[A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture].

OBJECTIVE: To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory. METHODS: The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups. RESULTS: Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504). CONCLUSION: Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Causal relationship between thyroid dysfunction and hallux valgus: A two-sample Mendelian randomization study.

Introduction: Previous observational studies have reported that thyroid dysfunction is associated with hallux valgus (HV). However, the causal effect of thyroid dysfunction on hallux valgus is still unknown. To assess whether there is a causal relationship between thyroid dysfunction and hallux valgus, we performed a two-sample Mendelian randomization (MR) study. Methods: The data of the two-sample Mendelian randomization study were obtained from public databases. In this study, hypothyroidism, hyperthyroidism, free thyroxine (FT4), and thyrotropin (TSH) were chosen as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for FT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. HV was used as the outcome. The SNPs associated with HV were selected from a GWAS of 202,617 individuals in the fignngen database. The inverse variance weighted (IVW) method was used as the primary analysis. Four complementary methods were applied, including MR-presso, MR-Egger, and weighted median. In addition, Cochran's Q test, MR-presso, MR-Egger regression, and the leave-one-out test were used as sensitivity analysis, and the MR-pleiotropy test was performed to examine pleiotropy. Results: According to the results of IVW, we found that there was a causal relationship between hypothyroidism and HV, and hypothyroidism increased the incidence of HV (OR = 2.838 (95% CI: 1.116-7.213); p = 0.028). There were no significant causal effects of hyperthyroidism, FT4, and TSH on HV (p > 0.05). Sensitivity analyses showed that the results were robust and reliable, and no horizontal pleiotropy was detected. Conclusions: Our findings provided genetic support that hypothyroidism might increase the risk of HV. It will predict the occurrence of HV in patients with hypothyroidism and provide suggestions for early prevention and intervention.

Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal.

Objective: To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors. Methods: A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group. Results: Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1-2 (IMA1-2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer-Lemeshow test showed a good degree of calibration (χ 2 = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737-0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%-70%. Conclusion: Second metatarsal length, second metatarsal peak pressure, HVA, IMA1-2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective. Level of Evidence: Level III, retrospective comparative study.

Effects and Anti-rotation Stabilization of the Non-bridging External Fixation for Pronation-Abduction Stage III Ankle Fracture: A Cadaveric Study.

OBJECTIVE: This study is aimed at providing a nonbridging external fixation technique with pinning fixation for the pronation-abduction stage III ankle fracture. The secondary purpose was to evaluate its effect on anatomic reduction and fracture fragment stability against cadaveric models' rotation. METHOD: A paired design study was conducted using 14 pairs of the cadaveric model which had been modeled for pronation-abduction stage III ankle fracture. One fracture model from each pair was randomly allocated to receive an open reduction and internal fixation, while the other was reduced and stabilized with the external fixation technique. After the surgery, the antirotational stability tests were performed with external rotation torques of 10 nm, 15 nm, and 20 nm applied, respectively. The postoperation reduction rate and ankle parameters were recorded in anteroposterior and lateral radiographs before and after the antirotational stability experiment. RESULT: The outcomes were assessed according to Burwell-Charnley's radiographic criteria of reduction. It showed no statistically significant differences in reduction between the two groups (P < 0.05). The displacement of lateral fragment following a reduction in the external fixation group was significantly larger than that of the internal fixation group (3.14 ± 0.56 vs. 1.49 ± 0.39, P < 0.05). After applying rotational torques of 10 nm, 15 nm, and 20 nm, the results of other parameters showed no significant differences between the two groups. CONCLUSION: This nonbridging external fixation method with pin fixation of fracture fragments might have the same effect as that of internal fixation on the reduction rate of pronation-abduction stage III ankle fracture.

[Minimally invasive osteotomy and manual reduction for hallux valgus].

OBJECTIVE: To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus. METHODS: From January 2018 to May 2019, 31 patients (42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of (50.1± 4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society (AOFAS)score were observed and measured. RESULTS: Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1± 1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0± 1.1)°, and improved to (14.3±4.7)°and (9.1±1.5)°after operation respectively(P<0.05). Preopertaive length difference between 1 and 2 metatarsals was 2-4(-0.59±1.80) mm, and 0 to -6(-3.53±1.60) mm after operation, the average shortening of the first metatarsal was 2.94 mm. There were significant difference between preoperative and postoperative. Preoperative AOFAS score was 57.8±9.7, increased to 92.1±9.3 at the final follow-up, there was significant differences (P<0.05). According to standard of AOFAS score, 32 feet obtain excellent results, 16 good and 3 moderate. CONCLUSION: Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.

