ChemInform Research Articles

Effect of ultrasound-guided individualized positive end-expiratory pressure on the severity of postoperative atelectasis in elderly patients: a randomized controlled study

Postoperative pulmonary complications (PPCs) are common in patients undergoing general anesthesia, with atelectasis being a key contributor that increases postoperative mortality and prolongs hospitalization. Our research hypothesis is that ultrasound-guided individualized PEEP titration can reduce postoperative atelectasis. This single-center randomized controlled trial recruited elderly patients for laparoscopic surgery. Patients were randomly assigned to two group: the study group (individualized PEEP groups, PEEP Ind group) and the control group (Fixed PEEP group, PEEP 5 group). All patients in these two groups received volume-controlled ventilation during general anesthesia. Patients in the study group were given ultrasound-guided PEEP, while those in the control group were given a fixed 5 cmH2O PEEP. Bedside ultrasound assessed lung ventilation. The primary outcome was the severity of atelectasis within seven days post-surgery. Eighty-nine patients scheduled for elective laparoscopic radical surgery for colorectal cancer were enrolled in our study. Lung ultrasound scores (LUSs) in the study group during postoperative seven days was significantly decreased compared with that in the control group (P < 0.05). The severity of postoperative atelectasis in the study group was significantly improved. The incidence of PPCs during postoperative 7 days in the study group was significantly less than that in the control group (48.6% vs. 77.8%; RR = 0.625; CI = 0.430–0.909; P = 0.01). In elderly patients undergoing laparoscopic radical resection, lung ultrasound-guided individualized PEEP can alleviate the severity of postoperative atelectasis.Clinical trial number and registry URL: No. ChiCTR2200062979 (https://www.chictr.org.cn).

Modified Textbook Outcome was a Predictor for Early Mortality After Oral Cancer Surgery.

To explore prognostic factors for early mortality among patients undergoing surgery for oral cavity cancer (OCC) and identify valuable strategies to improve patient outcomes. A total of 397 patients treated by primary tumor resection and neck dissection between 2017 and 2021 were retrospectively analyzed. Univariate and multivariate Cox regression analysis were used to explore the relationships between the study factors and early death (within 12months). Predictors were further incorporated into a nomogram for estimation of 1-year overall survival (OS). The mean age was 57.2 (SD, 9.8)years and 92.9% patients were male. The early death rate was 12.6% overall, 35.6% in patients with pN2-3, 22.3% in patients with tumor size > 3 cm, and 36.2% in patients with lymphovascular invasion. A non-modified textbook outcome (mTO), pN2-3, tumor size > 3 cm, and lymphovascular permeation were independent prognosticators for early mortality. A nomogram with the above-mentioned four factors were created with good discrimination and calibration. Among the pN2-3 or tumor size > 3 cm subgroup, a non-mTO, cancer resource center (CRC) visits, perineural invasion, and lymphovascular permeation were independent prognostic factors for early death. In addition to traditional clinicopathological features, a non-mTO and CRC visits could serve as prognostic factors for early death in OCC. A novel nomogram had good discrimination and calibration. Quality improvements in terms of mTO and patients demanding resource support could improve survival outcomes in OCC.

The “F-Words” in Pediatric Oncology: Improving Pediatric Cancer Care Through Innovative Thinking and Rehabilitation for Optimal Quality of Life

The “F-Words” in Pediatric Oncology: Improving Pediatric Cancer Care Through Innovative Thinking and Rehabilitation for Optimal Quality of Life

Lung Point of Care Ultrasound (POCUS) in Cardiorespiratory Physiotherapy and Respiratory Therapy Practices: Current Status and Future Directions.

Lung Point of Care Ultrasound (POCUS) strongly influences physiotherapy and respiratory therapy clinical decision-making in the intensive care unit (ICU). The uptake of Lung POCUS training by physiotherapists and respiratory therapists is low in some countries, often due to many barriers to its implementation. The safe and appropriate integration of Lung POCUS into physiotherapy and respiratory therapy clinical practice may be achieved by various means. This article describes the pathway for physiotherapists to become Lung POCUS-accredited in Australia, focusing on a novel fast-track approach that may apply internationally and in other professions, such as respiratory therapy. While a fast-track approach is resource intensive, such resource allocation may be justified to support the growth of Lung POCUS in physiotherapy and respiratory therapy practice where mentor support may be inconsistent, lacking, or absent.

