Perforator flaps became popular in past 30 years due to the minimum donor site morbidity and good aesthetically contour. Limitations are found in the use of traditional perforator flap, such as limited surface area, unsuitable for repairing super-long wounds, extensive wound and wounds accompanying with dead space, etc. Special form of perforator flap is derived from the perforator flap. It overcomes the shortcomings of traditional perforator flaps, such as less donor-site morbidity, thinner flap, better patient satisfaction and without severe complications in the recipient area. In addition it further improves the clinical curative effect and enhances the value and the applications of perforator flaps. In this article, the historical development and evolution of special form perforator flaps are reviewed, and the clinical applications of the special form perforator flap in recent years are summarised, for the purpose to promote the application and development of special form perforator flap in the reconstruction of complex soft tissue defects.

Objective:To compare the accuracy and timeliness of 3-lead electrocardiography (ECG) and pulse oximetry (POX) in neonatal heart rate (HR) monitoring after birth.Methods:This prospective study recruited 42 high-risk newborns with gestational age ≥37 weeks and birth weight >1 500 g who were born through cesarean section without resuscitation requirement in Xi'an People's Hospital (Xi'an Fourth Hospital) from October 2019 to August 2020. 3-lead ECG electrodes and POX sensors were attached to the neonates immediately after drying to continuously monitor the HR within 10 min after birth. All procedure was recorded by video camera, and data were independently analyzed by a clinician after the procedure was completed. Differences in time required to connect the devices, time to obtain a reliable HR and the interval between them, the time needed for obtaining a reliable HR after birth, the proportion of neonates with reliable HR obtained within 5 min after birth and the consistency in the reliable HR readings between the two devices were compared using Wilcoxon signed-rank test, McNemar test, Spearman's correlation coefficient, intraclass correlation coefficient or Bland-Altman bias analysis.Results:The median time required to connect POX and 3-lead ECG and to acquire a reliable HR were 13.0 s (10.0-17.0 s) vs 23.0 s (18.0-28.3 s) ( Z=-5.050, P<0.001), and 79.5 s (56.2-128.0 s) vs 11.0 s (10.0-13.3 s) ( Z=-5.646, P<0.001), respectively. The total time from the beginning of connecting the devices and birth to acquiring a reliable HR were both longer for POX than those for 3-lead ECG [92.0 s (71.3-139.0 s) vs 35.0 s (30.0-39.5 s), Z=-5.579, P<0.001; 110.5 s (85.8-153.5 s) vs 52.0 s (45.0-66.3 s), Z=-5.579, P<0.001]. Reliable HRs were obtained in 69.1% (29/42) and 2.4% (1/42) of the infants by 3-lead ECG and POX within 1 min after birth, respectively. The percentage of infants for obtaining a reliable HR detected by 3-lead ECG within 5 min after birth were more than those by POX, but with statistically significant differences only at the first 60 s, 90 s, 120 s and 150 s (all P<0.001). The median HRs obtained by 3-lead ECG and POX within 10 min after birth were 161 beats/min (147-175 beats/min) and 160 beats/min (146-176 beats/min), respectively ( r=0.966, P<0.001). The mean difference of HR detected by the two devices was 0.56 beats/min (95% CI:-4.3 to 5.4 beats/min). The intraclass correlation coefficient was 0.961, showing good internal consistency. Conclusions:Neonatal HR can be assessed accurately by 3-lead ECG within 1 min after birth, which is far earlier than that by POX. Therefore, 3-lead ECG can be an option for continuously HR monitor in neonatal resuscitation.

BACKGROUND:There is often space between implant and bone during immediate implantation.Whether biological membrane is needed to guide bone regeneration remains poorly understood.OBJECTIVE:To createdifferent sizes of space between femurand implantsindogs and to observe the effects of biological membrane on bone regeneration capacity of bone defects surrounding implants.DESIGN,TIME AND SETTING:A self-control animal experiment was performed at the Laboratory Animal Center,Norman Bethune College of Medicine,Jilin University and School of Stomatology,Jilin University between March and December 2005.MATERIALS:BLB hydroxyapatite-coated implant was provided by Beijing Leiden Biomaterial Co.,Ltd.,China;BME-10X collagen membrane was purchased from Fujian Better Biotechnology Co..Ltd.,China.METHODS:BLB implants were installed in the bilateral proximal femoral bone to create standard gradient bone defects with horizontal width 3 mm.vertical depth 5 mm,and horizontal lengths of 0,1,2,3,and 4 mm Bone defects on the left femur were sutured directly and those on the right femur were covered with biological membrane prior to suture.All animals were sacrificed at 3 months after surgery.Specimens containing implants were harvested to prepare tissue blocks for radiological observation.MAIN OUTCOME MEASURES:The quantity,color,and texture of newly formed bone surrounding implants were observed from the surface and profile levels.The implant-bone integration and new bone formation were also examined by soft X-ray photography.RESULTS:Grossobservation results revealed that when the horizontal length of bone defect was 3 mm or less,there was no significant differenee in bone density between the newly formed bone and the host bone no matter whether biological membrane existed or not;when the horizontal length of bone defect was 4 mm the bone density was better when biological membranes were used than not.Soft X-ray photography results revealed that when the horizontal length ofbone defect was 3 mm or less.no significant difference in bone density and bone trabecular morphology and orientating was found between newly formed bone and host bone no matter whether biological membrane was used or not;in the 4-mm-length bone defect areas.implants contacted with newly formed bone directly,but the calcified degree ofnewly formed bone was poor,bone trabecula was thin,and bone trabecular course was irregular,nevertheless,the calcified degree of newly formed bone was better under the condition of being with biological membrane than without biological membrane.CONCLUSION:Biological membrane exhibits strong capacity to promote the regeneration and repair of bone defect tissue with a horizontal length of 3 mm or less,and plays an important role in repatr of large sizes of bone detect