Mechanical stress promotes angiogenesis through fibroblast exosomes.

BACKGROUND: Mechanical stress can induce multiple functional changes in vascular endothelial cells, including proliferation, differentiation, and migration. Furthermore, human fibroblasts are susceptible to external mechanical stress. In this work, we investigated whether mechanical stress can induce exosome secretion from fibroblasts to modulate angiogenesis. METHODS: A CCK-8 cell proliferation assay was used to determine mechanical parameters. Then, exosomes from fibroblasts were isolated and characterized with regard to concentration and markers. We subsequently explored the effect of exosomes on proliferation, migration, and angiogenesis. Additionally, high-throughput sequencing was used to screen differentially expressed miRNAs in the mechanical stress-induced exosomes. RESULTS: A static stretching of 15% significantly enhanced the cell viability of the fibroblasts (p < 0.05) and significantly induced the secretion of exosomes from the fibroblasts, which had a stronger internalization ability. Further experiments demonstrated that the presence of static stretching-induced exosomes significantly increased cell proliferation, migration, and angiogenesis by regulating the Erk1/2 signaling pathway. Additionally, 12 up-regulated and 12 down-regulated candidate miRNAs were discriminated in the static stretching-induced exosomes. CONCLUSION: Our findings conclusively demonstrate that static stretching-derived exosomes from fibroblasts promote angiogenesis through differentially expressed miRNAs, providing novel insights into the molecular mechanism by which mechanical stress influences angiogenesis.

Bland-Altman Analysis of Different Radiographic Measurements of the Hallux Valgus Angle and the Intermetatarsal Angle After Distal Osteotomy.

OBJECTIVE: The aim of the present study was to evaluate commonly used approaches for detection of radiographic angles in hallux valgus deformity patients. METHODS: This retrospective study was conducted in patients with hallux valgus deformity at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2016 to January 2019. The inclusion criteria were: (i) postoperative dorsoplantar weight-bearing radiographs for the feet of patients with the hallux valgus; (ii) patients had been managed with a distal osteotomy of the first metatarsal and the osteotomized bone ends recovered. The exclusion criteria applied were as follows: (i) age > 65 years or < 18 years old; (ii) blurry image; (iii) previous history of severe foot trauma and surgery. Postoperative radiographs for hallux valgus were analyzed using six methods: by a line drawn through the long axis of the first metatarsal bone (method 1); an extended line drawn to bisect the shaft of the metatarsal at two levels with joined points of bisection (method 2); a line drawn to connect the center of the articular surface of the metatarsal head and the center of the proximal articulation (method 3); a line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4); a line drawn through the center of the head and the center of the proximal shaft (method 5); and a line drawn from the center of the head of the first metatarsal head through the center of the proximal articulation (method 6). The measurement results obtained were subjected to Bland-Altman analysis and consistency evaluation. RESULTS: A total number of 20 radiographs were collected for measurement. No statistically significant differences were found in the measurement values among the six methods (P > 0.05). The lowest values of the average measurement, standard deviation, and confidence interval were established in method 3, followed by those in methods 1 and 4. The standard deviation of the measurement value and the confidence interval in method 2 were the largest. Methods 1 and 4 had similar confidence intervals and were with a high consistency. Due to the nature of the retrospective study, no follow-up and complications were applicable in the present study. CONCLUSION: Line drawn through the long axis of the first metatarsal bone (method 1) and line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4) were reliable and well repeatable, and may be used for postoperative radiographs.

[Inner-heating acupuncture of lumbar degenerative lesions based on ß-catenin signaling pathway].

