Objective:To discuss the influence of intensive lipid-lowering therapy by atorvastatin on blood lipid and serum von Wille-brand factor ( vWF) and thrombomodulin ( TM) levels of patients with unstable angina pectoris. Methods: Totally 88 cases of patients with unstable angina pectoris were selected and divided into the intensive group (n=44) and the routine group (n=44) at random. The patients in the two groups were given routine medical treatment, such as nitrates, bayaspirin,β-blocker, low molecular heparin and etc. The patients in the routine group were orally given atorvastatin 20mg, qd, while the patients in the intensive group were given atorvastatin 40mg, qd with the treatment course of 8 weeks. The changes in serum vWF and TM levels in the two groups before and after the medical treatment were observed, and the occurrence rates of cardiac ischemia related events and untoward effect during the medical treatment were compared as well. Results:After the 8-week medical treatment, the levels of TC, TG and LDL-C in the two groups were obviously declined and the levels of HDL-C were obviously increased than those before the treatment (P<0. 05 or P<0. 01), and the declining and increasing rates in the intensive group were much higher than those in the routine group (P<0. 05). The serum vWF and TM levels in the two groups were obviously declined than those before the treatment (P<0. 05 or P<0. 01), and the declining rates in the intensive group were much higher than those in the routine group (P<0. 05). The occurrence rates of cardiac ischemia related events in the inten-sive group during the medical treatment were much lower than those in the routine group (P<0. 05). Respectively 4 and 6 cases of unto-ward effect appeared in the routine group and the intensive group during the medial treatment with light symptom, and the difference showed no obvious statistical significance (P>0. 05). Conclusion:Atorvastatin intensive lipid-lowering has favorable curative effect and security in the treatment of unstable angina pectoris, which can reduce the occurrence rates of cardiac ischemia related events, and the mechanism is related to reducing blood lipid and serum vWF and TM levels and improving the function of vascular endothelial cells.

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 explore the method of sensory reconstruction after the operation of reversed island pedicled sural flap and evaluate its therapeutic effect of clinical application. Methods Thirteen clinical cases with traumatic soft tissue defects in heel had recepted the treatment of reversed island pedicled sural flap. All flaps were innervated by anastomosing the distal end of the sural nerve in the flaps and the recipient nerve (superficial peroneal nerve) in end to end or end to side. All patients were evaluated at 9-15 months on the postoperative follow-up parameters, including flap contour, flap stability, locomotor activity,touch sensation, pain sensation, static two-point discrimination, thermal sensibility, and the skin sensory recovery level in lateral dorsutn of foot. Results Thirteen cases flaps had good blood supply and primary healing. All cases were followed up 9-15 months, the rate of good sensory recovery was 53.85%. All pa tients had protective sensory in lateral dorsum of foot, the rate of good sensory recovery was 61.54%. Conclusion Anastomosing the proximal end of sural nerve and superficial peroneal nerve together will be good for the sensory recovery in flap and lateral foot in repairing soft tissue defects in heel with reversed island pedicled sural flap.

s pedicel.

Solitary fibroma often occurs in the pleura, but rarely outside the pleura. Extrapleural solitary fibroma has atypical clinical symptoms and difficult imaging diagnosis. Here, we report a case of solitary fibroma recurred and metastasized to the bladder after pelvic surgery. He was treated with palliative resection in our hospital. The patient died of systemic metastasis 3 years after operation.

Objective To explore the treatment of multifocal lower extremity arteriosclerosis oblitera-tions. Methods From March 2014 to September 2014, combined procedures were performed on 30 lower limbs in 30 patients with multifocal lower extremity arteriosclerosis obliterations for revascularization. All the patients underwent endovascular , 20 of whom received endarterectomy , 10 received artery emboloctomy , and 8 received profundaplasty. The rates of technical success and clinical success were observed. The patients were followed up for 6-12 months to observe the total patency rate and rate of limb reservation. Results The technical success rate was 100%. The perioperative complication rate was 30% (9/30). 29 limbs gained improvement with differ-ent degree and the clinical success rate was 96.67% (29/30). The ankle-brachial index elevated 0.37 ± 0.19 on average (P < 0.001). Primary patency rate was 90% and 73% at 6 and 12 months, and 12-month limb reserva-tion rate was 97.67%. Conclusions The combined procedures for complex lower extremity arteriosclerosis oblit-erations have a higher short- to mid-term patency rate and limb reservation rate.

