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OBJECTIVE@#To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds.@*METHODS@#Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured.@*RESULTS@#Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up.@*CONCLUSION@#The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Subject(s)
Adult , Male , Female , Humans , Middle Aged , Plastic Surgery Procedures , Ilium/surgery , Perforator Flap/blood supply , Skin Transplantation/methods , Lower Extremity/surgery , Soft Tissue Injuries/surgery , Treatment OutcomeABSTRACT
Objective:To investigate the clinical effect of combining medial plantar flap with medial foot flap for repairing weight-bearing area defects of the foot.Methods:A retrospective case series study was used to analyze the clinical data of 12 patients with weight-bearing area defects of the foot, who were admitted to the Affiliated Hospital of Zunyi Medical University from March 2020 to March 2022. There were 9 males and 3 females, with the age of 27-62 years [(39.3±8.7)years]. There were 4 patients with palm defects and 8 with heel defects. The defect area ranged from 10 cm×8 cm to 13 cm×12 cm. The cutting area of skin flap ranged from 11 cm×8 cm to 14 cm×13 cm. A total of 5 patients were treated with free flaps (4 patients with palm and 1 with heel defects) and 7 with pedicled flaps (all with heel defects). The flap donor areas were repaired with skin grafting. The flap survival was observed after surgery. At the last follow-up, the appearance, texture, and two point discrimination of the flap were recorded; the foot function was evaluated by Maryland foot function score; the sensory function of the reconstructed skin flap was evaluated by testing the two-point discrimination using a bipedal gauge.Results:The patients were followed up for 6-24 months [(11.8±5.3)months], and all the flaps survived. At the last follow-up, the flaps were free of any swelling and ulceration, with good texture and no sliding. The Maryland foot function score was (92.8±7.2)points at the last follow-up, which was significantly higher than the preoperative (36.6±6.1)points ( P<0.01), being excellent in 9 patients and good in 3. The two-point discrimination of the reconstructed flap was (17.8±5.7)mm at the last follow-up, and there was no significant difference compared with the contralateral (16.3±5.1)mm ( P>0.05). The sensation of the flap returned to normal. There were residual scars in the flap donor area after skin grafting, but no significant impact on foot movement. Conclusion:The medial plantar flap combined with medial foot flap has a large cutting area and good texture, meets the functional requirements, and achieves good postoperative sense recovery, making it a good choice for the repair of weight-bearing area defects of the foot.
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Objective:To analyze the influencing factors on initial testing qualified rate of condition monitoring of digital radiography (DR) devices in China and provide the scientific basis for key points of national medical radiation protection monitoring work.Methods:The data of quality control detection of DR devices, reported by 31 provinces in 2020, were collected from National Radiation Health Information Platform-National Medical Radiation Protection Monitoring System. Logistic regression was used to analyze the related influencing factors of initial testing qualified rate of condition monitoring of DR devices.Results:The result of logistic regression analysis showed that the nature of radiological health technical service institutions, the level of medical and health institution and the regions where they are located in China were the independent influencing factors of initial testing qualified rate of condition monitoring of DR devices ( χ2=15.41-21.18, P < 0.05). Private institution group ( OR=1.714, 95% CI: 1.310-2.243), tertiary hospital group ( OR=1.710, 95% CI: 1.310-2.232) and secondary hospital group ( OR=1.540, 95% CI: 1.203-1.971) had a higher qualified probability of DR devices, while western region group ( OR=0.670, 95% CI: 0.526-0.852) had a lower qualified probability of DR devices. Conclusions:Supervision on quality control of DR devices should be strengthened, such as strengthening the random inspection and double-check to the devices. And great attention should be paid to the quality control testing of DR devices in the western China and in the primary and ungraded hospitals.