OBJECTIVE: By observing the effect of inner-heating acupuncture on the expression of Wnt1, Axin and ß-catenin in the intervertebral disc of rats with lumbar degenerative disease and to explore the regulatory mechanism of inner-heating acupuncture on the apoptosis of annulus fibrosus cells in rats with lumbar degenerative disease. METHODS: Forty SD rats were randomly divided into normal group, model group, inner heating acupuncture group and acupuncture group with 10 rats in each group. Except for normal group, all rats were modeled. Bilateral Da Chang Shu were selected for inner-heating acupuncture and acupuncture treatment. Western-bolt assay was used to detect the expression of Wnt1, Axin and ß-catenin in rat intervertebral discs. RESULTS: Compared with the model group, Wnt1 and ß-catenin expression in annulus fibrosus cells of rats in the inner heating acupuncture group and the acupuncture group were significantly decreased(P<0.05);the expression of Axin in annulus fibrosus of rats in the inner heating acupuncture group was significantly increased(P<0.05). There was no significant difference in the expression of Axin in annulus fibrosus of rats between acupuncture group and model group(P>0.05). CONCLUSION: Inner heating acupuncture can down regulate the expression of Wnt1 and ß-catenin and up regulate the expression of Axin in annulus fibrosus of rats with lumbar degenerative desease. It is suggested that the mechanism may be to regulate the expression of related factors in the ß-catenin signaling pathway, so as to achieve the goal of treating lumbar degenerative diseases.

The Biomechanical Relationship between Hallux Valgus Deformity and Metatarsal Pain.

Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and metatarsal pain has not been systematically examined. The purpose of the present study was to investigate the correlation between metatarsal pain and the degree of HV deformity. Between October 2017 and September 2018, 512 HV patients (944 feet) participated in an evaluation of their HV angle (HVA) using X-ray images. The participants were divided into four groups corresponding to their HVA (<15°, 15° to 20°, 21° to 40°, or >40°). Load rate, impulse, contact duration, and contact area were measured and recorded as dynamic gait parameters using the RsScan system. Data were evaluated using SPSS statistical software. The visual analog scale (VAS) was used to assess metatarsal pain. For the four HV deformity groups, the peak value of impulse and contact duration was concentrated on the second and third metatarsals (Meta2 and Meta3) (P < 0.05); contact area was also shown on metatarsals 1, 2, and 5 (P < 0.05). Metatarsal pain on Meta2 had the highest VAS score (VAS: 6.57), followed by Meta3 (Mean VAS: 5.72). In the HV > 40° group, the load location on Meta2 was transferred to Meta1. The percent of pain attributed to Meta2 and Meta3 was also increased in this group. These findings illustrated that metatarsal pain was primarily located on Meta2 and Meta3 in the different degrees of HV deformity. This information can provide the location to target for pain relief and help guide further rehabilitation.

[Systematic review on clinical efficacy and safety of Cheezheng Pain Relieving Plaster for soft tissue injury].

To systematically evaluate the clinical efficacy and safety of Cheezheng Pain Relieving Plaster in the treatment of soft tissue injury. Four Chinese databases(namely CNKI, WanFang, VIP, CBM) and 2 English databases(namely PubMed, Cochrane Library) were retrieved from the establishment of each database to March 2019. The randomized controlled trials of Cheezheng Pain Relieving Plaster compared with routine therapy in treatment of soft tissue injury were included. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Five studies were included, and 367 patients were enrolled. None of the included studies reported randomized concealment, blinding, follow-up and dropping off. The results showed that Cheezheng Pain Relieving Plaster may have advantages in alleviating joint pain, swelling, tenderness and dysfunction and other symptoms, with no serious adverse reaction. Compared with routine therapy, Cheezheng Pain Relieving Plaster may have advantages in the treatment of soft tissue injury. However, due to the quality of the included RCTs, the conclusions of this study were limited. In addition, to produce high-quality evidences for the clinical application of Cheezheng Pain Relieving Plaster, the conclusions of this study shall be further verified with large-sample, scientifically designed and strictly implemented clinical trials.

[Bibliometric analysis and quality assessment of clinical evidence on Xiaotong Tiegao].

Many clinical studies on Cheezheng Xiaotong Tiegao have been accumulated since it was launched in 1993,but they have not been comprehensively analyzed and evaluated. This study systematically retrieved relevant studies in six databases at home and abroad as of December 2017. This study analyzed the statistics of the included studies in several aspects,including publication time,region,fund,disease category and type of study. In this study,various tools were used to evaluate the methodological quality of included studies,such as the Cochrane collaboration's tool for assessing the risk of bias in randomized trials,MINORS,IHE,AMSTAR2.The results showed that the literatures were mainly published from 2010 to 2011,and a total of 28 projects were financially supported.The most involved disease was arthropathy. The randomized controlled trials were the majority in the included studies,but the quality was low,and most of the literatures didn't report the allocation concealment and blinding. This study comprehensively reflected the current situations and shortcomings of the clinical studies of Cheezheng Xiaotong Tiegao,and put forward several suggestions,in the expectation of providing a reference for the future clinical research direction of Cheezheng Xiaotong Tiegao.

