A comparative study for the efficacies of transaxillary non-inflatable endoscopic surgery versus traditional surgery for papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

Comparison of three kinds of free flaps used in patients with oral and oropharyngeal tumors / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps. Methods: The clinical data of 103 patients, including 66 males and 37 females, aged 26-74 years, who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed. Anterolateral thigh flap (ALTF) was used in 43 patients, radial forearm free flap (RFFF) in 45 patients, and lateral arm free flap (LAFF) in 15 patients. Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale (HIP-14 Chinese edition). SPSS 23.0 software was used for statistical analysis. Results: The T staging of RFFF or LAFF group was significantly lower than that of ALTF group (P<0.05). There was no significant difference in mean flap areas between ALTF group ((55.87±27.38) cm2) and LAFF group ((49.93±19.44) cm2), while RFFF group had smaller mean flap area ((33.18±6.05) cm2) than ALTF group (t=5.311, P<0.001) and LAFF group (t=3.284, P=0.005). In terms of oral functions including swallowing, mastication, taste and spitmouth, there were no significant differences between LAFF group and RFFF group (P>0.05), but both groups had better oral functions than ALTF group (P<0.05). There was no significant difference in appearance scores between LAFF group (75(75, 75)) and ALTF group (75(75,75) vs.75(75,75),Z=-1.532, P=0.126), and both groups had higher scores than RFFF group (50(50, 75),Z values were -3.447 and -3.005 respectively, P<0.05). RFFF group had higher speech score (100(67, 100)) than LAFF group (67(50, 76),Z=-2.480, P<0.05) and ALTF group (67(33, 67),Z=-5.414, P<0.05). ALTF group had lower mean score of quality of life than RFFF group [72(56,77) vs.79(69, 89),Z=-3.070, P<0.05), but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group (Z=1.754, P=0.079). According to the evaluation of oral health impact scale (HIP-14 Chinese version) 1 year after surgery, individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups (P<0.05), with no significant difference between RFFF group and LAFF group (P>0.05). Conclusions: RFFF has unique advantages for small tissue defects, while ALTF is suitable for large tissue defects, such as buccal penetrating defect, whole tongue and near whole tongue defect, and LAFF is a compromise choice between ALTF and RFFF. ALTF is inferior to RFFF and LAFF in oral functional reconstruction, including swallowing, chewing, taste and spittle. ALTF and LAFF are superior to RFFF in postoperative appearance.

Re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism after parathyroidectomy with autotransplantation / 临床耳鼻咽喉头颈外科杂志

To analyze the clinical profile and therapeutic effect of re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism(SHPT)after parathyroidectomy with autotransplantation.Twelve persistent SHPT patients who were treated with reoperation of paramyroidectomy(PTX)were enrolled in this study during the period from Jan 2014 to Jul 2017 in our hospital.We evaluated the location of the remaining parathyroid glands by ultrasonography,dual-phase 99 Tcm-sestamibi scintigraphy,CT and MR imaging of the neck before the operation.We resected the parathyroid gland tissue in situ,and the ectopic parathyroid glands hiding in thymus,mediastinal,tracheal esophageal groove,thyroid gland and other locations in the neck.During the surgery,nanocarbon imaging was used to help identify the parathyroid gland and parathyroid hormone assay(IOPTH)was measured at the end of the surgery.We observed the changes of clinical symptoms after the surgery and collected blood parameters including serum intact aramyroidhomone(i-PTH),calcium(Ca),phosphoms(P),calcium and phosphorus product before and after surgery.Complications and failure were also analyzed.All the 12 patients underwented successful operation.The postoperative pathological results were hyperplastic parathyroid glands tissue.22 parathyroid glands were resected,among which 14 were located at the neck in situ,8 were ectopic,i.e.,located at thymus in 4 cases,superior mediastinum in 2 cases and thyroid parenchyma in 2 cases.The clinical symptoms were significantly improved including osteoarthritis,skin itching and limb weakness.The levels of serum iPTH,calcium,phosphorus and calcium and phosphorus product were significantly lower than those before operation(<0.05).Ten patients presented hypocalcemia after surgery and the level of calcium returned to normal after supplement of calcium.Temporary injury of laryngeal nerve was found in4 cases,but there was no patient with transient bucking,dyspnea or death.No recurrence was found during 1 year follow-up.It was very important to locate the residual parathyroid gland accurately with a variety of imaging methods in uremic patients complicated with persistent or recurrent SHPT when they needed re-operation.Surgeons should explorate ectopic parathyroid gland according to the concept of the superior mediastinum dissection and the central compartment neck dissection.Meanwhile,the use of nanocarbon assisted parathyroid gland negative imaging and rapid IOPTH can significantly improve the success rate of surgery and reduce surgical complications.