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Objective:To explore artificial intelligence technology and propose an algorithm for automatic identification of dicentric chromosomes to realize fast and high-throughput biodosimetry. In order to solve the time-consuming and laborious problem of manual analysis of dicentric chromosomes.Methods:Combining artificial intelligence technology and image processing technology, based on MATLAB software, algorithms like image preprocessing, threshold segmentation algorithm, binarization processing, area identification algorithm, convolutional neural network algorithm and double centripetal recognition algorithm were applied. A fuzzy membership function was defined to describe the degree of each chromosome belonging to a dicentric chromosome, and the discrimination threshold was set to realize the automatic identification of dicentric chromosomes.Results:Through the test on 1 471 chromosome images, compared with manual recognition, the detection rate of dicentric chromosomes cells of this algorithm reached 70.7%.Conclusions:This algorithm method carries out a preliminary study on the automatic identification of dicentric chromosomes with good result.
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Objective To investigate the personal dose level of occupational external exposure among interventional radiology workers in Liaoning Province of China, and to provide a reference for better occupational radiation protection. Methods According to the national standard GBZ 128—2016 Specifications for individual monitoring of occupational external exposure, the thermoluminescence method was used to measure the monitoring dose inside the lead clothes (HW) and outside the lead clothes (HN) of interventional radiology workers, and the Mann-Whitney U test and the Kruskal-Wallis H test were used for statistical analysis. Results Dual dosimeter monitoring data were collected from 307 interventional radiology workers in Liaoning Province in 2019, with a mean annual effective dose of 0.81 mSv and a maximum annual effective dose of 7.03 mSv, and 72.96% of the workers monitored had an annual effective dose of less than 1 mSv. The interventional radiology workers in tertiary hospitals had a significantly higher mean annual effective dose than those in secondary hospitals (0.95 mSv vs 0.65 mSv, P < 0.05). There was a significant difference in mean annual effective dose between departments (P < 0.05), and the department of interventional radiology had a significantly higher mean annual effective dose than the other departments (0.92 mSv vs 0.64 mSv), while the department of cardiology had a similar mean annual effective dose to the cerebrovascular department (0.78 mSv vs 0.78 mSv). Conclusion The occupational exposure dose of 307 interventional radiology workers in Liaoning Province meets the requirements in national regulations and standards and is higher than the national level, which suggests that radiation protection supervision and personal training should be further strengthened for interventional radiology.
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Objective To propose a computer recognition algorithm for solid nuclear track images based on the machine learning method, and to realize the automatic, fast and accurate recognition of nuclear tracks and improve the efficiency of solid track image analysis. Methods Firstly, 143 images containing tracks were scanned by morphological method to determine the location of suspected tracks, and 1250 material images were captured. 50% of the material were selected as the training set and 30% as the validation set for training the machine learning model. Another 20% of the material were selected as the test set for testing the model recognition result. The algorithm code was written and trained based on the MATLAB software. Results The established solid track recognition algorithm had a strong recognition capability, and the recognition accuracy of the test set could reach 84.8%. The machine learning model program constructed by the algorithm could evolve continuously with the input of training data, further improving the accuracy. Conclusion Based on image morphology and machine learning, the track recognition algorithm was investigated, by which the automatic recognition of solid tracks was better realized. In the future, we will increase the data input of the model, optimize the algorithm, and improve the recognition accuracy, in order to provide a more accurate and efficient method for automatic image track recognition.
