted interventions and therapies.

Exploration of the effect of simultaneous removal of EDCs in the treatment process of different types of wastewater.

The SPE-HPLC-MS/MS method was used to investigate the concentration distribution of nine types of estrogens in 18 locations of pollution source along the Jiuzhou River belonging to river systems in Guangdong province and Guangxi Zhuang autonomous region in China, and the estrogenic activity and potential ecological risks were evaluated by calculating the estradiol equivalency (EEQ). The results showed that the calculated estradiol equivalents (cEEQs) of wastewater treatment plants from 17 locations were all higher than 1 ng/L. To further study the removal effect of the treatment process on the estrogens, the pig breeding wastewater from P4 and the municipal wastewater from P13, as well as the black-odorous water, were sampled and surveyed during the entire process. It turned out that estrogens were effectively removed after nitrification activated sludge treatment. Meanwhile, there was a positive correlation between the removal of NH3-N, total nitrogen (TN) and total phosphorus (TP) and the removal of endocrine disrupting chemicals (EDCs). It is shown in the study the secondary treatment process has achieved a significant effect on the removal of estrogen in both the wet and dry periods and that there has been a positive correlation between the activities of total phosphorus compounds, nitrogen-based compounds and the removal of EDCs.

[Application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect].

Objective: To investigate the application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect. Methods: Between October 2018 and March 2021, bilateral free lower abdominal flaps were used to repair large-area complex defects after chest wall tumor surgery in 23 patients. The patients were all female; the age ranged from 23 to 71 years, with an average age of 48.5 years. There were 11 cases of locally advanced breast cancer, 4 cases of phyllodes cell sarcoma, 3 cases of soft tissue sarcoma, 3 cases of recurrence of breast cancer, and 2 case of osteoradionecrosis. The size of secondary chest wall defect after tumor resection and wound debridement ranged from 20 cm×10 cm to 38 cm×14 cm, the size of flap ranged from 25 cm×12 cm to 38 cm×15 cm, the length of vascular pedicle was 9-12 cm (mean, 11.4 cm). Fourteen cases of simple soft tissue defects were repaired by flap transplantation; 5 cases of rib defects (<3 ribs) and soft tissue defects were repaired by simple mesh combined with flap transplantation; and 4 cases of full-thickness chest wall defect with large-scale rib defect (>3 ribs) were repaired by "mesh plus bone cement" rigid internal fixation combined with flap transplantation. The anterior serratus branch of thoracodorsal vessel was selected as the recipient vessel in all cases, the revascularization methods include 3 types: the proximal end of the anterior serratus branch plus other recipient vessels (13 cases), proximal and distal ends of anterior serratus branch (6 cases), and proximal ends of two anterior serratus branches (4 cases). Results: The main trunk of thoracodorsal vessels was preserved completely in 23 patients. All patients were followed up 10-18 months, with an average of 13.9 months. After operation, the flap survived completely, the shape of reconstructed chest wall was good, the texture was satisfactory, and there was no flap contracture deformation. There was only a linear scar left in the flap donor site, and the abdominal wall function was not significantly affected. There was no tumor recurrence during follow-up. Conclusion: The anterior serratus branch of thoracodorsal vessel has a constant anatomy and causes little damage to the recipient site, so it can provide reliable blood supply for free flap transplantation.

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

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 2; 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.

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

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.

Occurrence and removal of 25 antibiotics during sewage treatment processes and potential risk analysis.

The occurrence and removal of 25 antibiotics, including ten quinolones (QNs), four macrolides (MLs), four tetracyclines (TCs) and seven sulfonamides (SNs), were analysed at two sewage treatment plants (STPs) with different treatment units in Guangxi Province, China. The results showed that 14 and 16 antibiotics were detected in the influent of the two STPs, with concentrations ranging from 13.7-4265.2 ng/L and 14.5-10761.7 ng/L, respectively. Among the antibiotics, TCs were the main type in the study area, accounting for more than 79% of the total concentration of all antibiotics. The antibiotic removal efficiencies of the different process units ranged from -56.73% to 100.0%. It was found that the SN removal efficiency of the multistage composite mobile bed membrane bioreactor (MBBR) process was better than that of the continuous-flow Intermission biological reactor (IBR) process, while the IBR process was better than the MBBR process in terms of removing TCs and MLs; however, there was no obvious difference in the QN removal efficiencies of these two processes. Redundancy analysis (RDA) showed a strong correlation between antibiotic concentration and chemical oxygen demand (COD). Risk assessments indicated that algae, followed by invertebrates and fish, were the most sensitive aquatic organisms to the detected antibiotics.

Application value of indocyanine green fluorescence in sentinel lymph node biopsy for early-stage tongue cancer and oropharyngeal cancer. / å²å“šèç»¿è§å ‰æ˜¾å½±åœ¨æ—©æœŸèˆŒç™ŒåŠå£å’½ç™Œå‰å“¨æ·‹å·´ç»“æ´»æ£€ä¸­çš„åº”ç”¨ä»·å€¼.

OBJECTIVES: Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer. METHODS: Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed. RESULTS: SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively. CONCLUSIONS: Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.

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

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.

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

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 ( χ 2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant ( P=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.

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

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.

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

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.

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

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 ( P<0.05). Multivariate analysis showed that preoperative NC and non-ICG angiography were the risk factors of flap-related complications ( P<0.05), and also the risk factors of regional flap necrosis ( P<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.

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

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.

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

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.

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

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 2N 1M 0, 2 cases were T 3N 1M 0, 1 case was T 3N 2M 0, 2 cases were T 4N 1M 0. 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．.

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

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.

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

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.

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

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.

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

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.

[Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma].

Objective: To investigate the clinical outcome of free thoracoacromial artery perforator (TAAP) flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods: Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control (UICC) TNM stage, 3 cases were classified as T 4N 0M 0, 3 cases as T 4N lM 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, and 1 case as T 3N 0M 0. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm×3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm (0.8 cm on average) in thickness, with a pedicle length of 6.8-9.9 cm (7.2 cm on average). Results: All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months (17.2 months on average). The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Conclusion: The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.