Objective To explore the change patterns of microcirculation in congested flap. Methods A congested flap model for long-term microeirculation observation was set up, and the mi-crocireulation of the congested tissues was observed carefully. Results Following congestion, the number of the capillaries in the congested flap were decreasing, the velocity of the bloodstreams were getting slower, and the aggregation of the red blood cells and the formation of the white thrombus were becoming more serious. About 72 hours later, the original microcirculation system of the flap was nearly exhausted. About 36 hours later, the neogenetie capillaries could be observed, with clear neogenetie capillaries observed at 48 hours. The congested tissues with nascent capillaries survived, while the capillaries without nascent formation suffered from necrosis in the end. Conclusions If the cause is not removed, the microcirculation status of the congested flap would get worse irreversibly, and the nascent capillaries would play an important role in the survival of congested tissues.

OBJECTIVE: To investigate the characteristics and regularity of adverse drug reactions (ADR) of out- patients occurred in our hospital. METHODS: 494 cases of ADR cases collected in our out- patient dispensary from 2007 to 2008 were analyzed retrospectively. RESULTS: Of total 494 ADR cases,ADR incidence of female (62.96%) was obviously higher than male (37.04%). 58.50% of ADR cases were induced via intravenouse route drugs and 51.21% were caused by antibiotics,among which 104 cases were caused by fluoroquinolones and 90 cases by macrolide,followed by the cardiovascular and cerebral system drugs (13.97%) and traditional Chinese medicine (13.16%). The main clinical manifestations of ADR cases were lesion of skin and appendant (29.17%),injury of digestive system(22.37%) and nervous system(17.34%). CONCLUSION: More attention should be paid to the ADR monitoring to provide reference for clinical rational use of drug.

Objective To gain the best cosmetic result and to avoid the manifest postoperative scar, bleeding and injury of the sensory nerves in the nipple and areola. Methods The gynecomastia was corrected under the endoscope through a small incision (2~3.5 cm) around the areola combined with the tumescent liposuction of the breast to individuals whose breast hyperplasia was mainly because of the fat tissue hyperplasia and the incised tissues were sent for pathological examinations. Results Since March 2000, 16 young men with normal men genitals appearance had undergone this operation, in which 4 cases were breast gland tissue hyperplasia, 3 cases of fat tissue hyperplasia and 9 cases of mixed fat and gland tissue hyperplasia. The results were satisfactory with normal men breast appearance and small areola incisions. No complications happened such as hematoma, abnormal feeling and necrosis in nipple and the breast. The incised tissue of the unilateral breast was 100~320g with average of 130g. The sunction lipectomy volume of the unilateral breast was 20~130ml with average of 68ml. The pathological examination revealed that the incised tissue were fat tissue and breast gland tissue. During 5 months to 3 years following up, no breast hyperplasia recurred. Conclusions The endoscopic operative technique is an ideal option to correct the gynecomastia because it minimizes the areolar incision and avoids the injury of the nipple and areola. It is also helpful to the distal part incision and remoulding of the breast.

Objective To study the histologic characteristics of the capsule of breast implant. Methods Four miniprostheses were seperatelly implanted in four positions beneath the panniculus carnosus muscle in 30 rabbits. After 3 weeks, 1, 2, 3, 4, 6 and 12 months, capsular histology examination and the assay of capsular collagen content and type were performed. Results ⑴ Capsule was divided into two layers: the inner layer was dense and the outer loose connective tissues. Collagen component was more, cellular component was less and capsule was thicker (P0.05). ⑵ Capsular collagen content increased gradually in 3 months (P0.05). ⑶Collagen fibers were the most component, reticular fibers were second and elastic fibers were least. After 3 months, elastic fibers decreased, and collagen and reticular fibers became full layer gradually. ⑷ Capsular collagen type I in the capsule was gradually increased and type III decreased before 3 months. There were no significant changes after 3 months. Conclusions Histology of the implant capsule is similar to that of scar and the result of wound healing around implant.

