Objective To report our results of a study of 21 patients who underwent reconstruction of complicated head and neck defects following cancer ablation using microvascular anastomotic anterolateral thigh flap To discuss the advantages and disadvantages of using this flap Methods Twenty one consecutive free anterolateral thigh flaps in 21 patients were transferred for reconstruction of head and neck defects following cancer ablation between May 1990 and April 2001 The success rate was 95 percent (20 of 21),with one flap lost due to a twisted perforator The anterolateral thigh flaps were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle Type I is the most common,in which a vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 61 9 percent of cases (13 of 21) Reconstruction of one layer facial skin defect was carried out in 3 cases,through and through defect in 15 cases,the skin defects of the anterior cervical region and the mucosa defects of the hypopharynx in 3 cases Results Nineteen of 21 flaps survived One flap was totally lost and another was partially lost after surgery The mean follow up was 46 months (range:6 to 120 months) A total of 9 patients were disease free survival Two patients are alive with persistent tumor 5 patients died of local recurrence 4 patient died of regional lymph node metastasis,brain metastasis,second primary cancer and cerebral vascular accident respectively,1 patient was lost to follow up Conclusion The anterolateral thigh flap provides more tissue than the radial forearm flap,no important artery sacrificed and the donor scar is more easily hidden The anterolateral thigh flap can be successfully used to repair a variety of complicated defects of the head and neck

Objective To explore the effects of recombinant human growth hormone(rhGH) on the serum levels of cytokines in severely burned patients.Methods Thirty-six burn patients were en-rolled in the study and were randomly divided into 3 groups according to the rhGH dosage used,i.e. small(0.3IU?kg -1 ?d -1 ,A),large(0.6IU?kg -1 ?d -1 ,B) dose groups and control group(C,with normalsaline).The rhGH was administered beginning from 3 postburn days(PBDs) and lasted for 20 days.The dynamic changes in the serum levels of TNF-?,IL-6,IL-8 and LPS at different time points were observed.Results When compared with these in C group,the serum levels of TNF-?,IL-6 in A,B groups were decreased,especially in B group with earlier decrease and bigger range(P0.05).Conclusions rhGH might decrease the production of postburn inflammatory mediators.The clinical application of rhGH might be a supplementary measure in preventing and ameliorating postburn SIRS and MODS in severely burned patients.

Objective To study the therapeutic effect of anti-LPS antibody and different antibiotic in treatment and prevention of sepsis a common complication of serious burns.Methods Twenty-nine patients were divied into anti-LPS+antibiotic treatment group and antibiotic treatment group.Plasma endotoxin,serum TNF,IL-6 and IL-8 were detected at different time phase after burn.Results The results showed that the antibodies to LPS could decrease the level of LPS,IL-6,IL-8 and TNF obviously,but some antibiotic couldn't decrease the level of LPS,IL-6,IL-8 and TNF obviously in blood.Impenem was a weak endotoxin inducer and ceftazidime and ciprofloxacin were stronger endotoxin inducers.Conclusion The appropriate selection of antibiotics and anti-LPS antibody has a considerable influence on treating sepsis and its complications after serious burns.

Objective To investigate the bacteriological monitoring and antibiotic use of invasive infection in patients with burns. Method The index of burn wound、 eschar distribution、 strains of bacteria, bacterial classification、sensitivity and drug resistance were determinated in 100 cases with burns. Results The wound and eschar 382 strain were isolated from the wound and eschar;The wound bacteria 250 strain(65.4%) were significantly higher than that eschar 132 strain (34.6%) (x~2 = 3. 987,P ＜ 0.05); Gram-negative (G -) 227 strain (59. 4%) were significantly higher than that Gram-positive(G +) 155 strain(40. 6%) (x~2 = 3. 887, P ＜ 0.05); Pseudomonas aeruginosa and Enterobacteriaceae in Gram-negative is major strains,while Staphylococcus aureus in Gram-positive is major strains;The Pseudomonas aeruginosa resistance rate(10.38%) was significantly lower than gentamicin(70. 12%) (x~2 =7. 451 ,P＜ 0.01) ;The rate of methicillin-resistant(82. 14%) for Staphylococcus aureus was significantly higher than that of vancomycin(5.35%) (x~2 =7.548 ,P ＜0.01). Conclusion The Gram-negative infection could treat with imipenem,Gram-positive infections could treat with vancomycin for patients with burns.

BACKGROUND: Different pretreatments of the tendon allograft for repairing hand tendon defect due to traumatic injuries have received much attention in the study of tissue engineering for hand surgeries.OBJECTIVE:To explore the characteristics of deep-frozen glutaraldehyde-treated tendon allograft for repairing hand tendon defect.DESIGN: A self-controlled study.SETTING:Ward of Orthopedic Department, Huizhou People's Central Hospital.PARTICIPANTS:Fifteen patients (aged 20-35 years) with 17 defected tendons were hospitalized in the Department of Orthopedics of Huizhou People's Central Hospital between January 1997 and August 2001. Among the 17 defected tendons, 8 were extensor tendons and 9 flexor tendons,with the length of defects varying from 2 to 9 cm.METHODS:The allogenic tendon grafts were obtained from young donors died in accidents or non-replantable amputated limbs due to traumatic injuries with informed consent obtained from the donors or their family members. These grafts were stored at -80 ℃ and immersed in 3.5 g/L glutaraldehyde solution before transplantation. Surgical operation was conducted following standard microsurgical procedures. According to the assessment criteria for total rang of motion (ROM) recommended by International Hand Surgery Association, the outcome of the surgically repaired hands was graded as excellent, good, acceptable and poor.MAIN OUTCOME MEASURES:Total ROM of the digits and graft rejection.RESULTS:None of the 15 patients was lost for analysis. The follow-up lasted for 8 months, during which 4 transplanted tendons had excellent, 6good, 4 acceptable and 3 poor functions, with a total effective rate of 82.36% (14/17). Neither cortical hormone nor immunosuppressants were used in these cases and no acute graft rejection or rupture of the tendons occurred.CONCLUSION: The antigenicity of the tendon allografts can be lowered after deep freezing of the grafts at -80 ℃ with preoperative glutaraldehyde treatment, which also increases the strength and tenacity of the tendons and decreases the risk for infection. The treated grafts provide a good alternative for autologous tendon graft but the complication of tendon adhesion still awaits to be tackled.