Repairing proximal and middle lower-leg wounds with retrograde sartorius myocutaneous flap pedicled by perforating branches of medial inferior genicular artery or posterior tibial artery.

BACKGROUND AND OBJECTIVES: The blood supply of the lower one-third of the sartorius muscle is mainly provided by the descending genicular artery (saphenous artery). The terminal branches of the saphenous artery, together with the perforators of the posterior tibial artery and medial inferior genicular artery, form a stable and rich anastomotic network in the genus inferior medialis. Based on this anatomy, we designed a retrograde sartorius myocutaneous flap to repair wounds in the proximal and middle thirds of the lower leg. METHODS: A sartorius myocutaneous flap with the posterior tibial (or medial inferior genicular) artery perforators as the pedicle was designed. The flap was based on a retrograde flow route: medial inferior genicular and posterior tibial artery perforators, the vascular network at the inferomedial knee, the saphenous artery, saphenous artery perforators, to the sartorius muscle. With this design, the flap can be transferred to the middle and proximal tibia. Between January 2007 and June 2010, 12 patients with middle/proximal lower-leg wounds were successfully treated with this method. RESULTS: Ten of 12 myocutaneous flaps survived with primary healing of wounds. Two cases developed a small degree of distal superficial skin necrosis but with normal muscular blood supply and healed after conservative treatment. CONCLUSION: Retrograde sartorius myocutaneous pedicle flaps from the perforating branches of the medial inferior genicular artery or posterior tibial artery have advantages in terms of reliable blood supply, ease of operation and minimal amount of damage, and can be used to repair proximal and middle lower-leg wounds. They are especially applicable when lower-leg flaps are unavailable due to poor soft-tissue conditions following trauma or multiple operations. However, the safety flap size needs to be determined in future studies.

[Early treatment of high-voltage electric burn wound in the limbs].

OBJECTIVE: To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs. METHODS: Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up. RESULTS: Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture. CONCLUSIONS: Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.

[Characterization and biological significance of peripheral blood dendritic cell subsets in patients with severe burn].

OBJECTIVE: To investigate the characteristics of dendritic cells (DCs) in patients with severe burn. METHODS: Peripheral blood samples were obtained from 12 patients with severe burn 1, 2, 3, and 4 weeks after burn, and from 10 healthy donors as controls. Mononuclear cells were isolated, and GM-CSF 1000 and IL-4 were used to induce the transformation of DCs. Mature DCs were harvested and underwent flow cytometry to detect the expression of HLA-DR, CD80, CD83, CD86, CD14, and CD11c. RESULT: 1, 2, 3, and 4 weeks after burn, the expression levels of HLA-DR were 62.1% +/- 8.4%, 65.0% +/- 6.2%, 68.4% +/- 5.7%, and 75.4% +/- 8.4% respectively; the expression levels of CD80 were 12.9% +/- 3.7%, 14.7% +/- 2.5%, 16.1% +/- 4.2%, and 16.2% +/- 4.8%; the expression levels of CD83 were 15.1% +/- 4.2%, 15.1% +/- 4.0%, 22.2% +/- 7.7%, and 21.3% +/- 7.0% respectively; the expression levels of CD86 were 69.2% +/- 7.1%, 70.5% +/- 5.4%, 75.1% +/- 6.1%, and 79.6% +/- 6.4% respectively, all significantly lower than that of the control group (84.3% +/- 8.2%, all P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD14 in the DCs of the severe burn patients were 12.7% +/- 1.9%, 12.0% +/- 1.5%, 11.3% +/- 1.3%, and 9.3% +/- 1.7% respectively, all significantly higher than that of the control group (7.3% +/- 1.5%, P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD11c in the DCs of the severe burn patients were 86.8% +/- 6.1%, 89.5% +/- 5.1%, 91.3% +/- 2.8%, and 89.4% +/- 4.0% respectively, a little lower than that of the control group, however, without significant difference (92.6% +/- 3.8%, P > 0.05). CONCLUSION: The functions of DCs in the patients with severe burn are declined, which may partly contribute to infection after burn.

[Preliminary study on the improvement of wound microcirculation and retrospection on several methods of the management of deep partial thickness burn wound].

