Microsurgery has gone through three stages in china.At the initial stage from 1960s to 70s,impr ovement of microsurgical apparatuses and vascular anastomosis technique,an d replantation of cut-off limbs and f ingers were the main achievements.At the development stage from 1970s to 80s,efforts were made to increase the rate of successful vascular anastomosis,popularize digital replantation an d expand the application scope of mic ro-surgery.The maturity stage since 1980s has witnessed wider application of microsurgical techniques in more an d more surgical fields and establish ment of systematic theories so that microsu rgery has developed into an independent clinical specialty of orthopedics.All these achievements have resulte d from great efforts of Chinese orthopedic scholars. [

Dysfunction of micturition and defecation after spinal cord injury would severely affect the health and life quality of paraplegics. At present, there is no remarkable advance in the study in spinal cord regeneration. Reconstruction of bladder function via nerve pathway of paraplegics has become the focus of research activities in recent 2 decades . Some of the research results had been translated to clinical practice. This article is intended to introduce the advances in this field which may be helpful for further studies.

Small to moderate-sized wounds of the hand were resurfaced in one stage by digital arterial flaps from the lateral surgace of the near by digit in 30 Cases. The flaps included only the digital arteries and small venules in their pedicles in 15 cases, preserving digital nerve intact in the donor digit.Wounds of the fingertips were repaired by transferring digital arterial flaps with a dorsal branch of the digital nerve so that the sense of the flap was preserved and the sensory loss of the donor digit was minimized in 16 cases. Excellent results were obtained in all. This technique minimizes the sensory loss of the donor digit. The lengthy pedicle allows an arc of coverage over the palm and dorsum of hand and adjacent digits. The procedure is simpler and safer than microsurgical flap transfer. The treatment period is slhoter and the outward appearance and function are better as compared with traditional tube-pedicle grafts or cross-digiti flaps.

An experimental model and training method of end-to-side microvascular anastomosis in 1 mm diameter were recommended by utilizing the left common iliac artery into right in 60 rats. Under uniform microvascular techniques the patency rates and flow measurements and thrombi of end-to-side anastomosis were compared with end-to-end anastomosis. The patency rates between two experimental series achieved 100 per cent. There was no statistical difference in flow and thrombi between two experimental series. The shape of the anastomosis mouth and the anastomosis angle in end-to-side anastomosis were discussed. A study of the advantage about end-to-side anastomosis was detailed. The end results of this experiment demonstrated a patency rate in end-to-side anastomosis equal to that in end-to-end anastomosis in 1 mm vessels. It is suggested that the and-to-side microvascular suturing technique may be used widespread in the clinical reconstructive microsurgery, especially in arteries.

Objective:To prepare and evaluate the effectiveness of chitosan-carboxymethylcellulose membrane in preventing postoperative intestinal adhesion.Methods: Chitosan-carboxymethylcellulose membrane was prepared with 11 ratio of chitosan and carboxymethylcellulose.Glutaraldehyde and ammonium aluminium sulfate were used for cross-linkage,glycerin for enhancing plasticity;and then the product was dried.The membrane was observed with scanning electron microscopy(SEM) and its tensile strength and breaking elongation were measured.Forty-eight SD rats with ileum injury were randomly divided into A,B and C groups(n=16).During operation,the injury in group A was treated with chitosan-carboxymethylcellulose membrane,in group B with chitosan membrane,and in group C without treatment(control group).The adhesion was observed on the 14~(th) postoperative day.Results: The tensile strength of chitosan-carboxymethylcellulose membrane was 20 MPa and the breaking elongation was 65%.SEM showed that the morphology of the membrane had crossed fibroid structures and irregular pores. The severity of adhesion in group A and B was significantly lower than that in group C(P