Objective To study clinical application value of sacral and epidural block in treating lumbar intervertehral disc protrusion (LIDP), and explore technical operation methods, indications and con-traindications of sacral block. Methods Sacral block was adopted in 120 patients with LIDP(sacral group), they were injected triamcinolone acetonide 40 mg, vitamin B1 100 mg, vitamin B12 1 mg, 2% lidocaine 100 mg, added physiological saline 20-30 ml, twice a week, three times as a period. Compared therapy effect with epidural block (120 cases, epidural group). Results The achievement ratio of once puncture was 93.3% (112/120) in sacral group and 82.5% (99/120) in epidural group, P < 0.05. After treatment, the excellent and good rate of sacral group and epidural group were 85.0%(102/120) and 93.3%(112/120), there was not obvious difference, P>0.05, but the fair and bad rate were 15.0%(18/120) and 6.7%(8/120), there was ob-vious difference, P<0.05. Conclusions Sacral block and epidural block are effective methods to treat LIDP. They can relieve the stress at nerve root, especially sacral block, which has the advantages of easily operation, less pain, less side effect and safety.

Objective To investigate the effect of short bowel syndrome treated with living-related small bowel transplantation(SBT).Methods A male patient with residual intestine 20cm in length,which resulted from subtotal small bowel resection and right hemi-colectomy owing to intestinal volvulus,received a living-related SBT.The donor was the patient′s mother.Donor specific blood transfusion,50mL/per week,was carried out for 8 weeks.Cytomegalovirus infection status in both donor and recipient was negative.A 160cm segment of intestine was transplanted.The graft ileocolic artery and vein was anastomosed to the recipient′s infrarenal aorta and inferior vena cava end-to-side,respectively.A distal ileostomy was performed.(Immunosuppression),anti-infection and anticoagulation therapy,and nutritional support were given(postoperatively).Results The donor had an uneventful recovery.No technical complications were observed.The recipient was alive and well 31 weeks after operation.No graft rejection or infection was found.The(patient) was taken off TPN 8 weeks after operation,and got a low-fat meal.The result of D-xylose test was near normal.Conclusions Living-related small intestine transplantation is an effective treatment for short bowel syndrome.

Objective Cervical radiculopathy treatment experts' consensus to establish radiculopathy type by using the modified Delphi method. Methods Use document retrieval method to review information and articles about the treatment guidelines and articles of cervical radiculopathy including domestic and international areas, established a protocol about clini?cal consensus of the treatments for cervical radiculopathy. This protocol included 23 questions (the effective proportion of non?operating therapy, neck immobilization, physiotherapy, pharmacologic treatment, surgical indications, contraindications, anteri?or surgical decompression, anterior surgical implants). We performed a modified Delphi survey in which current professional opinions from experienced experts, representing from almost all of the Chinese provinces, were gathered. And then we modi?fied the protocol according to those professional opinions. Three rounds were performed and finally we established consensus. Consensus was achieved with ≥70% agreement. Results The panel included 30 experienced experts. The recycling question?naire's quantity of three rounds were 30(100%), 24(80%) and 16(53.3%) respectively. After three expert assessments, there were 18 questions which achieved with≥70%agreement and these questions accounted for 64.3%(18/28) of all the questions. Consen?sus of the treatments for cervical radiculopathy was reached on 7 aspects, including:the effective proportion of non?operating thera?py (1 question), neck immobilization (1 question), physiotherapy (1 question), pharmacologic treatment (5 questions), surgical indi?cations (3 questions), contraindications (4 questions), surgery (3 questions). Conclusion This modified Delphi study had reached a consensus concerning several treatment issues on cervical radiculopathy which had strong representativeness of experts and good convergence of opinions. In the absence of high?level evidence, at present, these experts' opinion findings will guide health care providers to define appropriate treatment in their regions. Areas with no consensus provide excellent insight for future research.

