Objective To provide the anatomical basis for the appl ication of the superficial inferior epigastric artery flap. Methods Ten cadavers which were immersed in formal in less than 6 months and were perfused by red latex were used in this study. There were 8 males and 2 females with an average age of 58 years (range, 35-78 years). The origin, course, branch,distribution, diameter, pedicle length, and neighbour of superficial inferior epigastric artery and vein were observed in the 2 sides of inguinal region. Results In these series of 10 cadaver (20 sides) dissections, the superficial inferior epigastric artery was identified in 18 sides, which average cal iber was 1.48 mm with a mean vascular pedicle length of 4.80 cm. In 11 sides, the superficial inferior epigastric artery arose aspart of a common trunk with one or more other vessels; in other 7, it originated from the femoral. There were 4 branch modes of superficial inperior epigastric artery: single trunks (5 sides), double ramification (3 sides), single lateral ramification (7 sides), and single medial ramification (3 sides). The superficial inferior epigastric vein was observed in 20 sides, which average cal iber was 2.33 mm with a mean sides pedicle length of 5.45 cm. In 8 sides, the venous drainage was as an individual vein; in 12 sides, both patterns were observed (a pair of venae comitantes and an individual vein). Conclusion The inferior epigastric artery flap can be appl ied to microsurgical flap transfer, potentially in breast reconstruction, phalloplasty, reconstruction of head, neck and four l imbs defects.
To develop a novel biodegradable collagen-chitosan-[poly(vinyl alcohol), PVA] composite artificial lacrimal canal iculus for treating tear overflowing (epiphora) caused by canal icular obstruction. Methods Homogeneously mixing solution composed of collagen, chitosan and PVA with different ratios was prepared. After several cycles of freezing/thawing process, the mixing solution was transferred into elastic hydrogel. Then the hydrogel was rinsed, punctured, dehydrated and trimmed, and three groups (T1, T2 and T3) of novel artificial lacrimal canal iculus were obtained. The appearance and diameter of all samples were observed under optical microscopy. The cross-section before and after drying as well as phase distribution of sample T2 was observed by SEM. The water absorption ratio and expanding ratio in PBS solution were calculated from three swell ing behavior curves. The degradabil ity of groups T1, T2 and T3 were prel iminary analyzed by degradation experiment in vitro. Results The micro-tubes with 0.5-0.7 mm in inner diameter, 0.9-1.5 mm in outer diameter and more than 20 mm in length were fabricated successfully through physical crossl inking without addition of toxic cross-l inker. SEM result showed that the sample had uniform phase distribution and smooth surface at dried state as well as interpenetrate network structure at hydrogel state. It was seen from the swell ing behavior curves that groups T1, T2 and T3 swelled rapidly within 10-30 minutes, and formed elastic composite hydrogel pipes. In addition, the expanding ratio of inner and outer diameter of the tube was 20%-30% and 100%-120% with swell ing, respectively. The equil ibrium water content of the hydrogel pipes increased with increase of collagen composition. Three groups of samples were immerged in PBS solution contained 2 mg/mL lysozyme at 37 for 1 month, their nozzle cracked, their wall became thin and more transparent. And also, there was small floc deposited on the tube surface. The samples were degraded into mash after they were soaked in PBS solution at 70 for 2 days. Conclusion The novel artificial lacrimal canal iculus with good mechanical property and high water absorption is in favor of operation, tear passing and anti-conglutination. It will be a potential candidate for treating the lacrimal passage occlusion.
ObjectiveTo investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap.MethodsSixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien’s donor area, the recovery of transoral feeding function, and the presence of complications.ResultsComparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements (P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant (t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed.ConclusionThe superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.