Objective To assess the clinical diagnostic value of color Doppler ultrasogography in restrictive cardiomyopathy and constrictive pericarditis.Methods Observing mitral valvular, tricuspid valvular, pulmonary and hepatic venous flow in 16 cases of restrictive cardiomyopathy (RCM) and 20 cases of constrictive pericardities (CP), getting the spectrum results of above, analysis was made on the spectrum change accompanied with respiration. Twenty cases of normal served as control. Results Both during inspiration and expiration, the maximal peak velocity and time (E M and E T) of mitral and tricuspid valvular in group constrictive pericardities had statistical difference compared with normal group (P

Objective To explore the feasibility and clinic outcome of the modified latissimus dorsi flap when it is used to repair huge soft tissue defects in lower limbs.Methods The latissimus dorsi muscle is rich blood supply and available for harvest huge areas.According to these characteristics the modified latissimus dorsi flap was designed:a limited latissimus dorsi skin flap with a large area of latissimus dorsi muscle flap,skin graft area was transferred from donor-site to recipient-site.From April 2009 to August 2011,ten patients with large soft tissue defects in lower limbs were treated with modified latissimus dorsi flap.The size of skin and soft tissue defects range from 19 cm × 10 cm to 32 cm × 16 cm.Ten modified latissimus dorsi flaps had been used for coverage of these wounds,which were amplified 1-2 cm compared with the corresponding wounds.The size of skin flap was 20 cm × 6 cm-33 cm × 10 cm which was allowable to get direct closure of donor-site wounds.Results All the flaps and skin graft survived completely with no complication.Donor-site and recipient-site were primary closed and healing in all patients.All of the patients had got follow-up from 6 months to 36 months.All flaps survived with excellent color and quality,and no extremely fat contour.The results in donor site were satisfying and only left liner scar.It has no effect in the shoulder function.Conclusion The modified latissimus doris flap can provide with a huge amount of skin and soft tissue and be designed in various ways.It is a safe and reliable way to reconstruct huge skin and soft tissue defect in lower limbs.

Objective To explore the relationship among left ventricular(LV) peak systolic strain rate,the mitral annular motive amplitude(MAMA) and left ventricular ejection fraction(LVEF) in essential hypertension patients with different left ventricular patterns.Methods According to level of LV mass index and relative wall thickness,40 patients with hypertension were divided into patterns of normal geometric LV(LVN) and remodeling LV(LVR),20 normal patients were on control group. The apical views were used to determine MAMA and peak systolic strain rate(SSR).MAMA was determined by anatomic M-mode(AMM) and strain rate imaging was applied for obtaining SSR of LV basal and middle segments.LVEF was determined by Simpson rule.The LV systolic function was evaluated by mean of MAMA,SSR and LVEF. Results In all subjects,mean SSR by strain rate imaging of LV wall correlated negatively with mean MAMA(r=(-0.91),P(0.05)).Conclusions Strain rate imaging provides a sensitive,simple and trust tool to assess globle LV function in patients with essential hypertension.