[Treatment of knee osteoarthritis with six-step manipulation combined with extracorporeal shock wave].

OBJECTIVE: To observe the clinical effect of six-step manipulation combined with extracorporeal shock wave in the treatment of knee osteoarthritis. METHODS: Seventy-six patients with KOA from December 2016 to June 2018 were divided into control group and treatment group, 38 in each group. The patients in the control group were treated with oral medicine combined with extracorporeal shock wave therapy, while the patients in the treatment group were treated with six-step manipulation combined with shock wave therapy. The VAS score, WOMAC score and clinical efficacy of the two groups were compared before treatment, 1 day, 1 month and 6 months after treatment. RESULTS: There was no significant difference in VAS score and WOMAC score between the two groups before treatment(P>0.05). VAS score and WOMAC score in treatment group were significantly lower than those in control group at 1 day, 1 month and 6 months after treatment, and the difference was statistically significant(P<0.05). CONCLUSIONS: Six-step manipulation combined with extracorporeal shock wave therapy can significantly alleviate pain and improve knee function in patients with knee osteoarthritis, and the clinical effect is obvious.

[Preparation instructions for Experts consensus statement on Cheezheng Xiaotong Tiegao in clinical practice].

As a topical plaster developed by modern pharmaceutical technology based on traditional Tibetan medicine,Cheezheng Xiaotong Tiegao has functions of promoting blood circulation,relieving swelling and relieving pain. Since its introduction in 1993,it has been widely used in the treatment of various types of acute and chronic musculoskeletal pain and various types of spinal,joint and soft tissue diseases. In order to better standardize the clinical application and improve the clinical efficacy of Cheezheng Xiaotong Tiegao,the research and development work of the Experts consensus statement on Cheezheng Xiaotong Tiegao in clinical practice was officially launched on October 19,2017,upon approval from China Association of Chinese Medicine. In this paper,main R&D process and related technical links for the experts consensus on Cheezheng Xiaotong Tiegao would be summarized,which will help the various medical workers understand,master and apply more accurately,and also provide reference for the development of experts consensus on clinical application of other topical Chinese medicines.

[Experts consensus statement on Cheezheng Xiaotong Tiegao in clinical practice].

Cheezheng Xiaotong Tiegao is a Tibetan traditional prescription,which has the functions of promoting blood circulation,relieving swelling and relieving pain. It has been widely used in various clinical departments such as orthopedics department,rheumatology department,pain management department,and rehabilitation department to treat all types of acute and chronic skeletal muscle pain. However,duet to the lack of detailed description of the specific use of various diseases in its manual,and in the published guidelines,monographs,and clinical reports,the introduction of the dominant clinical disease,usage,treatment,safety,etc. of Cheezheng Xiaotong Tiegao is not detailed. Therefore,this experts consensus statement has been prepared based on the research and analysis of clinicians and patients,evidence-based medical research and evaluation,combined with the experience of clinical experts. The experts consensus statement regulates usage,dosage,combination,safety,etc. in the treatment of acute and chronic contusion( soft tissue injury),osteoarthritis,low back pain,frozen shoulder,cervical spondylosis postoperative recovery pain and other pain relief and other skeletal muscle system diseases to provide evidence and reference for the rational and safety using of Cheezheng Xiaotong Tiegao.

Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study.