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Objective:To analyze the therapeutic effect of modified cross-leg free skin flaps in repairing soft tissue defects of the lower leg.Methods:A retrospective case series study was conducted to analyze clinical data of 8 patients with soft tissue defects of the lower leg admitted to Affiliated Hospital of Zunyi Medical University from June 2018 to June 2020. There were 6 males and 2 females with the age range of 23-60 years［（39.6±5.7）years］. Area of defect was from 10.0 cm×4.5 cm to 21.0 cm×9.0 cm，with the size of flap from 12 cm×5 cm to 25 cm×10 cm. The free flaps were harvested to repair the wound of the affected leg and the blood vessels were anastomosed by cross-leg with the contralateral posterior tibial artery and vein at the first stage，including lateral circumflex femoral artery flap for 6 patients，superficial circumflex iliac artery flap for 1 and latissimus dorsi myocutaneous flap for 1. At the same time，the pedicled posterior tibial artery perforator flap or random flap was cut to wrap the vascular pedicle. After operation，both legs were placed in a parallel and straight position. After pedicle cleavage at the second stage，the posterior tibial artery and distal artery were re-anastomosed，and the flap was sutured to its original position. Incidences of pressure sores and deep venous thrombosis of the lower leg and patients' acceptance of the position were documented during leg crossing at the first stage. The survival of the flap was observed after pedicle amputation at the second stage. The appearance，texture，function of the affected limb and influence on the healthy leg were observed at the last follow-up. Simultaneously，the lower extremity functional score（LEFS）was used to evaluate the overall function of the affected leg and the Kofoed score to evaluate ankle function.Results:All patients were followed up for 6-18 months［（8.3±1.8）months］. There reported none of pressure ulcer or deep venous thrombosis of the lower leg，without resistance to body position at stage I. All flaps survived after pedicle amputation at stage II. The shape，texture and function of the injured leg were good，with no impact on function of the healthy leg at the last follow-up. The LEFS score of the affected leg and the Kofoed score of the ankle were increased from（31.5±6.9）points and（51.0±10.5）points preoperatively to（51.7±9.8）points and（84.8±8.1）points at the last follow-up（ P<0.01）. Conclusion:For patients with soft tissue defects of the lower leg，the treatment with modified cross free flap has advantages of relatively comfortable position，no impact on function of the healthy leg，good appearance and texture of the flap and satisfactory recovery of the affected leg.
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Objective:To investigate the effectiveness of ramified flap of the lateral circumflex femoral artery for repairing complex wounds of lower extremity.Methods:A retrospective case series study was performed on 25 patients with complex wounds of lower extremity treated in Affiliated Hospital of Zunyi Medical University from September 2018 to September 2020. There were 18 males and 7 females at age of 18-69 years［（42.2 ± 3.7）years］. The wounds were located at the calf in 7 patients，at the ankle in 7 and at the dorsum of foot in 11. Single wide irregular wound was noted in 15 patients for an area of 10 cm × 9 cm to 18 cm × 12 cm，and 2 to 3 sites of wounds occurred in 10 patients with each wound ranging from 4 cm × 3 cm to 12 cm × 5 cm. All wounds were covered using ramified flap of the lateral circumflex femoral artery. All donor sites were closed directly. At the latest follow-up，appearance and texture of the flap，formation of scar on the donor sites and walking function of the affected limb were observed. One month after operation and at the latest follow-up，British Medical Research Association（BMRC）grade and Vancouver Scar Scale（VSS）score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites，respectively.Results:All patients were followed up for 7-30 months［（12.1 ± 1.8）months］. At the latest follow-up，good appearance and soft texture of the flap were observed，leaving only linear scar at the donor sites and normal function of the affected limb. At the latest follow-up，there were 23 patients with BMRC at grade of S3 and S4 compared to none at 1 postoperative month（ P < 0.01），and the VSS score was 4-8 points［（6.0 ± 1.3）points］compared to 7-13 points［（9.9 ± 1.6）points］at postoperative 1 month（ P < 0.01）. Conclusion:For complex wounds of lower extremity，ramified flap of the lateral circumflex femoral artery has advantages of good recovery of the appearance，texture and sensory function of the recipient sites and only linear scar in the donor sites.
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Objective@#To investigate the feasibility of repairing soft tissue defects of extremities with the perforator flap based on the first perforating artery of profunda artery.@*Methods@#From January 2015 to December 2018, 9 patients with soft tissue defects of extremities were treated in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. 5 males and 4 females; aged 29-48 years, average 36 years old. The causes of injury were traffic accident injury (4 cases), heavy object crush injury (3 cases) and mechanical injury (2 cases). There were 3 cases of soft tissue defect of upper limb, 6 cases of soft tissue defect of lower extremity, 2 cases of tendon and nerve rupture, 2 cases of fracture, 1 case of tendon and 1 case of bone exposure. All soft tissue defects were repaired with the perforator flap based on the first perforating artery of Profunda artery. After debridement, The range of soft tissue defect was 10 cm×5 cm-16 cm×10 cm. The intraoperative flap area was 12 cm×6 cm-18 cm×11 cm. The vascular anastomosis was performed in the area, the flap covered the wound surface and the donor site directly pulled the suture or grafted skin.@*Results@#All flaps survived completely and there were no complications such as vascular crisis. Follow-ups were performed in various forms for 6 to 12 months. These flaps were satisfactory in appearance and function and had a good texture.@*Conclusions@#The perforator flap based on the first perforating artery of profunda artery can repair the defects of the limbs in the soft group. The donor site of the flap is hidden, the amount of tissue available is relatively large and the repair effect is good.
