In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis). MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software. ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis. ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
ObjectiveTo analyze responsiveness of Chinese version of Neck Outcome Score (NOOS-C) and provide a reliable measure to assess intervention effect for patients with neck pain.MethodsCross-cultural adaptation of NOOS was performed according to the Beaton’s guidelines for cross-cultural adaptation of self-report measures. Eighty patients with neck pain were recruited between September 2016 and May 2017. Those patients were assessed using NOOS-C and Chinese version of Neck Disability Index (NDI) before and after intervention. And 71 patients completed those questionnaires. The statistic differences of the score of each subscale and the total scale before and after intervention were evaluated by paired-samples t test. Internal responsiveness was determined by effect size (ES) and standardized response mean (SRM) based on the calculated difference before and after intervention. External responsiveness was analyzed by Spearman correlation coefficient.ResultsThe differences in symptom subscale, sleep disturbance subscale, participating in everyday life subscale, every day activity and pain subscale, and the scale between before and after intervention were significant (P<0.05) except for mobility subscale (P>0.05). The difference of NDI-C before and after intervention was –12.11%±17.45%, ES was 0.77, and SRM was 0.69. The difference of NOOS-C before and after intervention was 13.74±17.22, ES was 0.83, and SRM was 0.80. Spearman correlation analysis revealed that the relativity about NOOS-C and NDI-C before and after intervention were both negative (r=–0.914, P=0.000; r=–0.872, P=0.000).ConclusionNOOS-C’s responsiveness is good.
Objective To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. Methods From January 2003 to November 2004, 9 cases of sustained severeneck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm×8 cm to 20 cm×11 cm，while the minimum one was 15 cm×4 cm to 15 cm×6 cm. Results The combined scapular/parascapular flapswere successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105°.Conclusion The combined bilobar scapular/parscapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is agood option for reconstruction of the severe neck contracture.
OBJECTIVE To repair facial and neck scar using tissue expanding technique. METHODS From January 1991 to January 1995, 16 cases with facial and neck scar were treated. Multiple tissue expanders were put under the normal skin of facial and neck area, after being fully expanded, the scars were excised and the expended skin flaps were transplanted to cover the defects. The size and number of tissue expanders were dependent on the location of the scars. Normally, 5 to 6 ml expanding volume was needed to repair 1 cm2 facial and neck defect. The incisions should be chosen along the cleavage lines or in the inconspicuous area, such as the nasolabial fold or submandibular region. The design of flap was different in the face and in the neck. In the face, direct advanced flap was most common used, whereas in the neck, transposition flap was often used. Appropriate tension was needed to achieve smooth and cosmetic effect. It was compared the advantages and disadvantages of several methods for repair of the defect after facial and neck scar excision. RESULTS Fifteen cases had no secondary deformity after scar excision. Among them, 1 case showed blood circulation disturbance and cured through dressing change. Ten cases were followed up and showed better color and texture in the flap, and satisfactory appearances. CONCLUSION Tissue expanding technique is the best method for the repair of facial and neck scar, whenever there is enough expandable normal skin.
In order to study the clinical efficacy of bilateral cervico-thoracic skin flap on repairing the contracture of the burn scar of the neck, 66 flaps were used in 33 patients from 1983 to 1995. The size of the flap ranged from 5 cm x 6 cm to 8.5 cm x 15 cm. The donor site was covered with split skin graft. The ratio between the length and the width of the flaps should not exceed 3:1. Fifty-nine flaps survived completely, but 7 had necrosis of small area which was healed without any influence on the function and appearance. The operative technique of the bilateral cervico-thoracic skin flaps were reported. The advantages of this type of skin flap and its applied anatomy and the postoperative care were discussed. In the repair of the cicatritial contracture deformity of the neck, it was important to define whether the skin defect was located in the submandibular, anterior cervical or anterior thoracic region, thus appropriate type of repair could then be given accordingly.
