An investigation of psychological profiles and risk factors in congenital microtia patients.

OBJECTIVES: Among congenital deformities, microtia is often said to be one of the most difficult for the reconstructive surgeon. However, few reports have investigated patients' and their families' psychological profiles. This study sought to determine the prevalence of mood disorders among patients with microtia and to explore clinical features associated with mood disorders. METHODS: Congenital microtia patients were interviewed about Symptom Checklist-90 (SCL-90) and the Achenbach Child Behavior Checklist (CBCL), gender and age of patients, severity of malformation, first perceived age and approach to deformity, being teased by peers, education level of parents, family harmony or not, emotional impact of un-repaired microtia on parents and attitudes of family to patients. RESULTS: The prevalence of mood disorders among microtia patients: 'depression' 20.2%, 'interpersonal sensitivity/social difficulties' 36.6% and 'hostility/aggression' 26.3%. Multivariate analyses suggested that age of patients, severity of microtia, low levels of maternal education, being teased by peers, family disharmony, psychological impact on parents and overprotection from parents are significantly associated with mood disorders of patients. CONCLUSION: Our findings suggest that microtia patients exhibit three significant mood disorders including depression, interpersonal sensitivity/social difficulties and hostility/aggression. Some risk factors should be actively prevented and controlled, such as being teased by peers, family disharmony, psychological impact on parents and overprotection from family.

The effects of nitric oxide on the survival of a random pattern skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the effect of nitric oxide (NO) on the survival of a random pattern skin flap.</p><p><b>METHODS</b>Caudal based random skin flaps (9 cm x 3 cm) were raised on the back of Wistar rats. Six methods were used in the experiment to observe the effect of NO synthase inhibitor L-NAME and NO synthase substrate L-arginine on flaps: image analysis technology; light and electron microscopic studies; enzyme histochemistry of NOS in flaps; concentration of NO2-/NO3- in plasma and wet/dry ratio of the flap tissue.</p><p><b>RESULTS</b>Survival area of flap in the L-arginine-treated group significantly increased (67.06 +/- 5.65)% (p < 0.01) whereas the area in the L-NAME-treated group significantly decreased (35.17 +/- 1.87)% (p < 0.01) compared with the control group (53.25 +/- 3.24)% at seven days after the operation. General and microscopic observations showed that pathological changes in the L-arginine-treated group were fewer. Abundant capillaries and fewer inflammatory cells were noticed in the L-arginine-treated group. Transmission Electron Microscopy (TEM) studies find endothelial swelling, thrombosis-formation and endothelial loss of contact with the basement membrane in the L-NAME treated group. Before operation, the serum NO concentrations were not significantly different in three groups (p > 0.05). After operation, NO concentration of the control group began to increase and reached to the top at the third day. L-Arg kept serum NO concentration in a higher level than the control. Enzyme histochemistry of NOS in flaps: microvessel intima in dermis, hair follicles, sweat glands and inflammatory cells showed oxford blue, more positive in flaps of the L-Arg treated group than the control group at the third day after operation. The flaps of L-NAME-treated group demonstrated negative or weak positive. Wet/dry ratio: twenty-four hours after flap elevation wet/dry weight ratios increased significantly in all regions of the flap of the L-arginine-treated rats compared with saline-treated rats. The ratios of the flaps of L-NAME-treated rats were reduced compared with saline-treated rats.</p><p><b>CONCLUSION</b>NO could improve microcirculation of the flap and increase its survival rates. The mechanism might be that NO could accelerate flap vascularization and protect flaps from ischemia-reperfusion injury.</p>