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Objective@#To investigate the clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities.@*Methods@#From January 2016 to November 2017, 14 patients (9 males and 5 females, aged 19 to 54 years) with skin and soft tissue defects in extremities accompanied with tendon and bone exposure were admitted to our unit. The size of skin and soft tissue defects after debridement ranged from 7 cm×3 cm to 10 cm×7 cm. The defects were repaired with free superficial femoral artery femoral triangle perforator flaps, with size ranging from 13.0 cm×2.0 cm to 20.0 cm×4.5 cm. The medial femoral cutaneous nerve was applied to the flap. The perforator flap was grafted onto the medial femoral cutaneous nerve in 6 patients. The donor sites were sutured directly. The survival of flaps and the follow-up of patients were observed.@*Results@#All flaps of 14 patients survived successfully. The recipient sites and donor sites were healed completely in 13 patients, and 1 patient with partial skin necrosis at the edge of flap was healed after treatment. All patients were followed up for 6 months to 1 year after the operation. The flaps were in good shape, with nearly normal color and soft texture and no cicatrix contracture deformity. The flaps recovered protective sense in 6 patients who had medial femoral cutaneous nerve grafting, and the sensory recovery of the flap was slightly worse in the remaining 8 patients. There was no significant complications on the appearance and walking of the donor thigh in 14 patients, only a linear scar was left on the inner thigh, and no numbness was felt in the donor sites of patients.@*Conclusions@#The free superficial femoral artery femoral triangle perforator flap is an ideal therapy for repairing skin and soft tissue defects in extremities.
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Objective@#To explore the effect of the perforator flap of the proper digital artery on the ulnar or radial side of the finger in the treatment of webbed scar contracture of the same finger in child.@*Methods@#From January 2012 to January 2016, 26 children who were treated with dressing change after burn of finger and then had webbed scar contracture along with growth and development were hospitalized in our unit, involving a total of 50 fingers. There were 14 males and 12 females among the children aged from 2 to 14 years. After the scar was dissected and released, the wound area ranged from 1.6 cm×1.0 cm to 5.0 cm×2.6 cm. The perforator flap of the proper digital artery of the ulnar or radial side of the same finger was used to repair the wound. The flap area ranged from 1.8 cm×1.0 cm to 4.6 cm×1.8 cm. The donor sites were sutured directly. The residual wounds in donor and recipient sites were repaired by full-thickness skin graft collected from inguinal area/adjacent area or adjacent perforator flap. The postoperative development and function of the fingers were followed up and observed. The range of motion of the fingers was evaluated according to the Chinese Medical Association Hand Surgery Society′s upper limb functional evaluation trial standard, the Kantor Scar Cosmesis Assessment and Rating Scale was used to score the scar of finger, and the latest data were recorded.@*Results@#The flaps and skin grafts survived successfully after operation. The patients were followed up for 6 to 24 months. The perforator flaps of the proper digital artery on the ulnar or radial side of the finger survived well at the latest follow-up, with good color and texture and a two-point discrimination distance of 9 to 12 mm. There was no contracture of the fingers, a little pigmentation in the skin graft area, no flexion deformity of the fingers, no lateral bending of the fingers to the flap-harvesting side, and no scar contracture at the webs of the fingers. Compared with that of healthy side, the development of finger was not obviously abnormal. The range of motion of the fingers was excellent in 38 fingers and good in 12 fingers, and the scar score of the fingers was 2-3 points in 31 fingers, 4-7 points in 15 fingers, and 8-10 points in 4 fingers.@*Conclusions@#The efficacy of perforator flap of the proper digital artery of the ulnar or radial side of finger in the treatment of the webbed scar contracture of the same finger in child is reliable, with high postoperative survival rate of the flap, better color and texture, and fewer complications, which can avoid the risk of re-contracture of the finger in a short period after operation, and does not affect the growth and development of the finger.