OBJECTIVETo investigate the possibility of using dense-packing hair grafting technique for restoration of cicatricial alopecia.

METHODSUnder local anesthesia, a scalp strip was harvested from the back of the head. A series of micro-grafts with 1-3 hairs and mini-grafts with 4-6 hairs were created from this strip. In the scarring recipient area, micro-slots were made with a 18 G needle for the micro-grafts and mini-slits were made with a No. 64 mini-blade for the mini-grafts. The grafts were then implanted into these holes.

RESULTSNinety-six patients with 128 bald scarring areas, resulted from burn, trauma or infection, were treated with the above-mentioned technique from April. 1998 to February. 2000. All of the patients were satisfied with the appearance. In the micro-graft area, the graft density reached 10-15 mini-grafts/cm2 per session. In the micro-graft area, the graft density reached 16-19 micro-grafts/cm2 per session. Postoperative following-up for more than 1 year showed that the grafted hairs were growing well with 90%-95% survival of the hair. One third of the patients obtained satisfactory results with only one session. Two thirds of the patients needed the second session to improve the appearance.

CONCLUSIONSThe dense-packing hair grafting technique is a simple, safe and effective method for hair restoration surgery. It is not only used for male pattern baldness, but could also be applied for restoration of cicatricial alopecia.

Adolescent ; Adult ; Alopecia ; therapy ; Child ; Cicatrix ; Female ; Hair ; transplantation ; Humans ; Male ; Middle Aged

Objective To investigate the changes in cerebral hemodynamics in different body positions in healthy volunteers.Methods Sixty right-handed healthy male volunteers,aged 22-26,height 167-178 cm,weighing 51-67 kg,were randomly divided into 4 groups ( n =15 each): 15 degrees head-down tilt group (group Ⅰ ),30 degrees head-down tilt group (group Ⅱ ),15 degrees head-up tilt group (group Ⅲ) and 30 degrees head-up tilt group (group Ⅳ ).Blood flow signals of right middle cerebral artery (MCA) and extracranial internal carotid artery (EICA) were detected by transcranial Doppler and systolic blood flow velocity (Vs),diastolic blood flow velocity (Vd ),mean blood flow velocity (Vm),pulsatility index (PI) and resistance index (RI) were recorded at supine position (baseline),immediately,10 and 30 min after body position change(T1-3 ).Lindegaard index was calculated.Results Compared with the baseline,in group [Ⅱ Lindegaard index was increased at T2,while Vs and Vm of MCA were decreased at T2,3,in group Ⅳ Vs of MCA and PI of EICA at T2,Vd and Vm of MCA at T2,3 were decreased ( P ＜ 0.05),while there was no significant difference in the variables mentioned above in the other two groups ( P ＞ 0.05 ).Conclusion In healthy adults,cerebral blood flow velocity decreases in 30 degrees headdown and head-up tilt positions,however there is no change in cerebral blood flow velocity in 15 degrees headdown and head-up tilt positions.

OBJECTIVETo explore a combined application of tissue expansion, perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.

METHODSIn the first stage, the position and course of the perforators were confirmed with the multi-detector computed tomography ( MDCT) and color Doppler ultrasound. The expanders were implanted between subdermal vascular plexus and superficial fascia. In the second stage, the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.

RESULTS26 cases with extensive facial and cervical scars were included in this study. Except for one case with necrosis at the distal end, the other 25 flaps survived completely. The maximum flap size was 35 cm x 10 cm with a pedicle of 8 cm x 4 cm. Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap, thus avoiding secondary flap debulking and revisions. All the patients got improvement in contours, facial features and emotional expression.

CONCLUSIONSThe combined application of tissue expansion, perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.

Cicatrix ; surgery ; Face ; surgery ; Humans ; Multidetector Computed Tomography ; Neck ; surgery ; Perforator Flap ; transplantation ; Reconstructive Surgical Procedures ; Tissue Expansion ; methods