Post-Exercise Hypotension after Exercising in Hypoxia with and Without Tart Cherry Supplementation.

Horiuchi Masahiro and Samuel J. Oliver. Post-exercise hypotension after exercising in hypoxia with and without tart cherry supplementation. High Alt Med Biol. 00:00-00, 2024. Background: This study investigated the effects of hypoxic exercise with and without tart cherry (TC) supplementation on post-exercise hypotension (PEH). Method: In a randomized order, 12 healthy young adults (9 men and 3 women) completed cycle exercise to exhaustion (1) in normoxia without any supplementation (Norm), (2) in hypoxia (13% O2) with placebo (Hypo), and (3) in hypoxia with TC supplementation (Hypo + TC). Supplements were supplied for 5 days pre-trial (TC was 200 mg anthocyanin per day for 4 days and 100 mg on day 5). Results: Cycle exercise total energy expenditure was greater in Norm than Hypo and Hypo + TC (p < 0.001) with no difference between Hypo and Hypo + TC (p = 0.41). Mean arterial pressure (MAP) decreased during recovery in all trials (main effect of time, p < 0.001), with no difference in PEH between the trials (p > 0.05, change [Δ] in MAP from pre-exercise at 60 minutes recovery, mean difference, Norm Δ-4.4 mmHg, Hypo Δ-6.1 mmHg, and Hypo + TC Δ-5.2 mmHg). Cardiac baroreflex sensitivity decreased during recovery in all trials (p < 0.001) and was lower in Hypo than Norm and Hypo + TC (main effect of trial, p = 0.02). Conclusion: PEH was not increased after exercise in hypoxia, with or without TC supplementation, compared with exercise in normoxia.

Antibiotic Resistance in Mycobacterium Tuberculosis and Non-Tuberculous Mycobacteria

Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) antibiotic resistance presents an important challenge to the treatment of mycobacterial infections. The therapeutic approaches are complicated by the resistance of both MTB and NTM to a variety of antibiotics. Resistance to first-line drugs such as isoniazid, rifampicin, ethambutol, and streptomycin has been consistently increasing in MTB, underscoring the necessity of effective treatment strategies. Conversely, the necessity of species-specific treatment regimens is underscored by the high resistance rates of NTM species, such as Mycobacterium avium complex, M. kansasii, and M. abscessus complex, to commonly used anti-tuberculosis pharmaceuticals. A combination of intrinsic and acquired factors are involved in the mechanisms of antibiotic resistance in these mycobacteria. Features such as biofilm formation, thick cell walls, and reduced drug uptake are responsible for intrinsic resistance in NTM, whereas acquired resistance can develop as a result of protracted antibiotic exposure. Understanding these resistance mechanisms is essential for the development of new therapies and the prevention of the increasing prevalence of drug resistance in mycobacterial infections. The significance of continuous surveillance, species-specific treatment protocols, and the development of novel antimicrobial agents to effectively manage mycobacterial diseases is emphasized by the prevalence of antibiotic resistance in MTB and NTM. This review article focuses on the molecular mechanisms that have resulted in the development of resistance in both MTB and NTMs, as well as the extent to which various classes of antimycobacterial drugs act.

Robotic pulmonary lobectomy without using intercostal sites: The first case of lung cancer surgery using the da Vinci SP surgical system in Japan

Robotic pulmonary lobectomy without using intercostal sites: The first case of lung cancer surgery using the da Vinci SP surgical system in Japan

Current clinical trials on gastric cancer surgery in China.

Gastric cancer (GC) is the leading diagnosed malignancy worldwide, especially in China. Radical surgery is the cornerstone of GC treatment. We reviewed previous clinical trials and aimed to provide an update on the factors related to the surgical treatment of GC. The number of registered clinical trials in the field of GC surgery is rapidly increasing. With the development and popularization of endoscopic, laparoscopic, and robotic techniques, GC surgery has gradually entered a new era of precise minimally invasive surgery. Postoperative quality of life has become a major issue in addition to surgical oncological safety. Although great progress has been made in clinical research on GC in China, there are still deficiencies. Many studies enrolled large numbers of patients, but the research data were not of high quality. The characteristics of GC in China include a high incidence, large population, and large proportion of patients with advanced GC, which provides sufficient reason for studying this disease. There is still a need for well-designed, large, randomized clinical trials to improve our knowledge of the surgical treatment of GC.