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Objective@#To evaluate the outcome of modified rotary-propulsion facial artery perforator flaps for infraorbital defects repair, after facial tumorresection.@*Methods@#Between January 2014 and June 2017, 21 patients with midface tumor were treated, including basal cell carcinoma (n=17) and squamous cell carcinoma (n=4). The size of the tumor ranged from 0.8 cm × 2.0 cm to 2.0 cm× 3.5 cm. The extended resection of the tumor tissue was performed, based on the tumor type. Intraoperative frozen specimen was used to make sure no tumor residual at margin or wound base. According to the location and size, anarterial perforator flap was designed to cover the defect.The donor site was closeddirectly. The flap size ranged from 1.5 cm × 3.0 cm to 3.0 cm × 5.0 cm. The length of flap pedicle was 1.0 cm to 2.5 cm.@*Results@#All flaps completely survived, with satisfying blood flow.The incisions healed well. After 12 to 36 months follow-up, most scars in the donor site were hidden in nasal buccal sulcus and nasolabial folds. There was no lower eyelid ectropion, eyelid and eyeball separation, oral commissural and nasal distortion. The texture and color of the flap was similar to surrounding skin.The overall appearance is satisfactory.@*Conclusions@#The modified rotary-propulsion facial artery perforator flaps, to repair soft tissue defects in infraorbital area, is reasonable and useful. It is characterized by limited tissue damage indonor site, flexible rotation of flaps, and hidden incision scars. More importantly, it can reduce the occurrence of lower eyelid ectropion
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Objective: To investigate the effectiveness of Ilizarov technique in treatment of the clubfoot after burns.
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Objective: To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm. Methods: Between January 2012 and July 2017, a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old (range, 15-40 years). The duration of cicatricial contracture was 4-23 years (mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site. Results: All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months (mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months (mean, 9 months). At last follow-up, the flap recovered to level S 4 in 5 cases, level S 3 in 3 cases, and level S 3 in 2 cases. The two-point discrimination was 6.0-10.0 mm (mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored. Conclusion: The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.
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Objective: To summarize the effectiveness of Ilizarov technique in the correction of flexion contracture deformity of the knee after burn. Methods: Between April 2012 and July 2017, Ilizarov technique was used to treat 14 cases (17 knees) of knee flexion contracture patients. There were 11 males (13 knees) and 3 females (4 knees), with an age of 20-48 years (mean, 37 years). The duration of scar formation was 8 months to 24 years (mean, 5 years). The scar ranged from the upper part of the thigh, down to the middle part of the leg, from both sides to the inside and outside of the popliteal fossa, without ulceration. The area after scar contracture was 12 cm×10 cm to 30 cm×22 cm. Preoperative total activity of motion (TAM) was 30-115° (mean, 69°). There were 4 cases in wheelchair, 5 cases walking with double crutches, 3 cases with limp, and 2 cases with half squat walking. According to the knee function evaluation criteria by QIN Sihe, the preoperative knee function was fair in 3 knees, poor in 5 knees, and very poor in 9 knees. Results: All patients were followed up 6 months to 5 years (mean, 2 years). No local skin necrosis, needle tract infection, limb numbness, and other complications occurred. Knee flexion deformities were all corrected. The postoperative TAM was 70-145° (mean, 125°). All patients were able to walk with plantar weight-bearing, and their gait improved when compared with that before operation. Five cases could walk without a crutch and only slightly claudication after operation. At last follow-up, according to the knee function evaluation criteria, the results were excellent in 9 knees, good in 5 knees, and fair in 3 knees, all were significantly improved when compared with that before operation ( Z=-3.677, P=0.000). Conclusion: Ilizarov technique has the advantages of minimally invasive, safe, and easy to operate for the treatment of flexion contracture deformity of the knee after burn.