Objective To explore the feasibility and clinical effect of modified peroneal artery perforatorbased propeller flap which excludes small saphenous vein and sural nerve for coverage of the soft tissue defects of the ankle and foot.Methods From January,2009 to August,2013,20 patients with soft tissue defects of the foot or ankle underwent the procedures of reconstruction.After the proper perforators being identified with doppler sonography,the propeller flap was designed,which selected the location where terminal perforator vessels perforate deep fascia as the pivot point,the line from this point to the point where the second perforator near the wound around the line from the midpopliteal point to the midpoint of the achilles tendon and lateral malleolus perforated the deep facia as the axis.The flap was raised above the level of the deep fascia.The small extrinsic vessels around the sural nerve and small saphenous vein were contained in the flap,while the small saphenous vein and sural nerve were kept in the original position.The donor site was closed directly.The skin flaps measured from 7 cm × 4 cm to 21 cm × 7 cm.Results All 20 flaps survived completely without complications.During 10-28 months' followed-up (average 13 months),all flaps showed good texture matches and contour.All patients recovered walking and shoe wearing function.No one showed sensory disturbances at the lateral foot.Conclusion The modified peroneal artery perforator-based propeller flap excluding small saphenous vein and sural nerve still has stable blood supply,which is an idea way for covering skin and soft tissue defects in foot and ankle.

Objective To explore the safety and clinical effect of the human acellular nerve allograft (hANG) for repairing peripheral nerve defects.Methods During November,2009 to October,2010,6 patients with 3 digital nerve defects and 3 radial nerve defects were repaired with hANG.During postoperation period,safety was evaluated by local wound response and laboratory testing,while the efficacy was evaluated by British Medical Research Council sensory function assessment standards,static 2-point discrimination (2PD) and Semmes-Weinstein monofilament testing.Results Three patients with 6 digital nerve defects received hANG transplant.The length of nerve graft was 20-50 mm(mean 30.8 mm).After followed up for 31-40 months,the excellent rate of 2PD was 66.7％.Two of 3 patients rahabilited as well as the normal.Three patients with radial nerve defects,whose length of nerve graft was 35-60 mm(mean 48.3 mm).The strength of extensor carpiradialis longus muscle had restored Ⅲ in 1 case,and other 2 cases had no restoration.Conclusion hANG is safe and effective for repairing peripheral nerve defects,especially for digital nerve defects.

Objective To explore the clinical effect and experience of separating deep circumflex iliac artery osteocutaneous perforator flap (DCIAP) from the bone flap.Methods According to local applied anatomy of groin,vascularized chimerical flaps of deep iliac circumflex artery was designed and applied.From May,2008 to June,2012,12 patients who combined bone and composite skin and soft-tissue defects were positioned by color dopplar ultrasound before operation and treated with vascularized chimerical flaps of deep iliac circumflex artery.The deep circumflex iliac perforator flaps was 8 to 19 cm in length and 2 to 6 cm in width,and the iliac bone grafts ranged from 5 to 8 cm in length.Results All flaps were fully survival.After 8-10 months postoperative followed-up,all the bone defect gained healing.The function and appearance of cutaneous flaps were satisfactory.There was no serious complication in donor sites of groin.The average time of healing was 9 (8-10) months.Conclusion Vascularized iliac bone graft and a perforator flap are nourished by the same deep circumflex iliac artery.There is more mobile scope and only 1 blood vessel between the bone graft and skin flap,which should be called chimeric perforator flap based on the deep iliac circumflex artery,and is a kind of good method to repair bone and soft-tissue defects of limbs.

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.