The application of a new method of microvascular anastomosis: a review of 109 microvascular anastomosis surgery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and clinical significance of the new method for microvascular anastomosis.</p><p><b>METHODS</b>Between February 2013 and May 2013, 108 patients aged 31 to 73 years underwent free flap reconstruction of the defects as a result of resection of oralmaxillofacial tumors. Of 108 patients, 78 were men and 30 were women. The cases were divided into experimental group(46 flaps) and control group (63 flaps) according to different methods of microvascular anastomosis.Isometric double notches end to end microvascular anastomosis was used for artery anastomosis in experimental group, conventional end to end anastomosis was used for artery anastomosis in control group and venous anastomosis was performed in both groups.</p><p><b>RESULTS</b>The entire procedure of artery anastomosis took (7.3 ± 1.7) min in experimental group, (14.5 ± 2.6) min in control group, the difference between the two groups was significant (P = 0.00). There was only one venous compromise which was complete failure in experimental group. There were two venous compromise and one artery compromise in control group, and one of the venous compromise was a complete failure.</p><p><b>CONCLUSIONS</b>The isometric double notches end to end microvascular anastomosis proved successful and clinically feasible with advantages of fixed-point accuracy, time-saving and high patency rate.</p>

Preparative technique of anterolateral thigh flap / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the surgical techniques and methods of anterolateral thigh (myocutaneous) flap.</p><p><b>METHODS</b>Two hundred and forty-five consecutive free anterolateral thigh (myocutaneous) flaps for reconstruction of the defects of oral and maxillofacial region following the malignant tumors resection from January 2007 to August 2009 were reviewed. The incision was designed in the upper, middle or lower part 3 cm medial of the iliac-patella line according to the thickness of flaps needed. The perforators with suitable vessel diameter and strong pulse were chosen to make flaps with muscular tissue to fill dead space. More than one perforators were taken when large flaps were harvested. The size of the flaps ranged from 4 cm × 4 cm to 10 cm × 25 cm. Eighteen fat flaps were made thinned.</p><p><b>RESULTS</b>Of the 245 flaps harvested, 3 complete necrosis occurred, and the survival rate was 98.8%. Blisters occurred in 8 thinned flaps, but they all survived. All the wounds were closed directly except 5 cases, which needed skin graft because of too large defects of skin. All the skin graft came from the upper part of the wound of donor site. The shape and function were satisfactory after the reconstruction.</p><p><b>CONCLUSIONS</b>When anterolateral thigh (myocutaneous) flaps are harvested, the incision should be designed 3 cm medial of the iliac-patella line according to the thickness of flaps needed. It is helpful to find the perforators. All of the lower, middle and upper parts of anterolateral thigh region have cutaneous perforators. The skin defects within 8 cm can be closed directly, while the skin defects more than 8 cm often need skin grafting. The skin grafts can be taken from the upper part of donor site wounds.</p>

Effect of ketamine on high-voltage-activated calcium currents in rat hippocampal neurons / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effect of ketamine on the high-voltage-activated calcium currents (ICa(HVA)) in rat hippocampal neurons.</p><p><b>METHODS</b>Neurons were cultured from Wistar rat hippocampus. ICa(HVA) was recorded using whole-cell patch clamp technique. After application with ketamine at different concentrations (10, 30, 100, 300, and 1000 μmol/L), the effect of ketamine on ICa(HVA) was evaluated.</p><p><b>RESULTS</b>ICa(HVA) was inhibited by ketamine in a concentration-dependent manner. Ketamine at 10 μmol/L showed no effect on ICa(HVA). Four concentrations of ketamine (30, 100, 300,and 1000 μmol/L) reduced the peak ICa(HVA) currents by (17.5 ∓ 4.5)%, (25.5 ∓ 6.9)%, (38.5 ∓ 4.1)%, and (42.3 ∓ 4.6)% respectively,with a mean half maximal inhibitory concentration of 68.2 μmol/L and Hill coefficient of 0.47. The maximal activation membrane potential was shifted to (5.3 ∓ 0.8) from (5.4 ∓ 0.9). The half maximal activation membrane potential of inactivation curve was shifted from(-26.7 ∓ 3.9) mV to(-32.8 ∓ 4.2) mV.</p><p><b>CONCLUSION</b>Ketamine can remarkably inhibit calcium currents in the central neurons,which may explain at least partly the action of ketamine on central nervous system.</p>