Objective:To investigate the effect of carboxymethylchitosan on autocrine growth factor and morphology of fibroblasts cultured in vitro,so as to discuss the possible mechanism by which carboxymethylchitosan alleviates overhealing and prevents adhesion in wound healing.Methods: Fibroblasts were cultured in vitro.Fibroblasts of passage 4-6 were treated with different concentrations of carboxymethylchitosan(0.01,0.1,1.0 and 10 mg/ml) for 4 days or with 0.1 mg/ml carboxymethylchitosan for 1,2,3, 4,5,and 6 days.The levels of autocrine transforming growth factor-?_(1 )(TGF-?_(1)) and epidermal growth factor(EGF) of fibroblasts were determined by ELISA and radioimmunoassay.The fibroblastic morphology was detected by transmission electron microscopy(TEM) and microscope after fibroblasts were treated with different strategies.Results: Carboxymethylchitosan(≥0.1 mg/ml)inhibited autocrine TGF-?_(1) of fibroblast in a time-and concentration dependent manner(P0.05).Carboxymethylchitosan ((≥0.1 mg/ml))also inhibited the proliferation of fibroblasts and caused their ultrastructural changes.Conclusion: Carboxymethylchitosan (≥0.1 mg/ml)can inhibit fibroblasts proliferation and reduce tissue adhesion, possibly through altering fibroblast ultrastructure and selectively inhibiting secretion of TGF-?_(1).

Objective To elucidate the mechanism of prevention of postoperative tissues from adhesion by chitosan by stadying the effect of chitosan on indncing apoptosis of fibroblasts.Methods The cultured fibroblasts were treated for 48 hours with 0,0.01,0.1,1,10mg/ml chitosan,respectively.Then cell proliferation was detected by MTT assay and the cell apoptosis by flow cytometry.Results When the concentrations of chitosan were 0.01,0.1,1,and 10mg/ml,the optical density(A)values of the fibroblasts were 0.377?0.047,0.324?0.030,0.271?0.035 and 0.224?0.037,respectively,which were significantly lower than that of control group(0.561?0.044,P

[Objective]To evaluate the diagnostic value of ultrasonography in patients with carpaltunnel syndrome (CTS) by measuring the thickness of transverse carpal ligament.[Method]Forty patients who had clinically and electrophysiologically confirmed as CTS underwent surgery and ultrasonographic examination by the same operator for the thickness of transverse carpal ligaments at the level of the hook of the hamate bone in transverse plane preoperatively.Twenty-four asymptomatic normal wrists served as control.Data of the ultrasonography and surgey from patients and the control groups were compared to determine the diagnostic parameters.[Result]The ultrasonographic thickness of transverse carpal ligaments in CTS patients was (0.42?0.08)cm at hamate hook leve and the data from surgey was (0.40?0.10).The data in control group was (0.29?0.07)cm.There was significant difference in the mean value of thickness of transverse carpal ligaments between the two groups at the same level.There was no significant difference between the data of CTS from surgey and ultrasonography.[Conclusion]Ultrasonography examination of the thickness of transverse carpal ligamentsis is a new and feasibile method in the diagnosis of carpal tunnel syndrome.

Objective: To compare the effectiveness of chitosan and sodium hyalurate in preventing intestinal adhesion. Methods: Forty five SD rats were randomly divided into A, B and C groups. During operation, chitosan, sodium hyalurate or normal saline was applied on injured part of ileum respectively. Biopsy was taken on the 14th postoperative day. Results: The severity of adhesion in group A and B were significantly lower than in group C( P

Objective To compare L 5 anterior roots which is mostly composed of somatic motor nerve fibers and S2 anterior roots which is mostly composed of parasympathetic nerve fibers as dynamic nerve on bladder reinnervation and functional reconstruction after spinal cord injury. Methods Randomly select one side as experimental side and the other side as control, then L 5-S2 anterior roots cross extrameningeal anastomosis in the experimental side and S2-S2 self extrameningeal anastomosis in the control side were performed in 5 dogs. The changes of bladder pressure, urethral pressure responsed to electrical stimulation of the anastomosis roots on each side were recorded in the mean time and the two groups data were compared after one year. Results There were no significant difference between the changes of bladder pressure, urethral pressure responded to the stimulation of left side and right sides anterior roots as the anastomosis operation performed. After one year, both of experimental sides L 5 and control sides S2 anterior roots established neural relationship with bladder detrusor and urethral sphincter. There were no significant difference in the change of bladder pressure responded to electrical stimulation of the anastomosis roots between experimental side (5.0?2.1) kPa and control side (4.6?1.8) kPa(P=0.17) as well. The change of urethral pressure responded to electrical stimulation of the anastomosis roots between experimental side (4.2?1.7)kPa and control side (4.4?1.6)kPa also has no significant difference(P=0.31). Conclusion In the treatment of bladder dysfunction after spinal cord injury, L 5 anterior root can serve a similar role as S2 on bladder functional reconstruction as a dynamic nerve.