BACKGROUND: Deformity of the first ray in hallux valgus patient has been deemed to mainly contribute to instability of the metatarsophalangeal joint. However, it is not clear whether the fixation of the distal osteotomy fragment and transposition of the sesamoid represent the best method for hallux valgus treatment. The aim of this study was to examine how postoperative hallux valgus osteotomy affects the stability of the first ray. METHODS: To accurately investigate the biomechanical behavior of the first ray in pre-/postoperative hallux valgus patients, we described the relative displacement and stress distribution of the first metatarsal bone and sesamoid by imageology, test measurement and foot finite element model. FINDINGS: Compared with the preoperative hallux valgus, the plantar pressure decreased by 47.8% and was redistributed on second metatarsal region. The peak stress and relative displacement of the distal osteotomy fragment increased by +55.7% and -59.9%, respectively. The movement of this component shifted toward the positive sagittal axis direction. In addition, the relative displacement of sesamoid decreased by 87.4% (0.18 mm) in vertical axis direction and the stress was also redistributed on medial and lateral region. Moreover, the strain of the medial main ligament was more favorable to reconstruct function of the first ray. INTERPRETATION: The findings showed that the osteotomy method was helpful for stability of the first ray. This would provide the stability suggestions for postoperative hallux valgus fixation and guide further rehabilitation.

Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus.

Hallux valgus (HV) was one of the most frequent female foot deformities. The aim of this study was to evaluate mechanical responses and stabilities of the Kirschner, bandage and fiberglass fixations after the distal metatarsal osteotomy in HV treatment. Surface traction of different forefoot regions in bandage fixation and the biomechanical behavior of fiberglass bandage material were measured by a pressure sensor device and a mechanical testing, respectively. A three-dimensional foot finite element (FE) model was developed to simulate the three fixation methods (Kirschner, bandage and fiberglass fixations) in weight bearing. The model included 28 bones, sesamoids, ligaments, plantar fascia, cartilages and soft tissue. The peak Von Mises stress (MS) and compression stress (CS) of the distal fragment were predicted from the three fixation methods: Kirschner fixation (MS=6.71MPa, CS=1.232MPa); Bandage fixation (MS=14.90MPa, CS=9.642MPa); Fiberglass fixation (MS=15.83MPa, CS=19.70MPa). Compared with the Kirschner and bandage fixation, the fiberglass fixation reduced the relative movement of osteotomy fragments and obtained the maximum CS. We concluded that fiberglass fixation in HV treatment was helpful to the bone healing of distal fragment. The findings were expected to guide further therapeutic planning of HV patient.

Assessing PAHs pollution in Shandong coastal area (China) by combination of chemical analysis and responses of reproductive toxicity in crab Portunus trituberculatus.

The concentrations of PAHs in seawater and sediments were measured at three selected sites (S1, S2, and S3) along the coastal area of Shandong (China) in April, May, and June, 2015, which ranged from 29.72 to 123.88 ng/L and 82.62 to 232.63 ng/g, respectively. Meanwhile, the reproductive toxicity responses in crab Portunus trituberculatus were also evaluated to assess the pollution of PAHs during the sampling period. Chemical analysis showed that S3 was the most PAH-contaminated area while S1 was the least, and the biochemical parameters concerned with reproduction were efficiently responded to the three sites, especially in S3 (p < 0.05). Moreover, the principal component analyses (PCA) showed that parameters for DNA alkaline unwinding, protein carbonyl content, and lipid peroxidation levels in two genders, 17ß-estradiol in female, testosterone and TESK2 gene expression in male crabs, were closely correlated with the concentrations of PAHs (2 + 3 rings, 4 rings, and 5 + 6 rings), which were considered to be good candidate indicators to assess the environmental pollutions resulting from PAHs in the coastal area of Shandong, China.

[Reconstruction of buccal defect using free anterolateral thigh flaps after radical resection of buccal cancer].

Objective: To explore the value of different designed anterolateral thigh flaps(ALT) in the reconstruction of buccal defect after radical resection of buccal cancer. Methods: From March 2009 to May 2016,142 cases were diagnosed as buccal cancer in the Department of Oral and Maxillofacial Surgery of Nanjing University. All patient underwent radical resection, followed by reconstruction with different anterolateral thigh flaps. The clinical date were retrospectively analyzed. . Results: Among 142 cases, the muscuiocutaneous ALT flaps were used in 60 cases, the fasciocutaneous ALT flaps in 60,and the thin ALT flaps in 22.The size of the flaps ranged from 4 cm ×5 cm to 14 cm × 10 cm. Operative exploration during the perioperative period were performed in 4 patients, including 2 flaps with thrombotic events and 2 flaps with venous thrombosis. Among them,2 flaps survived completely and 2 flaps were failure. The mean follow-up period was 37 months (range:3 to 85 months). Conclusions: The different designed anterolateral thigh flap for the buccal defects resulting from tumour excision is an ideal choice for reconstruction of buccal defects