Comparing with free perforator flap, pedicled flap is a relatively simpler and safer technique, with lesser donor site morbidity. In recent years, the application of pedicled perforator flaps has emerged as a new option for breast reconstruction. Those pedicled perforator flaps include thoracodorsal artery perforator flap, intercostal artery perforator flap (lateral intercostal artery perforator flap, anterior intercostal perforator flap) etc. Serratus anterior artery perforator flap, superior epigastric artery perforator flap, and lateral thoracic artery perforator flap can also be raised technically. To enhance surgical accuracy, it is necessary to evaluate the location and quality of perforator vessels preoperatively. Proper flap design is of more importance for pedicled flap when compared with it's free flap counterpart. Although free flap approach remains the golden standard in breast reconstruction when considering autologous tissue transplantation, pedicled perforator flap has the apparent merits of minimized surgical trauma, less time-consuming and less stress for reconstructive surgeons.

Objective To explore the clinical effect of the modified rhytidectomy technique with hidden temporal and buccal incision.Methods 26 cases of aging face were collected.The operation was performed with modified preauricular incision which was the leading edge of the cartilage of helix and hair line.Preauricular remporal fascia was modified as suspended vertically and SMAS superficial to parotic gland was suspended vertically to nasolabial sulcus.Results All the patients reported fine rejuvenescent effects,the satisfaction rate was 100％ without any severe complications,such as scar,hair loss on temperal incision.Conclusions This surgical technique may maintain natural configuration of preauricular area,result in invisable incision scar with no obvious baldness,and avoid important nerves or vessel injury.

Objective To compare the perinipple round-block technique with the conventional periareolar round-block technique in areolar reduction operations.Methods A total of 37 patients who underwent areolar reduction operations in our department were randomly allocated into two groups:Group A (19 patients) received a conventional periareolar round-block technique,while group B (18 patients) through a new perinipple round-block technique.In the latter approach,an intraareolar donut of pigmented skin was deepithelialized,and the exposed areolar dermis was then telescoped inward and stretch-anchored to an imaginary circular line situated beneath the breast skin areola junction.The roundblock technique was then utilized to approximate the skin edges,resulting in a minimal scar,totally inconspicuous,confined to the immediate perinipple area.The operative time,perioperative complications,scars,absorption time of the skin folds,the sensation of the nipple-areolar complex and the patients' satisfaction were compared between the two groups.Results The mean operative time of group A and group B was 40.5 min and 45.8 min,respectively (P＜0.05).No perioperative complications were found in these two groups.No patient had experienced permanent nipple sensory changes.The skin folds absorption time of group A was 4.34 months,while the time of group B was 8.78 months (P＜0.01).The perinipple round-block technique produced a more inconspicuous scar with a better aesthetic results.Conclusions The traditional periareolar round-block technique leaves a sharply demarcated areola by a circular scar which has a totally unnatural and artificial look.As for the perinipple round-block technique,the incision as well as any residual cutaneous wrinkling or puckering is well concealed by the dome of the nipple and the areolar,but it needs a longer skin folds absorption time.

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.

Objective To evaluate the preliminary outcome of stable vitiligo treatment with ReCell(R )technique.Methods Six patients with stable vitiligo were treated with ReCell(R ) technique.In each patient,a thin razor-thickness cutaneous biopsy was harvested from uninvolved area near the vitiligo patches.It was then processed through the ReCell(R ) system and 1 ml autologous epidermal cell suspension was obtained.The lesion area was dermabraded using a diamond fraise wheel to the dermoepidermal junction.The cell suspension was then sprayed on the wound and covered with non-adhering dressings.Results The patients were followed up for 6 months.5 patients presented with repigmentaion in the treated area.There was no significant response in one patient who was diagnosed as systematic vitiligo.Conclusions The ReCell(R ) technique is an alternative treatment for stable vitiligo patients.The clinical outcome will be satisfactory when appropriate patients are selected.

Objective To explore a new method for improving healing of skin graft donor sites.Methods A total of 40 patients who needed intermediate thickness skin graft from thigh,from January 2014 to December 2015,were randomly devided into experiment group and control group.Skin graft donor sites of the experiment group were covered with Physiotulle Ag and Allevyn foam dressing,while donor sites of the control group were covered with petrolatum impregnated gauze,sterile gauze,and compression bandage.Postoperative infection rate,pain scoring during the first dressing change,time of dressing change between operation and complete healing,duration for complete healing,and the area of non-healing two weeks after operation were compared and statistical analysis was performed with SPSS17.0.Results There was no infection in the experiment group.Two patients developed infection in the control group,with wound exudate culture positive for pseudomonas aeruginosa,and the wounds healed after dressing change.The experiment group was significantly better than that of the control group in pain scoring during the first dressing change,time of dressing change between operation and complete healing,duration of complete healing (U=81.5,P=0.001;U=109.5,P=0.011;t=0.769,P＜0.001).Conclusions The Physiotulle Ag combined with Allevyn foam dressing can enhance healing of skin graft donor sites,alleviate pain of the patient,and reduce dressing change.This method is easy to perform,and skin graft donor sites heal well in two weeks,which may lead a prospected application.

