ObjectiveTo investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients.MethodsBetween January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation.ResultsAll IMAP propeller flaps survived well, and the donor sites healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment.ConclusionIMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.
ObjectiveTo summarize the application experience of off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries, and evaluate its safety and efficacy. MethodsThe clinical data of the patients with severe multiple coronary arteries stenosis undergoing off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries in the Affiliated Hospital of University of Electronic Science and Technology ＆ Sichuan Provincial People’s Hospital from November 2020 to April 2023 were retrospectively analyzed. Results Finally 24 patients were enrolled. There were 23 males and 1 female. The mean age was 53.63±4.33 years. The cardiac function class was from grade Ⅱ to Ⅲ according to New York Heart Association. There were 3.17±0.38 distal anastomoses. Y graft in 12 patients and sequential graft in 4 patients were performed. Coronary endarterectomy in 1 patient, intraaortic balloon pump (IABP) catheter implantation in 10 patients, and thymoma resection in 1 patient were also performed simultaneously. The operation time was 308.13±30.39 mi. The ventilator support time was 15.42±7.42 h, and the intensive care unit stay time was 46.08±27.32 h. The postoperative hospital stay time was 11.71±1.90 d. There were no death, but acute renal failure in 1 patient and cerebral infarction in 1 patient were found after operation. The postoperative left ventricular end diastolic diameter by echocardiogram before discharge was significantly reduced, the postoperative left ventricular ejection fraction and short axis shortening rate were significantly increased, compared to preoperative ones (P≤0.05). All arterial grafts were patent suggested through coronary artery computed tomography angiography (CTA) examination before discharge. All patients were followed up for 14.58±8.75 months. No angina recurrence and death were found. All arterial grafts were still patent in 16 patients suggested through coronary artery CTA or angiography examination at 1 year after operation. Conclusion Off-pump total artery coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries for patient with severe multiple coronary arteries stenosis is safe and effective. For high-risk patient, IABP assistance during operation is recommended.