Traditional Chinese medicine combined with chemotherapy for breast cancer after operation: A systematic review and meta-analysis.

This systematic review aims to explore the effect of traditional Chinese medicine combined with chemotherapy on the clinical efficacy of breast cancer postoperative patients, providing theoretical basis for the treatment of breast cancer postoperative patients with traditional Chinese medicine. A comprehensive search was conducted on databases such as China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, and the Cochrane Library from their inception to August 2023 to screen RCTs comparing the effect of traditional Chinese medicine combined with chemotherapy with that of chemotherapy alone on the clinical efficacy of breast cancer postoperative patients. The included literature was systematically reviewed. A total of 22 RCTs involving 1834 breast cancer postoperative patients were finally included, with 918 patients in the traditional Chinese medicine combined with chemotherapy group (treatment group) and 916 patients in the chemotherapy alone group (control group). Meta-analysis showed that compared with the control group, therapeutical effective rate, CD3, CD4, CD4/CD8, and adverse reactions in the treatment group were all improved, and the incidence of leukopenia and thrombocytopenia after chemotherapy were all reduced, with statistically significant differences. Traditional Chinese medicine combined with chemotherapy is superior to chemotherapy alone in improving the therapeutical effective rate after breast cancer surgery, reducing chemotherapy adverse reactions, and enhancing immune function.

Equimolar oxygen-nitrous oxide (EMONO) in dental pediatric care: which patients achieve therapeutic effects? A French national exploratory prospective observational multicenter study.

Equimolar oxygen-nitrous oxide mixture (EMONO) is considered as a reference for dental care in children. Completion of dental treatment has usually been used as a criterion to assess EMONO treatment. However, other patient-reported outcomes are needed. We sought to assess the prevalence of complete therapeutic effects (analgesia and anxiolysis) experienced by children during dental care under EMONO and identifying associated factors. A national prospective observational multicentric study was conducted between September 2018 and June 2020 in 13 French university hospitals. Participants were children between 3 and 15years of age requiring dental care under EMONO. 677 children were analyzed. Anxiolysis and analgesia were experienced by a large majority of patients (86.5% and 79.0%, respectively, and 73% experienced both effects). Several factors were associated with both analgesia and anxiolysis effects: the presence of expected effects (no loss of judgment and slight decrease in level of consciousness), the absence of agitation and distress, a positive perception of EMONO and ethnicity. Most patients benefit from the therapeutic effects (anxiolysis and analgesia) expected by EMONO during dental treatment. It is reassuring to observe that most sociodemographic characteristics and medical history do not seem to influence the effectiveness of care. The study was registered at www. gov under the reference number NCT03453411.

Review on the development of the organoids

Abstract. Organoids, a novel field, were first experimentally supported in 2007 and began to be engineered around 2020. Organoids can be developed from stem cells or organ progenitor cells through the process of differentiation, or they can be created by changing the alignment of pluripotent stem cells throughout the process of cell differentiation. Organoids are exploited for the purpose of scientific research in the areas of human development, illness, screening of medications, and gene therapy. The study utilized a literature review method to examine the evolution of organoid production, new application, and technological advancements. Organoids have advanced from basic tissue engineering organs to being used for modeling diseases and providing more therapeutic options. Their progress is noteworthy and has the potential to be a significant approach in biological medicine research in the future.

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Early postnatal corticosteroids in preventing mortality and bronchopulmonary dysplasia: the pivotal importance of selecting an appropriate treated population.

These findings underscore that the baseline event rates in the control group are potentially correlated with the efficacy of PCS in preventing BPD or mortality, offering more precise guidance beyond the general "high-risk" category and supporting baseline risk stratification for more targeted PCS therapy in clinical practice. • Early postnatal corticosteroids (PCS) have been widely studied for their anti-inflammatory effects in preventing bronchopulmonary dysplasia (BPD) in preterm infants. • Determining the optimal target population for PCS remains challenging due to varying baseline risks and associated neurodevelopmental concerns. • Stratifying infants by baseline BPD or mortality rates reveals that PCS shows greater efficacy in high-risk groups, particularly those with baseline event rates above 50%. • Considering baseline risk stratification represents a key direction for future clinical decision-making.