Objective To investigate whether an internet-based neck-specific training program can alleviate pain and disability in participants with cervical spondylotic radiculopathy (CSR). Methods Patients diagnosed with CSR at West China Hospital of Sichuan University between March 2022 and September 2022 were randomly allocated to either an telehabilitation group or a traditional treatment group. The primary outcome measures included Visual Analogue Scale, Neck Disability Index, and patient satisfaction. Secondary outcome measures included the Euroqol group’s 5-Domain questionnaire, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Tanaka Jingjiu cervical spondylosis symptom scale (20 points) and satisfaction. Quantitative outcome measures were collected at baseline, 12th and 24th weeks after the first intervention, while qualitative outcome measures were collected at 24th weeks after the first intervention. Results A total of 90 patients were included, with 45 in each group. There was no statistically significant difference between the two groups in terms of age, gender and other demography characteristics and general data (P>0.05). There is no interaction effect (group × time) for the Tanaka Jingjiu cervical spondylosis symptom scale (20 points) (P>0.05), the interaction effects (group × time) for other quantitative outcome measures were statistically significant (P<0.05). The time effect showed significant statistical differences across all quantitative outcome measures (P<0.001), while the group effect did not exhibit any significant statistical differences (P>0.05). The comparison results within the group showed that at different time points, the differences between the two groups were statistically significant (P<0.001). There were no significant statistical differences between the two groups in terms of qualitative outcome measures (P>0.05) . Conclusions An internet-based neck-specific training program or traditional treatment for 12 weeks can effectively reduce pain and disability among CSR patients, with significant long-term effects. There was no significant difference in treatment effectiveness between the two groups.
目的:探讨18F-FDG PET/CT在头颈部肿瘤的临床应用价值。方法:58例头颈部恶性肿瘤病例,男37例,女21例,年龄21~78岁。其中:牙龈癌3例,上颌窦癌2例,舌癌2例,腮腺癌1例,鼻咽癌24例,喉癌8例,甲状腺癌4例,原发灶不明的颈部淋巴结转移瘤14例。使用18F-FDG行全身PET/CT扫描,依据PET图像、CT图像和PET/CT融合图像及标准化摄取值(SUV)进行综合评价。结果:29例放疗患者中的11例拟行根治性放疗的患者,有4例改行姑息性放疗,8例重新勾画了放疗靶区及调整了放疗剂量,3例改行其它治疗;15例进行了放疗后的疗效评估;14例原发灶不明的颈部淋巴结转移瘤8例找到了原发灶。结论:PET/CT可以对头颈部恶性肿瘤进行准确的临床分期,精确勾画放疗的生物靶区,准确而快捷地确定肿瘤复发的位置与侵犯范围,在颈部不明原发灶转移瘤的应用中具有简便、快捷、无创和灵敏等临床特点。
Objective To evaluate the effect of a combined cervicalexpanded skin flap in repairing cervical scar contracture deformity after burn injury. Methods From April 2001 to May 2003, 16 cases （10 males and 6 females）of scar contracture deformity in the cervix were treated withexpanded clavipectoral axis skin flap combined with reverse axis skin flap．The tissue expanders were embedded under the part containing cutaneous branches of transverse cervical artery in cervical segments and the second and/or the third perforating branch of internal thoracic artery for the first operation. Normal saline was injected regularly. The expanded clavipectoral skin flap and reverse axis skin flap with perforating branch of internal thoracic artery were designed,the scar in the cevix was loosed or dissected according to the size of the skinflaps, the skin flaps were transferred to cover the wound, and the contracture deformity in the cervix was corrected. The size of the flaps were 9 cm×5 cm-15 cm×7 cm. Results All skin flap survived. The function and appearance of the cervix was improved significantly after 6-30 months follow-up. However, venous return dysfunction in reverse perforating branch of internal thoracic artery occurred in 1 case, andblood circulation was improved after treatment. Conclusion Expanded clavipectoral axis skin flap combined with reverse axis skin flap can be used to repair scar contracture deformity in cervix, which lessen scar and abatethe chance to contract again.