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Objective@#To evaluate the clinical effect of the modified nasolabial flap with facial subcutaneous pedicle advanced flap in repairing the defects after midcheek tumor resection.@*Methods@#From June 2012 to June 2017, 27 patients with facial tumors were treated, and according to the nature of the tumor, the tumor tissue was enlarged, frozen pathological examination was performed during the surgery. Once the edge and the base were reported to be negative, the nasolabial flap with facial subcutaneous pedicle advanced flap with a maximum 1 cm wider than the defect width was designed according to the position and size of the wound. The proximal border of the flap was designed at the cured edge of the circular wound. The curved bottom edge of the circular wound was the proximal end of the flap. The defects ranged from 2.0 cm×3.0 cm to 2.5 cm×4.0 cm. The donor site was directly sutured after subcutaneously loosening.@*Results@#The operation was smooth, and the flaps were about 3.0 cm×6.0 cm to 3.5 cm×7.0 cm. The flaps were well transported after surgery, and there was no bruising at the tip. The suture was removed 1 week after surgery. After 6-36 months of follow-up, postoperative scar was not obvious, which were most hidden in the nasolabial folds. There was no ectropion and mouth deformity. The flaps were not swollen, and the color and texture were close to that of normal skin. The appearance was satisfactory. Sensation of skin were well recovered.@*Conclusions@#The modified nasolabial flap with facial subcutaneous pedicle advanced flap is suitable for repairing the facial defects with satisfactory skin sensation and good appearance.
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Objective@#To summarize the individual design of the perforator flap based on the descending branch of the lateral circumflex femoral artery and ecological protection of the flap.@*Methods@#From June 2013 to June 2017, 33 cases of extremities wound defects were repaired with the descending branch perforator flap of the lateral circumflex femoral artery. According to the chracteristics of extremity wound and the anatomy of the descending branch perforator of the lateral circum flex artery, a medial incision of the flap according to the demarcation line was performed. Through meticulous dissection, two perforator branches were found and traced on the surface of facia lata. The size of the kiss flap was adjusted according to the perforator caliber. The chimeric muscular flap was incised according to muscular penetration point of the perforator and the course of lateral fermoral nerve with cautious protection of muscular branch of femoral nerve. During the incision, fascia lata, nerves and muscles on donor site were protected to reduce the damage to donor site. Meanwhile, ecological structure on donor site was reconstructed. Our series include 22 males, 11 females. The average age ranged from 13 to 71 years (mean: 47years). There were 21 cases of wounds on dorsum manus and wrists and 12 cases of wounds on the dorsum pedis and lower limbs. The wound dimension ranged from 7 cm×8 cm to 13 cm×24 cm. The flap dimension ranged from 6 cm×7 cm to 8 cm×15 cm.There were 22 cases of KISS flaps and 11 cases of chimeric flaps. Wounds on all donor sites were primarily sutured. Course of the disease ranged from 1 week to 2 months.@*Results@#All flaps were harvested uneventfully and survived well. No vascular crisis occurred. Wounds on all donor sites were primarily sutured. Three to 24 (mean 18) months of follow-up was made on 28 cases. The color and texture of flaps was good. Appearance of the flaps was good. Protective sensation recovered. Only linear scar can be seen on donor sites. No muscular hernia and cinesipathy was noticed on donor sites.@*Conclusions@#The size of KISS flaps depends on the caliber of perforator branch estimated intraoperatively. Muscular part of the chimeric flaps was harvested according to the muscular entry points of perforators and the demand of recipient sites. The wound defects were reconstructed individually according to the peculiarity of the defects. Fascialate, nervus cutaneus and muscle was cautiously protected in the course of flap harvest. Ecological structure was reestablished after flap harvest to reduce complications.