OBJECTIVE: To analyze several methods of wound repair for deep partial thickness burn wounds retrospectively, so as to evaluate the significance of improvement of wound microcirculation on wound healing. METHODS: (1) 2,976 burn patients admitted to our department were enrolled in the study, among them 614 undertook tangential excision, 32, eschar abrasion, 86 allo-skin coverage after debridement, 1836 tropical application of silver sulfadiazine and 408 with traditional Chinese medicine (Jing Wan Hong ointment) with gauze bandage. The results of the management with different methods were compared. (2) Rat model with deep partial thickness burn was reproduced and topical application of silver sulfadiazine was given. The rats were randomly divided into control (n = 10, with normal saline injected via caudal vein within 5 minutes postburn), and treatment (n = 10, with batroxobin injected via caudal vein within 5 minutes postburn) groups. The blood flow perfusion unit in the wound skin was measured before burn and at 0.5 to 72 postburn hours by Laser Doppler. The wound healing rate, contraction rate and wound healing time in each group were calculated on 14 and 18 postburn days (PBDs). The number of hair follicles after wound healing was observed by histological method. RESULTS: (1) The burn wound treated by tangential excision healed within 2 to 3 post operation weeks (POWs), with the healing rate of 94.8% in patients with burn covering 50% - 70% TBSA and 93.4% in those with burn of 80% approximately 98% TBSA. The healing time of patients with allo-grafts coverage after eschar abrasion was 13.8 +/- 2.1 days without scar formation. The wound healing time was 18.0 +/- 2.3 day in 82 patients with allo-graft coverage after debridement, and it was 26.0 +/- 3.2 days with subeschar healing in 1658 patients with topical application of silver sulfadiazine. Infection in burn wound was encountered in most patients undergoing traditional Chinese medicine bandage treatment with wound healing time of 26.0 +/- 2.8 days in the lower extremities. (2) The blood flow perfusion unit of the rats in the treatment group was significantly higher than that in the control group (P < 0.01). The wound healing rate in treatment group on 14 and 18 PBD was obviously higher than that in the control group (P < 0.01). But the wound contraction rate in the two groups was similar (P > 0.05). The wound healing time in treatment group was much shorter than that in control group (P < 0.01). A few hair follicles remained in the dermis of the rats in the control group on 30 PBD, and the number was evidently smaller than that in the treatment group (P < 0.01). CONCLUSION: Early tangential excision and eschar abrasion remained better methods in the management of deep partial thickness burn wounds, as they could ameliorate burn wound infection, shorten treatment period, raise wound healing rate and quality. Application of batroxobin could accelerate wound healing rate by improving wound microcirculation in deep partial thickness burn wound.

[Experimental and clinical study on the treatment of ischemic skin flap with topical application of PGE1].

OBJECTIVE: To evaluate the efficiency of PGE(1) in relieving the circulatory disorder of ischemic skin flap. METHODS: New Zealand rabbits were employed in the study with skip flaps each with the size of 2.5 x 6.0 cm(2) being raised from the back. PGE(1) cream in different concentrations, i.e. 0.2%, 0.4%, 0.8% was respectively topically applied to the skin flaps forming 3 groups (n = 10 in each group), while pure cream without PGE(1) was applied to those in control group (n = 30). The PGE(1) was applied 1 hour after the flap was opened, raised and sutured back. Blood perfusion in the flap was measured with Laser Doppler flowmetry before and 5, 10, 15, 20, 30, 45 and 60 mins after PGE(1) application. The tissue samples from the skin flap were harvested at 2 hours after PGE(1) application for immunohistological staining, and the cross sectional area of capillary lumens was measured under microscope. The survival area of the flap was assessed on the 3(rd) day after operation for the calculation of relative survival length of the flap. Clinically, PGE(1) ointment was applied onto the skin flap vulnerable to necrosis, and the outcome of the flap was observed thereafter. RESULTS: The blood perfusion in animal skin flaps was increased evidently after PGE(1) application, especially at 30 mins after PGE(1) usage when compared with that in control group (P < 0.05). The capillaries in the skin flap in PGE(1) application groups were dilated obviously after drug usage as observed under microscope (P < 0.05). The survival area and relative survival length in groups 1 and 2 on the 3(rd) post-operational day were much more increased when compared with those in other groups (P < 0.01). Clinically, the skin flaps treated with PGE(1) survived well even in the distal end of the flaps. CONCLUSION: The blood perfusion and the survival rate of the skin flaps could be improved by local application of PGE(1) in concentrations of 0.2% or 0.4%.