Effect of etomidate on voltage-dependent potassium currents in rat isolated hippocampal pyramidal neurons / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies demonstrated general anesthetics affect potassium ion channels, which may be one of the mechanisms of general anesthesia. Because the effect of etomidate on potassium channels in rat hippocampus which is involved in memory function has not been studied, we investigated the effects of etomidate on both delayed rectifier potassium current (I(K(DR))) and transient outward potassium current (I(K(A))) in acutely dissociated rat hippocampal pyramidal neurons.</p><p><b>METHODS</b>Single rat hippocampal pyramidal neurons from male Wistar rats of - 10 days were acutely dissociated by enzymatic digestion and mechanical dispersion according to the methods of Kay and Wong with slight modification. Voltage-clamp recordings were performed in the whole-cell patch clamp configuration. Currents were recorded with a List EPC-10 amplifier and data were stored in a computer using Pulse 8.5. Student's paired two-tail t test was used for data analysis.</p><p><b>RESULTS</b>At the concentration of 100 micromol/L, etomidate significantly inhibited I(K(DR)) by 49.2% at +40 mV when depolarized from -110 mV (P < 0.01, n = 8), while did not affect I(K(A)) (n = 8, P > 0.05). The IC(50) value of etomidate for blocking I(K(DR)) was calculated as 5.4 micromol/L, with a Hill slope of 2.45. At the presence of 10 micromol/L etomidate, the V1/2 of activation curve was shifted from (17.3 +/- 1.5) mV to (10.7 +/- 2.9) mV (n = 8, P < 0.05), the V1/2 of inactivation curve was shifted from (-18.3 +/- 2.2) mV to (-45.3 +/- 9.4) mV (n = 8, P < 0.05). Etomidate 10 micromol/L shifted both the activation curve and inactivation curve of I(K(DR)) to negative potential, but mainly affected the inactivation kinetics.</p><p><b>CONCLUSIONS</b>Etomidate potently inhibited I(K(DR)) but not I(K(A)) in rat hippocampal pyramidal neurons. I(K(DR)) was inhibited by etomidate in a concentration-dependent manner, while I(K(A)) remained unaffected.</p>

The chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for reconstruction of oromaxillary soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the application of the chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for large and complicated oromaxillary soft tissue defect.</p><p><b>METHODS</b>Based on the anatomic study of descending branches and cutaneous perforators of lateral circumflex femoral artery, the perforator vessels were found and used as flap pedicle. The perforator flap was made as chimeric flap for repairing the oromaxillary soft tissue defect in 8 cases. The chimeric perforator flaps were divided into three types as anterolateral thigh flaps and anteromedial thigh flaps, anterolateral thigh flaps and rectus femoris perforator flaps, and anterolateral thigh flaps and anterolateral thigh flaps.</p><p><b>RESULTS</b>All the 16 flaps in 8 cases survived completely with no complication. The wounds in donor sites were all primarily closed with no skin graft. The patients were followed up for 1-9 months with good functional and esthetic results. There was no morbidity in donor sites.</p><p><b>CONCLUSIONS</b>The chimeric perforator flap has a large tissue volume for large and complicated oromaxillary defect. There is no need for extra donor site and extra blood vessel anastomosis.</p>

Clinical application of free anterolateral thigh flap in the reconstruction of oromaxillo-facial defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the possibility and practicality of using free anterolateral thigh flap to repair defects of oromaxillo-facial region.</p><p><b>METHODS</b>One hundred and seventy-two patients underwent anterolateral thigh flap (ALP) reconstruction from Jan. 2007 to Dec. 2008. The size of the defect ranges from 4 cm x 4 cm to 10 cm x 25 cm. One hundred and six flaps were used for tongue reconstruction, 14 flaps for buccal reconstruction, 15 flaps for mouth floor reconstruction, 1 flap for lower lip and mental region reconstruction, 6 flaps for hard and soft palate reconstruction, 3 flap for maxillary part reconstruction, 18 flaps for submaxilla part reconstruction, 2 flaps for pharynx oralis reconstruction, 3 flaps for repairing large-area defect of facial, 1 flap for repairing neck and shoulder region and 3 flaps for repairing defect of Infratemporal fossa. Of these flaps, 151 were musculocutaneous flaps, 13 were fasciocutaneous flaps and 8 were chimeric flaps.</p><p><b>RESULTS</b>The success rate reaches 98.3% (169 of 172). Postoperatively, 4 cases encountered vascular crisis, 1 of which survived completely with successful vessel exploration, 3 cases with partial necrosis; and 3 cases with complete necrosis. One case with bleeding after operation. Six cases with parotid fluidly and parotid fistula, 8 cases with mouth floor fistula, 6 cases with infection, 3 cases with infection and partial necrosis on the lateral thigh. All patients achieved acceptable contour, appearance and function.</p><p><b>CONCLUSION</b>Free anterolateral thigh flap can repair kinds of complicated defects on oromaxillo-facial region.</p>