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Objective To evaluate therapeutic effect of endovascular treatment of iliac,femoral or popliteal artery injury with VIABAHN stent.Methods Endovascular treatment of iliac,femoral or popliteal artery injury was performed with VIABAHN stents in 12 patients admitted to our hospital from August 2015 to December 2013.Results Technical success rate was 100％.Strong instant postoperative pulsation of all dorsal and posterior tibial arteries could be palpated.No procedural and postoperative short term complications (endoleak,stent migration,hematoma at puncture site,thrombosis in arteries and stents and contrast nephropathy) were found.ABI value of injured lower limbs was promoted from preoperative 0.45 ± 0.12 to postoperative 0.95 ± 0.06.Mild stenosis (＜ 30％) of proximal end of stent was noted in one case by CTA.Patients were followed up for 3-18 months [averaging (10 ± 4) months].There was no postoperative limb ischeamia related symptoms.ABI was above 0.9 in all patients.Conclusion The short and middle term therapeutic effect of endovascular treatment of iliac,femoral and popliteal artery injury with VIABAHN stent was satisfactory.
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OBJECTIVE:To investigate the expression difference and its mechanism of miR-27a-3p and HOXB8 protein in cer-vical cancer tissues of HPV16-positive and HPV16-negative patients. METHODS:A total of 120 patients with cervical cancer in our hospital during Jan. 2012-Jan. 2016 were divided into HPV16-positive group(60 cases)and HPV16-negative group(60 cases) according to HPV16 infection situation. The expression of miR-27a-3p mRNA and HOXB8 mRNA in cervical cancer tissue were de-tected by RT-qPCR. The expression of HOXB8 protein was detected by Western blotting assay. DNA methylation level of miR-27a-3p promoter region was detected by nested-down methylation specific PCR (nMS-PCR). Histone methylation level of miR-27a-3p promoter region was detected by chromatin immunoprecipitation PCR (CHIP-PCR). The expression of miR-27a-3p mRNA and HOXB8 mRNA were detected after transfecting miR-27a-3p mimic and inhibitor into Human cervical cancer cell line SiHa,respectively. RESULTS:The expression of miR-27a-3p in HPV16-positive group was significantly lower than HPV16-nega-tive group,while HOXB8 mRNA and protein expression,DNA and histone methylation levels of miR-27a-3p promoter region were significantly higher than HPV16-negative group,with statistical significance (P<0.05 or P<0.01). After transfecting miR-27a-3p mimic into SiHa cells,the expression of miR-27a-3p was increased significantly,while that of HOXB8 mRNA was de-creased significantly;after miR-27a-3p inhibitor transfection,the expression of miR-27a-3p was decreased significantly,while that of HOXB8 mRNA was increased significantly,with statistical significance(P<0.01). CONCLUSIONS:HPV16 may down-regu-late the expression of miR-27a-3p through DNA methylation and histone methylation of promoter region,so as to influence the gen-eration and development of cervical cancer. HOXB8 may be the target protein of miR-27a-3p.
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Objective To summarize the individualized design of perforating branches in the KISS flap of the descending branch of lateral femoral circumflex artery and improve the survival rate of flap. Methods From September, 2012 to June, 2016, the individualized design KISS flap of perforating branches of lateral femoral circum-flex artery was used to repair the soft defect in arms and legs in 20 cases, which contained 12 males and 8 females aged from 23 to 71 years old with an average of 48 years. The wounds in upper limb and wrist were 16 cases, and in instep and lower extremity wounds were 4 cases. The areas of tissue defect were ranged from 8.5 cm ×12.0 cm to 12.0 cm×23.0 cm. The area of flap ranged from 5.0 cm×8.0 cm to 8.0 cm×14.0 cm. Donor sites were sutured directly. Post-operative follow-up was done termly. Results All flaps survived without vascular crisis. The wounds and incisions at donor sites were the primary healing. Seventeen cases were followed-up 6 to 24 months (average, 18 months). The color and texture of the flaps were good, and the appearance was satisfactory. The donor site of the flap only left linear scar. Conclusion Designed KISS flap according to diameter of the perforator artery in the operation can improve the survival rate of the flap. The design of the KISS flap is more flexible and reliable, which is worthy of promotion.