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study

ObjectiveThe efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation. MethodsA retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. ResultsAmong the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05. ConclusionCT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

Missing outcome data in randomised clinical trials of psychological interventions: a review of published trial reports in major psychiatry journals

BackgroundMissing outcome data can pose a serious threat to the validity of randomised clinical trial results. We aimed to study the extent of missing outcome data in randomised clinical trials of psychological interventions.MethodsWe performed a retrospective study of randomised clinical trial reports of psychological interventions published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics from 2017 to 2022. We assessed the proportion of missing outcome data, whether missing data patterns differed between types of outcomes, participants, intervention lengths, and psychological intervention types, how missing outcome data were handled in the statistical analyses, and whether trialists discussed missing outcome data in the discussion section of the manuscript.ResultsWe identified 182 randomised clinical trials (233 primary outcomes), of which 206 outcomes (88.4%) were assessed at high risk of bias due to missing data. The overall mean percentage of missing outcome data was 18.3% (95% confidence interval (CI): 16.7–20%) for all outcomes. The percentages of missing data were 18.9% (95% CI: 17.1–20.6%; 180 outcomes) for symptom severity scales and 1.8% (95% CI: 2.3–3.3%; 6 outcomes) for ‘hard’ binary outcomes. Trials including participants with borderline personality disorder had the highest percentage of missing outcome data (33.1%; 95% CI: 22.3–43.9%) compared with other psychiatric disorders. Fisher’s exact test showed that intervention lengths and psychological intervention types were associated with the proportion of missing outcome data (p < 0.001), but there were no clear patterns.ConclusionMissing outcome data is a considerable problem in randomised clinical trials of psychological interventions, and trialists should consider the corresponding methodological limitations in the design and analysis to reduce the risk of bias due to missing outcome data.Clinical trial registration numberNot applicable.

Implementation of Immunization Services Through a Pediatric Urgent Care Clinic.

Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

Identification and transfer to stepped care of depressed and psychosocially stressed parents during peri- and postpartum—UPlusE: study protocol for cluster randomized trial of a screening intervention

BackgroundPerinatal depression affects 10–15% of mothers and approximately 5% of fathers. However, only a small number of affected individuals seek treatment. If left unrecognized and untreated, it can have negative long-term consequences for the family’s health, leading to subsequent high costs. Early treatment is crucial, yet there is a notable underdiagnosis and undertreatment. Affected individuals are often seen during this time, e.g. in paediatric practices, but not by specialists in mental health. Consequently, this study aims to increase detection and treatment rates of affected individuals by implementing a screening for depression and psychosocial stress in perinatal and postpartum parents within routine obstetric and paediatric care with subsequent advice and—if necessary—further referral to a mental health specialist.MethodsUPlusE is a prospective, cluster-randomized controlled trial conducted in an outpatient setting. Obstetric and paediatric practices will be randomized into an intervention and control group (1:1 ratio). Practices and enrolling patients will be required to use specific smartphone apps (practice apps) for interaction. The screening will occur with the apps at each paediatric checkup up to the child’s age of 12 months, using the Edinburgh Postnatal Depression Scale (EPDS), KID-PROTEKT questionnaire, and the scale 1 (impaired bonding) of the Postpartum Bonding Questionnaire (PBQ-1). The goal is to screen 10,000 patients across Germany. Gynaecologists and paediatricians will receive certified training on peripartum depression. Participants in the intervention group with scores above cut-offs (EPDS ≥ 10, KID-PROTEKT ≥ 1, PBQ-1 ≥ 12) will receive counselling through their treating gynaecologists/paediatricians and will be provided with regional addresses for psychiatrists, psychotherapists, and “Frühe Hilfen” (early prevention) as well as family counselling centres, depending on symptom severity. At each screening, participants will be asked whether they sought support, where, and with whom (utilization). Utilization is the primary outcome.DiscussionThe screening is designed to reduce underdiagnosis to enable suitable support at an early stage (especially for those often overlooked, such as individuals with “high-functioning depression”) and hence to avoid manifestation of mental health problems in the whole family, especially infants who are exceptionally dependent on their parents and their well-being will benefit from this program.Trial registrationGerman Clinical Trials Register, DRKS00033385. Registered on 15 January 2024.

