Bipedicled Expanded Cervical Postauricular Combined Flap or Bipedicled Expanded Cervical Flap for Facial Reconstruction.

BACKGROUND: Large facial reconstruction is a complicated surgical procedure. The purpose of this study was to develop 2 procedures for large facial reconstruction: an expanded cervical postauricular combined skin flap and a bipedicled expanded cervical skin flap. METHODS: Two patients with large facial nevus lesions were selected for reconstruction. In 1 case, an expanded cervical postauricular combined flap with a bipedicle was designed; the upper pedicle was based at the temple region, the lower pedicle was based at the neck. In another case, an expanded cervical-only flap with a bipedicle was designed; the lower pedicle was based at the neck and the upper pedicle was based on healthy facial skin and a nevus lesion skin. All donor sites were closed simultaneously. Both patients underwent a second operation to cut the upper pedicle and repair the facial defect that resulted from the nevus lesion excision, using healthy skin to form a skin flap. The authors also formed a free skin graft from the scalp portion of the tubed pedicle to repair the facial defect where the flap could not reach. RESULTS: Both patients were treated successfully. All flaps survived, without infection or necrosis. Scarring was minimal and the aesthetic and functional outcomes were good. CONCLUSION: This technique provides a large source of skin, proximal to the lesion, as well as good blood supply, especially to the distal end of the flap. It is a safe and reliable alternative for the treatment of large facial nevus lesions.

The Study of Immune Pathogenesis and The Effective of Immune Therapy in Patients with Recurrent Vulvovaginal Candidiasis / 医学研究杂志

Objective To study the role of immunoregulation in patients with Recurrent vulvovaginal candidiasis(RVVC) that evaluate the efficacy of application with combining clotrimazole and rhIFN-? therapy.Methods Patients were divided randomly into two groups :treatment group(60) and control group(60). The patients in treatment group were scheduled to receive clotrimazole therapy, 400mg,pv,qd,and add to rhIFN-? 1000000u im,biw; control group only using clotrimazole therapy.Results The curative rate betweet two groups had significant difference (68.33 (41/60) vs. 35.0(21/60). The efficiency rate in control group was significantly higher than treatment group( (56.67(34/60)vs 26.67(16/60)),In treatment group ,the serum levels of IL-18(pg/ml)(before treatment (111.71?18.45),after treatment (189.18?28.17))and TNF-? (pg/ml)(before treatment (52.66?18.75),after treatment (124.25?43.77))were significantly increased (P0.05). Conclusion The application with combining clotrimazole and rhIFN-? can significant ameliorate the curative rate of RVVC,by regulate immune fanction in the patients that were induced the produce of IL-18 and TNF-?. rhIFN-?can improve cell-mediated immunity in patients with RVVC.