Objective To explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors.Methods Between August,2014 and December,2015,149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study.All patients were divided into two groups:primary closure of the donor site (135 cases) and none primary closure of the donor site (14 cases).The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap.The parameter,including the age,patients' body mass index,subcutaneous fat thickness,thigh circumference and the maximum flap width,were recorded in 79 patients who were randomly choose from all patients.The method through stretching donor site skin was used to assess the maximum flap width.The maximum flap width-to-thigh circumference ratio was calculated.The Pearson test was used to analysis the correction between those parameters.Results Primary closure of the donor site was possible in 135 patients and impossible in 14 patients.The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75cm.The method assessed the reliable width of the flap was (8.37±1.67) cm through stretching donor site skin.the reliable width of the flap was (8.55±1.65) cm in the male patients and (7.42±1.5) cm in the female patients.There was significant different between the two group (P ＜ 0.05).Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than (17.23±3.84) percent.There was a significant negative correlation between subcutaneous fat thickness and the ratio (R=-0.299,P ＜ 0.05) and between body mass index and the ratio (R=-0.21,P ＜ 0.05).Conclusion The width of flap less than 8.75 cm is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site.The patient's body mass index and subcutaneous fat thickness of the thigh should be taken into consideration.

OBJECTIVETo explore the feasibility and the effect of free chimeric perforator flap with deep inferior epigastric artery for the soft tissue defect on the lower extremity with deep dead space.

METHODSFrom Mar. 2010 to Aug. 2011, 8 patients with soft tissue defects on the lower extremities combined with dead space, bone or joint exposure were reconstructed with free hinged perforator flaps with deep inferior epigastric artery. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The defects on the donor sites were closed directly.

RESULTSAll the flaps survived with primary healing. Good color and texture was achieved. The patients were followed up for 12-24 months, with an average of 16 months. 2 over-thick flaps were treated by flap-thinning surgery. Only linear scar was left on the donor site on abdomen with no malfunction.

CONCLUSIONSThe free chimeric perforator flap with deep inferior epigastric artery can simultaneously construct the dead space and superficial defect with only anastomosis of one set of vascular pedicle. It is an ideal method with good results on recipientsites and less morbidity on donor sites.

Cicatrix ; Epigastric Arteries ; transplantation ; Feasibility Studies ; Follow-Up Studies ; Humans ; Leg Injuries ; surgery ; Lower Extremity ; Perforator Flap ; transplantation ; Soft Tissue Injuries ; surgery ; Time Factors ; Wound Healing

Objective To investigate the clinical results,indications and precautions of a variety of special forms of the perforator flap for reconstructing limb soft-tissue defect.Methods From January 2008 to December 2013,480 cases suffering from limb soft-tissue defect were treated with special forms of the perforator flap.Types of special forms of the perforator flap included flow-through perforator flaps,micro-dissected perforator flaps,conjointed perforator flaps,polyfoliate perforator flaps and chimeric perforator flaps.Derivative types combined two or three technologies used in basic types.Results Venous crisis of the flap was shown in 10 cases.Through a second surgical exploration,5 cases were diagnosed with anastomotic thrombosis,2 with vascular torsion and 3 with hematoma.After appropriate treatments,flaps survived in 4 cases,but partial necrosis occurred in 6 cases.Twelve cases were found to have infection,which led to arterial crisis followed by total flap necrosis in one of them at postoperative day 5.Other flaps survived and wounds healed by first intention.Donor sites were repaired by skin flap transfer in 8 cases,skin grafting in 3 cases and direct suture in the rest cases.Conclusion Special forms of the perforator flap are optimal for repair of soft-tissue defect of extremities.

Objective To elucidate the interaction between osteoblast of bone marrow microenvironment and leukemia cells,and to investigate the role of osteoblast in the leukemia cells survival and apoptosis and the influence of leukemia cells on the osteoblast.Methods Leukemia cells from AML1-ETO9a-Rac1 mouse leukemia model and osteoblast cells were used.The ratio of GFP+ leukemia cells that co-cultured with or without osteoblast was detected by FACS.In addition,the apoptosis level of leukemia cells was detected by flow cytometry by PI and Annexin Ⅴ labeling.Activation level of PARP was determined by Western-blot.Real-time PCR (RT-PCR) was utilized to detect the mRNA level of TPO,N-cadherin,OPN and Ang1 in osteoblast which was separated from leukemic mice.Results The ratio of GFP+ cells in AE9a-Rac1 leukemia cells co-cultured with osteoblast cell was significantly higher than that of AE9a-Rac1 leukemia cells cultured alone.The apoptotic level of AE9a-Rac 1 leukemia cells cultured alone was significant higher than that of AE9a-Rac 1 leukemia cells in co-culture system.Western blot showed that activated level of PARP in AE9a-Rac1 leukemia cells co-cultured with osteoblast was lower than that cultured alone.RT-PCR result showed that TPO and N-cadherin mRNA levels in primary osteoblast separated from leukemic mice were higher than that from normal mice.Ang1 and OPN mRNA levels of osteoblast from leukemia mice were lower.Conclusion Osteoblast cell can support the survival and inhibit the apoptosis of leukemia cells.Leukemia cells can influence the functions of osteoblast by microenvironment associated cytokines production.