Objective To study the clinical efficacy of micro-plasma radiofrequency with joint electron-beam radiation treatment for keloids.Methods A total of 15 patients with keloids over half a year were treated with single time micro-plasma radiofrequency technology by roller tip at 80-100 watts.The hypofractionated electron-beam was used,with 9 Gy dose per time covering the scar with a 1 cm margin,within 24 hours and 1 week after the micro-plasma treatment.The Vancouver Scar Scales (VSS) were assessed before and 6 months after the treatment.Patients' satisfaction and the adverse reactions were evaluated 6 months after the treatment.Results There was astatistically significant difference between the mean VSS of 15 patients pre-and 6 months posttreatment (from 11.73± 1.12 to 3.87±2.53,P＜0.05).The degree of improvement was:excellent in 1 case,good 10 cases,fair 3 cases,and poor 1 case.Patients' assessment was:extremely satisfied in 6 cases,satisfied 6 cases,approximately satisfied 2 cases and dissatisfied 1 case.The adverse reactions included hyperpigmentation within the radiation field on the anterior chest wall in 1 case and delayed healing of 1 patient 's scar wound.Conclusions Micro-plasma radiofrequency combined with electron-beam radiation therapy is highly effective and safe on keloids with good clinical application value.

Objective To explore the value of static and dynamic MRI before and after operation of pelvic organ prolapse (POP). Methods 29 patients with POP (POP group)and 12 normal women (control group)underwent static and dynamic MRI.The morphologic changes of pelvic floor were observed on MR images.The measurements of bladder,uterus,Douglas pouch to pubococcygeal line (B-PCL,U-PCL,D-PCL),the puborectal hiatus line (H-line),muscular pelvic floor descent (M-line),the levator hiatus size (LHS),the levator plate angle (LPA),the iliococcygeus angle (ICA)and the urethral inclination angle (UA)were recorded on dynamic MR images.Results 19 cystoceles,28 uterine prolapses,4 rectoceles and 14 hernias of Douglas pouch were detected with MRI.29 cases of pelvic floor relaxation,27 cases of levator ani muscle defect and 24 cases of pubocervical fascial defect were found.The values of B-PCL,U-PCL, D-PCL,H-line,M-line,LHS,LPA,ICA and UA of POP group were larger than control group (P<0.01).The positions of pelvic organ returned to normal in 9 cases of 21 postoperative cases,while 12 cases remained prolapses.There was no displacement of mesh in 8 cases of mesh implant.The values of B-PCL,U-PCL,D-PCL,UA after operation were smaller than those before operation (P<0.05).Conclusion Static and dynamic MRI can evaluate morphological and functional changes of pelvic floor before and after operation of POP comprehensively,and may reveal those invisible pelvic floor dysfunction and postoperative remnant defects.

BACKGROUND:Negative pressure wound therapy has been widely recognized, the currently published papers are limited in academic value and lack of scientific, objective, qualified index to confirm the therapy effectiveness. OBJECTIVE:To systemical y evaluate the clinical effect of negative pressure wound therapy, provide more evidence for its clinical application, and guide clinical research.
METHODS:Fifteen articles were screened out of peer-reviewed publications (Cochran library, Embase, PubMed-Medline and Chinese BioMedical Literature Database). Scientific data were col ected and evaluated by two researchers. The data were statistical y analyzed with RevMan software.
RESULTS AND CONCLUSION:Only 15 random-control ed trials were final y preserved, including 10 as B-grade moderate bias risk and focused on the effect of negative pressure wound therapy on chronic wounds, and 5 as C-grade high bias risk and focused on the effect of negative pressure wound therapy on acute wounds. There were significant differences in the main outcome measures between negative pressure wound therapy and conventional wound therapy. As for chronic wound patients, no significant difference was observed in the operation-preparing period, reducing wound area, promoting wound granulation, and amputation rate between two therapies. As for acute wound patients, the differences were significant in the operation-preparing period, promoting wound granulation, wound infection rate, and cost materials between two therapies. However, no difference was significant in the healing of wound and hospitalization time. Our findings indicate that, negative pressure wound therapy is an effective means for both acute and chronic wounds, it can shorten operation-preparing period, promote wound granulation, and reduce amputation rate and infection rate, thus providing evidence for clinical application. The wel-designed study is needed to develop high-quality random control ed trails.

BACKGROUND:Negative pressure wound therapy has been extensively used, but most people only knew the superiority of negative pressure wound therapy based on clinical experiences or subjective judgment.
OBJECTIVE:To observe the effects of negative pressure wound therapy on the wound on the body surface, and to compare with contemporaneous conventional method.
METHODS:A total of 45 patients with wound on the body surface treated in the Peking Union Medical Col ege Hospital from January 2006 to December 2011 were enrol ed in this study, including 25 patients undergoing negative pressure wound therapy and 20 patients undergoing conventional change dressing method. Al clinical data were recorded.
RESULTS AND CONCLUSION:Negative pressure wound therapy was better than conventional method (P<0.05), on terms of preoperative preparation period, wound granulation, bacterial scavenging, labor intensity of working staff and incidence of postoperative complications. However, no significant difference in therapy cost was detectable (P>0.05). These results suggested that compared with conventional method, negative pressure wound therapy positively contributed to the healing, obviously shortened preoperative preparation, accelerated the diminution of wound, decreased the incidence of complications of reconstruction, lessened patient’s distress, reduced their economic cost, and diminished labor intensity of working staff. Negative pressure wound therapy has been proven an excellent tool of to promote wound healing.