Fermentation and Microencapsulation of Red Palm Oil as a Nutraceutical Source

Red palm oil (RPO) has various bioactive and nutritional components with high potential to be developed as a source of nutraceuticals in addition to its potential as a functional food. The fermentation technology is a processing process that affects metabolite activity, increasing the durability of a product. Staphylococcus epidermidis is one of the bacteria that is generally used in the sugar and oil fermentation process. RPO fermentation by Staphylococcus epidermidis is supposed to increase nutraceutical value by adding probiotic properties to RPO products. Moreover, the instability of bioactive compounds in RPO needs to be protected with coating technology microencapsulation. So, this study aims to formulate a microencapsulation procedure for fermented RPO using Staphylococcus epidermidis ATCC 12228 as a potential nutraceutical. RPO was fermented using S. epidermidis with three variations of MRS media and RPO comparison, then microencapsulated using emulsification and extrusion methods. The physicochemical properties and bioactivity of the product, microcapsule, were then analyzed. Our data shows that RPO fermentation was able to increase the chemical components. RPO fermentation produced more 1,2-Benzenedicarboxylic acid (2-Ethylhexyl) ester. Furthermore, microencapsulation of fermented RPO has better yield, efficiency, and solubility in water than non-fermented RPO microencapsulation. Moreover, our work also shows that the microencapsulation process increased RPO stability.

Advantage of Log Odds of Metastatic Lymph Nodes After Curative-Intent Resection of Gallbladder Cancer.

Lymph node metastasis (LNM) is among the most important predictors of poor prognosis after surgery for gallbladder cancer (GBC). Traditionally, staging has been based on the raw count of LNM, with a high risk of understaging patients who undergo inadequate lymph node dissection (LND). The log odds of metastatic lymph nodes (LODDS) may represent an alternative staging approach to stratify patients more accurately after resection of GBC. In this cross-sectional study, patients who underwent curative-intent surgery with LND for GBC were identified from an international database. Two predictive models were built and compared, each integrating a different lymph nodes status indicator [i.e., American Joint Committee on Cancer (AJCC) and LODDS]. Among 199 patients, the median number of lymph nodes examined was 5 [interquartile range (IQR): 3.0, 8.0]; most patients had T1 (n = 26, 13.1%) or T2 (n = 97, 48.7%) disease, and a subset had LNM (n = 87, 44.0%). Multivariable Cox analysis demonstrated LODDS was an independent predictor of overall survival [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.5-2.3; p < 0.001]. The LODDS model demonstrated better performance compared with a traditional model that utilized the AJCC N category [concordance (C) index: 0.814 versus 0.763; p < 0.001]. Patients classified as high- versus low-risk based on LODDS had much worse overall survival (OS) (4.9% versus 83.7%, respectively; p < 0.001). The LODDS model performance remained high even among patients with inadequateLND (< 6 LN) (C index: 0.87). An online calculator was developed ( https://catalano-giovanni.shinyapps.io/LoddsGBC/ ). A novel prognostic model based on LODDS may overcome the inherent limitations of the current AJCC staging system, reducing understaging among patients with fewer than six total lymph nodes evaluated.

Keystone design perforator island flap for reconstruction of vermillion defects: A case series and literature review

Many repair techniques have been recommended to treat lower lip defects. Although effective in many instances, some techniques are accompanied by complications, such as flap necrosis, dysesthesia of the lip, lip flattening, shortening, and loss of the vermillion roll. This study aimed to report the use of keystone design perforator island flap (KDPIF) in small to medium defects to achieve an effective and functional reconstruction of vermillion defects after Mohs surgery for lip cancer. A retrospective review of consecutive patients who underwent lower lip reconstruction after Mohs cancer resection at the same institution from June 2022 to September 2023 was performed. Patient information, including medical history, flap size, operative time, complications, and postoperative recovery of the lip function, was comprehensively evaluated. Six patients underwent reconstruction using KDPIF. The mean (range) operation time was 22.5 (19-31) min. None of the 6 patients exhibited flap splitting necrosis or infection, 6 patients (100%) had good to excellent cosmetic results, and no functional impairment was noted in any of the patients. KDPIF is a reliable technique for the reconstruction of vermillion defects, preserving lip fullness and the vermillion roll.